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This is a resource developed by Suffolk Scouts and is suitable for Cubs and Scouts.
Other resources can be found here [https://hub.suffolkscouts.org.uk/]

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There is no right or normal brain, which means that everyone experiences the world and thinks uniquely. Neurodiversity is about recognising and respecting this, as we all have different bodies and different brains. And as such, we all have our strengths, weaknesses, and experiences.
Neurodiversity is centered around seeing the strengths of neurodiverse people. As well as supporting the needs they have within the society that has been built upon the premises of everyone is neurotypical (the societal norm.)
Many things fall under neurodiversity, such as autism, ADHD, dyslexia, dyspraxia, Tourette syndrome, to name a few.

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There is an individual certificate for each course plus an overall certificate for completion of both modules part of the Dyslexia Learning Path

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Dyslexia Awareness Part 2, in partnership with Made By Dyslexia

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Microsoft and Made By Dyslexia have a shared mission to empower every person with dyslexia to reach their potential, and we have partnered to create tools to help make this happen. This course will provide an overview of ways teachers can elevate their practice to scaffold support for students in any content area.

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There is an individual certificate for each course plus an overall certificate for completion of both modules part of the Dyslexia Learning Path

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Educator Center Overview - Microsoft Learn Educator Center

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Microsoft Learn for Educators takes the best of Microsoft Learn online learning paths and helps you to bring instructor-led training materials from Microsoft into your courses. This program provides members with access to Microsoft ready-to-teach curriculum and teaching materials aligned to industry-recognized Microsoft Certifications.

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Section Four (starting on page 58) will be the most useful from this resource

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Want to make sure the girls in your life know they can do and be anything they want? Then it's time to flex some muscle and start busting gender stereotypes! Girl Scouts' Developmental Psychologist Andrea Bastiani Archibald, Ph.D. puts it this way: "Kids have this amazing, natural ability to see the world as limitless, but when adults signal that certain things or behaviors are off limits for kids based on their gender, their worlds get smaller and smaller-and that's not just sad, it can be damaging as well."

Obviously, every parent has the best intentions, but sometimes it's possible to unknowingly promote stereotypes that can fence your girl in. To make sure she understands she can accomplish anything she wants in life, try these six easy tips and encourage your friends, family, and neighbors to do the same!

1. Let toys be toys-for girls and boys!
Make sure your children get a wide variety of toys to play with. You never know what they'll gravitate toward or why. "Maybe your son will love the mini kitchen playset, because he sees you cooking every day and wants to be like you," says Dr. Bastiani Archibald. "On the other hand, your toddler daughter might like toy trucks because she sees them drive through your neighborhood and likes to create scenarios around the things she encounters in her everyday world." The point is that you won't know what your child might really be into unless she's given options and encouraged to seek out what interests her most. And if she prefers dolls over dump trucks? So be it! "There's nothing wrong with a girl who loves playing tea party while wearing a dress, as long as it's her choice and not the only option presented her."

2. Plan meaningful meet-ups
Expose your children-boys and girls!-to women who've followed all sorts of paths in life. Your local fire department just hired a female firefighter? Stop by the station to say hi and thank her for her service. The woman next door is a computer programmer? Fantastic! Encourage your children to ask her about her career. "Women, even those with very successful careers in male-dominated fields, are still too often seen by children only as the ones who fix the snacks for the weekend soccer game," says Dr. Bastiani Archibald. "Helping your little ones understand that the women in their lives have interests, passions, and careers outside of the family life they see will expand your children's horizons and show them all the things women can be and do." And don't stop there! Look for kid-friendly biographies and autobiographies that showcase the amazing and wide-ranging achievements of girls and women all over the world. "She may not have the opportunity to meet a Supreme Court Judge or an astronaut in her neighborhood," says Dr. Bastiani Archibald, "but that shouldn't keep her from meeting the phenomenal women in those roles through books!"

3. Watch, then talk
After watching a movie or TV show with your girl, set aside some time to talk about what you've just seen, making sure to discuss how different genders were portrayed. Was the "smart" girl portrayed as nerdy or not as cool as the others? Was the main character male or female, and if he was male, would the story have made sense if they'd reversed that character's gender? Explain that because TV shows and online videos have a short period of time to tell a story, they too often rely on visual cues-often stereotypes-to quickly communicate ideas about their characters. As Dr. Bastiani Archibald notes, "the more we help our girls look critically at the media and come to understand the negative impact of gender stereotypes, the better equipped they'll be to defy them throughout their lives."

4. Think before you speak
The way you speak about the women in your life (and yourself!) has a huge impact on the way your girl views herself. Be honest: When you give compliments to your girlfriends, your sisters, or your female coworkers, are they mainly about the things they wear or how they look? Try broadening what you praise in other women by noting the smart comment they made in a meeting, her ability to stay calm under pressure, or even her thoughtfulness for calling you during a busy day. "We need to do more to show girls all that they're valued for," says Dr. Bastiani Archibald. "Of course you think your girl is beautiful, and there's no reason to not tell her so sometimes, but she-and all the women in your world-need to know they're valued for so much more than just their looks." And the same goes for negative comments. When your daughter hears you talking negatively about the way you or another woman looks, she's learning to pick apart her own looks and judge others based on appearances. She's looking to you as a role model in life, so if you want her to be kind to herself, you can show her how by being good to yourself first.

5. Remember that chores have no gender
When it comes to household responsibilities, families so often assign tasks in a very old-fashioned way without even realizing it. If you have a girl and a boy, does your daughter typically take care of domestic things like washing the dishes and setting the table, while your son is doing more physical tasks like mowing the lawn or climbing ladders to replace lightbulbs? "Put household responsibilities on a rotating schedule, so that everyone gets to try their hand at everything," says Dr. Bastiani Archibald. "Having mastered these skills will benefit both your girls and your boys, showing them that there's no such thing as men's work or women's work-it's all just work!"

6. Embrace Adventure
Have an open weekend where you and your girl could do pretty much whatever you wanted? There's nothing wrong with getting your nails done for some quality time, but make sure that's not what you're doing every time (or even most of the time) when you have a chance to bond. Change it up! Grab a basketball and head to the courts in your local park. Check out the new laser tag place in town to see what the fuss is all about. Heck, grab some wheels and cruise on over to the skate park. Engaging girls in active sports, especially those not traditionally seen as "ladylike" helps her see her body as strong and capable, and not just "pretty." Plus, it'll teach her from an early age that the fun of sports isn't just something for boys to enjoy-she belongs in these places and on these teams, too.

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6 Easy Ways to Bust Gender Stereotypes | Parenting Advice

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Want to make sure the girls in your life know they can do and be anything they want? Then it's time to flex some muscle and start busting gender stereotypes! Girl Scouts' Developmental Psychologist Andrea Bastiani Archibald, Ph.D.

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An educational resource pack for talking about Racism and the Far Right

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Why I'm No longer Talking to White People About Race by Reni Eddo-Lodge

Diversify by June Sarpong

How To Be Antiracist by Ibram X. Kendi

Don't Touch My Hair by Emma Dabiri

Me and White Supremacy by Layla F. Saad

Brit(ish) by Afua Hirsch

White Fragility: Why It's So Hard for White People to Talk About Race by Robin DiAngelo

Black and British: A Forgotten History by David Olusoga

The Good Immigrant, edited by Nikesh Shukla
Books to read with your children:
A Is For Activist by Innosanto Nagara (picture book)

Let's Talk About Race by Julius Lester, illustrated by Karen Barbour

Brick by Brick by Giuliano Ferri (board book)

Amazing Grace by Mary Hoffman, illustrated by Caroline Binch (6-8 years)

Don't Touch My Hair! By Sharee Miller

A Change Is Gonna Come by various (Young adult)

The Skin I'm In by Pat Thomas

Malcolm Little: The Boy Who Grew Up to Become Malcolm X by Ilyasah Shabazz, illustrated by AG Ford (6-10 years)

The Day You Begin by Jacqueline Woodson, illustrated by Rafael López (4-8 years)

Something Happened in Our Town by Marianne Celano, Marietta Collins and Ann Hazzard, illustrated by Jennifer Zivoin (4-8 years)

You can find more recommendations here.

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Scouts - How to talk about race and racism

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Why I'm No longer Talking to White People About Race by Reni Eddo-Lodge Diversify by June Sarpong How To Be Antiracist by Ibram X. Kendi Don't Touch My Hair by Emma Dabiri Me and White Supremacy by Layla F.

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A resource to help understand a looked after child's emotions and how to coach them to deal with their emotions

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Emotion Coaching Resources for Professionals

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Resources available for Emotion Coaching Professional practicioners

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1. Be available. Take time to get to know the child
2. Pay attention to emotions and ensure you listen and understand why these emotions have arisen
3. Even with a 'different past' a looked after child should not be treated differently
4. Try and understand what experiences they have had

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99,672: the number of children in care in the UK in 2018

Over a third of children come into the care system aged 4 or under

In England in 2018, figures showed that:

19 per cent of children come into care aged under 1.

18 per cent of children come into care aged 1 to 4.

18 per cent of children come into care aged 5 to 9.

28 per cent of children come into cares aged 10 to 15.

18 per cent of children come into care aged 16 and over.

Please note: The source material for this data rounds percentages to the nearest whole number. This means that the total figure may not always add up to 100.
3 in 4 children in care live with foster carers
In England in 2018, figures showed that:

73 per cent of children in care lived in foster care.

3 per cent of children in care were placed for adoption.

11 per cent of children in care lived in secure units, children's homes and semi-independent living accommodation.

6 per cent of children in care were placed with their parent(s). This may be because the parent(s) have consented to their child receiving care from the local authority, under an arrangement known as voluntary accommodation.

Other placement types include:

hostels

residential schools

living independently

residential care homes, receiving nursing care

mother and baby units or family centres

young offenders' institutions

Please note: The source material for this data rounds percentages to the nearest whole number. This means that the total figure may not always add up to 100.
One in three children in care have three or more placements in a year
In England in 2016, figures showed that:

10 per cent of children had three or more placements in the twelve months to 31 March 2015

68 per cent of children had one placement in the same period

21 per cent of children had two placements in the same period

Please note: The source material for this data rounds percentages to the nearest whole number. This means that the total figure may not always add up to 100. 1.5
Around 12,500 young people leave care to move into independence or semi-independence aged 16 or above each year

In 2018 in England, figures show that around 3,820 children in care left the care system because they were adopted.

31 per cent of children in care left the care system because they returned to live with parents or relatives with parental responsibility as part of the care planning process.

Around a third of children will return home to their birth family after a period of time spent in care, if it's decided that this is in the best interests of the child.

Others may find a permanent new home through adoption or a Special Guardianship Order.

But for those who are in care in their late teens, In 2018, 12,520 young people left care in England aged 16, 17, 18 or older.

11 per cent of young people left the care system aged 16 or 17

31 per cent of young people left the care system on their 18th birthday.
Please note: The source material for this data rounds percentages to the nearest whole number. This means that the total figure may not always add up to 100.
There is a contrast between how the state looks after young people and how other parents do. Young people who grow up in care are expected to live independently at a much younger age than their peers. And once they have left care, they are not necessarily able to rely on the support of their former carers in the same way that other young people are able to turn to their parents if they need a bit of extra support. A poll by Barnardo's in 2012 found that only 5 per cent of UK parents expected their children to leave home by 18, and 64 per cent of them expected them to be at least 22.

Data from the Office for National Statistics suggests that the number of 20 - 34 year olds living with their parents increased by 25 per cent between 1996 and 2013, with an estimated 1 in 3 men and 1 in 5 women in this age group continuing to live in the parental home.

Seven : the number of corporate parenting principles set out in the Children and Social Work Act

Removing a child from their parents is the most extreme intervention the state can make in family life. Once a child or young person is in care, responsibility for their wellbeing falls to their 'corporate parents': this refers to everyone who is elected to, or employed by, a local authority, and their partner agencies, who all share a collective responsibility to the children looked after by that local authority.

There are seven corporate parenting principles set out in the Children and Social Work Act 2017. These state that corporate parents must:

a) act in the best interests of and promote the health and wellbeing of children and young people in care

b) encourage children and young people in care to express their views, wishes and feelings

c) take into account the views, wishes and feelings of children and young people in care

d) help children and young people in care to access the full range of services provided by the local authority and partners

e) promote high aspirations, and secure the best outcomes, for children and young people in care

f) ensure the safety of children and young people and provide stability in their home lives, relationships and education

g) prepare children and young people for adulthood and independent living

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99,672: the number of children in care in the UK in 2018 Over a third of children come into the care system aged 4 or under In England in 2018, figures showed that: 19 per cent of children come into care aged under 1. 18 per cent of children come into care aged 1 to 4.

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Introduction

A child who has been in the care of their local authority for more than 24 hours is known as a looked after child. Looked after children are also often referred to as children in care, a term which many children and young people prefer.

Each UK nation has a slightly different definition of a looked after child and follows its own legislation, policy and guidance. But in general, looked after children are:

living with foster parents

living in a residential children's home or

living in residential settings like schools or secure units.

Scotland's definition also includes children under a supervision requirement order. This means that many of the looked after children in Scotland are still living at home, but with regular contact from social services.

There are a variety of reasons why children and young people enter care.

The child's parents might have agreed to this - for example, if they are too unwell to look after their child or if their child has a disability and needs respite care.

The child could be an unaccompanied asylum seeker, with no responsible adult to care for them.

Children's services may have intervened because they felt the child was at significant risk of harm. If this is the case the child is usually the subject of a court-made legal order.

A child stops being looked after when they are adopted, return home or turn 18. However local authorities in all the nations of the UK are required to support children leaving care at 18 until they are at least 21. This may involve them continuing to live with their foster family.

Most children in care say that their experiences are good and that it was the right choice for them (Biehal et al, 2014). But more needs to be done to ensure that all looked after children are healthy and safe, have the same opportunities as their peers and can move successfully into adulthood.

Impact of being looked after

Looked after children come from a range of different backgrounds and have varied experiences of care. Each child has their own different and specific sets of needs. However research can give us an insight into how their experiences before and during care makes them a particularly vulnerable group of young people.
> Find out what data is available about looked after children in our statistics briefing
Previous experiences of abuse

Children may enter care for all sorts of reasons. But many enter because they have been abused or neglected. These experiences can leave children with complex emotional and mental health needs, which can increase their vulnerability to abuse (Bazalgette, Rahilly, and Trevelyan, 2015; Luke et al, 2014).

Placement instability and disrupted relationships with caregivers

Many children move repeatedly in and out of care, or between placements. Placement breakdowns can have a detrimental impact on a child's emotional wellbeing and mental health. It can also prevent them forming stable relationships with the adults who could help protect them (Rahilly and Hendry, 2014).

Peer violence and abuse

Many looked after children have previous experiences of violence, abuse or neglect. This can lead to them displaying challenging behaviour and having problems forming secure relationships. Some find it hard to develop positive peer relationships.

The care system can struggle to provide effective management and interventions to address these problems (Bazalgette, Rahilly, and Trevelyan, 2015).

Going missing

Looked after children are more likely to go missing than their peers. Children may run away from care for all sorts of reasons. These include:

wanting to return home to their family

being unhappy or bored in their care placement

feeling like they didn't have enough control over their own lives.

Children who go missing are at greater risk of physical abuse, grooming and sexual exploitation (All Party Parliamentary Group for Runaway and Missing Children and Adults and All Party Parliamentary Group for Looked after Children and Care Leavers, 2012).

Comparisons with other groups of children

Research suggests that when looked after children are compared with children who have not been in care, they tend to have poorer outcomes in a number of areas such as educational attainment and mental and physical health (Rahilly and Hendry, 2014).

However, this is not necessarily the case when they are compared with other groups of children who are likely to have had similar experiences, such as children in need. One study, which analysed Government data, found that looked after children who were continuously in care in England had better educational attainment than children in need (Sebba et al, 2015).
> For more information about adolescents in the child protection system see our How safe are our children? report for 2020

Supporting looked after children

Providing children in and on the edge of care with the support they need, when they need it, can help them to achieve their potential.

Deciding whether a child should enter care

Children who come into care are often known to social services for a number of years before action is taken (Masson et al, 2008).

For many children the need to enter care could have been identified at a much earlier stage. This delay in decision-making can prolong children's experiences of abuse and neglect. This means that when they do enter care they can experience greater degrees of difficulty, and the specialist services they require are less likely to have an impact (Davies and Ward, 2012).

The New Orleans Intervention Model, first developed in the USA, helps social workers and judges decide whether a child should stay with their birth family or enter care permanently.

The model puts a child's attachment relationships at the heart of decision making, ensuring they experience a positive and secure care setting as early in life as possible.
> Find out more about the New Orleans Intervention Model
Children on the edge of care

Our publication Promoting the wellbeing of children in care (Rahilly and Hendry, 2014) identifies ways to better safeguard children on the edge of care:

improving understanding of how to identify damaging situations

improving decision making about when it is in a child's best interests to enter care ensuring that decisions are well planned and taken in a timely fashion.

Achieving these aims requires:

greater use of multi-agency approaches to assessment and support for children and families on the edge of care

revised training for social workers and other practitioners to ensure an improved understanding of:

child development

the identification of risk and protective factors

parental capacity to change

improvements in undergraduate and post-qualification training to ensure that social workers and other professionals are also able to develop a better understanding of the impact of care and effective interventions

greater effort to ensure stability for children and young people on the edge of care and following their entry to care (Rahilly and Hendry, 2014).

Supporting looked after children

Providing a secure, caring environment can help looked after children overcome their early life experiences.

NSPCC research has identified five priorities for change to improve the emotional and mental health of looked after children.

Embed an emphasis on emotional wellbeing throughout the system. Professionals working in the care system need the skills and knowledge to understand how they can support the emotional wellbeing of looked after children and young people.

Take a proactive and preventative approach. Support for looked after children should begin with a thorough assessment of their emotional and mental health needs.

Give children and young people voice and influence. Looked after children and young people need more opportunities to identify what is important to them and influence their own care.

Support and sustain children's relationships. Children's carers require training and support to be sensitive, understanding and resilient.

Support care leavers' emotional needs. Help young people identify and strengthen their support networks (Bazalgette, Rahilly and Trevelyan, 2015).

Supporting the birth family

It's important for professionals to support the child's birth family, to address the problems which resulted in the child entering care. In time, many children can return home to their family but even if this is not possible their birth family are still likely to be a central part of their lives.

The quality of contact a child has with their birth family can have an impact on their wellbeing, so it's important to support children to have safe, positive contact with their birth families if the child wants to (Bazalgette, Rahilly, and Trevelyan, 2015).

Children and young people leaving care

Children and young people leaving care

Returning a child home from care

For many children, returning home from care is the best possible outcome. But research shows that for others this can result in further abuse or neglect (Holmes, 2014).

Many children end up back in care, and a significant number move back and forth between care and their family. Other children remain at home despite continuing abuse or neglect.

There are a number of ways to improve a child's experience of returning home from care:

Assessing the risks the family could pose to their child, how much they are able to change and their ability to protect their child from harm.
The assessment should consider the family's history as well as the current situation.

Working with the child and their family to help strengthen their relationship.

Making sure the child has a trusted adult they can talk to.

Agreeing with the parents, in writing, what needs to happen before and after their child returns home.

Providing support and services for the child and their family before and after the return home.
This should include support from foster/residential carers, the child's school and friends.

Returning the child home gradually, and putting in place plans for what will happen if the return is not going well.

Monitoring how the child and their family are doing.

Reunification practice framework

Our Reunification practice framework, created in partnership with University of Bristol, supports practitioners and managers to apply structured professional judgement to decisions about whether and how a child should return home from care.

The framework also helps families and workers to understand what needs to change, to set goals, access support and services and review progress (Wilkins and Farmer, 2015).
> Find out more about the Reunification practice framework
Supporting care leavers

For some looked after children, leaving the care system can be a challenging time.

In all nations of the UK, children leaving care at 18 are entitled to support from their local authority until they are at least 21. England and Wales are governed by the Children (Leaving Care) Act 2000 and there is separate legislation for Scotland (Children and Young People (Scotland) Act 2014) and Northern Ireland (The Children (Leaving Care) Act (Northern Ireland) 2002).

For some children this will mean staying on with their foster carers. For others alternative accommodation options will be required.

Local authorities across the UK have a duty to assess and meet care leavers' individual needs and to develop a pathway plan, setting out the support that will be provided to the care leaver once they have left care. This should include making sure the care leaver has somewhere suitable to live.

In England, Wales and Northern Ireland, care leavers are also legally entitled to a personal adviser to help with the transition.

Legislation, policy and guidance

Legislation, policy and guidance on looked after children

There is legislation and guidance in each nation of the UK that sets out how the child protection system works and what agencies' responsibilities are to children and families who need support.

Find out more about the child protection system in:

In addition, there is specific legislation, policy and guidance relating to looked after children and care leavers. We've outlined the key points below.

Looked after children

England

In England and Wales, the Children and Young Persons Act 2008 aims to ensure children in care receive high-quality care and services, which are focused on and tailored to their needs.

The Children and Families Act 2014 amended the Children Act 1989 to require local authorities in England to appoint at least one person to promote the educational achievement of its looked-after children.

In England, the Department for Education (DfE) has provided guidance and regulations on care planning, placement and case review (PDF) (DfE, 2015).

The DfE has also published a protocol for local authority children's services, local care providers, police forces, criminal justice agencies and local health services (including mental health services) on reducing criminalisation of looked after children and care leavers (DfE, 2018a).

In England, schools must have a designated teacher for looked after and previously looked after children. The DfE has published statutory guidance for local authority maintained schools on their roles and responsibilities (DfE, 2018b).

The DfE has also published guidance on promoting the education of looked-after children and previously looked-after children (PDF) (DfE, 2018c).

The National Institute for Health and Care Excellence (NICE) quality standard on the health and wellbeing of looked after children and young people sets out best practice in meeting the health and wellbeing needs of looked after children and young people in England (NICE, 2013).

Northern Ireland

In Northern Ireland, The Children (Northern Ireland) Order 1995 sets out the duties, powers and responsibilities of local authorities regarding looked after children. It includes provisions about care and supervision, protection of children and children's homes.

The Department of Health in Northern Ireland has published a series of regulations and guidance relating to the Children (Northern Ireland) Order 1995. Volume 4 is about children in residential care (PDF) (Department of Health, 2006).

The Department of Health has also published Protecting looked after children (PDF), which advises professionals on protecting and safeguarding looked after children (Department of Health, 2016).

The Department of Health and Department of Education in Northern Ireland have set out proposals for a new strategy, Looked after children: improving children's lives (PDF). (Department of Health and Department of Education, 2018). Once finalised, this will replace the Care matters strategy (Department of Health, Social Services and Public Safety, 2007).

The Department of Education has also published guidance for educators of care-experienced children and young people in Northern Ireland and information for schools on the introduction of Personal Education Plans (PEPs) for looked after children (Department of Education, 2018 and 2011).

Scotland

In Scotland, the Children (Scotland) Act 1995 sets out many of the duties, powers and responsibilities that local authorities hold in respect of their looked after children and care leavers.

The Foster Children (Scotland) Act 1984 sets out provisions for foster care in Scotland. The Looked After Children (Scotland) Regulations 2009 includes provisions about care planning, fostering and emergency measures. It also sets out when a child can be classed as 'looked after' but still lives with their parents.

The non-statutory guidance Children and Young People (Scotland) Act 2014: national guidance on part 12: services in relation to children at risk of becoming looked after, etc (PDF) gives frontline practitioners, managers and strategic leaders an overview of the legal framework for providing support services where there is a risk a child may need to go into care, and describes for whom relevant services must be provided (Scottish Government, 2016a).

The Scottish Government has also published guidance to clarify local authorities' duties under the Looked After Children (Scotland) Regulations 2009 and the Adoption and Children (Scotland) Act 2007. This includes:

the legislative and policy context

the child's plan

the death of a looked after child

looked after children cared for by their parents

recruitment of foster carers and the fostering panel

the assessment and approval of foster carers

placement of children (Scottish Government, 2011).

The Scottish Government's strategy for looked after children (PDF) sets out priorities to improve the lives of looked after children and young people (Scottish Government, 2015).

Wales

In England and Wales, the Children and Young Persons Act 2008 aims to ensure children in care receive high-quality care and services, which are focused on and tailored to their needs.

In Wales, The Care Planning, Placement and Case Review (Wales) Regulations 2015 set out the responsibilities of local authorities to plan looked after children's care.

The Welsh government has issued a code of practice for looked after and accommodated children (PDF), which provides guidance on supporting looked after children, including:

care and support plans

accommodation and placements

secure accommodation

children accommodated in other types of establishment (Welsh Government, 2015a).

The code of practice for advocacy (PDF) sets out the requirements relating to advocacy services for looked after children in Wales (Welsh Government, 2018).

The Welsh Government has published guidance setting out the roles and responsibilities of the designated person for looked after children in schools and the key personnel who should support them (PDF) (Welsh Government, 2017).

Corporate parenting

In England, the Children and Social Work Act 2017 introduces corporate parenting principles, which set out local authorities' responsibilities for looked after children.

The Department for Education (DfE) has published guidance on the role of local authorities and the application of corporate parenting principles. Applying corporate parenting principles to looked-after children and care leavers: statutory guidance for local authorities (PDF) sets out seven principles that local authorities must follow when supporting children and young people in care and care leavers (DfE, 2018d).

In Northern Ireland, the Standards for Leaving Care Services (PDF) (DHSSPS, 2012) set out that the Health and Social Care Trusts have 'lead responsibility as corporate parents to safeguard and promote the well-being of young people in and leaving care.'

In Scotland, the Children and Young People (Scotland) Act 2014 sets out the law on corporate parenting.

In Wales, Part 6 of the Social Services and Well-being (Wales) Act 2014 covers Welsh local authorities' duties to children in their care.

Children missing from care

In England, the Statutory guidance on children who run away or go missing from home or care (PDF) outlines action that local authorities and their partners should take to stop children going missing from home or care and to protect those who do (DfE, 2014).

In Northern Ireland, the Police Service Northern Ireland (PSNI) and Health and Social Care Board have published a missing children protocol (PDF), which aims to ensure that the police and health and social care agencies work together effectively, and that the best interests of the child underpin their work (Health and Social Care Board and PSNI, 2015).

The Scottish Government has published a National missing persons framework, which includes provision for children (Scottish Government, 2017).

The Wales Safeguarding Project Procedures Board provides a practice guide for children who go missing from home or care (Wales Safeguarding Project Procedures Board, 2019).

Other types of care

Fostering for adoption

The Children and Families Act 2014 introduced 'fostering for adoption' in England. This allows approved adopters to foster children while they wait for court approval to adopt.

Family and friends care, kinship care or private fostering

Family and friends care (or kinship care) is an arrangement where a child who cannot be cared for by their parent(s) goes to live with a relative, friend or other connected person.

The arrangement can be a private arrangement directly between the parent(s) and the relative, friend or connected person or it can be arranged with the involvement of the local child protection services.

In England, the Department for Education (DfE) provides statutory guidance for local authorities about family and friends providing care for children who cannot live with their parents (DfE, 2011).

In Northern Ireland, The Children (Private Arrangements for Fostering) Regulations (Northern Ireland) 1996 set out how arrangements should be made for fostering a child privately. The Department of Health, Social Services and Public Safety (DHSSPS) has published guidance on children living with carers in private fostering arrangements (DHSSPS, 2011).

The DHSSPS has also published a set of minimum standards for kinship care in Northern Ireland (DHSSPS, 2014).

In Scotland, The Looked After Children (Scotland) Regulations 2009 set out legislation around foster and kinship care. The Children and Young People (Scotland) Act 2014 includes provisions about kinship care.

The Scottish Government has published interim guidance on the assessment and support of kinship carers of looked after children (PDF) (Scottish Government, 2008).

In Wales, Section 81(6) of the Social Services and Well-being (Wales) Act 2014 covers family and friends care.

Children in Wales has produced a guide on kinship care in Wales (PDF) (Children in Wales, 2014).

Special guardianship

Special guardianship is when a local authority places a child or young person to live with someone other than their parent(s) on a long-term basis. It aims to provide more security than long-term fostering for children where adoption is not the best option.

In England, the regulations for special guardianship are set out in The Special Guardianship Regulations 2005 and The Special Guardianship (Amendment) Regulations 2016.

The Department for Education (DfE) also provides statutory guidance for local authorities (DfE, 2016).

In Northern Ireland, the draft Adoption and Children (Northern Ireland) Bill 2017 includes special guardianship orders.

In Wales, the law on special guardianship is set out in The Special Guardianship (Wales) (Amendment) Regulations 2018.

The Welsh Government has also published guidance (PDF) on local authorities' functions in relation to special guardianship orders (Welsh Government, 2018b).

Voluntary care

In some circumstances, children may be taken into care with the permission of their parents. For example, this may happen if a child's parents are unable to look after them for a period of time due to illness. When this happens a parent retains all their legal rights and can ask for the child to be returned at any time.

A child may be taken into care voluntarily:

The Association of Directors of Children's Services (ADCS) provides guidance on the use of Section 20 in England and Section 76 in Wales (PDF) (ADCS, 2016).

Care leavers

For information and guidance during the coronavirus pandemic about care leavers, read our Coronavirus (COVID-19) briefing: safeguarding guidance and information for social workers.

In England and Wales, the Children (Leaving Care) Act 2000 aims to improve the life chances of young people living in and leaving local authority care.

The Children and Social Work Act 2017 introduced a new duty on local authorities in England to provide personal advisers who will support all care leavers up to age 25, if they want it. It also extends additional educational support to care leavers.

The Department for Education (DfE) has published statutory guidance on extending personal adviser support to age 25 (PDF). This sets out the responsibilities of local authorities in England around extending personal adviser support to all care leavers up to the age of 25 (DfE, 2018e).

Keep on caring: supporting young people from care to independence (PDF) sets out the English government's strategy to improve services, support and advice for care leavers. The strategy makes recommendations for local and national government, and wider society (Cabinet Office et al, 2016).

In England, the Department for Education (DfE) has announced the Care Leaver Covenant, a scheme which aims to create 10,000 work opportunities for care leavers over the next 10 years (DfE, 2018f).

In Northern Ireland, the Children (Leaving Care) Act (Northern Ireland) 2002 sets out agencies' responsibilities for young people leaving care.

The Children (Leaving Care) Regulations (Northern Ireland) 2005 goes into more detail about the matters to be taken into account when assessing and meeting the needs of young people preparing to leave care and care leavers.

In Northern Ireland, there is a duty on Health and Social Care Trusts to assess and meet young people's individual needs up to the age of 21 (or beyond, if in education) (Department of Health, 2018).

The Department of Health, Social Services and Public Safety (DHSSPS) has published Standards: leaving care services in Northern Ireland, which sets out minimum standards for leaving care and aftercare services (DHSSPS, 2012).

In Scotland, Part 10 of the Children and Young People (Scotland) Act 2014 states that any young person who ceases to be looked after on or after their 16th birthday, and is less than 26 years of age, is eligible (between the ages of 16 and 19) or potentially eligible (between the ages of 19 and 26) for aftercare. This applies to all care leavers regardless of the placement type while looked after.

Provisions in Part 11 of the Act state that a young person born after 1 April 1999 who is looked after in foster, kinship or residential care is eligible to remain in their current care placement until they turn 21. This is called Continuing Care.

The Scottish Government has published guidance to explain the changes made by Part 10 (Aftercare) and Part 11 (Continuing care) (PDF) of the Act (Scottish Government, 2016b and 2016c).

Staying put Scotland: providing care leavers with connectedness and belonging (PDF) provides guidance for local authorities and other corporate parents, and outlines an explicit philosophy of care. It emphasises the importance of relationship-based practice and extended and graduated transitions (Scottish Government, 2013).

In Wales, the Social Services and Well-being (Wales) Act 2014 places a duty on local authorities to provide support for children and young people leaving care. The support provided should be equivalent to that which a child who has not been looked after might reasonably expect from his or her parents.

The Care Leavers (Wales) Regulations 2015 make provision about the support to be provided to young people who are no longer looked after by a local authority.

In addition, the When I am ready: good practice guide provides guidance for practitioners involved in making and supporting arrangements for young people leaving care (Welsh Government, 2016).

References and resources

References and resources

Association of Directors of Children's Services (ADCS) (2016) Practice guidance for the use of s20 provision in The Children Act 1989 in England and the equivalent s76 of The Social Services and Well-being (Wales) Act 2014 in Wales (PDF). [Manchester]: ADCS.

Bazalgette, L., Rahilly, T. and Trevelyan, G. (2015) Achieving emotional wellbeing for looked after children: a whole system approach. [London]: NSPCC.

Biehal, N. et al. (2014) Keeping children safe: allegations concerning the abuse or neglect of children in care: final report. London: NSPCC.

Cabinet Office et al (2016) Keep on caring: supporting young people from care to independence (PDF). London: Cabinet Office.

Children in Wales (2014) Kinship care guide for Wales (PDF). Cardiff: Children in Wales.

All Party Parliamentary Group for Runaway and Missing Children and Adults and All Party Parliamentary Group for Looked after Children and Care Leavers (2012) Report from the joint inquiry into children who go missing from care. London: All Party Parliamentary Group (APPG) for Runaway and Missing Children and Adults (PDF).

Davies, C. and Ward, H. (2012) Safeguarding children across services: messages from research. London: Jessica Kingsley.

Department for Education (DfE) (2011) Children Act 1989: family and friends care. London: DfE.

Department for Education (DfE) (2014) Statutory guidance on children who run away or go missing from home or care (PDF). London: DfE.

Department for Education (DfE) (2015) The Children Act 1989 guidance and regulations volume 2: care planning, placement and case review (PDF). London: DfE.

Department for Education (DfE) (2016) Special guardianship guidance. London: DfE.

Department for Education (DfE) (2018a) National protocol on reducing criminalisation of looked-after children. London: DfE.

Department for Education (DfE) (2018b) Promoting the education of looked-after children and previously looked-after children: statutory guidance for local authorities (PDF). London: DfE.

Department for Education (DfE) (2018c) The designated teacher for looked-after and previously looked-after children: statutory guidance on their roles and responsibilities. London: DfE.

Department for Education (DfE) (2018d) Applying corporate parenting principles to looked-after children and care leavers: statutory guidance for local authorities (PDF). London: DfE.

Department for Education (DfE) (2018e) Extending personal adviser support to age 25: new burdens assessment (PDF). London: DfE.

Department for Education (DfE) (2018f) Major new scheme launched to support young people leaving care. London: DfE.

Department of Education (2011) Circular 2011/24 - The introduction of personal education plans for looked after children. Belfast: Department of Education.

Department of Education (2018) Putting care into education. Belfast: Department of Education.

Department of Health (2006) The Children (Northern Ireland) Order 1995.Guidance and regulations volume 4. Residential Care (PDF). Belfast: Department of Health.

Department of Health (2016) Protecting looked after children (PDF). Belfast: Department of Health.

Department of Health (2018). Children leaving care and aftercare. [Accessed 18 October 2018].

Department of Health, Social Services and Public Safety (DHSSPS) (2007) Care matters in Northern Ireland: a bridge to a better future (PDF). Belfast: DHSSPS.

Department of Health, Social Services and Public Safety (DHSSPS) (2011) Children living with carers in private fostering arrangements (PDF). Belfast: DHSSPS.

Department of Health, Social Services and Public Safety (DHSSPS) (2012) Standards: leaving care services in Northern Ireland (PDF). Belfast: DHSSPS.

Department of Health, Social Services and Public Safety (DHSSPS) (2014) Minimum kinship care standards Northern Ireland. Belfast: DHSSPS.

Department of Health and Department of Education (2018) Draft strategy for looked after children: improving children's lives (PDF). Belfast: Department of Health and Department of Education.

Health and Social Care Board and Police Service Northern Ireland (PSNI) (2015) Runaway and missing from home and care: missing children protocol (PDF). Belfast, Health and Social Care Board.

Holmes, Lisa (2014) Supporting children and families returning home from care: counting the costs. [London]: NSPCC.

Luke, N. et al. (2014) What works in preventing and treating poor mental health in looked after children? London: NSPCC.

Masson, J. et al. (2008) Care profiling study (PDF). London: Ministry of Justice.

National Institute for Health and Care Excellence (NICE) (2013). Looked after children and young people: quality standard. London: NICE.

Rahilly, T. and Hendry, E. (eds) (2014) Promoting the wellbeing of children in care: messages from research. London: NSPCC.

Scottish Government (2008) Guidance to local authorities on the assessment and support for kinship carers of looked after children (PDF). Edinburgh: Scottish Government.

Scottish Government (2011) Guidance on the Looked After Children (Scotland) Regulations 2009 and the Adoption and Children (Scotland) Act 2007. Edinburgh: Scottish Government.

Scottish Government (2013) Staying put Scotland: providing care leavers with connectedness and belonging (PDF). Edinburgh: Scottish Government.

Scottish Government (2015) Getting it right for looked after children and young people: early engagement, early permanence and improving the quality of care (PDF). Edinburgh: Scottish Government.

Scottish Government (2016a) Children and young people (Scotland) Act 2014: national guidance on part 12: services in relation to children at risk of becoming looked after, etc (PDF). Edinburgh: Scottish Government.

Scottish Government (2016b) Guidance on Part 10 (Aftercare) of the Children and Young People (Scotland) Act 2014. Edinburgh: Scottish Government.

Scottish Government (2016c) Children and young people (Scotland) act 2014: guidance on part 11: continuing care. Edinburgh: Scottish Government.

Scottish Government (2017) National missing persons framework. [Accessed 29/10/18].

Sebba, J. et al (2015) The educational progress of looked after children in England: linking care and educational data (PDF). Oxford: Rees Centre.

Wales Safeguarding Project Procedures Board (2019) Safeguarding children who go missing from home or care. Cardiff: Wales Safeguarding Project Procedures Board.

Welsh Government (2018a) Social Services and Well-being (Wales) Act 2014: Part 6 Code of Practice (Looked After and Accommodated Children) (PDF). Cardiff: Welsh Government.

Welsh Government (2015b) Social Services and Well-being (Wales) 2014: Part 10 Code of Practice (Advocacy) (PDF). Cardiff: Welsh Government.

Welsh Government (2016) When I am ready: good practice guide (PDF). Cardiff: Welsh Government.

Welsh Government (2017) Making a difference: a guide for the designated person for looked after children in schools (PDF). Cardiff: Welsh Government.

Welsh Government (2018b) Explanatory memorandum to: The Special Guardianship (Wales) (Amendment) Regulations 2018 and code of practice on the exercise of local authority functions in relation to special guardianship orders (PDF). Cardiff: Welsh Government.

Wilkins, M. and Farmer E. (2015) Reunification: an evidence-informed framework for return home practice. London: NSPCC.

Childline

If a child or young person needs confidential help and advice direct them to Childline. Calls to 0800 1111 are free and children can also contact Childline online or read about living in care on the Childline website. You can also download or order Childline posters and wallet cards.

Related NSPCC resources

Read our report about a whole system approach towards achieving emotional wellbeing for looked after children.

Further reading

For further reading about looked after children, search the NSPCC Library using the keyword "children in care".

If you need more specific information, please contact our Information Service.

Introduction

A child who has been in the care of their local authority for more than 24 hours is known as a looked after child. Looked after children are also often referred to as children in care, a term which many children and young people prefer.

Each UK nation has a slightly different definition of a looked after child and follows its own legislation, policy and guidance. But in general, looked after children are:

living with foster parents

living in a residential children's home or

living in residential settings like schools or secure units.

Scotland's definition also includes children under a supervision requirement order. This means that many of the looked after children in Scotland are still living at home, but with regular contact from social services.

There are a variety of reasons why children and young people enter care.

The child's parents might have agreed to this - for example, if they are too unwell to look after their child or if their child has a disability and needs respite care.

The child could be an unaccompanied asylum seeker, with no responsible adult to care for them.

Children's services may have intervened because they felt the child was at significant risk of harm. If this is the case the child is usually the subject of a court-made legal order.

A child stops being looked after when they are adopted, return home or turn 18. However local authorities in all the nations of the UK are required to support children leaving care at 18 until they are at least 21. This may involve them continuing to live with their foster family.

Most children in care say that their experiences are good and that it was the right choice for them (Biehal et al, 2014). But more needs to be done to ensure that all looked after children are healthy and safe, have the same opportunities as their peers and can move successfully into adulthood.

Impact of being looked after

Looked after children come from a range of different backgrounds and have varied experiences of care. Each child has their own different and specific sets of needs. However research can give us an insight into how their experiences before and during care makes them a particularly vulnerable group of young people.
> Find out what data is available about looked after children in our statistics briefing
Previous experiences of abuse

Children may enter care for all sorts of reasons. But many enter because they have been abused or neglected. These experiences can leave children with complex emotional and mental health needs, which can increase their vulnerability to abuse (Bazalgette, Rahilly, and Trevelyan, 2015; Luke et al, 2014).

Placement instability and disrupted relationships with caregivers

Many children move repeatedly in and out of care, or between placements. Placement breakdowns can have a detrimental impact on a child's emotional wellbeing and mental health. It can also prevent them forming stable relationships with the adults who could help protect them (Rahilly and Hendry, 2014).

Peer violence and abuse

Many looked after children have previous experiences of violence, abuse or neglect. This can lead to them displaying challenging behaviour and having problems forming secure relationships. Some find it hard to develop positive peer relationships.

The care system can struggle to provide effective management and interventions to address these problems (Bazalgette, Rahilly, and Trevelyan, 2015).

Going missing

Looked after children are more likely to go missing than their peers. Children may run away from care for all sorts of reasons. These include:

wanting to return home to their family

being unhappy or bored in their care placement

feeling like they didn't have enough control over their own lives.

Children who go missing are at greater risk of physical abuse, grooming and sexual exploitation (All Party Parliamentary Group for Runaway and Missing Children and Adults and All Party Parliamentary Group for Looked after Children and Care Leavers, 2012).

Comparisons with other groups of children

Research suggests that when looked after children are compared with children who have not been in care, they tend to have poorer outcomes in a number of areas such as educational attainment and mental and physical health (Rahilly and Hendry, 2014).

However, this is not necessarily the case when they are compared with other groups of children who are likely to have had similar experiences, such as children in need. One study, which analysed Government data, found that looked after children who were continuously in care in England had better educational attainment than children in need (Sebba et al, 2015).
> For more information about adolescents in the child protection system see our How safe are our children? report for 2020

Supporting looked after children

Providing children in and on the edge of care with the support they need, when they need it, can help them to achieve their potential.

Deciding whether a child should enter care

Children who come into care are often known to social services for a number of years before action is taken (Masson et al, 2008).

For many children the need to enter care could have been identified at a much earlier stage. This delay in decision-making can prolong children's experiences of abuse and neglect. This means that when they do enter care they can experience greater degrees of difficulty, and the specialist services they require are less likely to have an impact (Davies and Ward, 2012).

The New Orleans Intervention Model, first developed in the USA, helps social workers and judges decide whether a child should stay with their birth family or enter care permanently.

The model puts a child's attachment relationships at the heart of decision making, ensuring they experience a positive and secure care setting as early in life as possible.
> Find out more about the New Orleans Intervention Model
Children on the edge of care

Our publication Promoting the wellbeing of children in care (Rahilly and Hendry, 2014) identifies ways to better safeguard children on the edge of care:

improving understanding of how to identify damaging situations

improving decision making about when it is in a child's best interests to enter care ensuring that decisions are well planned and taken in a timely fashion.

Achieving these aims requires:

greater use of multi-agency approaches to assessment and support for children and families on the edge of care

revised training for social workers and other practitioners to ensure an improved understanding of:

child development

the identification of risk and protective factors

parental capacity to change

improvements in undergraduate and post-qualification training to ensure that social workers and other professionals are also able to develop a better understanding of the impact of care and effective interventions

greater effort to ensure stability for children and young people on the edge of care and following their entry to care (Rahilly and Hendry, 2014).

Supporting looked after children

Providing a secure, caring environment can help looked after children overcome their early life experiences.

NSPCC research has identified five priorities for change to improve the emotional and mental health of looked after children.

Embed an emphasis on emotional wellbeing throughout the system. Professionals working in the care system need the skills and knowledge to understand how they can support the emotional wellbeing of looked after children and young people.

Take a proactive and preventative approach. Support for looked after children should begin with a thorough assessment of their emotional and mental health needs.

Give children and young people voice and influence. Looked after children and young people need more opportunities to identify what is important to them and influence their own care.

Support and sustain children's relationships. Children's carers require training and support to be sensitive, understanding and resilient.

Support care leavers' emotional needs. Help young people identify and strengthen their support networks (Bazalgette, Rahilly and Trevelyan, 2015).

Supporting the birth family

It's important for professionals to support the child's birth family, to address the problems which resulted in the child entering care. In time, many children can return home to their family but even if this is not possible their birth family are still likely to be a central part of their lives.

The quality of contact a child has with their birth family can have an impact on their wellbeing, so it's important to support children to have safe, positive contact with their birth families if the child wants to (Bazalgette, Rahilly, and Trevelyan, 2015).

Children and young people leaving care

Children and young people leaving care

Returning a child home from care

For many children, returning home from care is the best possible outcome. But research shows that for others this can result in further abuse or neglect (Holmes, 2014).

Many children end up back in care, and a significant number move back and forth between care and their family. Other children remain at home despite continuing abuse or neglect.

There are a number of ways to improve a child's experience of returning home from care:

Assessing the risks the family could pose to their child, how much they are able to change and their ability to protect their child from harm.
The assessment should consider the family's history as well as the current situation.

Working with the child and their family to help strengthen their relationship.

Making sure the child has a trusted adult they can talk to.

Agreeing with the parents, in writing, what needs to happen before and after their child returns home.

Providing support and services for the child and their family before and after the return home.
This should include support from foster/residential carers, the child's school and friends.

Returning the child home gradually, and putting in place plans for what will happen if the return is not going well.

Monitoring how the child and their family are doing.

Reunification practice framework

Our Reunification practice framework, created in partnership with University of Bristol, supports practitioners and managers to apply structured professional judgement to decisions about whether and how a child should return home from care.

The framework also helps families and workers to understand what needs to change, to set goals, access support and services and review progress (Wilkins and Farmer, 2015).
> Find out more about the Reunification practice framework
Supporting care leavers

For some looked after children, leaving the care system can be a challenging time.

In all nations of the UK, children leaving care at 18 are entitled to support from their local authority until they are at least 21. England and Wales are governed by the Children (Leaving Care) Act 2000 and there is separate legislation for Scotland (Children and Young People (Scotland) Act 2014) and Northern Ireland (The Children (Leaving Care) Act (Northern Ireland) 2002).

For some children this will mean staying on with their foster carers. For others alternative accommodation options will be required.

Local authorities across the UK have a duty to assess and meet care leavers' individual needs and to develop a pathway plan, setting out the support that will be provided to the care leaver once they have left care. This should include making sure the care leaver has somewhere suitable to live.

In England, Wales and Northern Ireland, care leavers are also legally entitled to a personal adviser to help with the transition.

Legislation, policy and guidance

Legislation, policy and guidance on looked after children

There is legislation and guidance in each nation of the UK that sets out how the child protection system works and what agencies' responsibilities are to children and families who need support.

Find out more about the child protection system in:

In addition, there is specific legislation, policy and guidance relating to looked after children and care leavers. We've outlined the key points below.

Looked after children

England

In England and Wales, the Children and Young Persons Act 2008 aims to ensure children in care receive high-quality care and services, which are focused on and tailored to their needs.

The Children and Families Act 2014 amended the Children Act 1989 to require local authorities in England to appoint at least one person to promote the educational achievement of its looked-after children.

In England, the Department for Education (DfE) has provided guidance and regulations on care planning, placement and case review (PDF) (DfE, 2015).

The DfE has also published a protocol for local authority children's services, local care providers, police forces, criminal justice agencies and local health services (including mental health services) on reducing criminalisation of looked after children and care leavers (DfE, 2018a).

In England, schools must have a designated teacher for looked after and previously looked after children. The DfE has published statutory guidance for local authority maintained schools on their roles and responsibilities (DfE, 2018b).

The DfE has also published guidance on promoting the education of looked-after children and previously looked-after children (PDF) (DfE, 2018c).

The National Institute for Health and Care Excellence (NICE) quality standard on the health and wellbeing of looked after children and young people sets out best practice in meeting the health and wellbeing needs of looked after children and young people in England (NICE, 2013).

Northern Ireland

In Northern Ireland, The Children (Northern Ireland) Order 1995 sets out the duties, powers and responsibilities of local authorities regarding looked after children. It includes provisions about care and supervision, protection of children and children's homes.

The Department of Health in Northern Ireland has published a series of regulations and guidance relating to the Children (Northern Ireland) Order 1995. Volume 4 is about children in residential care (PDF) (Department of Health, 2006).

The Department of Health has also published Protecting looked after children (PDF), which advises professionals on protecting and safeguarding looked after children (Department of Health, 2016).

The Department of Health and Department of Education in Northern Ireland have set out proposals for a new strategy, Looked after children: improving children's lives (PDF). (Department of Health and Department of Education, 2018). Once finalised, this will replace the Care matters strategy (Department of Health, Social Services and Public Safety, 2007).

The Department of Education has also published guidance for educators of care-experienced children and young people in Northern Ireland and information for schools on the introduction of Personal Education Plans (PEPs) for looked after children (Department of Education, 2018 and 2011).

Scotland

In Scotland, the Children (Scotland) Act 1995 sets out many of the duties, powers and responsibilities that local authorities hold in respect of their looked after children and care leavers.

The Foster Children (Scotland) Act 1984 sets out provisions for foster care in Scotland. The Looked After Children (Scotland) Regulations 2009 includes provisions about care planning, fostering and emergency measures. It also sets out when a child can be classed as 'looked after' but still lives with their parents.

The non-statutory guidance Children and Young People (Scotland) Act 2014: national guidance on part 12: services in relation to children at risk of becoming looked after, etc (PDF) gives frontline practitioners, managers and strategic leaders an overview of the legal framework for providing support services where there is a risk a child may need to go into care, and describes for whom relevant services must be provided (Scottish Government, 2016a).

The Scottish Government has also published guidance to clarify local authorities' duties under the Looked After Children (Scotland) Regulations 2009 and the Adoption and Children (Scotland) Act 2007. This includes:

the legislative and policy context

the child's plan

the death of a looked after child

looked after children cared for by their parents

recruitment of foster carers and the fostering panel

the assessment and approval of foster carers

placement of children (Scottish Government, 2011).

The Scottish Government's strategy for looked after children (PDF) sets out priorities to improve the lives of looked after children and young people (Scottish Government, 2015).

Wales

In England and Wales, the Children and Young Persons Act 2008 aims to ensure children in care receive high-quality care and services, which are focused on and tailored to their needs.

In Wales, The Care Planning, Placement and Case Review (Wales) Regulations 2015 set out the responsibilities of local authorities to plan looked after children's care.

The Welsh government has issued a code of practice for looked after and accommodated children (PDF), which provides guidance on supporting looked after children, including:

care and support plans

accommodation and placements

secure accommodation

children accommodated in other types of establishment (Welsh Government, 2015a).

The code of practice for advocacy (PDF) sets out the requirements relating to advocacy services for looked after children in Wales (Welsh Government, 2018).

The Welsh Government has published guidance setting out the roles and responsibilities of the designated person for looked after children in schools and the key personnel who should support them (PDF) (Welsh Government, 2017).

Corporate parenting

In England, the Children and Social Work Act 2017 introduces corporate parenting principles, which set out local authorities' responsibilities for looked after children.

The Department for Education (DfE) has published guidance on the role of local authorities and the application of corporate parenting principles. Applying corporate parenting principles to looked-after children and care leavers: statutory guidance for local authorities (PDF) sets out seven principles that local authorities must follow when supporting children and young people in care and care leavers (DfE, 2018d).

In Northern Ireland, the Standards for Leaving Care Services (PDF) (DHSSPS, 2012) set out that the Health and Social Care Trusts have 'lead responsibility as corporate parents to safeguard and promote the well-being of young people in and leaving care.'

In Scotland, the Children and Young People (Scotland) Act 2014 sets out the law on corporate parenting.

In Wales, Part 6 of the Social Services and Well-being (Wales) Act 2014 covers Welsh local authorities' duties to children in their care.

Children missing from care

In England, the Statutory guidance on children who run away or go missing from home or care (PDF) outlines action that local authorities and their partners should take to stop children going missing from home or care and to protect those who do (DfE, 2014).

In Northern Ireland, the Police Service Northern Ireland (PSNI) and Health and Social Care Board have published a missing children protocol (PDF), which aims to ensure that the police and health and social care agencies work together effectively, and that the best interests of the child underpin their work (Health and Social Care Board and PSNI, 2015).

The Scottish Government has published a National missing persons framework, which includes provision for children (Scottish Government, 2017).

The Wales Safeguarding Project Procedures Board provides a practice guide for children who go missing from home or care (Wales Safeguarding Project Procedures Board, 2019).

Other types of care

Fostering for adoption

The Children and Families Act 2014 introduced 'fostering for adoption' in England. This allows approved adopters to foster children while they wait for court approval to adopt.

Family and friends care, kinship care or private fostering

Family and friends care (or kinship care) is an arrangement where a child who cannot be cared for by their parent(s) goes to live with a relative, friend or other connected person.

The arrangement can be a private arrangement directly between the parent(s) and the relative, friend or connected person or it can be arranged with the involvement of the local child protection services.

In England, the Department for Education (DfE) provides statutory guidance for local authorities about family and friends providing care for children who cannot live with their parents (DfE, 2011).

In Northern Ireland, The Children (Private Arrangements for Fostering) Regulations (Northern Ireland) 1996 set out how arrangements should be made for fostering a child privately. The Department of Health, Social Services and Public Safety (DHSSPS) has published guidance on children living with carers in private fostering arrangements (DHSSPS, 2011).

The DHSSPS has also published a set of minimum standards for kinship care in Northern Ireland (DHSSPS, 2014).

In Scotland, The Looked After Children (Scotland) Regulations 2009 set out legislation around foster and kinship care. The Children and Young People (Scotland) Act 2014 includes provisions about kinship care.

The Scottish Government has published interim guidance on the assessment and support of kinship carers of looked after children (PDF) (Scottish Government, 2008).

In Wales, Section 81(6) of the Social Services and Well-being (Wales) Act 2014 covers family and friends care.

Children in Wales has produced a guide on kinship care in Wales (PDF) (Children in Wales, 2014).

Special guardianship

Special guardianship is when a local authority places a child or young person to live with someone other than their parent(s) on a long-term basis. It aims to provide more security than long-term fostering for children where adoption is not the best option.

In England, the regulations for special guardianship are set out in The Special Guardianship Regulations 2005 and The Special Guardianship (Amendment) Regulations 2016.

The Department for Education (DfE) also provides statutory guidance for local authorities (DfE, 2016).

In Northern Ireland, the draft Adoption and Children (Northern Ireland) Bill 2017 includes special guardianship orders.

In Wales, the law on special guardianship is set out in The Special Guardianship (Wales) (Amendment) Regulations 2018.

The Welsh Government has also published guidance (PDF) on local authorities' functions in relation to special guardianship orders (Welsh Government, 2018b).

Voluntary care

In some circumstances, children may be taken into care with the permission of their parents. For example, this may happen if a child's parents are unable to look after them for a period of time due to illness. When this happens a parent retains all their legal rights and can ask for the child to be returned at any time.

A child may be taken into care voluntarily:

The Association of Directors of Children's Services (ADCS) provides guidance on the use of Section 20 in England and Section 76 in Wales (PDF) (ADCS, 2016).

Care leavers

For information and guidance during the coronavirus pandemic about care leavers, read our Coronavirus (COVID-19) briefing: safeguarding guidance and information for social workers.

In England and Wales, the Children (Leaving Care) Act 2000 aims to improve the life chances of young people living in and leaving local authority care.

The Children and Social Work Act 2017 introduced a new duty on local authorities in England to provide personal advisers who will support all care leavers up to age 25, if they want it. It also extends additional educational support to care leavers.

The Department for Education (DfE) has published statutory guidance on extending personal adviser support to age 25 (PDF). This sets out the responsibilities of local authorities in England around extending personal adviser support to all care leavers up to the age of 25 (DfE, 2018e).

Keep on caring: supporting young people from care to independence (PDF) sets out the English government's strategy to improve services, support and advice for care leavers. The strategy makes recommendations for local and national government, and wider society (Cabinet Office et al, 2016).

In England, the Department for Education (DfE) has announced the Care Leaver Covenant, a scheme which aims to create 10,000 work opportunities for care leavers over the next 10 years (DfE, 2018f).

In Northern Ireland, the Children (Leaving Care) Act (Northern Ireland) 2002 sets out agencies' responsibilities for young people leaving care.

The Children (Leaving Care) Regulations (Northern Ireland) 2005 goes into more detail about the matters to be taken into account when assessing and meeting the needs of young people preparing to leave care and care leavers.

In Northern Ireland, there is a duty on Health and Social Care Trusts to assess and meet young people's individual needs up to the age of 21 (or beyond, if in education) (Department of Health, 2018).

The Department of Health, Social Services and Public Safety (DHSSPS) has published Standards: leaving care services in Northern Ireland, which sets out minimum standards for leaving care and aftercare services (DHSSPS, 2012).

In Scotland, Part 10 of the Children and Young People (Scotland) Act 2014 states that any young person who ceases to be looked after on or after their 16th birthday, and is less than 26 years of age, is eligible (between the ages of 16 and 19) or potentially eligible (between the ages of 19 and 26) for aftercare. This applies to all care leavers regardless of the placement type while looked after.

Provisions in Part 11 of the Act state that a young person born after 1 April 1999 who is looked after in foster, kinship or residential care is eligible to remain in their current care placement until they turn 21. This is called Continuing Care.

The Scottish Government has published guidance to explain the changes made by Part 10 (Aftercare) and Part 11 (Continuing care) (PDF) of the Act (Scottish Government, 2016b and 2016c).

Staying put Scotland: providing care leavers with connectedness and belonging (PDF) provides guidance for local authorities and other corporate parents, and outlines an explicit philosophy of care. It emphasises the importance of relationship-based practice and extended and graduated transitions (Scottish Government, 2013).

In Wales, the Social Services and Well-being (Wales) Act 2014 places a duty on local authorities to provide support for children and young people leaving care. The support provided should be equivalent to that which a child who has not been looked after might reasonably expect from his or her parents.

The Care Leavers (Wales) Regulations 2015 make provision about the support to be provided to young people who are no longer looked after by a local authority.

In addition, the When I am ready: good practice guide provides guidance for practitioners involved in making and supporting arrangements for young people leaving care (Welsh Government, 2016).

References and resources

References and resources

Association of Directors of Children's Services (ADCS) (2016) Practice guidance for the use of s20 provision in The Children Act 1989 in England and the equivalent s76 of The Social Services and Well-being (Wales) Act 2014 in Wales (PDF). [Manchester]: ADCS.

Bazalgette, L., Rahilly, T. and Trevelyan, G. (2015) Achieving emotional wellbeing for looked after children: a whole system approach. [London]: NSPCC.

Biehal, N. et al. (2014) Keeping children safe: allegations concerning the abuse or neglect of children in care: final report. London: NSPCC.

Cabinet Office et al (2016) Keep on caring: supporting young people from care to independence (PDF). London: Cabinet Office.

Children in Wales (2014) Kinship care guide for Wales (PDF). Cardiff: Children in Wales.

All Party Parliamentary Group for Runaway and Missing Children and Adults and All Party Parliamentary Group for Looked after Children and Care Leavers (2012) Report from the joint inquiry into children who go missing from care. London: All Party Parliamentary Group (APPG) for Runaway and Missing Children and Adults (PDF).

Davies, C. and Ward, H. (2012) Safeguarding children across services: messages from research. London: Jessica Kingsley.

Department for Education (DfE) (2011) Children Act 1989: family and friends care. London: DfE.

Department for Education (DfE) (2014) Statutory guidance on children who run away or go missing from home or care (PDF). London: DfE.

Department for Education (DfE) (2015) The Children Act 1989 guidance and regulations volume 2: care planning, placement and case review (PDF). London: DfE.

Department for Education (DfE) (2016) Special guardianship guidance. London: DfE.

Department for Education (DfE) (2018a) National protocol on reducing criminalisation of looked-after children. London: DfE.

Department for Education (DfE) (2018b) Promoting the education of looked-after children and previously looked-after children: statutory guidance for local authorities (PDF). London: DfE.

Department for Education (DfE) (2018c) The designated teacher for looked-after and previously looked-after children: statutory guidance on their roles and responsibilities. London: DfE.

Department for Education (DfE) (2018d) Applying corporate parenting principles to looked-after children and care leavers: statutory guidance for local authorities (PDF). London: DfE.

Department for Education (DfE) (2018e) Extending personal adviser support to age 25: new burdens assessment (PDF). London: DfE.

Department for Education (DfE) (2018f) Major new scheme launched to support young people leaving care. London: DfE.

Department of Education (2011) Circular 2011/24 - The introduction of personal education plans for looked after children. Belfast: Department of Education.

Department of Education (2018) Putting care into education. Belfast: Department of Education.

Department of Health (2006) The Children (Northern Ireland) Order 1995.Guidance and regulations volume 4. Residential Care (PDF). Belfast: Department of Health.

Department of Health (2016) Protecting looked after children (PDF). Belfast: Department of Health.

Department of Health (2018). Children leaving care and aftercare. [Accessed 18 October 2018].

Department of Health, Social Services and Public Safety (DHSSPS) (2007) Care matters in Northern Ireland: a bridge to a better future (PDF). Belfast: DHSSPS.

Department of Health, Social Services and Public Safety (DHSSPS) (2011) Children living with carers in private fostering arrangements (PDF). Belfast: DHSSPS.

Department of Health, Social Services and Public Safety (DHSSPS) (2012) Standards: leaving care services in Northern Ireland (PDF). Belfast: DHSSPS.

Department of Health, Social Services and Public Safety (DHSSPS) (2014) Minimum kinship care standards Northern Ireland. Belfast: DHSSPS.

Department of Health and Department of Education (2018) Draft strategy for looked after children: improving children's lives (PDF). Belfast: Department of Health and Department of Education.

Health and Social Care Board and Police Service Northern Ireland (PSNI) (2015) Runaway and missing from home and care: missing children protocol (PDF). Belfast, Health and Social Care Board.

Holmes, Lisa (2014) Supporting children and families returning home from care: counting the costs. [London]: NSPCC.

Luke, N. et al. (2014) What works in preventing and treating poor mental health in looked after children? London: NSPCC.

Masson, J. et al. (2008) Care profiling study (PDF). London: Ministry of Justice.

National Institute for Health and Care Excellence (NICE) (2013). Looked after children and young people: quality standard. London: NICE.

Rahilly, T. and Hendry, E. (eds) (2014) Promoting the wellbeing of children in care: messages from research. London: NSPCC.

Scottish Government (2008) Guidance to local authorities on the assessment and support for kinship carers of looked after children (PDF). Edinburgh: Scottish Government.

Scottish Government (2011) Guidance on the Looked After Children (Scotland) Regulations 2009 and the Adoption and Children (Scotland) Act 2007. Edinburgh: Scottish Government.

Scottish Government (2013) Staying put Scotland: providing care leavers with connectedness and belonging (PDF). Edinburgh: Scottish Government.

Scottish Government (2015) Getting it right for looked after children and young people: early engagement, early permanence and improving the quality of care (PDF). Edinburgh: Scottish Government.

Scottish Government (2016a) Children and young people (Scotland) Act 2014: national guidance on part 12: services in relation to children at risk of becoming looked after, etc (PDF). Edinburgh: Scottish Government.

Scottish Government (2016b) Guidance on Part 10 (Aftercare) of the Children and Young People (Scotland) Act 2014. Edinburgh: Scottish Government.

Scottish Government (2016c) Children and young people (Scotland) act 2014: guidance on part 11: continuing care. Edinburgh: Scottish Government.

Scottish Government (2017) National missing persons framework. [Accessed 29/10/18].

Sebba, J. et al (2015) The educational progress of looked after children in England: linking care and educational data (PDF). Oxford: Rees Centre.

Wales Safeguarding Project Procedures Board (2019) Safeguarding children who go missing from home or care. Cardiff: Wales Safeguarding Project Procedures Board.

Welsh Government (2018a) Social Services and Well-being (Wales) Act 2014: Part 6 Code of Practice (Looked After and Accommodated Children) (PDF). Cardiff: Welsh Government.

Welsh Government (2015b) Social Services and Well-being (Wales) 2014: Part 10 Code of Practice (Advocacy) (PDF). Cardiff: Welsh Government.

Welsh Government (2016) When I am ready: good practice guide (PDF). Cardiff: Welsh Government.

Welsh Government (2017) Making a difference: a guide for the designated person for looked after children in schools (PDF). Cardiff: Welsh Government.

Welsh Government (2018b) Explanatory memorandum to: The Special Guardianship (Wales) (Amendment) Regulations 2018 and code of practice on the exercise of local authority functions in relation to special guardianship orders (PDF). Cardiff: Welsh Government.

Wilkins, M. and Farmer E. (2015) Reunification: an evidence-informed framework for return home practice. London: NSPCC.

Childline

If a child or young person needs confidential help and advice direct them to Childline. Calls to 0800 1111 are free and children can also contact Childline online or read about living in care on the Childline website. You can also download or order Childline posters and wallet cards.

Related NSPCC resources

Read our report about a whole system approach towards achieving emotional wellbeing for looked after children.

Further reading

For further reading about looked after children, search the NSPCC Library using the keyword "children in care".

If you need more specific information, please contact our Information Service.

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Introduction A child who has been in the care of their local authority for more than 24 hours is known as a looked after child. Looked after children are also often referred to as children in care, a term which many children and young people prefer.

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Recovery means different things to different people. It might mean that you don't ever have an eating problem thought or behaviour again. Or it might mean you do still have them but they don't happen as often and they have less impact on your life.

Your thoughts about how you perceive your relationship with food, and whether you want to recover, might change over time too.​ At times you might feel that you don't have a problem, or that your behaviours are actually helpful to you. Your eating problem may feel comforting, safe or even exhilarating. And you may feel scared of the changes that come that will with recovery. For example you might feel:

afraid of losing or putting on weight

anxious about losing control

that your eating problem is such a big part of your life that you aren't sure who you are without it.​

Whatever recovery looks like to you, it can take a long time to get there - even when you feel ready to try. You may have to think in years rather than weeks and months. If you have tried to recover before, or have relapsed, you might start to feel as if you are completely beyond help. But it is possible to feel better, even if it takes a long time.

We hope that the information on this page, and our page treatment and support, will help you think about some positive steps you could take.

"It has taken me a long time to effect any change for the better in myself, and I am still a long, long way from where I want to be, but when I finally came to terms with the implications on my life of my condition I was able to start at least planning how to get better."

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Recovery and self-care for eating problems

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Recovery means different things to different people. It might mean that you don't ever have an eating problem thought or behaviour again. Or it might mean you do still have them but they don't happen as often and they have less impact on your life.

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Eating problems are complex and can have lots of different causes. Learn about some of the common causes, including social pressure and family issues.

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Supporting Someone with an Eating Disorder

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Supporting Someone with an Eating Disorder

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If you know somebody who has an eating disorder or who you think might have an eating disorder, Beat can help you. On these pages you can find information about...

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An eating disorder is when you have an unhealthy attitude to food, which can take over your life and make you ill.
It can involve eating too much or too little, or becoming obsessed with your weight and body shape.

But there are treatments that can help and you can recover from an eating disorder.

Men and women of any age can get an eating disorder, but they most commonly affect young women aged 13 to 17 years old.

Coronavirus advice

You can get advice and support during the coronavirus outbreak from the eating disorder charity Beat.

Your GP or local NHS eating disorder team can also provide help and support.

Types of eating disorders

The most common eating disorders are:

anorexia nervosa - when you try to keep your weight as low as possible by not eating enough food, exercising too much, or both

bulimia - when you sometimes lose control and eat a lot of food in a very short amount of time (binging) and are then deliberately sick, use laxatives (medicine to help you poo), restrict what you eat, or do too much exercise to try to stop yourself gaining weight

binge eating disorder (BED) - when you regularly lose control of your eating, eat large portions of food all at once until you feel uncomfortably full, and are then often upset or guilty

other specified feeding or eating disorder (OSFED) - when your symptoms do not exactly match those of anorexia, bulimia or binge eating disorder, but it does not mean it's a less serious illness

OSFED is the most common, then binge eating disorder and bulimia. Anorexia is the least common.

Check if you have an eating disorder

If you or people around you are worried that you have an unhealthy relationship with food that's affecting your eating habits, you could have an eating disorder.

Symptoms of eating disorders include:

spending a lot of time worrying about your weight and body shape

avoiding socialising when you think food will be involved

eating very little food

deliberately making yourself sick or taking laxatives after you eat

exercising too much

having very strict habits or routines around food

changes in your mood

You may also notice physical signs, including:

feeling cold, tired or dizzy

problems with your digestion

your weight being very high or very low for someone of your age and height

not getting your period for women and girls

You can read more about the specific symptoms of:

It's important to remember that even if your symptoms do not exactly match those for anorexia, bulimia or binge eating disorder, you may still have an eating disorder.

Warning signs of an eating disorder in someone else

It can often be very difficult to identify that a loved one or friend has developed an eating disorder.

Warning signs to look out for include:

dramatic weight loss

lying about how much and when they have eaten, or how much they weigh

eating a lot of food very fast

going to the bathroom a lot after eating, often returning looking flushed

excessively or obsessively exercising

avoiding eating with others

cutting food into small pieces or eating very slowly

wearing loose or baggy clothes to hide their weight loss

Getting help for an eating disorder

If you think you may have an eating disorder, even if you're not sure, see a GP as soon as you can.

They'll ask you questions about your eating habits and how you're feeling, and will check your overall health and weight.

If they think you may have an eating disorder, they should refer you to an eating disorder specialist or team of specialists.

It can be very hard to admit you have a problem and ask for help. It may make things easier if you bring a friend or loved one with you to your appointment.

You can also talk in confidence to an adviser from eating disorders charity Beat by calling their adult helpline on 0808 801 0677 or youth helpline on 0808 801 0711.

Getting help for someone else

It can be difficult to know what to do if you're concerned that someone you know has an eating disorder.

People with an eating disorder are often secretive and defensive about their eating and their weight, and they may deny being unwell.

Let them know you're worried about them and encourage them to see a GP. You could offer to go along with them.

Read more about talking to your child about eating disorders and supporting someone with an eating disorder.

The eating disorder charity Beat also has information on:

Treatment for eating disorders

You can recover from an eating disorder, but it may take time and recovery will be different for everyone.

After being referred to an eating disorder specialist or team of specialists, they'll be responsible for your care.

They should talk to you about any other support you might need, such as for other mental or physical health conditions you have, and include this in your treatment plan.

Treatment will be different depending on the type of eating disorder you have, but will usually involve some kind of talking therapy.

You may also need regular health checks if your eating disorder is having an impact on your physical health.

It may also involve working through a guided self-help programme if you have bulimia or binge eating disorder.

Most people will be offered individual therapy, but those with binge eating disorder may be offered group therapy.

Read more about the different treatments for:

Treatment for other specified feeding or eating disorder (OSFED) will depend on the type of eating disorder your symptoms are most like.

For example, if your symptoms are most like anorexia, your treatment will be similar to the treatment for anorexia.

What causes eating disorders?

We do not know exactly what causes eating disorders.

You may be more likely to get an eating disorder if:

you or a member of your family has a history of eating disorders, depression, or alcohol or drug addiction

you have been criticised for your eating habits, body shape or weight

you're overly concerned with being slim, particularly if you also feel pressure from society or your job - for example, ballet dancers, jockeys, models or athletes

you have anxiety, low self-esteem, an obsessive personality or are a perfectionist

you have been sexually abused

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An eating disorder is when you have an unhealthy attitude to food, which can take over your life and make you ill. It can involve eating too much or too little, or becoming obsessed with your weight and body shape. But there are treatments that can help and you can recover from an eating disorder.

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In this guide we provide information and strategies for parents of primary aged children. Some suggestions may also feel appropriate for older children and young people.

What is challenging behaviour?

Just like us, children behave differently at different times. Feeling upset, sad, cross, frustrated and lots of other kinds of emotions is a normal and healthy part of their life. Many children go through phases of testing boundaries, and they are likely to behave in ways that are harder to manage when they are tired, ill or stressed. It is normal for younger children to have tantrums sometimes, while older children may sometimes shout, storm out or lash out.

When we talk about 'challenging behaviour', we mean behaviours that are persistent and difficult for both you and your child to manage. This includes things like:

Having lots of angry outbursts

Regularly shouting, swearing and being very argumentative

Frequently hitting, biting or kicking others

Kicking, smashing or damaging things in their home or school

Being unkind or bullying towards other family members or children

Persistently getting into trouble at school.

How can I talk to my child about their behaviour?

Your child's behaviour is a communication about how they're feeling. When your child is acting out, it can be useful to think of an iceberg. The difficult behaviour is the tip, but there are likely to be a range of emotions hidden under the surface.

By opening up a conversation with your child, you can find out more about how they're feeling and what's going on for them.

1. Find a suitable time and place to talk. Your child might find it easier to talk if you start the conversation while doing an activity. Have a look at our list of activities for some ideas.

2. Make it clear that the behaviour is the problem, and not them. Let them know that it's okay to feel however they feel, whether that's sad, angry, worried or something else, and that you can work together to find new ways of managing these feelings.

3. Explain why the behaviour is not okay so they understand. For example, you might say that while it's normal to feel angry, it hurts other people when they hit.

4. Be curious, empathetic and non-judgmental. Focus on listening and trying to understand things from their perspective.

5. Use simple phrases such as 'I notice there is a lot of shouting happening', 'I think something might be upsetting you', 'I feel worried you're not happy', and 'I need you to know you can talk to me about what's going on'.

6. Reassure them that you love them and want to help them feel happier and enjoy things again.

How can I help my child?

1. Set clear boundaries and routines, and stick to these as much as you can. You could do this by creating a family agreement covering things like screen-time limits, family meals and times for getting up and going to bed.

2. Follow through on consequences. Your child may respond better if you give a warning before the consequence, so they have an opportunity to change their behaviour. After the consequence has been given, it's important to chat together about what happened and return to positive interactions.

3. Give your child positive praise. Notice and encourage them when they demonstrate the kinds of behaviours you have asked for, and be specific about why you're praising them.

4. Talk together about activities that help them to express their feelings and calm down. This might be drawing or painting, doing something active like running, jumping or their favourite sport, reading a book, writing a story, baking or making something out of playdough or Lego.

5. Help your child understand their feelings. When you are curious about your child's feelings, this helps them understand and find words to describe them. You can also help them think about the signs that let them know they might be about to 'blow their top' - such as feeling hot, muscles clenching or breathing more heavily.

6. Try to stay calm. You may feel frustrated, angry or overwhelmed when your child is behaving in challenging ways - and this is completely normal. Try not to react or argue back when things are like this. Give yourself and your child a chance to have some space before you talk about it.

7. Spend quality time with your child. Find things you can enjoy together - such as going to the park, playing a board game, cooking something or watching a favourite film. As a parent you will often be juggling different things, so try to set aside time when you can be really present with your child.

8. Talk to your child's school. Share your concerns with their teacher and find out what their experience is. How does your child behave at school? Is it similar or different to the way they behave at home? If your child's teacher has found something that works, it may be helpful to try it at home to provide consistency.

Finding professional help

Counselling and therapy

If your child needs support to help them understand and manage their feelings, they may benefit from seeing a counsellor or therapist. Therapists working with younger children will usually do this through play and arts activities such as painting, drawing and making things.

You can ask your GP to refer your child for counselling or therapy, either through the NHS or another local service.

You may be able to access free or subsidised counselling through your child's school. You can talk to your child's teacher or another member of staff to find out what's available, and ask them to make a referral.

You can search online for free counselling services in your area, and the Youth Access directory can help you do this.

If it's an affordable option, you can find a private counsellor, therapist or family therapist using the directories listed in our guide.

Getting support from your child's school
As well as counselling, there may be other services provided by your child's school that can help, such as mentoring, learning support, peer buddying and clubs and activities. Be open with the school about what's going on and ask what support they can provide.

Speaking to your GP
If you're worried about your child's mental health or wellbeing, you can speak to your GP (with or without your child) about next steps and finding support. Together you can discuss whether referral to Child and Adolescent Mental Health Services (CAMHS) and/or an assessment by a mental health specialist is needed.
Identifying additional needs
Sometimes, challenging behaviour can be a sign of an additional need or developmental difficulty - such as autism or difficulties hearing or speaking - which your child may need specialist help with. If you think this could be the case, speak to your GP or your child's teacher to discuss whether your child needs a referral for further assessment.

More information and advice

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Parents Guide To Support - Challenging behaviour

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In this guide we provide information and strategies for parents of primary aged children. Some suggestions may also feel appropriate for older children and young people. Just like us, children behave differently at different times. Feeling upset, sad, cross, frustrated and lots of other kinds of emotions is a normal and healthy part of their life.

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A person's behaviour can be defined as "challenging" if it puts them or those around them (such as their carer) at risk, or leads to a poorer quality of life.

It can also impact their ability to join in everyday activities.

Challenging behaviour can include:

aggression

self-harm

destructiveness

disruptiveness

Challenging behaviour is often seen in people with health problems that affect communication and the brain, such as learning disabilities.

What can you do to help?

As a carer, try to understand why the person you look after is behaving in this way. For example, they might feel anxious or bored, or be in pain.

If you can recognise the early warning signs, you may be able to prevent behavioural outbursts.

For example, if being in a large group of people makes your child feel anxious and they become agitated, you could arrange for them to be in a smaller group or have 1-to-1 support.

Some people find a distraction can focus a person's energies elsewhere and prevent them displaying challenging behaviour.

Your child might behave in a challenging way to get your attention.

If this is the case, consider not responding directly to their behaviour - although you should not ignore them completely.

But if their behaviour puts them or someone else at risk, you'll need to intervene as calmly as possible.

Professional help

If you're finding it hard to cope with the behaviour of your child, ask a GP to refer you to a specialist.

The specialist will want to know what situations or people trigger the behaviour, what the early warning signs are, and what happens afterwards.

In extreme circumstances - for example, if your child's behaviour is harmful to themselves or others and all methods of calming them have been tried - a doctor may prescribe medicine.

If you're concerned about the side effects of medicine, speak to your child's GP.

Tips for carers

seek support - many organisations for children with learning disabilities have schemes to connect carers with others in a similar situation

share your experiences - contact your local carers support group or call the Carers Direct helpline on 0300 123 1053

get respite care for your child so you can take a break. Your local council can provide respite care after a care needs assessment, or a carer's assessment for you. Find your local council on GOV.UK

keep in touch with friends and family members - they can be an important source of practical and emotional support

do not be tempted to restrain the person you look after unless you believe their behaviour is putting them at risk and they do not have the mental ability or capacity to make a decision

Sexual behaviour in children

Sexual exploration and play is a natural part of childhood sexual development, and helps children develop physically and emotionally.
Read the NSPCC's information on sexual behaviour in children Read the NSPCC's information on the normal behaviours typical of each development stage
Sometimes children show sexual behaviour that's inappropriate or unexpected for their age. This can be because of:

curiosity

anxiety

a traumatic experience

a learning disability

a mental health problem

If a child acts inappropriately in public, try to distract them with another activity. This can be a useful way to defuse the situation.

If you think a child's behaviour is related to an illness, speak to the healthcare professionals involved in their care and ask for advice on how to manage their behaviour.

They can tell you about local or national organisations that could help.

If you're concerned about the safety or welfare of a child, contact the NSPCC helpline on 0808 800 5000.

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How to deal with challenging behaviour in children - Social care and support guide

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Read some tips on how to deal with challenging behaviour in children.

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learning disabilities

Challenging Behaviour in Young People with a Learning Disability

Challenging behaviour is any behaviour that someone displays that is a challenge for others to manage and/or puts the young person or others at risk. Lots of young people with learning disabilities have behaviours that challenge.

There are lots of different types of challenging behaviour and behaviours that one person finds challenging another person may not.
Examples of common challenging behaviour:

Aggression (e.g. hitting, kicking, biting)

Self-injurious behaviour (e.g. head banging, biting self, hitting self)

Shouting/swearing

Sexualised behaviour in public

Throwing items/breaking things

Soiling/smearing

Positive Behaviour Support (PBS) can be a useful framework for thinking about challenging behaviour. It is a person-centered approach which has been recommended for people with LD. It is based on the principle that 'All behaviour happens for a reason' and we need to find the reasons or 'functions' for each individual in order to reduce that behaviour.

There are a number of common possible 'functions' or reason that young people create in a challenging way:

Social attention- to get noticed or acknowledged by others

Escape/avoidance - to get away from a situation or task the person finds difficult

Tangible - to get something they want (e.g. food, activities, etc.)

Sensory - because it feels good

Communication - to express their emotions to others

Pain/feeling unwell - to let other know about it or to manage their discomfort.

This list is not exhaustive and there could be many other reasons that a young person may behave in a challenging way. There may be also be lots of different reasons or functions for each individual, which can change over time.

Ask yourself the following questions:

Could they have difficult expressing their frustration? Do they need help in labeling their emotions?

Might they be unclear about what is happening and need to be given some clear, visual timelines of what is happening?

Think about their sensory needs. Is the environment too noisy? Is it too high pitched? Is it too bright? What touch are they experiencing? (some children prefer deep pressure as opposed to light touch).

It can be worth thinking through all of these questions to consider where any problems may be. Usually, several of these issues need to be addressed in order to reduce challenging behaviour.

As a first step in understanding challenging behaviour, it can be useful to keep a record of where and when behaviours occur, as well as a note of what happened before and after, paying particular attention to the environment. This might help identify the triggers and functions of the behaviour (what keeps it going).

From there, we can prevent difficulties happening in the following ways:Altering the environments to better fit a young person's needs

Developing the young person's coping strategies and everyday life skills

Developing and supporting communication (both receptive and expressive skills)

And increasing the young person's quality of life generally

A 'Positive Behavior Support Plan' is always a good place to start. In this, you can select two or three key areas to work on - or just one areas at a time. Positive Behaviour Support Plans will often focus on the following areas:

Routine & structure: We know that having routine and structure in place helps children to understand what is going on around them and to feel safe. Giving them a visual timeline or 'Now and Next board' can help with this.

Communication: Try using signs, pictures or symbols to support them to understand what is expected of them and/or to communicate their needs to others.

Demands: Make sure that that the things we are asking a child to do meets their individual needs. They will be more stressed if they are overwhelmed by a task, or indeed if they are under-stimulated by certain activities.

Quality of Life: Sometimes children with behaviour that challenges miss out on activities and interactions that make them feel good about themselves e.g. accessing community activities, playing, interacting with their peers or going out. Make sure there are plenty of these opportunities available to them where possible.

Physical Environment: Sometimes young people with LD are more sensitive to the physical environment than other children, this might mean thinking about noise levels, lights, sounds or smells.

Sleep, pain, health: as many young people with LD struggle to communicate to others about their needs, they may have difficulties that have not been picked up on before such as being tired, in pain or uncomfortable in some way. Check in with them regularly and think about discomfort.

CONSIDER SEEKING HELP:
Please talk to your Paediatrician, Social Worker, or School about a referral to the LD-CAMHS team.

TheNational Autistic Society provides information and support for people with Autism and their families and for professionals. They are a very active organisation and offer some really useful information about strategies and approaches for supporting people with Autism.
Website

The British Institute of Learning Disabilities also have some useful information and further advice about a variety of common issues.
Website

Local Offer is a Derbyshire-specific site which allows you to search for lots of different services, including parenting support groups, in the local area.
Website

Positive Behaviour Support helpline
Bild is offering a Positive Behaviour Support (PBS) helpline to support families and carers of people with learning disabilities, mental health issues or autistic people with the challenges of living with COVID-19 restrictions.

Families and carers can book a call with a PBS consultant to discuss how you are doing, to gain reassurance that you are doing the right thing, or you might want to talk through some ideas and get some practical suggestions.

Select a day and time you would like to receive a call, alongside providing some brief contact details and a brief description of the issue or how you would like support.

There is no structure to the phone call; it is purely a chance to talk to someone who is experienced and who can offer support and guidance.

Please click here to be taken to the information page where there is a further link to book a call.

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Challenging behaviour is any behaviour that someone displays that is a challenge for others to manage and puts the young person or others at risk. Lots of young people with learning disabilities have behaviours that challenge.

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'Challenging behaviour' is how we talk about a range of behaviours which some people with severe learning disabilities may display to get needs met.

Behaviours might be things like:

Hurting others (e.g. hair pulling, hitting, head-butting)

Self-injury (e.g. head banging, eye poking, hand biting)

Destructive behaviours (e.g. throwing things, breaking furniture, tearing things up)

Other behaviours (e.g. spitting, smearing, removing clothes in public , running off )

For two of the widely used definitions click here.
'Most children without learning disabilities display lots of challenging behaviour during the 'terrible twos,' but usually this doesn't last because most 2-year olds develop a range of communication and social skills which enable them to get what they want and need more easily. Many children with learning disabilities do not develop these skills and are left with the same needs as other children their age but are much less able to get them met.'
Peter McGill, Tizard Centre, University of Kent

Many challenging behaviours are effective ways for a person with learning disability to control what is going on around them.

Have a look at our information on Understanding Challenging behaviour to find out more.

We provide information and support to families and professionals, and we are committed to driving change to ensure that people with severe learning disabilities whose behaviour is described as challenging and their families can live happily and have active lives in their communities with access to healthcare, employment, leisure and education - just like everyone else.

Behaviour described as challenging can have a significant impact, not only on the individual with learning disabilities themselves, but also family and friends caring for that person. We provide support networks to enable families to share experiences with other families who have been in similar circumstances.

We believe that family carers should be supported in their role, and that professionals should view families as experts on their relative and work in partnership with them to ensure that they receive good quality, local support.

We know that there are 30,000 people in the UK with a severe learning disability whose behaviour can challenge.

We need help to reach these 30,000 and their families. Find out how to support us here.

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What is Challenging Behaviour. Drafts. The Challenging Behaviour Foundation, UK

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'Challenging behaviour' is how we talk about a range of behaviours which some people with severe learning disabilities may display to get needs met. Behaviours might be things like: Hurting others (e.g. hair pulling, hitting, head-butting) Self-injury (e.g. head banging, eye poking, hand biting) Destructive behaviours (e.g.

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What is challenging behaviour?

'Challenging behaviour' sounds like a pretty broad term, and it is. Challenging behaviour describes behaviour that is challenging to parents, carers, teachers and other professionals.

Challenging behaviour can include tantrums, hitting or kicking other people, throwing things or self-harming.

Behaviour is challenging if it is harmful to the person and others around them, and if it stops the person achieving things in their daily life, such as making friends or concentrating at school.

Living with challenging behaviour can be a stressful and exhausting time. Every day activities, such as going to school or to the park, can become more complicated.

Challenging behaviour and learning disability

Challenging behaviour is not a learning disability, but people with a disability are more likely to show challenging behaviour.

This can be due to people having difficulty communicating and expressing frustrations. Challenging behaviour can also be a sign that something is wrong, like pain or discomfort, that your child cannot express in another way.

Challenging behaviour can also be a sign of wider problems, including with someone's mental health.

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'Challenging behaviour' sounds like a pretty broad term, and it is. Challenging behaviour describes behaviour that is challenging to parents, carers, teachers and other professionals. Challenging behaviour can include tantrums, hitting or kicking other people, throwing things or self-harming.

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This section gives information on anxiety disorders. It explains the symptoms, treatments and way to manage an anxiety disorder. This information is for people affected by anxiety disorders in England who are 18 or over. It's also for their carers, friends and relatives and anyone interested in this subject.

If you would like more advice or information you can contact our Advice and Information Service by clicking .

Need more advice?

If you need more advice or information you can contact our Advice and Information Service.

About

What are anxiety disorders?

We all have feelings of anxiety, worry and fear sometimes. These can be normal responses to certain situations. For example, you might worry about a job interview, or about paying a bill on time. These feelings can give you an awareness of risks and what you need to do in a difficult or dangerous situation. This reaction is known as 'fight or flight'.

Your brain responds to a threat or danger by releasing stress hormones such as adrenaline and cortisol. Even if the danger is not real, these hormones cause the physical symptoms of anxiety. Once the threatening situation has stopped, your body will usually return to normal.

But if you have an anxiety disorder these feelings of fear and danger can be ongoing and interrupt your daily routine long after the threat has gone. They can make you feel as though things are worse than they actually are.

Everyone's experience of anxiety disorders is different. Not everyone who has an anxiety disorder will experience the same symptoms.

Mental symptoms of anxiety can include:

If you dissociate you might feel like you are not connected to your own body. Or like you are watching things happen around you, without feeling it.

Physical symptoms of anxiety can include:

Anxiety can lead to depression if left untreated.

You can see more about breathing techniques further down this page. And you can find details of the Every Mind Matters website in the further reading section at the bottom of this page.

You can find more information about:

* Depression by clicking here.
* Talking therapies by clicking here.

Types of anxiety & causes

What are the different types of anxiety disorder?

This section provides an overview of the most common types of anxiety disorders.

Generalised anxiety disorder (GAD)

GAD is common. The main symptom of GAD is over worrying about different activities and events. This may feel out of your control. You feel anxious a lot of the time if you have GAD. You might feel 'on edge' and alert to your surroundings.

This can affect your day-to-day life. You might find that it affects your ability to work, travel places or leave the house. You might also get tired easily or have trouble sleeping or concentrating. You might have physical symptoms, such as muscle tension and sweating.

It is common to have other conditions such as depression or other anxiety disorders if you have GAD.

GAD can be difficult to diagnose because it does not have some of the unique symptoms of other anxiety disorders. Your doctor is likely to say you have GAD if you have felt anxious for most days over six months and it has had a bad impact on areas of your life.

Panic disorder

You will have regular panic attacks with no particular trigger if you have panic disorder. They can happen suddenly and feel intense and frightening. You may also worry about having another panic attack.

Panic disorder symptoms can include the following.

You may also dissociate during a panic attack. Such as feeling detached from yourself.

Certain situations can cause panic attacks. For example, you may have a panic attack if you don't like small places but you have to use a lift. This doesn't mean that you have panic disorder.

Social anxiety disorder

Social anxiety disorder is sometimes known as social phobia. Lots of people may worry about social situations but if you have social anxiety you will have an intense fear or dread of social or performance situations. This will happen before, during or after the event.

Some common situations where you may experience anxiety are the following.

Speaking in public or in groups.

Meeting new people or strangers.

Dating.

Eating or drinking in public.

You may be worried that you will do something or act in a way that is embarrassing.

You might feel aware of the physical signs of your anxiety. This can include sweating, a fast heartbeat, a shaky voice and blushing. You may worry that others will notice this or judge you. You might find that you try to avoid certain situations. You might realise that your fears are excessive, but you find it difficult to control them.

Your GP will ask you questions about your symptoms. And might ask you to fill out a questionnaire. This will help them find out how anxious you feel in social situations. They may refer you to a mental health specialist for a full assessment.

You can ask for a telephone appointment with your GP if it would be too difficult for you to see them in person.

Phobias

A phobia is an overwhelming fear of an object, place, situation, feeling or animal.

Phobias are stronger than fears. They develop when a person has increased feelings of danger about a situation or object. Someone with a phobia may arrange their daily routine to avoid the thing that's causing them anxiety.

Common examples of phobias include the following.

Animal phobias. Such spiders, snakes or rodents.

Environmental phobias. Such as heights and germs.

Situational phobias. Such as going to the dentist.

Body phobias. Such as blood or being sick.

Sexual phobias. Such as performance anxiety.

Leaving your home.

Being in public spaces.

Using public transport.

Being in crowded spaces.

You might find that these situations make you feel distressed, panicked and anxious. You may avoid some situations altogether. This can affect day-to-day life.

Agoraphobia can make it difficult to make an appointment with your GP to talk about your symptoms. You might not feel able to leave your house or go to the GP surgery. You can arrange a telephone appointment if you have symptoms of agoraphobia. A GP will decide on the best treatment options for you depending on what you tell them.

Obsessive-compulsive disorder (OCD)

You will have obsessions, compulsion or both if you have OCD.

Obsession. An obsession is an unwelcome thought or image that you keep thinking about and is largely out of your control. These can be difficult to ignore. These thoughts can be disturbing, which can make you feel distressed and anxious.

Compulsion. A compulsion is something you think about or do repeatedly to relieve anxiety. This can be hidden or obvious. Such as saying a phrase in your head to calm yourself. Or checking that the front door is locked.

You might believe that something bad will happen if you do not do these things. You may realise that your thinking and behaviour is not logical but still find it very difficult to stop.

Speak to your GP if you think you have OCD. They should discuss treatment options with you. Or you could try to self-refer to an NHS talking treatment service.

You can find more information about 'Obsessive-compulsive disorder' by clicking here.

Skin-picking

Skin picking is medically known as dermatillomania. It is an impulse control disorder. You will regularly pick at your skin. Often you will pick healthy skin. This can cause damage to your skin, including bleeding, bruising and sometimes permanent marks. You will usually pick the skin on your face but might also pick other areas of the body. You will find it difficult to stop yourself doing it.

No one knows the cause for skin-picking. It is thought that it could be a type of addiction. Or it relieves tension and stress. It is common to have OCD and dermatillomania at the same time.

Your GP may arrange for you to see a specialist mental health doctor like a psychiatrist for diagnosis.

Hair pulling

Hair pulling is medically known as trichotillomania. It is an impulse control disorder. You feel the urge to pull out your hair if you have this condition. This can be from your scalp or other places such as your arms, eyelashes, legs or pubic area. You will find it difficult to stop yourself doing this.

You might experience a build-up of tension which you can relieve by pulling out the strand of hair. You might not even be aware that you're doing it.

It can be difficult to stop, which can lead to hair loss. This in turn can make you feel guilty, embarrassed and affect how you feel about yourself or how your friends and family see you.

Your doctor will look at the following to diagnose your condition.

Health anxiety

You may have health anxiety if you spend a lot of time worrying about if you are ill. Or worrying about getting ill. You may:

worry that your doctor has missed something,

check your body a lot for signs of illness,

constantly worry about your health,

spend a lot of time asking people if they think you are ill,

spend a lot of time looking at health information on the internet, on the tv or in newspapers, or

act as if you were ill.

Symptoms like headaches or a racing heartbeat can be caused by anxiety. But if you have health anxiety you may mistake these for signs of illness.

Body dysmorphic disorder (BDD)

You will have upsetting thoughts about the way you look if you have BDD. The thoughts don't go away and have a big effect on daily life.

This is not the same as being vain about your appearance. You may believe that you are ugly and that everyone sees you as ugly, even if they reassure you that this isn't true. Or you may believe that people are focused on an area of your body such as scar or birthmark. It can be very distressing and lead to depression.

You may spend a large amount of time doing the following:

Staring at your face or body in the mirror.

Comparing your features with other people's.

Covering yourself with lots of makeup.

Thinking about plastic surgery when you do not need it.

Speak to your GP if you think you have BDD. They should discuss treatment options with you. The GP may arrange for a team with more BDD experience to help you.

Post-Traumatic Stress Disorder (PTSD)

You may have PTSD if your anxiety symptoms developed after a stressful or distressing event. Or if you have experienced trauma over a long period of time.

You can find more information about 'Post-Traumatic Stress Disorder' by clicking here.

What causes anxiety disorders?

We don't fully understand what causes anxiety disorders. But it is thought that the following factors can cause anxiety.

Genetics. Some people seem to be born more anxious than others. You may get anxiety through your genes.

Life experience. This could be bad experiences such as being abused or losing a loved one. It could also include big changes in life such as moving home, losing your job or pregnancy.

Drugs. Caffeine in coffee and alcohol can make you feel anxious. Illegal drugs, also known as street drugs can also have an effect.

Circumstances. Sometimes you know what is causing your anxiety. When the problem goes, so does your anxiety.

Help & treatment

How can I get help if I think I have an anxiety disorder?

You should make an appointment to talk with your GP if you are worried about your symptoms. Or they are causing problems in your day to day life.

Your doctor will look at different things when deciding on your treatment such as the following.

The service can be run by the local NHS Trust or a non-NHS agency, like a charity who work with the local Trust.

IAPT should be available in your area. You can often self-refer or ask your GP to refer you.

To find your local the IAPT service you can search online here:
www.nhs.uk/ServiceSearch/Psychological%20therapies%20%28IAPT%29/LocationSearch/10008

You can also ask your GP or PALS service for details of local IAPT services.

You can get more information about:

GP: What to expect from your GP by clicking here.

Medication. Choice and managing problems by clicking here.

Talking therapies by clicking here.

How are anxiety disorders treated?

You can check what treatment and care is recommended for anxiety disorders on the National Institute for Health and Care Excellence (NICE) website.

NICE produce guidelines for how health professionals should treat certain conditions. NICE only provide guidelines for:

Generalised anxiety disorder (GAD) and panic disorder,

Obsessive-compulsive disorder (OCD) and body dysmorphic disorder (BDD),

Post-traumatic stress disorder (PTSD), and

Social anxiety disorder.

The NHS does not have to follow these recommendations. But they should have a good reason for not following them.

We have described some of the treatments for anxiety disorders below. The treatments you will be offered depend upon the type of anxiety disorder you are experiencing.

You can find more information about treatments for:

Post-traumatic stress disorder (PTSD) by clicking here.

Obsessive-compulsive disorder (OCD) by clicking here.

A written or electronic information based on cognitive behavioural therapy principles.

Instructions to work through the material over at least 6 weeks.

Very brief support from a therapist such as a 5-minute telephone conversation.

get written or electronic materials,

be supported by a trained professional, who delivers the self-help programme and reviews progress and outcomes, and

get support to use the materials, either face-to-face or over the telephone.

Your learning should:

be based on CBT,

get you involved,

include presentations from a trained professional,

include self-help manuals,

have 1 therapist to about 12 people, and

usually be 6 weekly sessions, each lasting 2 hours.

If these treatments do not work you should be offered cognitive behavioural therapy (CBT), applied relaxation or medication.

Depending upon the type of anxiety disorder you have you may be offered individual or group sessions. If you have social anxiety disorder you should not be offered group CBT sessions.

A trained therapist will teach you different techniques to manage your situation.

Depending on the anxiety that you have, you will usually get 12-15 weekly sessions each lasting 1 hour. You will get less if you recover sooner and more if you need it.

This type of therapy is specifically used for people with social anxiety disorder. You will usually have up to 25 or 30 sessions which last 50 minutes. The therapy will usually take place over a 6 to 8 month period.

You will make eye movements while thinking about the traumatic event. EMDR helps make your brain deal with painful memories in a different way. So, these can become less painful for you.

Medications

You can get more information about:

Talking therapies by clicking here.

Antidepressants by clicking here.

Benzodiazepines by clicking here.

Complementary and alternative therapies by clicking here.

Unhappy with treatment

What if I am not happy with my treatment?

If you are not happy with your treatment you can:

There is more information about these options below.

Treatment options

You should first speak to your doctor about your treatment. Explain why you are not happy with it. You could ask what other treatments you could try.

Tell your doctor if there is a type of treatment that you would like to try. Doctors should listen to your preference. If you are not given this treatment, ask your doctor to explain why it is not suitable for you.

Second opinion

A second opinion means that you would like a different doctor to give their opinion about what treatment you should have. You can also ask for a second opinion if you disagree with your diagnosis. You don't have a right to a second opinion. But your doctor should listen to your reason for wanting a second opinion.

Advocacy

An advocate is independent from the mental health service. They are free to use. They can be useful if you find it difficult to get your views heard. There are different types of advocates available. Community advocates can support you to get a health professional to listen to your concerns. And help you to get the treatment that you would like.

You can search online to search for a local advocacy service. If you can't find a service you can contact the Rethink Mental Illness Advice Service on 0300 500 927, we will look for you. But this type of service doesn't exist in all areas.

The Patient Advice and Liaison Service (PALS)

PALS is part of the NHS. They give information and support to patients.

You can find your local PALS' details through this website link:
www.nhs.uk/Service-Search/Patient-advice-and-liaison-services-(PALS)/LocationSearch/363.

You can find out more about:

Medication. Choice and managing problems by clicking here.

Second opinions by clicking here.

Advocacy by clicking here.

Complaining about the NHS or social services by clicking here.

Managing symptoms

What can I do to manage my symptoms?

You can learn to manage your symptoms by looking after yourself. Selfcare is how you take care of your diet, sleep, exercise, daily routine, relationships and how you are feeling.

Lifestyle

Making small lifestyle changes can improve your wellbeing and can help your recovery.

Routine helps many people with their mental wellbeing. It will help to give a structure to your day and may give you a sense of purpose. This could be a simple routine such as eating at the same time each day, going to bed at the same time each day and buying food once per week.

Breathing exercises

Breathing exercises can help to calm you when you are feeling anxious. Or having a panic attack. You will get the most benefit if you do them regularly, as part of your daily routine.

There is more information about breathing exercises in the further reading section at the bottom of this page.

Support groups

You could join a support group. A support group is where people come together to share information, experiences and give each other support.

You might be able to find a local group by searching online.

Rethink Mental Illness have support groups in some areas. You can find out what is available in your area if you follow this link:
www.rethink.org/about-us/our-support-groups
Or you can call the Rethink Mental Illness Advice Service on 0300 5000 927 for more information.

Recovery College

Recovery colleges are part of the NHS. They offer free courses about mental health to help you manage your symptoms. They can help you to take control of your life and become an expert in your own wellbeing and recovery. You can usually self-refer to a recovery college. But the college may inform your care team.

Unfortunately, recovery colleges are not available in all areas. To see if there is a recovery college in your area you can use a search engine such as Google. Or contact Rethink Mental Illness Advice Service on 0300 5000 927.15

You can find more information about 'Recovery' by clicking here.

Carer's, friends & relatives

Information for carers, friends and relatives

If you are a carer, friend or relative of someone who hears voices, you can get support.

How can I get support?

You can do the following.

How can I support the person I care for?

You can do the following.

A care plan should always include a crisis plan. A crisis plan will have information about who to contact if they become unwell. You can use this information to support and encourage them to stay well and get help if needed.

Your relative or friend needs to give permission for the NHS to share information about them. And their care.

You can find out more about:

Supporting someone with a mental illness by clicking here.

Getting help in a crisis by clicking here.

Suicidal thoughts. How to support someone by clicking here.

Responding to unusual thoughts and behaviours by clicking here.

Carers assessment by clicking here.

Confidentiality and information sharing. For carers, friends and family by clicking here.

Money matters: dealing with someone else's finances by clicking here.

Worried about someone's mental health by clicking here.

Benefits for carers by clicking here.

Stress by clicking here.

Useful contacts

Anxiety UK
A user led organisation that supports anyone with anxiety, phobias, panic attacks or other anxiety disorders.

Telephone: 03444 775 774 (Monday to Friday 9.30am-5.30pm)
Text: 07537 416905
Address: Anxiety UK, Nunes House, 447 Chester Road, Manchester, M16 9HA
Email: support@anxietyuk.org.uk
Website: www.anxietyuk.org.uk

Social Anxiety UK
Offers support with social anxiety disorder. They are a web-based organisation and offer forums, a chat room and information about social anxiety.

Email: contact@social-anxiety.org.uk
Website: www.social-anxiety.org.uk

OCD-UK
Gives information, advice and support on obsessive compulsive disorder (OCD) and related disorders such as body dysmorphic disorder (BDD), skin-picking and hair pulling.

Telephone: 03332 127890 (10am - 4:45pm, Monday to Friday)
Address: OCD-UK, Harvest Barn, Chevin Green Farm, Chevin Road, Belper, Derbyshire, DE56 2UN
Email via website: www.ocduk.org
Website: www.ocduk.org

No Panic
Offers emotional support and information on anxiety disorders and medication including tranquilizers. They have a 1 to 1 mentoring scheme and a telephone recovery group available to their members.

Telephone: 0300 772 9844 (Everyday 10:00am - 10:00pm)
Address: Jubilee House, 74 High Street, Madeley, Telford, Shropshire, TF7 5AH
Email: sarah@nopanic.org.uk
Website: www.nopanic.org.uk

Need more advice?

If you need more advice or information you can contact our Advice and Information Service.

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This section gives information on anxiety disorders. It explains the symptoms, treatments and way to manage an anxiety disorder. This information is for people affected by anxiety disorders in England who are 18 or over. It's also for their carers, friends and relatives and anyone interested in this subject.

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Can anxiety problems be inherited genetically?

Research shows that having a close relative with anxiety problems increases your chances of experiencing anxiety problems yourself. But at the moment there is not enough evidence to show whether this is because we share some genetic factors that make us more vulnerable to developing anxiety, or because we learn particular ways of thinking and behaving from our parents and other family members as we grow up.

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Research shows that having a close relative with anxiety problems increases your chances of experiencing anxiety problems yourself. But at the moment there is not enough evidence to show whether this is because we share some genetic factors that make us more vulnerable to developing anxiety, or because we learn particular ways of thinking and behaving from our parents and other family members as we grow up.

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Anxiety and physical health problems

Some studies suggest that experiencing anxiety could increase the risk of developing certain long-term physical health problems, including diabetes, stomach ulcers and heart problems. But there's not enough evidence to say for sure exactly what the risks are, or what groups of people are most likely to be affected. Having a physical illness or disability can also make you feel stressed and anxious, so it might sometimes feel like your anxiety problems and physical health problems are part of a vicious circle.

Sometimes it might be difficult to work out whether your symptoms are totally related to anxiety, or might be related to a different illness. If you're experiencing any physical symptoms it's best to talk to your GP, so they can check out what may be causing them.

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Anxiety and physical health problems Some studies suggest that experiencing anxiety could increase the risk of developing certain long-term physical health problems, including diabetes, stomach ulcers and heart problems. But there's not enough evidence to say for sure exactly what the risks are, or what groups of people are most likely to be affected.

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Overview of Generalised Anxiety Disorder (GAD)

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Overview of Generalised Anxiety Disorder (GAD)

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Overview - Generalised anxiety disorder in adults

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Everyone has feelings of anxiety at some point in their life. However, some people find it hard to control their worries. Their feelings of anxiety are more constant and can often affect their daily lives.

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What is the 'fight, flight or freeze' response?

Like all animals, human beings have evolved ways to help us protect ourselves from danger. When we feel under threat our bodies react by releasing certain hormones, such as adrenaline and cortisol. These hormones:

make us feel more alert, so we can act faster

make our hearts beat faster, quickly sending blood to where it's needed most.

After we feel the threat has passed, our bodies release other hormones to help our muscles relax. This can sometimes cause us to shake.

This is commonly called the 'fight, flight or freeze' response - it's something that happens automatically in our bodies, and we have no control over it.

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Like all animals, human beings have evolved ways to help us protect ourselves from danger. When we feel under threat our bodies react by releasing certain hormones, such as adrenaline and cortisol. These hormones: make us feel more alert, so we can act faster make our hearts beat faster, quickly sending blood to where it's needed most.

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The Case Studies at the bottom of this page will provide ideas for practical support

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There are currently 1.86 million people in the UK with a visual impairment and it is estimated to exceed 2.25 million by 2020.

User needs vary depending on the nature and severity of the visual impairment and when the sight loss occurred. Increasing levels of sight loss generally lead to added challenges in accessing educational resources - the subjects being studied have a significant influence in determining the level and nature of these challenges.

Potential issues

Non expert provision

There are a number of schools and colleges that offer specialist provision for learners with vision impairment. However there are an estimated 40,000 people under the age of 25 with a severe impairment - the majority of these will have some sight. This means many will attend mainstream organisations that don't have the expertise to support these learners.

Choices and challenges

Courses with a high visual content can be particularly challenging. This includes science, technology, engineering and mathematics () courses. It is important that learners have support in their subject of choice as they have valuable contributions to make to these fields.

Provide appropriate staff development

Teaching staff

They will need training on producing accessible learning resources. This includes:

Accessible documents and presentations

Delivering accessible digital learning.

IT staff

They must be aware of built in accessibility features in operating systems and ensure they are enabled. There is a lot of free and open source software that may be useful to visually impaired learners which IT staff should also be aware of.

Library staff

It is likely that visually impaired learners will need books in an electronic format; library staff need to know how to obtain these.

Disability staff

Disability staff should be aware of accessibility features in Windows, Mac OS or in mobile devices like phones and tablets. They may also find it useful to know about free and open source assistive technologies.

Support the use of assistive technology

Software

No two learners with visual impairments have the same issues so there is no simple solution that will suit everyone. However, there are a number of basic enabling technologies that are useful and should be made available, for example text-to-speech tools and the accessibility tools built into Windows and Mac OS.

Learners who require screen readers will have access to their own commercial application but it is worth making a free screen reader tool available. NonVisual Desktop Access (NVDA) can run from a memory stick and is popular with many screenreader users. Window-Eyes is also free for Office 2010.

Mainstream technologies from to e-book platforms may also offer accessibility options.

Many users can benefit from the range of apps on tablets and phones - for example magnification tools, colour identification and object identification.

Hardware

Magnifiers are helpful. These may include CCTV, handheld electronic devices and low tech magnifying sheets or lenses.

Scanning and reading devices allow visually impaired people to read physical copies of textbooks and magazines. Key features to look for include:

Audio feedback during operation

Accuracy of the optical character recognition (OCR)

The ability for displayed text to reflow when magnified

The ability to output to synthetic speech audio including saving to MP3 format.

Some apps on tablet devices can now compete with bespoke hardware tools and learners may prefer to use a mainstream device like an iPad, rather than having additional equipment to carry around.

Tools that identify or describe objects can be invaluable in labs, workshops, kitchens or salons. These include optical identification (OID) and radio frequency identification (RFID) devices. Small tactile markers can be assigned an audio message and attached to the object. When the user scans the marker with a receiver they get the message played back to them.

Hardware focused on tactile senses includes refreshable braille devices for writing or reading on a laptop or phone, a talking tactile tablet or the low tech alternatives of bump ons with braille labels. Wikki Stix and plastic embossing film (German film) allow tutors to create instant tactile diagrams.

Other tools for different areas of the curriculum include talking thermometers for science or talking scales in food technology.

Browser plug-ins

The choice of browser installed on the network can make a difference. Browser plug-ins like Spreed can help people with limited visual field read much more quickly. Other plug-ins enable the user to change the contrast or speak out loud text content.

Accessible platforms

Where your organisation subscribes to e-book systems or other e-content, the procurement policy can make a substantial difference. Ensuring that the organisation subscribes to an accessible platform can provide substantial savings on additional support costs.

Non academic skills

Learners with more severe visual impairments often need additional skills to access the curriculum. For example, they may need advanced braille or screenreader expertise. At all levels, they may need additional mobility and independence training so they can take part in fieldwork or work placements.

Inaccessible systems and resources

Websites, intranets, 's and e-book platforms must be designed and tested for accessibility. If not, they are likely to create barriers.

Visual resources can be of great benefit to many learners. Images, mindmaps, flow diagrams and videos can still be used as long as they are annotated, described and transcribed appropriately.

Learning activities

Start with...

Giving learners access to the lesson resources in digital format before the lesson

Considering how visually impaired students will access interactive whiteboard content

Involving the learner with testing online - accessibility can vary with the assistive technology used and the learner's degree of skill.

Progress to...

Traditional learning activities like dialogue, discussion and questioning can work well with learners with sight impairment. Remember that screenreader users rely on audio feedback through headphones to both read and write. This makes it harder to read or write when discussions are going on. When working with visually impaired learners, you should:

Allow adequate time and adapt tasks if necessary

Provide as many resources as possible in digital format

Make resources available before the lesson - reading with magnification or screenreader software takes longer and learners struggle to access everything at the same time

Where learners have some functional sight, make use of cameras or interactive whiteboards to record transient information

Make use of existing technologies ie, free tools that synchronise a learner's laptop with an interactive whiteboard/tutor PC for accessing content with magnification software

Be aware of mobility issues. Changing the desk layout for different lessons might be a good idea for most learners but could disorientate a blind learner

Anticipate hazards in practical, workshop or outdoor activities but let the learner grow in confidence by encouraging independence

Try to anticipate which parts of your lesson may create conceptual barriers to people who, for example, have never seen a colour or whose experience of a tree is tactile not visual

When setting group tasks play to the strengths of the visually impaired student. Are they better researchers or presenters?

Liaise with the learner and support staff to anticipate barriers in planned activities. The Web2Access site includes accessibility tests and scores for a variety of online tools

Ensure assessments are accessible to screenreaders and, where necessary, consider how they could be adapted to minimise barriers

Where learners study subjects involving maths, ensure the learner can access additional support where appropriate. This might involve extra tuition in braille Maths or, for those accessing via screenreader, getting specialist guidance in creating and using MathML

Documents and presentations

Visually impaired people may need to work with text at much higher magnification levels. This makes any resource they are working with more difficult to navigate. If tutors use the inbuilt heading styles when creating documents, the navigation pane makes it simpler for magnification or screen reader users to rapidly move around the document.

Presentations tend to be very visual and may be inaccessible for visually impaired learners. If you are making them available to learners:

Save them in PowerPoint presentation (.ppt or .pptx) format rather than PowerPoint show (.pps or .ppsx). Learners with a visual impairment cannot easily zoom in on slides in presentation format

Include notes in the notes field so that you can import text as a Word document and read in the user's chosen way

See the video resource for guidance on checking and improving your PowerPoint presentation's accessibility

IT and network staff

These staff members have a crucial role in ensuring barriers are minimised in mainstream installations. This includes accessibility testing on the and support with assistive technology solutions.

Library staff

They have a critical role in liaising with publishers, teaching staff and support staff to ensure the learners have access to accessible digital copies of textbooks.

Learners

They have a crucial role to play. Success may depend more on their braille skills, screenreader skills and mobility skills than native abilities in a subject. A willingness to try new formats (eg, DAISY, EPUB) and new tools helps to:

Find more efficient ways of working

Encourage flexibility in the face of difficulties

Develop more independence as a learner.

Multimedia

Here are some of the issues to consider with audio and video and how to address them.

Start with...

Adding accessibility at the start of a multimedia resource than afterwards

Checking that screenreader software can access the media controls - if you can control video using only keystrokes like 'Tab', 'Spacebar' and 'Enter', it is likely to work for a blind user

Checking that the media content is accessible to the user. If you are using video that contains important visual content that isn't explicitly described, learners with a sight impairment will be disadvantaged.

Progress to...

Making multimedia accessible to people with sight impairments. This depends on:

Where the audio strand does not convey all of the information in the pictures and text

Where the video quality creates a difficulty for someone with limited vision. A video taken on (or viewed on) a phone may create difficulties; a video with good lighting, better image resolution and displayed on a plasma screen may be ok.

Alternatives include:

Audio description (an additional voice track describing the scene or the action)

Separate notes describing the visual content or one-to-one mentor support to describe the visual content

The best solution will be dependent on the local context. In many cases, describing the gaps to a learner is the most appropriate adjustment, allowing the learner to ask questions for clarification where needed. Audio description is worth considering for resources that will be used a lot or for a long time. Other learners can also benefit from the extra explanations.

Describing video

Redundant material that can often be ignored includes:

The colour and style of clothes of participants (usually irrelevant to the content of their dialogue)

Most background activity

Maps, diagrams and text captions (they usually just reinforce the audio track).

However, multimedia will need additional explanation in circumstances where the visual content is delivering relevant additional information, for example where:

Body language or facial reaction are significant to the message

Images convey emotional content such as irony or suffering

Key information is conveyed by vision alone - for example

Action happening on the screen -"he is creeping up behind her"

On screen text - scribbled notes, signs, name captions, locations, telephone numbers etc.

Range of adjustments

Different reasonable adjustments relate to differing contexts, for example whether the materials:

Form a major or minor element of a course

Will be used for repeated independent use or one-off supported use

Are available commercially (eg, video of a mainstream film)

Are created by in-house experts or by modestly skilled teaching staff

In almost all cases, verbal description (either one-to-one or in the class setting) or summary notes to support the use of multimedia is adequate.

Technical and production issues

If you're producing multimedia resources but you're not a specialist, the best adjustment is to ensure the narrative, video and supporting text (eg, subtitles, text summaries, etc.) mutually reinforce the key learning objectives.

Where educational organisations create multimedia in-house using a specialist team, they should note the relevant web accessibility guidelines. The options available may depend on software used in production, the hardware used in playback or the expertise available in the team.

If you are providing audio description, it must be carefully scripted so that it fits conveniently into the gaps between speech in the original product.

Explore other media

There are thousands of educationally focused podcasts that may suit your learners. Consider creating your own audio summaries or get the learners to create their own audio files to support their learning.

Tables

Tables can be difficult to navigate when viewed at large magnification and even more difficult if accessed by a screenreader.

Start with...

Only using tables where appropriate, for example, for displaying data but not for formatting and layout of pages

Splitting tables up into smaller subsets of data, if they include lots of rows and columns. For example, instead of a big table of economic data for 50 countries, use separate tables for European countries, Asian countries etc

Lay out the rows and columns so that screenreader users can explore the data they need

Where possible provide a text summary of the key teaching points to accompany the table.

Progressing further

Tables can be difficult to navigate when viewed at large magnification and even more difficult if accessed by a screenreader. Screenreader users have to interpret the data from left to right, one line at a time. Their only way of comparing data on different rows is by remembering the first item, navigating to the right place in the next row(s), listening to the new value and comparing it (by memory) to the one they had previously remembered.

Problems with tables arise from the following factors:

Size - tables that are too large for a page of braille or print. The largest piece of braille paper used in standard braille writers and embossers contains 40 characters width. Using magnified text can also create additional problems - by the time detailed tables have been enlarged, the table is too big to successfully navigate, the user is disoriented and cannot see line or column headings.

Layout - screenreaders read a table from left to right and top to bottom. This provides a limited and restricted view, unlike that of a sighted person who can easily scan by columns or rows depending on the question asked. The two tables below show identical data with two different layouts.

In the first layout it's easy for a screenreader user to answer the question 'which was the best day for hiking?' because all the information for the day is read in one go. This is much harder to answer using the second table because the information for each day is disaggregated across separate rows.

The second layout is better for answering questions like 'how did temperature vary through time?'

Range of adjustments

Tables rarely constitute such a proportion of course material that they provide an obstacle to success (although great care must be taken before proceeding in such courses as economics and statistics). They do however frequently present an unexpected obstacle in a wide variety of courses. Typical ways of dealing with tables are as follows:

Description - this can be the most efficient way of enabling a learner to access a table as it gives the learner the immediate option of choosing between horizontal or vertical axis

Paragraphing - it is generally not recommended to render tables in braille. Tables can be written in paragraph form with each cell separated from the next by a semicolon. This can be difficult to interpret, though, because they have to mentally 'translate back' into spatial information from the paragraph form

Enlargement - this is the most common method of providing tables for people with limited vision, but the enlargement required for reading might compromise navigation and the ease with which they can grasp overall trends.

Graphs and images

If a graph or image supplements or summarises a text description then it may not need any further work. If it replaces a text description or conveys significant information then an alternative text description should be made available.

If learners are required to demonstrate specific skills in interpreting visual media like graphs, maps or flow diagrams, a tactile version might be more appropriate. You can create these to some extent using high tech tools like the talking tactile tablet, or low tech solutions such as plastic embossing film, swell paper or WikkiStix.

What organisations can do

What tutors and teachers can do

It is important that tutors and learners work together on the most appropriate adjustments. The right adjustments can significantly reduce the need for additional support and will benefit other learners. Talk to the learner about their preferred way of accessing content and find out how compatible that is with your existing teaching resources.

Tutors may need to adapt their usual practices to maximise learner independence. For example, if your organisation's VLE is difficult to access, or your learner's preferred technology is not a Windows-based PC, then it may be more effective to share files through cloud based services such as Dropbox or Google Drive.

What others can do

Case studies

This series of case studies show how learners with visual impairments use various apps and assistive technology to aid their learning:

Matt's story - using apps to help with printed text

Jake's story - changing accessibility settings

"My name is Jake and my story tells you about changing computer accessibility settings, talking watch and mobile phone accessibility settings.

"I can go on the computer when I am at home and at college. I can get to college on time and know what time to come back after a break by using my watch. I keep in touch with my family when I am out using my mobile phone."

Jim's story - using magnification and audio

"About four years ago I was introduced to Anne Aust and Julie Duffy (Portsmouth Central Library). I explained that I had never used a typewriter or a computer and as I could not see to read the words on television, I doubted I would be able to see to use a computer.

"I was shown how to use ZoomText, which magnifies letters and numbers and allows me to read the screen whilst sitting away from the computer and reducing the glare.

"I also use earphones to listen to what has been written on the screen. There are also attachments which can magnify photographs and pages in magazines.

"With these aids I have learned to explore the internet for information and have discovered that I can write short stories which some people seem to like. I am happy that I have shared my stories which other people can enjoy.

"I have found these aids have helped me to experience a much broader and fuller life."

Irene's story - using a PC and MP3 player

"Since learning to use a computer 14 years ago I can write my own letters, correspond with friends via email and read magazines and newspapers, which I was unable to do before, being totally blind.

"I am also able to catch up with radio and TV programmes if I haven't been able to hear or watch them when they were broadcast or shown.

"Having an MP3 player means I am able to listen to books and magazines and listen to music wherever I am."

Rosie's story - making documents easier to read

In March we met Rosie, who is studying business and IT at Royal National College for the Blind.

In this video she also demonstrates Genius Scan, an app that allows her to take pictures of documents and enhance them to make them easier for her to read.

Fran's story - communicating through SMS using VoiceOver

Fran is studying administration at Royal National College for the Blind in Hereford. In this video, Fran demonstrates her iPhone and VoiceOver, and shows us how she uses it to write text messages.

Saleh's Story - staying social

Meet Saleh, a student at Royal National College for the Blind in Hereford.

In this video, Saleh shows us how he uses his VoiceOver on his iPhone with the social media apps Facebook, WhatsApp and Instagram to stay in touch with his friends.

June's story - using magnification software to facilitate laptop use

"For many years before I was diagnosed and treated for macular degeneration, I struggled to read the menus on my computer. Following my diagnosis I was fortunate enough to attend a workshop for partially sighted people where I was told about weekly meetings for people interested in using computer programmes which magnified the text and, if you would like it, an encouraging voice tells you what you have written so if necessary you can correct it.

"This sounded great to me, just what I had been searching for, so I started to go to the Wednesday meetings organised by Julie Duffy and her guide dog Marble.

"Over a few sessions Julie showed me some of the details of a talking and magnification programme called Dolphin Guide and I realised that this programme was what I required to enable me to continue using my laptop. So I obtained a copy of Dolphin Guide and since it was installed, I have enjoyed dealing unaided each day with my emails, scanning and storing photographs, and sending these as attachments to some of my emails.

"I appreciate that Dolphin Guide will enable me to independently do other computer skills in time and I am looking forward to the challenge.

"I now look forward to using my laptop whereas before Dolphin Guide, I made so many errors I felt frustrated and gave up using it. I love trying my luck and feel my confidence is returning due not only to the Dolphin Guide programme but because of Julie's weekly help, and also because I know if something goes wrong with Dolphin Guide and the laptop, I have a telephone number for Dolphin Guide for help."

David's story - learning to use a computer

"I lost my eye sight about three years ago. After this I contacted the Royal National Institute for the Blind (RNIB) for some help and support. They thought it would be a good idea to get some new apparatus to help me to get my life back on track.

"The first thing I decided to do was to get a guide dog so I could get out and about again. The dog was a must for me and it well and truly changed my life. They then suggested I try to learn to use a talking computer, a talking phone and have a go at learning braille.

"The computer and phone were the scariest thing I had to learn, I had never used a computer in my life. As I had a lot of time on my hands I gave it a go. So off I went to the city library where I met Julie Duffy who worked with blind people on computers and taught braille. After four or five lessons I was surprised at how much I had learnt.

"I then purchased a new laptop and bought Dolphin Guide and away I went. I then had a few more lessons and practiced at home.

"A year down the line I can write a letter, send emails, search the web and have set up an address book. This has exceeded my expectations of what I thought would be possible for somebody like me to do.

"I then purchased a talking phone. After a few more lessons with Julie in the library I was back in touch with the world and have never looked back. I'm now taking braille lessons.

"What I have learnt in the past three years has exceeded all expectations. If you told me three years ago that I would be able to use a talking computer, a talking phone, have a guide dog and be learning braille I wouldn't have believed you but now I can do it all.

Sarah's story - using technology to function independently

"Modern technology has made a positive impact upon my life. I am able to perform basic tasks on a computer with support from speech synthesis such as JAWS. I felt a great sense of achievement when I learned to boot up a computer, listen to menus, read letters, access some sites on the internet, send and receive emails and access information stored on other devices.

"I currently use my tablet, which has the excellent Google voice actions to access my information. I have found that using the touch screen in conjunction with the keyboard gives me much better access to screen functions. My tablet currently stores all of my books and music.

"Lastly I have an iPhone 4S which is invaluable and it's the best piece of inclusive technology that I have experienced to date. My phone enables me to make calls, store contacts, send and receive messages as well as allowing me to browse emails and download media such as BBC iPlayer. I also use my phone as an alarm, reminder and as a diary.

"Modern technology has improved my life because I can communicate with others, perform tasks and function independently with others in a way that was not previously possible. If you have partial vision or, like me, no vision, these facilities are extremely important so that we can be part of the community and have as much independence and control over our lives as possible.

Hubert's story - using the TuneIn radio app

Meet Hubert, a student at the Royal National College for the Blind in Hereford.

Hubert is studying music technology and A-level media. In this video, he shows us how he uses the TuneIn Radio app in combination with VoiceOver to listen to the radio.

Michael's story - using technology to adapt to unexpected sight loss

Michael lost his sight unexpectedly. The optician told him to see his GP as a matter of urgency and two years later he was registered blind. Michael had never used a computer before but the Portsmouth City Council visual impairment (VI) advisor put him in touch with Julie Duffy, the vision impairment officer at Portsmouth Central library. Julie introduced Michael to the library's computer facilities and helped him get to grips with the accessibility features.

Michael says:

"I wanted to research my family tree but my sight wouldn't handle the normal text sizes on menus and pages. ZoomText made a great difference enabling me to increase the size of the text on the monitor screen to a much larger size.

It does have disadvantages because the monitor does not increase in size so on you are only able to see parts of the web page and you have to navigate with the mouse around the page to see it all. This can be a bit difficult and some people feel quite seasick at first but with practice you soon get to it. Although expensive it enables you to carry on using a computer."

In addition to using the library for family tree research, Michael was a keen user of the library's audio books. However, most libraries can only stock a limited range of audiobooks. Michael came across the Calibre service and suddenly found over 8,500 audiobooks available to him.

"You can go through the catalogue picking titles that appeal to you - they are sent by a free nationwide postal and Internet service. I personally have found this a very good service as I can once again read lots of books like I used to do."

Although Calibre is mainly used by people like Michael with age-related sight loss, there is a special Young Calibre service providing books aimed at a younger audience.

Michael's adventures in technology extend beyond research and reading. For day-to-day living he recommends his Alcatel One Touch Mobile.

"This is a relatively cheap mobile phone which is most helpful for visually impaired people as it has talking numbers which also light up so that you know what number you have pressed. It has a very clear screen with large display plus many other features including FM radio, alarm clock, torch and calculator.

It also has a SOS key which you can pre-program with any numbers that you may require in an emergency situation. I have found it a very useful and convenient mobile phone."

David's story - using an iPhone to write scripts

David is a student at the Royal College for the Blind and plans to study for a degree in creative writing. In this video he explains why he finds it easier to write his scripts on his iPhone rather than on his personal computer.

Allan's story - using a flexible keyboard app to support communication

Meet Allan, a student at the Royal National College for the Blind.

In this video, he demonstrates the Fleksy app which replaces the on-screen keyboard of his mobile phone, and explains why he finds it easier to use than the default keyboard.

Derek's story - using a portable device to aid reading

"I am registered partially sighted. I have a field of vision problem called Homonymous Hemianopsia which was caused by a brain tumour in 1968 when I was seven years old. I have no left field of vision in both eyes so my field of vision is about 90 degrees (normal field of vision 180 degrees). I have always found the mechanics of reading a book tiring, and getting in the way of a good read.

"So the bit of technology which has changed how I read a book is a Daisy player by Humanware called the Victor Reader Stratus, the device is about eight inches by eight inches and about two inches thick.

"The Victor Reader is very easy to use it can play Daisy Books, music, podcast and can even convert text files into speech. It runs off the mains and also via a built in rechargeable battery.

"The audio reproduction is very good you can alter the speed of the speech to make it go faster and slower, you can effortlessly go from one chapter to another chapter using the navigation keys in the middle of the player. And the most important thing for reading a book is the ability to book mark the precise place in the book where you stopped.

"In combination with the Victor Stratus I have joined the RNIB talking books service. The only bit of technology not on the Victor Stratus is some sort of sensor which will detect when I fall asleep and either stop the book or wake me up."

Kieren's story - using a braille display with an iPhone

"Hi, my name is Kieran. I am studying for a BTEC in information and music technology at the Royal College for the Blind in Hereford. I am a confident braille user and I also like using technology.

"I regularly use a braille display with my iPhone. This is a small device that converts the text on my phone to braille so I can read it easily.

"The phone and the braille display are linked together via Bluetooth. You use the text-to-speech voice over (on mute so nobody else hears it) to read the text and whatever is being said comes up on the braille display. It works both ways so I can use commands on the braille display to navigate around my iPhone and use its different features. It's really useful in a classroom or lecture because I can search for and read up on things that the tutor mentions.

"The best thing about it is how discreet it is. I can have my iPhone in my pocket and my braille display on the desk in front of me. Nobody knows if I am working or texting my friends! It is a really nice piece of kit (but it isn't cheap)."

David's story - creating comic strips

David is currently studying performing arts at the Royal College for the Blind and is into all things creative. In this clip, David explains how he uses a variety of applications to create comic strips.

Rosie's story - using VoiceOver to aid reading

In this video, Rosie explains how she uses VoiceOver to help her read when she is tired or has a lot of text to get through.

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Supporting learners with visual impairments

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Exploring common issues faced by blind and partially sighted students, and tips for achievement in the classroom
It is estimated that around 25,000 children and young people in England and Wales have a sight impairment that requires specialist education support. Of these, more than 60 per cent are educated in mainstream schools where their requirements might not be so easy to address. As many as half of young people with a sight impairment also have additional disabilities. So how can schools ensure that blind and partially sighted learners are best supported?

According to the Royal National Institute of Blind People (RNIB), severe visual impairment or blindness can substantially delay early childhood development and learning. Even a moderate visual impairment can have a notable impact. So what are the learning issues that schools should consider?

The main functional effects of visual impairment include central or peripheral vision loss, poor image sharpness, low contrast sensitivity or adaptability to light, and impaired eye movement or colour loss; but not all visual impairment is the same. A person's "functional revision" is a key concept here, referring to what can be seen, rather than what can't.

Adopting this mindset allows educators to consider how a learner's level of useful vision can be maximised. Considering the practical implications for the individual learner is vital; the distinctions in their educational needs will have a direct impact on the teaching and learning approaches required.

Blind learners

Educationally blind learners have a level of sight that is insufficient to learn visually, and so rely on their other senses. Distinguishing between those who have had some past sight and those who have never seen, may influence the visual concepts they can understand.
Questions to consider:

how much sight, if any, does the learner have and how useful is it?

how competent is the student with Braille and tactile skills?

what experience of vision does the learner have, if any?

how competent is the student in moving around the classroom independently?

Partially sighted learners

Partially sighted learners still work primarily through the visual medium, and make up the majority of learners with visual impairment. Their needs vary considerably and many work with normal print, which can create difficulties as their needs may be underestimated.
Questions to consider:

is the student's level of sight stable or variable and under what conditions?

is the learner's field of vision restricted?

what size/style of print is comfortable for the student?

does the learner have particular preferences for the learning environment, in terms of, for example, lighting or choice of seat?

Impact on learning

Stevie Wonder said, "Just because a man lacks the use of his eyes, doesn't mean he lacks vision." This is an important lesson; we may be inclined subconsciously to have different expectations of academic achievement for learners with visual impairment, but there is no direct correlation between visual impairment and intelligence. Most learners with visual impairment have the same range of intelligence and abilities as their sighted peers, just with additional barriers. More than a third will have some additional needs that may affect their learning.

Of course, additional barriers can affect a number of areas, such as the speed of working, communication skills (particularly reading or writing), environmental and spatial awareness, and social interaction, with a reduced ability to recognise body language and facial expressions. As a result, students can suffer from lower self-confidence which can have a negative impact on learning.

What is needed to succeed?

Inclusion is key to the successful education of students with visual impairment. According to The Centre for Studies in Inclusive Education, inclusive education means disabled and non-disabled young people learning together in ordinary school provision, with appropriate networks of support. They should have access to the same information, at the same time and, if possible, in the same way to participate in and enjoy mainstream settings to the best of their abilities, whatever their needs. Leoni Masterson, qualified teacher of the visually impaired (QTVI) at Linden Lodge School, explains: "Blind and visually impaired students face barriers to learning. If we can break down these barriers through tactile resources, we are promoting inclusion. They can take part in activities they've not been able to before."

In mainstream settings, it is important to make the most of specialist support that is available. Many mainstream educators will not have the skill set to teach specialist areas such as Braille, but QTVIs can visit and work closely with schools to advise how to meet children's needs through inclusive teaching and learning methodology. Each local authority has a vision impairment service which includes at least one QTVI.

Educators should also consider what they can do to enrich the learning process. As Leoni notes, "Visually impaired and blind children need a rich learning environment as sometimes they miss out on the visual clues." Sighted children's learning is constantly reinforced by things such as colours, shapes, people and landscapes. These give us a wealth of information subconsciously. Learners with visual impairment have reduced opportunities for incidental learning, so it is important to include as much multi-sensory learning in the classroom as possible, such as touch or smell. Also consider that visual and spatial concepts need more explanation; many learners with visual impairment struggle with concepts such as brighter versus darker, or telling which object is bigger at a glance.

Social inclusion is also important. Helen Keller said that "The chief handicap of the blind is not blindness, but the attitude of seeing people towards them." To reduce the risk of the student being ostracised by peers, consider the Circle of Friends approach, designed to enhance inclusion in a mainstream setting. It creates a support network for the student, with a peer group encouraged to look at their own behaviour, and understand the behaviour and difficulties of the student with visual impairment, in order to develop strategies and practical solutions to help them. In time, this can close the gap whilst strengthening core social skills.

Tips and ideas for the classroom

The classroom environment can have a significant impact on the success of teaching and learning. On top of dealing with core health and safety issues, it is important to consider the room's sensory nature. Your school might have had an audit conducted by a QTVI to suggest improvements, but here are some questions to consider for your classroom:

is the space clear and tidy to allow easier movement?

are frequently used resources kept in the same accessible place, and labelled?

is the level of lighting right for the learner?

are learners with visual impairment sitting close to a power source if they are using accessible ICT devices?

do you use real objects to support your teaching?

have you allowed adequate space for any special equipment or large print resources to be stored and used?

Accessible resources

Jennifer Williamson, resources technician at Joseph Clarke School, highlights the importance of accessible resources: "For students who have visual impairment, it is really important to strengthen their learning; therefore, learning materials need to be interesting enough to engage them."

Consider the issue of time for both staff and students. Visually impaired learners will often require extra time to process information and complete tasks, so using the simplest formats can help them. Make sure you and any support staff have the time to modify materials to include, for example, larger print or bolder colours. Providing both a print and a digital copy can be useful as this can be further adapted by the student to suit, if needed.

If you don't have time to modify items, look out for pre-created versions; a wide range of Braille materials, audio-visual resources, and tactile pictures and diagrams is available from various educational suppliers.

Role of access technology

Access technology has enormous potential for supporting learners with visual impairment across different ages and abilities. Assistive technology, such as audio-visual devices or software, allows students to work at their own pace and, with the right training, often independently. Technology isn't a magic wand, though; to be a success, it requires the right device, training and time. When this is achieved, students can take control of part of their learning journey, improving not only their academic progress, but also their self-confidence in learning and wider life.

If we can metaphorically open our eyes to the specific needs of visually impaired students, and take the time to recognise the impact they have on their learning and social integration, we can take the first steps towards making education an inclusive process.

Further information

Robene Dutta is Managing Director at educational publisher Mantra Lingua:
www.mantralingua.com

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Supporting the visually impaired learner * SEN Magazine

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Exploring common issues faced by blind and partially sighted students, and tips for achievement in the classroom

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A look into the difference between what constitutes someone as visually impaired or blind

A question people ask often is, "What's the difference between someone who is blind and someone who is visually impaired?" So, today, I sat down with our newest intern, Katie, to ask her some questions about the differences between visual impairment and blindness. She told me we should first start with the definitions of both.

What is the difference between visual impairment and blindness?

The definition of visual impairment is "a decrease in the ability to see to a certain degree that causes problems not fixable by usual means, such as glasses." Blindness is "the state of being unable to see due to injury, disease or genetic condition."

In the U.S., there are four terms used to describe different levels of vision impairment and blindness-partially sighted, low vision, legally blind and totally blind.

Partially sighted means a person has partial vision, either in one or both eyes.

Low vision refers to a severe visual impairment in which visual acuity is 20/70 or poorer in the better-seeing eye and cannot improve with glasses or contacts.

Legally blind means a person has a corrected vision of 20/200 in their best-seeing eye. If visual aids such as glasses can correct a person's vision to 20/20, they are not considered legally blind.

Totally blind refers to a complete loss of sight.

While the phrase "visual acuity" may seem new to you, Katie explained that it is something most of us are familiar with. It is a measurement determined by the letter chart tests we take when we get our eyes checked; the number represents your eyes' clarity or sharpness. For example, a person with a visual acuity measurement of 20/70who is 20 feet away from an eye chart sees what a person with 20/20 vision can see from 70 feet away.

Does a totally blind person with their eyes open see the same thing as a sighted person with their eyes closed?
Most people who are born blind say they see nothing. But, people who previously had vision before going blind say they usually see black and sometimes faded shapes, flashes of light or color, and experience vivid hallucinations.
From what distances are visually impaired people able to see?
It depends on the type of visual impairment someone is living with. For Katie and probably many others, objects are only visible from a certain distance-this distance could be as close as right in front of the eye or as far as 20 feet away. From a distance, objects may be blurry or faint. Some people may also see in tunnel vision, which is the loss of peripheral vision. Visual impairment can improve with glasses or other types of adaptive technology such as CyberEyez.
Can blind or visually impaired people still lead normal lives?
Absolutely! Many blind and visually impaired people adjust to their disabilities. Being visually impaired or blind doesn't mean they can't live normal lives just like anyone else. They work, go to the movies, explore new parts of town, and even win national talent contests.

Being blind or visually impaired isn't about what they can or cannot do. It's about learning the best way to accomplish whatever goals they set out to achieve.

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Blind vs. Visually Impaired: What's the Difference? | IBVI | Blog

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A look into the difference between what constitutes someone as visually impaired or blind A question people ask often is, "What's the difference between someone who is blind and someone who is visually impaired?" So, today, I sat down with our newest intern, Katie, to ask her some questions about the differences between visual impairment and blindness.

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This is a list of UK organisations we think may be of interest to adults with hearing loss, their friends and families.

AbilityNet exists to change the lives of disabled people by helping them to use digital technology at work, at home or in education.

The Access London Theatre brochure features audio-described, captioned, signed and relaxed performance listings for theatres across London and is available in print, Braille and CD.

Action on Hearing Loss is the largest charity in the UK campaigning, lobbying and raising awareness of deafness and hearing loss.

Age UK brings together Age Concern and Help the Aged. The Age UK Group works to improve later life for everyone by providing life-enhancing services and vital support.

Alliance on Hearing Loss

Hearing Link is an active member of the Alliance on Hearing Loss - a coalition of charities and professional representative groups working together to prevent and reduce the impact of hearing loss and tinnitus. The Alliance promotes the inclusion and participation of people who are deaf and hard of hearing in society. Download the declaration and quality statement for hearing services.

The aim of ATLA is to create a world where lipreading classes are available to anyone who needs them.

BAA is the largest association of professionals in hearing and balance in the UK. Membership extends internationally and provides services in both the public and private sector.

Bid Services is a charity working with children and adults with hearing loss, sight loss or both. They provide a range of services including specialist equipment support, employment support and social work. To check which services are available in your area, please visit their website for further information.

Deaf and Equal is particularly aimed at sectors that have a poor reputation for discriminating against Deaf people by either refusing access or refusing to provide information in an accessible format.

DeafblindUK supports people with combined sight and hearing loss to live the lives they want.

Gloucestershire Deaf Association (GDA) delivers specialist services and community activities for D/deaf and hard of hearing adults and children in Gloucestershire.

Hearing Dogs for Deaf People train hearing dogs to alert deaf people to select household sounds and danger signals in the home, work place and in public buildings - providing a life-changing level of independence, confidence and security.

The JDA is an independent, national charity offering professional support services, information and a range of social, cultural and educational programmes to people with all levels of hearing loss, people experiencing tinnitus, their friends, families and colleagues.

The NADP provides information and support for deafened people who have lost all or most of their useful hearing, and for their families and friends, to help enable them to regain their independence and enjoy the best quality of life. The NADP is run by and for deafened people.

The National Institute for Health Research (NIHR) Nottingham Hearing Biomedical Research Unit is a partnership between University of Nottingham, Nottingham University Hospitals Trust and Medical Research Council Institute of Hearing Research.

Open Ears is a non-denominational Christian charity for people who have various degrees of impaired hearing, mainly (but not exclusively) those who communicate orally, assisted by hearing aids or cochlear implants and lip-reading.

RAD strives to meet the individual needs of Deaf children and adults and deafblind people through the provision of services and the use of RAD Centres for Deaf People.

Sense is a national charity that supports and campaigns for adults and children who are deafblind. Services include: one-to-one support to help people live independently, communicator guides, housing, holidays and employment opportunities.

Soundz Off brings together, in one place, a list of organisations, support services, forums, social media links, general information and lots more for people in the UK who are hard of hearing or d/Deaf.

Stagetext makes theatre and culture accessible to deaf, deafened and hard of hearing people.

UKCoD is the umbrella body for voluntary organisations working with deaf people in the UK.

Subtitled film listings for all four countries of the UK.

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This is a list of UK organisations we think may be of interest to adults with hearing loss, their friends and families. AbilityNet exists to change the lives of disabled people by helping them to use digital technology at work, at home or in education.

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Hearing loss statistics in the UK

It is estimated that there are approximately 11 million people in this country with a hearing loss which makes it the second most common disability in the UK.

However, as an invisible disability, it so often goes unnoticed, making it easier for those living with hearing loss to be ignored or forgotten.

1 in 6 of the UK adult population is affected by hearing loss.

8 million of these are aged 60 and over.

6.7 million could benefit from hearing aids but only about 2 million people use them.

About 900,000 people are severely or profoundly deaf.

About 12,000 people in the UK use cochlear implants.

Many people with hearing loss also have tinnitus which affects 1 in 10 adults. They may also have balance difficulties.

Hearing loss is associated not only with mental health conditions (see below) but also with numerous physical health conditions such as diabetes, cardiovascular disease, anaemia, chronic kidney disease, rheumatoid arthritis, sleep apnea, balance problems and an increased risk of falls. Please visit our page on causes of hearing loss.

Hearing loss in older people

Hearing loss increases sharply with age - nearly 42% of those aged over 50 years have hearing loss, increasing to about 71% of people aged 70+.

About 400,000 older people live in care homes and are disproportionately affected by hearing loss, with approximately 75% of residents having a hearing problem.

Unassisted hearing loss have a significant impact on older people leading to social isolation, depression, reduced quality of life and loss of independence and mobility.

Hearing loss and dementia

When hearing loss is unassisted, those with a mild hearing loss are twice as likely to develop dementia as people without hearing loss, whilst those with moderate hearing loss are three times more likely to develop dementia and those with severe hearing loss are five times more likely to develop dementia.

There is evidence that cognitive decline can be addressed through early detection of hearing loss and the provision of amplification.

It is estimated that at least £28 million per year could be saved in England by properly managing hearing loss in people with dementia.

Deafness employment statistics UK

At least 4.4 million people with hearing loss are of working age.

The employment rate for those with hearing loss is 65%, compared to 79% of people with no long-term health issue or disability.

On average, people with hearing loss are paid £2,000 less per year than the general population; this amounts to £4 billion per year in lost income across the UK.

Recent estimates suggest that the UK economy loses £25 billion a year in lost productivity and unemployment due to hearing loss.

Research in 2014 on the experience of people with hearing loss and employment found that:

Almost three-quarters (74%) of respondents felt that their employment opportunities were limited because of their hearing loss.

70% agreed that their hearing loss sometimes prevented them from fulfilling their potential at work.

Just over two-thirds (68%) agreed that they sometimes felt isolated at work because of their hearing loss.

Two-fifths (41%) had retired early due to the impact of their hearing loss and struggles with communication at work.

Hearing loss and deafness in the future

The number of people with hearing loss is increasing. Estimates suggest that by 2035, about 15.6 million people in the UK will have hearing loss - that's one in five of the population.

If nothing is done to address lower employment rates for those with hearing loss, by 2031 the UK economy will lose £38.6bn per year in potential economic output.

By 2030, adult onset hearing loss will be in the top ten of disease burdens in the UK above cataracts and diabetes as measured by disability life adjusted years.

Words describing deafness and hearing loss

There are no rights and wrongs about the words used to describe a person's hearing loss. However, generally accepted definitions are as follows:

Deafened - people who were born with hearing and have lost most or all of their hearing later in life.

Hard of hearing - people who have lost some but not all hearing.

deaf (lower case 'd') - people who have hearing loss; they may be born deaf or become deaf. They mix well in the hearing world and may communicate orally and may also be users of sign language.

Deaf (upper case 'D') refers to people who are members of the Deaf community and who communicate almost exclusively with sign language.

Hearing impaired - anyone with any level of hearing loss.

Acquired hearing loss - people who were born with hearing but have lost some or all of their hearing.

Congenital hearing loss - born with hearing loss which may become progressively worse.

References

Hearing Matters. RNID, 2015
Webpage reviewed: November 2022 If you're looking for answers, seeking support for hearing loss or simply need to talk to someone who understands - we can help. Hearing connects us to people, enabling us to communicate in a way that none of our other senses can achieve.

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Deafness and hearing loss facts, figures and statistics in the UK including employment and ageing. Get information from charity Hearing Link.

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The World Health Organization (WHO) estimates that more than five percent of the world's population has some form of disabling hearing loss.

Doctors will describe someone as having hearing loss when they cannot hear well or at all.

You may have heard the terms "hard of hearing" and "deaf" to describe hearing loss. But what do these terms actually mean? Is there a difference between them? In this article, we answer these questions and more.

The difference between being hard of hearing and being deaf lies in the degree of hearing loss that's occurred.

There are several different degrees of hearing loss, including:

Mild: Softer or subtler sounds are hard to hear.

Moderate: It's hard to hear speech or sounds that are at a normal volume level.

Severe: It may be possible to hear loud sounds or speech, but it's very difficult to hear anything at a normal volume level.

Profound: Only very loud sounds may be audible, or possibly no sounds at all.

Hard of hearing is a term that refers to someone with mild-to-severe hearing loss. In these individuals, some hearing capability is still present.

Deafness, on the other hand, refers to profound hearing loss. Deaf people have very little hearing or none at all.

Deaf people and those who are hard of hearing can nonverbally communicate with others in several different ways. Some examples include American Sign Language (ASL) and lip-reading.

Some of the symptoms of being hard of hearing can include:

feeling like speech and other sounds are quiet or muffled

having trouble hearing other people, particularly in noisy surroundings or when more than one person is speaking

frequently needing to ask others to repeat themselves or to speak more loudly or slowly

having to turn the volume up on your TV or headphones

In children and babies

Children and babies with hearing loss may show different symptoms than adults. Symptoms in children can include:

having unclear speech or talking very loudly

often replying with "huh?" or "what?"

not responding to or following directions

a delay in speech development

turning up the volume too high on the TV or headphones

Some symptoms in babies include:

not being startled by a loud noise

only noticing you when they see you and not when you say their name

appearing to hear some sounds but not others

not responding to or turning toward a sound source after they've reached 6 months of age

not saying simple single words by 1 year of age

A variety of factors can lead to being hard of hearing. They can include:

Aging: Our ability to hear decreases as we age due to the degeneration of the structures in the ear.

Loud noises: Exposure to loud noises during leisure activities or at your workplace can damage your hearing.

Infections: Some infections can lead to hearing loss. These can include things like chronic middle ear infections (otitis media), meningitis, and measles.

Infections during pregnancy: Certain maternal infections can lead to hearing loss in babies. These can include rubella, cytomegalovirus (CMV), and syphilis.

Injury: An injury to the head or ear, such as a blow or fall, can potentially lead to hearing loss.

Medications: Some medications can cause hearing loss. Examples include some types of antibiotics, chemotherapy drugs, and diuretics.

Congenital abnormalities: Some people are born with ears that haven't formed properly.

Genetics: Genetic factors can predispose someone to develop hearing loss.

Physical factors: Having a perforated eardrum or a buildup of earwax can make hearing difficult.

It's important to see your doctor if you have hearing issues that interfere with your day-to-day activities. Your doctor can do simple tests to check your ears and your hearing. If they suspect hearing loss, they may refer you to a specialist for further testing.

People who are hard of hearing can choose from among several different treatment options. Some options include:

Hearing aids: Hearing aids are small devices that sit in the ear and come in a variety of types and fits. They help amplify sounds in your environment so that you can more easily hear what's going on around you.

Other assistive devices: Examples of assistive devices include captioning on videos and FM systems, which use a microphone for the speaker and a receiver for the listener.

Cochlear implants: A cochlear implant may help if you have more severe hearing loss. It converts sounds into electrical signals. These signals travel to your acoustic nerve, and the brain interprets them as sounds.

Surgery: Conditions affecting the structures of your ear, such as the eardrum and bones of the middle ear, can cause hearing loss. In these types of cases, doctors may recommend surgery.

Earwax removal: A buildup of earwax can cause temporary hearing loss. Your doctor may use a small tool or suction device to remove earwax that's accumulated in your ear.

There are several steps that you can take to protect your hearing. For instance, you can:

Turn the volume down: Avoid listening to your TV or headphones at a loud volume setting.

Take breaks: If you're being exposed to loud noises, taking regular quiet breaks can help protect your hearing.

Use sound protection: If you're going to be in a noisy environment, protect your hearing by using earplugs or noise-canceling earphones.

Clean carefully: Avoid using cotton swabs to clean your ears, as they can push earwax deeper into your ear and also increase the risk of a perforated eardrum.

Vaccinate: Vaccination can protect against infections that can cause hearing loss.

Get tested: If you feel like you're at risk for hearing loss, get regular hearing tests. That way, you'll be able to detect any changes early.

If you have hearing loss, there are a variety of resources that you may find useful. These include the following:

Hearing Loss Association of America (HLAA): This organization provides information and support for people with hearing loss and also offers resources for their loved ones.

National Institute on Deafness and Other Communication Disorders (NIDCD): Here, you can find information on various hearing and communication disorders and the ongoing research.

Ava - 24/7 Accessible Life: This app enables deaf people and those who are hard of hearing to follow conversations in real time. The app transcribes what people say and presents it as text on your screen.

Sound Alert: This app allows you to record important sounds in your home, such as the smoke detector alarm, doorbell, and phone ringtone. You can then receive a notification on your smartphone when these noises occur.

Subtitles Viewer: This app allows you to download subtitles onto your mobile device, which you can sync with the corresponding movie or TV program.

If you have a loved one who's hard of hearing, you can communicate in ways that make it easier for them to understand you. Here are some tips to keep in mind:

Try to talk in an area without a lot of background noise. If you're in a group, make sure that only one person is speaking at once.

Speak at a natural, steady pace and just a little bit louder than you usually would. Avoid shouting.

Use hand gestures and facial expressions to provide clues as to what you're saying.

Avoid activities that can make lip-reading difficult. These include eating while talking and covering your mouth with your hand.

Remain patient and positive. Don't be afraid to repeat something or to try different words if they don't understand what you've said.

The difference between being hard of hearing and being deaf lies in the degree of hearing loss.

People typically use being hard of hearing to describe mild-to-severe hearing loss. Meanwhile, deafness refers to profound hearing loss. Deaf people have very little, if any, hearing.

There are many different causes of hearing loss, including aging, exposure to loud noises, and infections. Some types of hearing loss are preventable, while others can be present at birth or develop naturally with age.

If you have hearing loss that interferes with your daily life, see your doctor. They can evaluate your condition and may refer you to a specialist for further testing and treatment.

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Hard of Hearing vs. Deaf: Differences, Symptoms, Treatment

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The difference between being hard of hearing and being deaf lies in the degree of hearing loss. Being hard of hearing typically means that you have mild-to-severe hearing loss. Being deaf means that you have very little, if any, hearing.

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e-learning

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Do you know what to do if someone has a seizure? Complete this short online learning module to find out more.

It covers: absence, atonic, focal, myoclonic, tonic and tonic-clonic seizures.

This training is free as part of our commitment to improving life for all those affected by epilepsy.

If you have valued using this training consider a donation to Epilepsy Action - thank you.

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Let others know that you have done this training and help to raise awareness about epilepsy. You can use links below to share.
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Learn more

You can find out more about different types of seizure by visiting the advice and information pages on the Epilepsy Action website.

Other first aid products from Epilepsy Action

There is more information about first aid for seizures available from our online shop:

Epilepsy Action is the working name of British Epilepsy Association, a registered charity in England and Wales (No. 234343) and a company limited by guarantee (No. 797997) in England.

Registered Office: New Anstey House, Gate Way Drive, Yeadon, Leeds LS19 7XY, United Kingdom

Main office: +44 (0)113 210 8800

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What to do when someone has a seizure | Epilepsy Action Learning

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Do you know what to do if someone has a seizure? Find out in our quick e-learning module.

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What to do if someone is having an epileptic seizure

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What to do if someone is having an epileptic seizure

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First aid for someone who is having an epileptic seizure

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Learn first aid for someone having an epileptic seizure, when a person collapses and is making sudden jerking movements.

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Epilepsy is a condition of the brain causing seizures.

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Epilepsy is the fourth most common neurological disorder and affects people of all ages.

Epilepsy means the same thing as "seizure disorders."

Epilepsy is characterized by unpredictable seizures and can cause other health problems.

Epilepsy is a spectrum condition with a wide range of seizure types and control varying from person-to-person.

Public misunderstandings of epilepsy cause challenges that are often worse than the seizures.

Join our mailing list to stay to date about programs, events, and news about epilepsy.

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The human brain is the source of human epilepsy.

Epilepsy is a chronic disorder, the hallmark of which is recurrent, unprovoked seizures. A person is diagnosed with epilepsy if they have two unprovoked seizures (or one unprovoked seizure with the likelihood of more) that were not caused by some known and reversible medical condition like alcohol withdrawal or extremely low blood sugar.

The seizures in epilepsy may be related to a brain injury or a family tendency, but often the cause is completely unknown. The word "epilepsy" does not indicate anything about the cause of the person's seizures or their severity.

Many people with epilepsy have more than one type of seizure and may have other symptoms of neurological problems as well. Sometimes EEG (electroencephalogram) testing, clinical history, family history, and outlook are similar among a group of people with epilepsy. In these situations, their condition can be defined as a specific epilepsy syndrome.
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Essentially, anything the brain can do, it can do in the form of a seizure.

Although the symptoms of a seizure may affect any part of the body, the electrical events that produce the symptoms occur in the brain. The location of that event, how it spreads, how much of the brain is affected, and how long it lasts all have profound effects. These factors determine the character of a seizure and its impact on the individual.

Having seizures and epilepsy can affect one's safety, relationships, work, driving, and so much more. Public perception and treatment of people with epilepsy are often bigger problems than actual seizures.

Are you new to epilepsy and seizures?
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Our Mission

The mission of the Epilepsy Foundation is to lead the fight to overcome the challenges of living with epilepsy and to accelerate therapies to stop seizures, find cures, and save lives.

P

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Epilepsy is the fourth most common neurological disorder and affects people of all ages. Epilepsy means the same thing as "seizure disorders." Epilepsy is characterized by unpredictable seizures and can cause other health problems. Epilepsy is a spectrum condition with a wide range of seizure types and control varying from person-to-person.

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15 Reasons to Choose WageDayAdvance for Payday Loans

Putting Customers First

Wage Day Advance prides itself on being a customer first business. This puts customer service and satisfaction at the forefront of our operation. It is because of this that we've aimed to make our entire payday loans service as safe, secure and user friendly as possible. We realise that our customers want bad credit payday loans as quickly and as easily as possible and we hope with our super fast application process, we've managed to achieve that and succeeded in making your access to finance as hassle-free as possible. We will also ensure a prompt payment should you be accepted for a loan.

In addition to our simple application process, we've made sure that the direct payday loans companies we partner with also share our ethos and echo our commitment to customer satisfaction and support. All of the lenders who facilitate the loans we offer respect and adhere to the FCA's outlined treating customer fairly policy and all provide excellent customer support.

Our Promise To You

The team at WageDayAdvance are committed to providing secure, quick and easy access to short term loans for any purpose. We aim to do this with minimal stress and hassle with a view of making the entire journey from application to ultimately paying back your loan as straight forward as possible.

Customer satisfaction is at the heart of what we do and we stake our reputation on it. As well as providing a reputable brokerage service, we also pride ourselves on treating our customers fairly as do the direct lenders we partner with. We will never charge you any hidden fees or inflate interest rates and we will endeavour to be on hand to assist in whatever queries you have both before, during and after the application process.

WageDayAdvance is more than just another payday loan broker. We're a highly experienced, customer-first broker. We know what our customers want and equally what they don't and we will do our utmost to consistently deliver a best in class service.

Debt Help and Money Advice

If you're struggling with debt or cannot keep up repayments on your loan, it is important that you seek advice as quickly as possible. Help is available to assist with your situation and guide you on the right path. Below, we've put together a collection of links that you may find useful if you're struggling with debt or simply want to seek free, impartial and independent advice regarding your current financial situation. You can also find more information in our debt advice section.

MoneyHelper - A government run website featuring a wealth of debt advice plus tools such as budget calculators and planners. They're available both over the phone or web chat.

Citizens Advice - They have a great section on financial advice if you're struggling with debt or dealing with lenders.

StepChange - A reputable debt charity who offer free advice when it comes to dealing with debt. They can help get you back on track with debt management plans and other formal arrangements.

National Debt Line - A respected UK debt charity who may be able to assist you. You can speak with them over the phone to discuss your situation or browse their extensive collection of resources via their website.

We Understand Financial Difficulty

As a short term loan broker, we realise that a lot of the people who come to us are in some kind of financial difficulty. This ranges from those needing a quick, urgent influx of cash to tide them over until payday right through to those wishing to acquire more finance over a longer period, often to consolidate other loans or make ends meet. It is because of this we feel we have a good understanding of the financial difficulties our customers face and as a result aim to deliver a range of loan options and terms to cover the majority of our customer's needs.

At WageDayAdvance, we realise that facilitating a loan is only part of the journey. As a responsible credit-broker we make sure we only partner with lenders who also understand the financial difficulties our customers face and are willing to provide access to finance in a responsible and fair manner. This includes offering repayment assistance where necessary, not charging inflated interest rates and ultimately abiding by the treating customers fairly policy set out by the Financial Conduct Authority.

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A Class Divided (full documentary) | FRONTLINE

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Privilege/Class/Social Inequalities Explained in a $100 Race - Please Watch to the End. Thanks.

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Epilepsy is a neurological condition characterised by seizures which are caused by excessive electrical activity within networks of neurons in the brain.

It is one of the most common neurological conditions in the world. Its impact can vary considerably from person to person depending on which part of the brain is affected. Epilepsy can affect anyone of any age, gender, race or ethnicity, but is most commonly diagnosed in childhood and in people over the age of 60.

There are over 40 different types of seizure, but the International League Against Epilepsy (ILAE) has identify 3 main types:

generalised onset

focal onset

seizures of unknown onset

Seizures of generalised onset involve large areas on both sides of the brain and often result in loss of consciousness. Focal onset seizures affect a specific region in one side of the brain where consciousness may be altered but is not lost. Seizures of unknown onset are where the origin of the seizure is unclear.

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What is epilepsy? | Epilepsy Research UK

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Epilepsy is a neurological condition characterised by seizures which are caused by excessive electrical activity within networks of neurons in the brain. It is one of the most common neurological conditions in the world. Its impact can vary considerably from person to person depending on which part of the brain is affected.

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How to know if someone is having an Asthma Attack?

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How to know if someone is having an Asthma Attack?

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Blue reliever isn't helping, or you need to use it more than every four hours

You're wheezing a lot, have a very tight chest, or you're coughing a lot

You're breathless and find it difficult to walk or talk

Your breathing is getting faster and it feels like you can't get your breath in properly

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What is asthma?

Asthma is a long-term condition that affects your airways - the tubes that carry air in and out of your lungs.

It usually causes symptoms such as coughing, wheezing and breathlessness.

If you come into contact with one of your asthma triggers, it can make your symptoms worse and even bring on an asthma attack.

How do my airways react to triggers?

If you have asthma you have 'sensitive' airways that are inflamed and ready to react when they come into contact with something they don't like.

If you come into contact with one of your asthma trigger s it causes your airways to react in three ways:

1. The muscles around the walls of the airways tighten so that the airways become narrower.

2. The lining of the airways becomes inflamed and starts to swell.

3. Sticky mucus or phlegm sometimes builds up, which can narrow the airways even more.

These reactions in the airways make it difficult to breathe and lead to asthma symptoms, such as chest tightness, wheezing, or coughing. It can also lead to an asthma attack.

Who gets asthma?

In the UK, around 5.4 million people are currently receiving treatment for asthma. That's one in every 12 adults and one in every 11 children.

Asthma affects more boys than girls. Asthma in adults is more common in women than men.

It tends to run in families, especially when there's also a history of allergies and/or smoking.

Is asthma the same for everyone?

Everyone with asthma has their own personal set of triggers and symptoms. Using a written asthma action plan is the best way to keep a record of your individual treatment plan.

You can have a certain 'type' of asthma too. For example, occupational asthma is caused by triggers in your workplace. Around 4% of people with asthma have a type of asthma called severe asthma, which needs specialist treatment because the usual medicines don't keep symptoms under control.

Will I always have asthma?

Asthma is a lifelong condition; most people who have asthma will always have asthma.

But if you've been diagnosed with asthma as a child, your asthma might improve or disappear completely as you get older, particularly if the asthma was mild.

Even if asthma goes away it can come back later in life, perhaps because you've come into contact with new triggers in your job, or you've moved to an area with more air pollution for example. Hormonal changes such as pregnancy and menopause can also bring it on again.

But the good news is that even though asthma doesn't go away there are lots of safe and effective treatments available to help you stay symptom-free.

If you've tried taking all the usual treatments in the right way, but you're still having symptoms, your GP can refer you to a specialist to see if you have severe asthma. This kind of asthma only affects around 4% of all people with asthma. An asthma specialist can help you find the right treatments for you, for example monoclonal antibodies.

Can asthma get worse at different times in my life?

There are certain stages in your life that might affect your asthma. For example, some women find that being pregnant can make asthma either better or worse and hormonal changes, at puberty, menopause or during the menstrual cycle might have an impact too.

There are lots of other life changes that might temporarily affect your asthma symptoms. Stress, for example, whether from a relationship breakdown or family illness, can make symptoms worse.

Having frequent asthma attacks can also make asthma worse over time. Asthma attacks can cause scarring in your airways which makes them narrower. This is sometimes called 'airway remodelling'.

If your airways are scarred and narrow, you're more likely to have worse symptoms more often.

How can I stop my asthma getting worse over time?

The best way to stop your asthma getting worse over time is to stick to a good routine of taking your preventer medicines as prescribed.

And if you notice your symptoms are getting worse, see your GP or asthma nurse as soon as possible so they can review your treatment.

You can also cut your risk of frequent asthma attacks, and your asthma getting worse, by stopping smoking.

Having an asthma reviewat least once a year, gives you a chance to talk through any symptoms or new triggers. You can check you're on the right medicine and that you're u sing your inhaler in the right way to get the most benefits.

You can also talk to your GP or asthma nurse about whether you need a higher dose or an 'add-on' treatment to help with symptoms.

How serious is asthma?

Tragically, three people die every day because of asthma attacks and research shows that two thirds of asthma deaths are preventable.

The reassuring fact is that most people with asthma who get the right treatment - and take it correctly - can manage their symptoms and get on with what they want to do in life.

Can asthma be cured?

Here at Asthma UK we're striving to find a cure, but currently there is no cure for asthma.

The good news, though, is that there are lots of safe and effective treatments available to manage the symptoms.

You just need to work with your GP or asthma nurse to find the ones that work well for you, and get into good habits so you take them exactly as prescribed, so you can get the benefits.

You can get more answers to your questions about asthma here.
Last reviewed January 2019 Next review due January 2022

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Asthma is a long-term condition that affects your airways - the tubes that carry air in and out of your lungs. It usually causes symptoms such as coughing, wheezing and breathlessness. If you come into contact with one of your asthma triggers, it can make your symptoms worse and even bring on an asthma attack.

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What is anaphylaxis?

Anaphylaxis (pronounced an-a-fill-ax-is) is a severe and potentially life-threatening allergic reaction affecting more than one body system such as the airways, heart, circulation, gut and skin. Symptoms can start within seconds or minutes of exposure to the food or substance you are allergic to and usually will progress rapidly. On rare occasions there may be a delay in the onset of a few hours.

Anaphylaxis is potentially life-threatening, and always requires an immediate emergency response.

What are the causes of anaphylaxis?

The common causes of anaphylaxis include foods such as peanuts, tree nuts, milk, eggs, shellfish, fish, sesame seeds and kiwi fruit. Non-food causes include wasp or bee stings, natural latex (rubber), and certain drugs. Each year in the UK, approximately 500 people have severe allergic reactions to an anaesthetic drug, which translates to one in every 10,000 procedures. In some people exercise can trigger a severe reaction - either on its own or in combination with other factors such as a food.

Sometimes the cause of the reaction is not found. Such reactions may be labelled "idiopathic anaphylaxis" (cause unknown). This does not mean the condition is psychological, though emotional stress can sometimes worsen a reaction.

What are the symptoms of anaphylaxis?

Most healthcare professionals consider an allergic reaction to be anaphylaxis when it involves a difficulty in breathing or affects the heart rhythm or blood pressure. Any one or more of the following symptoms may be present. These are often referred to as the ABC symptoms:

There may be a dramatic fall in blood pressure (anaphylactic shock). If that happens, the person may become faint and dizzy, or in the case of a child they may become floppy. This may lead to collapse, unconsciousness and - on rare occasions - death.
In addition to the ABC symptoms listed above, the following symptoms may occur:
* Widespread flushing of the skin
* Nettle rash (otherwise known as hives or urticaria)

* Swelling of the skin (known as angioedema) anywhere on the body (for example, lips, face).
* Abdominal pain, nausea and vomiting

Those symptoms can also occur on their own. In the absence of the more serious ABC symptoms listed above, the allergic reaction may be less severe but you should watch carefully in case ABC symptoms develop.

Watch Professor John Warner OBE, Emeritus Professor of Paediatrics, Imperial College London, explain anaphylaxis and allergy:

What increases the risk of a severe reaction?

There are times when you may be particularly vulnerable and at increased risk of a severe reaction. Times when you need to be particularly careful to avoid the culprit allergen include:
* If you have asthma that is poorly controlled
* If you are suffering from an infection, or have recently had one
* If you exercise just before or just after contact with the allergen
* If you are also suffering from hay fever
* During times of emotional stress
* If you have been drinking alcohol
* If you have taken a 'non-steroid anti-inflammatory drug' (NSAID) such as aspirin or ibuprofen.

What is the treatment for a severe reaction?

Pre-loaded auto-injectors containing adrenaline are prescribed for people believed to be at risk of anaphylaxis. Adrenaline is referred to in some countries as epinephrine, which is the internationally recognised term for adrenaline.

Because severe allergic reactions can occur rapidly, the prescribed auto-injectors must be readily available at all times. The injection should be given as soon as any symptoms of anaphylaxis are present. If in doubt, give adrenaline. A second dose should be given after 5-10 minutes if symptoms of anaphylaxis remain, or if there is any doubt about whether the symptoms have improved.

An ambulance must be called immediately following an injection of adrenaline, even if there is immediate improvement. The emergency service operator must be told the person is suffering from anaphylaxis and needs to be attended by paramedics.

In our view it is important to ensure that you carry two adrenaline auto-injectors at all times which are in date and of the correct dose. To read more about adrenaline, including the need to carry two, click here.

Further information:

* Our online training programme AllergyWise provides information on what to do in an emergency.
* View our tips on What to do in an emergency.

Key messages

1. If you suspect you have an allergy, see your GP as soon as possible. Many GPs are well informed about allergy and can make a diagnosis to decide whether you need adrenaline or not. In many cases, the GP will need to refer you to an NHS allergy clinic.
2. If you are at risk of the severe form of allergy - anaphylaxis - you are likely to be prescribed adrenaline. This must be available at all times.

3. If you have asthma as well as allergies, make sure your asthma is well managed. If you have poorly controlled asthma, there is a higher likelihood of any allergic reaction becoming severe. See your GP or asthma nurse for advice on this crucial point and to obtain an asthma management plan to help you self-manage.
Reviewers
This fact sheet has been peer reviewed by Dr Alexandra Croom, consultant allergist based in the Respiratory Department at Glenfield Hospital, Leicester.

Disclaimer - The information provided in this Factsheet is given in good faith. Every effort has been taken to ensure accuracy. All patients are different, and specific cases need specific advice. There is no substitute for good medical advice provided by a medical professional.
About the Anaphylaxis Campaign: Supporting people at risk of severe allergies
The Anaphylaxis Campaign is the only UK wide charity to exclusively meet the needs of the growing numbers of people at risk from severe allergic reactions (anaphylaxis) by providing information and support relating to foods and other triggers such as latex, drugs and insect stings. Our focus is on medical facts, food labelling, risk reduction and allergen management. The Campaign offers tailored services for individual, clinical professional and corporate members.
Our sources
All the information we produce is evidence based or follows expert opinion and is checked by our expert clinical and research reviewers. If you wish to know the sources we used in producing any of our information products, please let us know, and we will gladly supply details.

Publication Date: March 2020

Next Review Date: March 2023

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Anaphylaxis (pronounced an-a-fill-ax-is) is a severe and potentially life-threatening allergic reaction affecting more than one body system such as the airways, heart, circulation, gut and skin. Symptoms can start within seconds or minutes of exposure to the food or substance you are allergic to and usually will progress rapidly.

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Make sure you know which young people have an allergy and ensure that all leaders are aware of their medical plan for an allergic reaction.
When completing your first aid module make sure you ask about allergic reactions if you are unsure.

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What is Asthma?

Asthma is a common and long term lung condition that requires ongoing management. Asthma causes sensitivity to the airways, which can become inflamed and narrow on exposure to certain triggers, leading to difficulty in breathing.

The symptoms of Asthma commonly starts in childhood but it is possible to develop asthma at any age. This condition cannot be cured, but with a good Asthma action plan it can be well controlled.

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Asthma | Asthma Symptoms and Treatment | Allergy UK

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Asthma is a common and long term lung condition that requires ongoing management. Asthma causes sensitivity to the airways, which can become inflamed and narrow on exposure to certain triggers, leading to difficulty in breathing. The symptoms of Asthma commonly starts in childhood but it is possible to develop asthma at any age.

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Allergy Symptoms and Conditions | Allergy Advice | Allergy UK

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Download our helpful free resources and factsheets to find out more about allergy symptoms, conditions and how to manage your allergy now.

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your lips, mouth, throat or tongue suddenly become swollen

you're breathing very fast or struggling to breathe (you may become very wheezy or feel like you're choking or gasping for air)

your throat feels tight or you're struggling to swallow

your skin, tongue or lips turn blue, grey or pale (if you have black or brown skin, this may be easier to see on the palms of your hands or soles of your feet)

you suddenly become very confused, drowsy or dizzy

someone faints and cannot be woken up

a child is limp, floppy or not responding like they normally do (their head may fall to the side, backwards or forwards, or they may find it difficult to lift their head or focus on your face)

You or the person who's unwell may also have a rash that's swollen, raised or itchy.

These can be signs of a serious allergic reaction and may need immediate treatment in hospital.

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Find out about allergies, including typical symptoms, common allergies, when to get emergency medical help and allergy testing and treatments.

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Speech, Language and Communication Needs (SLCN) is an umbrella term which can describe difficulties in one or more areas. It is estimated that 10 per cent of children and young people have some form of SLCN.

What are Speech, Language and Communication Needs (SLCN)?

SLCN is an umbrella term which can describe difficulties in one or more areas, including:

Receptive language (understanding what others say)

Expressive language (selecting and joining words together in the correct order to convey meaning)

Social communication and pragmatics (interacting with others, including turn-taking and interpreting facial expressions and body language)

Speech (using speech sounds accurately and in the right places)

Fluency (the flow and rhythm of speech)

Voice (quality of voice)

How many people have SLCN?

It is estimated that 10 per cent of children and young people have some form of speech, language and communication need (SLCN) - that equates to 2-3 in every classroom.

Why does it matter?

SLCN are often an 'invisible disability', resulting in children and young people being misunderstood by those around them. In the long-term, research has linked SLCN to poorer employment prospects, lower educational attainment and mental health difficulties. It is therefore essential that children and young people have access to the specialist support and resources needed, so that they can reach their full potential now and in the future.

Real life

These videos explain what SLCN are like from the perspective of children and young people:

Wait! I'm not finished yet!

The way we talk

Signs of SLI (DLD)

Study Speech and Language Therapy

If you're interested in a career in Speech and Language Therapy then find out more about our course and apply now to start in September! Part-time places available.
Apply now

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Speech, Language and Communication Needs

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Speech, Language and Communication Needs (SLCN) is an umbrella term which can describe difficulties in one or more areas. It is estimated that 10 per cent of children and young people have some form of SLCN. What are Speech, Language and Communication Needs (SLCN)?

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Nottinghamshire Healthcare NHS Foundation Trust

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What do we mean by speech, language and communication?

Speech refers to:

Speaking with a clear voice, in a way that makes speech interesting and meaningful

Speaking without hesitating too much or without repeating words or sounds

Being able to make sounds like 'k' and 't' clearly so people can understand what you say

Language refers to:

Knowing and choosing the right words to explain what you mean

Joining words together into sentences, stories and conversations

Making sense of what people say

Communication refers to:

Using language or gestures in different ways, for example to have a conversation or to give someone directions

Being able to consider other people's point of view

Using and understanding body language and facial expressions, such as:

Knowing when someone is bored

Being able to listen to and look at people when having a conversation

Knowing how to take turns and to listen as well as talk

Knowing how close to stand next to someone

What are speech, language and communication needs?

Difficulty in communicating with others

Difficulties saying what they want to

Difficulty in understanding what is being said to them

Difficulties understanding and using social rules

Speech, language and communication needs can occur on their own without any other developmental needs, or be part of another condition such as general learning difficulties, autism spectrum disorders or attention deficit hyperactivity disorder.

For many children, difficulties will resolve naturally when they experience good communication-rich environments. Others will need a little extra support from you. However, some may need longer term speech and language therapy support.

It is important for practitioners to recognise what level of support children require as early as possible. Contact your local Children's Centre speech and language therapist or use our website to find the support and training you feel you need.

Feedback on our services

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Nottinghamshire Healthcare NHS Foundation Trust

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What do we mean by speech, language and communication?

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What do we mean by speech, language and communication?

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PDA (Pathological Demand Avoidance) is widely understood to be a profile on the autism spectrum, though we are still at an early stage in our understanding and PDA research is in its infancy.

Whilst autism is a widely recognised term, our understanding of the full breadth and complexity of the autism spectrum is still evolving.

The National Autistic Society explains autism as "a lifelong disability which affects how people communicate and interact with the world". Many autistic advocates embrace the social model of disability and view a range of neurological differences as being part of a natural human variation (neurodiversity).

We know that autism is dimensional - it involves a complex and overlapping pattern of strengths, differences and challenges that present differently from one individual to another and in the same individual over time or in different environments.

A cluster of traits can be called a presentation or a profile - in some cases this can be quite different from what some people think autism 'looks like'.

This can lead to presentations in some people - including autistic women and girls, and PDA individuals - being missed altogether, misunderstood or misdiagnosed, which can in turn lead to poor outcomes.

All research points to early identification and tailored support being the best predictor of positive long-term outcomes. Recognising these profiles signposts the approaches or support that will be most helpful for each individual.

A PDA profile of autism means that individuals share autistic characteristics ...

"persistent difficulties with social communication and social interaction" and "restricted and repetitive patterns of behaviour, activities or interests" present since early childhood to the extent that these "limit and impair everyday functioning" (according to the Diagnostic and Statistical Manual Fifth Edition (DSM-5))

often including a different sensory experience in relation to sight, smell, taste, touch, hearing, vestibular, proprioception and interoception.

... and also:

have a need for control which is often anxiety related

are driven to avoid everyday demands and expectations (including things that they want to do or enjoy) to an extreme extent

tend to use approaches that are 'social in nature' in order to avoid demands

present with many of the 'key features' of PDA rather than just one or two

tend not to respond to conventional parenting, teaching or support approaches

A PDA profile of autism is normally identified during an ASD assessment undertaken by an experienced multi-disciplinary diagnostic team.

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About autism & PDA PDA (Pathological Demand Avoidance) is widely understood to be a profile on the autism spectrum, though we are still at an early stage in our understanding and PDA research is in its infancy. Whilst autism is a widely recognised term, our understanding of the full

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Introduction

Autism and the PDA profile are dimensional - this means that approaches need to be tailored for each individual child, applied flexibly and reviewed regularly. There is no wrong or right way to do things, it's about learning as much as you can about PDA, finding out what works best for you and your child and building a framework of approaches.

This page covers:

understanding behaviours

adjusting your mindset

optimising the environment

reducing the perception of demands

being cautious with rewards/praise/sanctions

supporting sensory needs

supporting social interaction & communication

approaching behaviour that challenges - also see understanding behaviours

supporting emotional well-being

Our PDA Panda ambassador symbolises helpful approaches for PDA and the P A N D A mnemonic on our infographic below provides a useful summary:

There are many resources, including webinars and books, which cover helpful approaches for children with PDA and our adult life section may be useful for older children. Our Keys to Care one-pager was written primarily with in-patient settings in mind but is also a useful summary of helpful approaches.

Many more generic autism resources - such as social stories, books, games, activities, computer games and apps - may also be helpful, but may require some creative adaption, or a more indirect form of implementation, to be effective with PDA children. Likewise therapists may need to adopt a tailored approach when working with PDA.

Similarly, these approaches can be helpful with other presentations/conditions as well as with a PDA profile of autism - they may be beneficial for autistic and non-autistic people at times of heightened emotional states or extreme anxiety, or for times of extreme demand avoidance regardless of the underlying cause.

Understanding behaviours

Anxiety - the most important starting point is to understand and accept that a PDA child's behaviours are underpinned by anxiety and a need to feel in control. Anxiety can be expressed in many different ways including avoidance, anger, shouting, crying, restlessness, boredom, fidgeting, rocking, ticks, repetitive actions, obsessing, skin picking, swearing, hiding, running off, withdrawing, throwing things and lashing out at others. The anxiety curve model is a really helpful way to understand anxiety and echoes the hierarchy of demand avoidance approaches seen in a PDA profile of autism. All the helpful approaches explained below are designed to help our children remain on the 'lower slopes' of the anxiety curve and avoid escalation where possible.

In addition, any or all of the following may be underlying ...

Difficulties in processing language - our children may have good expressive language but may not be able to process verbal communication quickly enough to keep up during a conversation and may be confused by non-specific questions or instructions (please listen to our webinar about PDA and speech & language for more detail).

Difficulties with social interaction - our children may not always understand the 'unwritten rules' of social interaction or non-verbal communication including body language and tone of voice.

Confusion about emotions - our children may not be able to understand or accurately 'label' emotions in themselves or other people, or may feel overwhelmed by their own and others' emotions.

Intolerance of uncertainty - our children may struggle with all the 'what ifs' of life, not knowing how things might 'pan out', what might be expected of them, where a situation might lead, when a situation might end and whether they will be able to cope with whatever may come along.

Sensory overload - our children's heightened sensory perception can also contribute to anxiety, overload and avoidance (please listen to our webinar about PDA & sensory processing for more detail).

Adjusting your mindset

A repeated theme in our case studies is that PDA turns "parenting norms" upside down, so our own mindset and mood are key factors in developing a toolkit of helpful approaches. Please listen to our webinar for more detail on this, but some key pointers are:

Look beyond surface behaviours - outward behaviours are just the tip of the iceberg with many contributory factors lying below the surface as explained above.

Re-balance your relationship - a more equal relationship between child and adult, based on collaboration and respect, builds trust. Try to aim for win:win solutions.

Keep calm and carry on - try not to take things personally; model desired behaviours; pick your battles; treat every day as a fresh start.

Focus on the long term objective of building a child's ability to cope rather than short term compliance.

Be flexible - helpful approaches require creativity and adaptability.

See the positives - whilst supporting our children's challenges, try not to lose sight of their many positive qualities.

Support and self-care for you - being in touch with others who are having similar experiences can be enormously helpful and local families may have invaluable tips relevant to your area (please search our resources directory for support groups near you). It's also important to ensure you are caring for yourself as well as possible.

Optimising the environment

Just like giant pandas, our children can thrive in the right environment - in place of firm boundaries and the use of rewards, consequences and praise, an approach based on negotiation, collaboration and flexibility tends to work better in PDA households. Top tips include:

Balancing tolerance and demands - a child's ability to cope with demands will vary from day to day and from hour to hour, so try to control the 'input' of demands accordingly (remembering that demands are many and varied) and build in plenty of 'downtime' to give space for anxiety to lessen and tolerance levels to replenish.

Agreeing non-negotiable boundaries - these will vary from household to household and from child to child. For some, the barest minimum of non-negotiable boundaries (such as basic health and safety requirements or those relating to their siblings) may be needed when anxiety is very high, but they may be increased over time. Sharing clear reasons for these boundaries, and agreeing on them together as a family, can help our children to adhere to them. Enforcing these boundaries without exacerbating things may require the use of other helpful approaches (please see next section on reducing the perception of demands).

Allowing plenty of time - time is an additional demand, so it's helpful to build in plenty of time (for instance, setting alarms earlier on a school morning). Always try to plan ahead, anticipate potential challenges and allow some flexibility to accommodate fluctuating anxiety levels.

Having an exit strategy - knowing how to extract yourself from a situation can help with reducing anxiety (for instance, you might agree a quiet zone where a child can retreat to or provide reassurance that if something can't be done today it can be tried again tomorrow).

Reducing the perception of demands

Re-framing demands to make them feel less 'demandy' is a key technique. There are lots of ways to do this - you will probably find that a 'mix and match' approach works best:

Phraseology and tone: subtle adaptations to our language and tone can benefit our children greatly. Using declarative language (like a 'commentary') or rephrasing things to talk about an object rather than a person and even simple things like starting rather than ending requests with the word 'please' can all make a big difference. For instance, when getting ready for school you might say "The clothes are on the bed. I'm happy to help." and then walk away, rather than "You need to get dressed now" or if your child hasn't had a drink all day you might just place the drink alongside them and say "Here's a drink". Similarly phrases such as "I wonder whether ..." and "Let's see if ..." reduce the perception of demands. Likewise it's helpful to avoid trigger words like "no", "don't" or "can't" - you can convey the same message using different terminology (e.g. "I'm afraid it's not possible right now") and if you can also explain the reason and offer alternatives whilst delivering the message (e.g. "I'm afraid it's not possible to go to the park right now because there's a storm, but we can try this afternoon when the forecast is better and in the meantime would you like to bake a cake or watch a film?") this can help avoid escalation.

Indirect communication: indirect communication includes physical prompts (e.g. tapping shoes instead of saying "please put your shoes on"); visual prompts (pictures or checklists (ensuring our children have an element of choice and control, for instance in the order that things are done rather than a more formal 'first this ... then that ...' approach), post-it notes or communicating via instant messenger apps can work well); telling someone else to do something whilst in our child's earshot (e.g. telling another child or adult "Please remember the rules about not running at the side of the pool" when you know that they know the rules already); leaving leaflets/books 'lying around' for our children to pick up out of natural curiosity; communicating using role play or via a third party (e.g. communicate through a favourite toy or by adopting the persona of a favourite character).

De-personalising: explain that the requirement is made by some other, higher authority than you - for instance that "the pool manager is shutting the pool at 3pm" or that a certain law dictates certain rules.

Distracting/turning things into a game: the idea here is to focus on something else other than the demand, so you might say "let's see who can pull the silliest face between each item of clothing" when getting dressed or "let's list the top 10 dinosaurs" whilst getting into the bath for instance.

Using humour/novelty: humour is a great way to make everyone feel more relaxed and to help reduce the perception of demands; and novelty (provided the change in direction feels like a bonus/benefit for the child) can also work well.

Asking for help: saying that you don't know or can't remember how to do something can be a great way of making a demand more indirect.

Offering choices: the idea here is to give a child some control without losing all control as the adult, by offering limited choices (and being willing to accept a different choice of their own that still achieves the aim) or by offering free choice within certain parameters. For instance, you might ask "would you prefer to have a bath at 6 or 7 this evening" (and accept their negotiated answer of "6.30") or you might stock a cupboard or shelf in the fridge with a range of healthy options and allow your child free choice of any items from there.

Model behaviours or apply demands to yourself (with no expectation that your child will follow suit) - for instance, you might say "I'm feeling really stressed right now so I'm going to lie down in a quiet room and listen to some whale songs to help me to calm down".

Being cautious with rewards/praise/sanctions

It can be helpful to understand why more traditional parenting approaches - such as rewards/praise/sanctions - don't tend to be effective in PDA households.

Rewards create an additional demand on top of the demand itself; they magnify the problem if something isn't achieved because not only is the 'thing' not achieved the reward isn't earned either; and they don't address the underlying difficulties or lacking skills which may have prevented achievement in the first place. What can work well are surprise rewards, rewards that are bestowed immediately (rather than waiting until the end of the day/week) and rewards that are tangible (rather than stickers or tokens) or matter to the child (they may be things that are linked to their special interests or involve free time to pursue an activity of their choice).

Praise may be perceived as a demand to repeat or improve on previous performance, and encouragement can feel like a demand as it increases the sense of expectation. It can be helpful to praise indirectly - for example praising the results rather than the person (e.g. "what a wonderfully tidy room" rather than "well done for tidying your room") or praising your child to a third party in your child's earshot. When offering encouragement, providing choices and exit strategies can be effective (e.g. "It would be great for you to go to the cinema with your friends, but don't worry if it feels too much once you're there, you can call me and I'll come and pick you up").

Sanctions or consequences may feel unjust when behaviours are a question of "can't" not "won't", and may appear controlling and arbitrary when not directly related to the behaviours in question (e.g. what connection is there between not being allowed on electronics and being mean to a friend?) - they tend to lead to confrontation and escalation. Natural consequences which flow from behaviours (e.g. a friend not wanting to play or not being able to watch TV if it got broken during a meltdown) enable lessons to be learned in a more realistic way. When everyone is calm, discussing ways to avoid difficult situations from arising in future is another way for natural consequences to unfold.

Supporting sensory needs

Our children may be hyper-sensitive (seeking to avoid the sense) or hypo-sensitive (seeking out more of the sense) to any of the senses listed below:

Auditory

Visual

Oral

Smell

Tactile

Vestibular (the sense of movement and balance)

Proprioceptive (the sense of 'position' of your body in space and the input from muscles and joints to the brain)

Interoception (internal senses from your body, such as hunger, thirst, pain and needing to use the toilet)

It's possible to be both hyper and hypo sensitive to the same sense (for instance, someone may enjoy their own noise (e.g. their voice or choice of music) but find others' or background noises intolerable) and it's important to remember that sensory perception and sensitivity can also vary depending on levels of anxiety, illness, the type of surroundings and so on.

Falkirk Council's helpful guide " Making sense of sensory behaviour", the Sensory Processing Checklist and resources on Sensational Brain are useful places to start, along with our helpful webinar on this topic. The Greater Glasgow & Clyde NHS website also has useful sensory resources. An Occupational Therapist trained in sensory integration can assess a child's sensory needs in full and may suggest a 'sensory diet'. There are a few suggestions to try below:

Chewy toys for those who seek oral sensory input

Headphones playing a child's favourite music or audio book for those who become easily overstimulated by noise and crowded places

Carrying an object with a favoured scent (eg. candle, soap, pillow or spraying a sleeve or handkerchief) for those who become distressed by unfamiliar or unpleasant smells

Seamless socks, wide fitting shoes and cutting labels out of clothes for those who are hyper sensitive to touch

Asking before touching/hugging your child as some children are sensitive to touch - or equally some children may like the comfort of deep pressure and may feel well regulated using weighted blankets or similar.

Wearing tinted or sunglasses for those who are over sensitive to light

Taking packed lunches with preferred food/drinks for those who are avoidant of certain foods/textures.

Access to messy play or a fidget toy for those who seek tactile input

Plenty of opportunity for movement e.g. scooter, trampoline, running and bike rides for those who seek plenty of movement

Rough and tumble play, playing in ball pits and sensory toys (such as a body sock) can be helpful for those with proprioception needs.

Supporting social communication & interaction

Our children often need support in relation to processing language and social interaction. A speech and language therapist can assess a child's communication and interaction skills and make detailed recommendations. The Social Thinking website is useful place to start, along with our helpful webinar on this topic - a few top tips are shared below:

Communication

Allow extra processing time so that your child can make sense of what you have said and have time to think about how to respond - it can be helpful to count to 5 in your head following a statement or request.

Chunk questions or requests (space them out one at a time) rather than saying or asking many things in one go. Allow time for your child to answer your first question or respond to your first request before adding any follow-ups.

Be clear and precise whilst being indirect - for example "I wonder if you could help me. I need four blue cups, from that cupboard, to be put on the table in the kitchen".

Social Interaction

Role play can help our children understand other people's perspectives, how someone's actions can make another person feel and how this can affect relationships.

TV/books can be a good way to learn about emotions, relationships and social dynamics, and enable our children to develop understanding and skills, in a more indirect way.

Be inventive by linking activities to your child's special interests or by using role play (e.g. your child could be the teacher for the day and teach her/his toys a social story or how to act in certain social situations) or by making a poster together that will tell other children how to behave.

Approaching behaviour that challenges

The helpful approaches outlined above are often very effective, and the frequency or intensity of meltdowns usually subside. However, meltdowns (best seen as panic attacks) are still likely to occur - please see our detailed page on meltdowns for more on this. It's really useful to understand the triggers and/or possible purpose behind any behaviour that challenges - please see understanding behaviours for a structured approach to building up a picture of what can lead to these episodes that also points us towards the approaches that may be helpful.

Following a situation that has been tricky to handle, it can be helpful to reflect back and think about how a re-occurrence might be avoided in future. Try to approach this with a detective's hat on, take the learning points on board but try not to dwell too much on things.

Working together with our children collaboratively and proactively to find solutions can also be really beneficial - many families find Dr Ross Greene's approach in this area extremely helpful, it is explained in detail on his website and in his books 'The Explosive Child' and 'Lost at School'. Ross Greene's approach is also particularly useful when there may be doubt or disagreement about diagnosis as his approach is diagnosis 'agnostic'.

Recognising and regulating emotions is something most of our children find very difficult. Whilst our children are young, the adults around them will need to be very vigilant in spotting the signs that anxiety is escalating. As our children grow older and their emotional intelligence develops, they may be able to recognise their emotions and deploy their own coping skills more effectively.

Supporting emotional well-being

It is important to remember to try and support our children's emotional well-being by

focusing on their many positive qualities as well as trying to support them with areas that they find difficult

regularly reminding them that they're valued for who they are and that it's ok to be different

regularly reminding them that they're loved through whichever medium works best for them

supporting them with the things that they're interested in rather than trying to impose on them what you feel they should be doing

speaking about them in positive terms to other people e.g. "Millie has an amazing imagination, she always thinks of really good games to play" or "Luke really makes me laugh, he's such good fun to be with."

Moving forward

It can feel like a very steep learning curve to learn all about demand avoidance and develop a tailored, flexible framework of approaches. Eventually it's likely to become second nature as you become more in tune with your child's strengths and needs. Over time, as your child's self confidence, emotional maturity and trust in the world develops, and as they gain more control over their lives as they get older, they may be able to cope more flexibly with demands. Their demand avoidance won't go away, but they may develop more self-help tools and coping strategies.

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Helpful approaches with PDA - children Introduction Autism and the PDA profile are dimensional - this means that approaches need to be tailored for each individual child, applied flexibly and reviewed regularly.

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Support People with a Learning Disability

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Support People with a Learning Disability

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This is designed for GP Staff, not all is relevant but there are some good tips in here.

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Communicating with People who have a Learning Disability

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Communicating with People who have a Learning Disability

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"Sometimes I've got the words in my mind, and I'm trying to explain it in the best possible way, but it doesn't always come out."

Top tips for communication

Remember, everybody is unique, so take the time to ask the person you're communicating with what works best for them.

In person: Many people with a learning disability prefer face to face and one to one communication.

In writing: Use bigger text and bullet points, and to keep writing at a minimum. Too much colour can make reading harder for someone as well.

On the phone: Speak slowly and clearly, using easy to understand words.

You may also find these tips useful:

Find a good place to communicate in - somewhere without distraction. If you are talking to a large group be aware that some people may find this difficult.

Ask open questions; questions that don't have a simple yes or no answer.

Check with the person that you understand what they are saying e.g. "the TV isn't working? Is that right?"

If the person wants to take you to show you something, go with them.

Watch the person; they may tell you things by their body language and facial expressions.

Learn from experience - you will need to be more observant and don't feel awkward about asking parents or carers for their help.

Try drawing - even if your drawing isn't great, it might still be helpful.

Take you time, don't rush communication.

Use gestures and facial expressions. If you're asking if someone is happy or unhappy, make your facial expression unhappy to reinforce what you're saying.

Be aware that some people find it easier to use real objects to communicate, but photos and pictures can really help too.

Remember, all communication is meaningful, but you may need to work harder to understand.

Further help

Many people with a learning disability can use or recognise some signs. Signalong and Makaton are both Sign Supported English systems. They are based on British Sign Language (BSL), but are used to support the spoken word.

Visit the Signalong website or the Makaton website to find out more.

Visit the British Deaf Association website to find out more about BSL.

Talking Mats are a communication system that uses symbols and other images.

Widgit produce software symbols to help with communication and accessibility.

Symbol World is a website A website is a page you can go to on the internet like Google or YouTube. run by Widget for symbol users that includes nursery rhymes, stories and a monthly magazine.

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Communicating with people with a learning disability

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"Sometimes I've got the words in my mind, and I'm trying to explain it in the best possible way, but it doesn't always come out." Remember, everybody is unique, so take the time to ask the person you're communicating with what works best for them.

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Associated conditions

A lot of people with a learning disability A learning disability is to do with the way someone's brain works. It makes it harder for someone to learn, understand or do things. have more than one diagnosis and have a set of conditions that are unique to them.

Learn about some of the conditions associated with learning disability below.

Get in touch, we're here for you

The Learning Disability Helpline is our free help and advice line.

Our team can offer advice, information and discuss what support Mencap can offer tailored to your needs, in your area.

Call or email us

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A learning disability is a reduced intellectual ability and difficulty with everyday activities. There are three different types mild, moderate and severe.

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These are online training webinars and as such the charity will publish dates and organise joining themselves

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We are very pleased to be able to offer a range of online training, adapted from our regular training offering, covering a range of subjects.
New dates for our online training events will be added here in the new year for the following sessions:

Supporting early development from birth to 4 years

Early years and primary education

Secondary education

Supporting behaviour positively for children from 3 to 11 years

Supporting behaviour positively for young people from 11 to 18 years

Planning for a good life

Supporting adults who have Down's syndrome

Parent carer meetings

Puberty and adolescence

Workfit events

DSA updates

Ageing and dementia

Guest researcher webinars

Our Voice events

DS Engage events

And more...

Read more:
DSA update on COVID-19 and people who have Down's syndrome

Each week the DSA will provide an update on key issues relating to COVID-19 for people who have Down's syndrome, their parents, carers and supporters via Zoom.

08 January 2021 | 10.30 - 11.00am

WorkFit Event
New dates coming soon.
This meeting will include:
'I am not alone!'
Dementia and Down's syndrome
New dates coming soon.

We know that adults with Down's syndrome have a greater chance of developing dementia, but what are the changes we need to look out for? How do you go about getting an assessment for someone who might be developing dementia? A change in an adult's function could be due to some other issue, what else could be happening?

This 90-minute webinar will guide through this process and talk about resources and support available from The Down's Syndrome Association that focus on older age.

Puberty and Adolescence
New dates coming soon.
This two-hour online training is for suitable for parents, carers and practitioners supporting young people who have Down's syndrome through puberty. The training will cover body changes, hormones, privacy, boundaries, and consent. We will also be looking at accessible resources to support understanding around growing up.

Supporting Behaviour Positively: 11 to 18 years
New dates coming soon.
This training webinar will cover how we look to support behaviour positively for young people who have Down's syndrome aged 11 to 18 years.

We begin with a recap of the general learning profile associated with Down's syndrome and individual needs before looking at social and emotional development. We discuss ways of changing difficult to manage behaviours and strategies used to promote behaviour change. We then look at useful resources that can support you in these areas

Supporting Adults who have Down's Syndrome
DATES COMING SOON
A webinar for all those with an interest in supporting adults with Down's syndrome. The session will look at:

How what we know about the learning profile of people with Down's syndrome can help us to maximise opportunities for independence in adulthood.

An overview of the health needs of adults with Down's syndrome, with strategies to address possible health inequalities they may experience.

Supporting decision making and maximising opportunities for independence.

Personal Budgets and Self-Directed Support

This webinar is about Personal Budgets and Self-Directed Support - which means people, regardless of age and what help and support they may need, being in control of their own lives and being able to organise support and services in a way that makes sense and works well for them and their families.

'Personal budget' is the term used to describe the overall cost of the care and support services the local authority or CCG arranges or provides to meet a person's needs. It is usually worked out on a weekly basis and is an important part of getting help from the local authority.

This webinar will look at how personal budgets are set, what they can be used for, examples of how creatively you can use them - it will also give you an overview of your rights and entitlements and what good examples of personalised support can look like.

A personal budget is defined in the Care Act 2014 as having three parts:

1. overall cost to the local authority of meeting your needs (i.e. the eligible needs it is legally required to meet, or needs it decides to meet)

2. the amount payable by you (after you have had a financial assessment)

3. net amount the local authority must pay to meet your needs.

The amount of money in your personal budget can be spent in one of three ways:

1 A managed account: the local authority manages your personal budget in line with your wishes as agreed in the care plan. They look after the money, make arrangements for your care and support, and pay fees out of your personal budget. For example, if you need care and support at home, the authority arrange care services, usually provided by an agency, and pay them from your personal budget.

2 An account managed by a third party: Similar to a managed account, except a third party, sometimes called a broker, manages your personal budget. This can be the actual service provider. These are often referred to as 'individual service funds'.

3 Direct payments: You are given the personal budget money to spend yourself on meeting your needs, in line with your care plan, in the way that suits you best.

DSA Tell it Right® webinar for Maternity Services and Universities
Dates and times to follow
This Webinar is for all student and health professionals working in fetal medicine, maternity and neonatal services including midwives, neonatal nurses, sonographers and health visitors.
The Tell it Right ® webinar provides information about:

Down's syndrome that is balanced, accurate and up-to-date

How best to support expectant parents through the screening process

How best to impart information to parents and families, following a pre/post-natal diagnosis of Down's syndrome

Some common issues which may affect a baby who has Down's syndrome in the early weeks of life.

Through filmed case studies you will be able to reflect on:

The decision making processes related to screening

The parents' perspective

What life is like for a person with Down's syndrome

To find out more email: training@downs-syndrome.org.uk

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We are very pleased to be able to offer a range of online training, adapted from our regular training offering, covering a range of subjects. New dates for our online training events will be added here in the new year for the following sessions: Supporting early development from birth to 4...

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Teenagers and Young Adults

Mood swings, pushing boundaries, tiredness, feeling confused, crushes, first loves and spending ages in the bathroom... Whilst these changes may occur a little later than in people without Down's syndrome, young people with Down's syndrome will essentially be just like any other teenager. Sex and relationships, wanting independence, good personal hygiene, needing personal space and building good self-esteem are all issues that you will need to think about as your son or daughter grows up.

If you would like more support with any of these issues, or if you have another question, please call the DSA Helpline on 0333 1212 300.

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Mood swings, pushing boundaries, tiredness, feeling confused, crushes, first loves and spending ages in the bathroom... Whilst these changes may occur a little later than in people without Down's syndrome, young people with Down's syndrome will essentially be just like any other teenager.

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Here are some tips that can help you to foster good mental wellbeing in someone with Down's syndrome for whom you care and support:

Focus on the positives.
Change the focus from what the person can't do to what they can.
Encourage unique interests and talents or relative strengths.
Give the person the opportunity and means to express how they are feeling.

Encourage a healthier lifestyle involving exercise and a balanced diet.
Take a look at our easy read 'Staying Healthy' resource here and our tips for weight management here.

Create opportunities for the person to become more independent according to their individual abilities and needs.
This process can start with simple self-help skills and later move on to daily living skills.
We have an easy read resource 'Learning to be more independent' here.

Provide opportunities and support for making choices both big and small.
We all want to feel we have choice and some control over our lives. Remember to strike a balance, too many choices all at once can be difficult for a person to cope with.
See our easy read resource 'Making Choices' here.

Circles of Support can help with decision making and supporting greater independence.
Find out more about Circles of Support here.

Create opportunities for the person to feel they have accomplished something that is important to them.

Listen to hopes and dreams.
These may sometimes be unrealistic so look for similar realistic opportunities that might fulfil the same needs.

Involve the person in life planning.
See our resource 'Listen to Me - Growing up - thinking about being an adult 13+ Transition.

Have high, but realistic expectations.
These will be different for each person. Aim high but don't put the person in a position where they are likely to fail.

Teach new information and skills so they do not have to, and do not, make mistakes.

Like you or me, people with Down's syndrome want to feel that they are valued part of their communities.
Information about finding out about local activities can be found here.

Make sure the person is getting a good night's sleep.
See our information about sleep here.

Prepare the person for expected life events and changes.

Keep an eye on self-talk.
Whilst self-talk can be a very helpful, self-soothing strategy for the person, an increase or change in how they talk to themselves or what they are saying (e.g. negative thoughts or anger directed by the person at themselves) may be an early indicator that all is not well for that person.

Be realistic about what you can do
This is a long list of tips and realistically, if you are a busy parent or paid supporter, it is not always going to be possible to proactively ensure that all of these things are happening in a person's life. Sometimes people will experience poor mental wellbeing even if you have done everything you can to promote their mental wellness and it is important not to blame yourself for it. What is important is that if a person does show signs of poor mental wellbeing, they are able to access professional support if they need it. If you do have concerns about the mental wellbeing of a person with Down's syndrome, talk to your GP or community learning disability team.

Our Health Series includes resources about depression and about bereavement that you can download from our website.

Don't forget, you can call our Helpline (0333 1212 300) if you have any questions about health and healthcare.

Further information

Early Support - Information about Down's syndrome
This booklet contains information about growing up, developing independence, making choices and self-awareness (free download). Please note that any references to the law in this publication are likely to be incorrect as new legislation has been passed since it was last updated.

Feeling Down: Looking After My Mental Health
The Foundation for People with Learning Disabilities has produced this guide for people with learning disabilities to help them look after their mental wellbeing (free download)

The Royal College of Psychiatrists website
They have some useful information about learning disabilities and mental health

'Mental Wellness in Adults with Down Syndrome' by Dennis McGuire and Brian Chicoine (Woodbine House, 2006 - available from online book sellers)
This book clarifies what the common behavioural characteristics of people with Down's syndrome are, how some could be mistaken for mental illness and what actual mental health problems occur more commonly in people with Down's syndrome

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Focus on the positives. Change the focus from what the person can't do to what they can. Encourage unique interests and talents or relative strengths. Give the person the opportunity and means to express how they are feeling. Encourage a healthier lifestyle involving exercise and a balanced diet.

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What do we mean by behaviour? Behaviour refers to everything
that human beings (and animals)DO.

We all react to situations and communicate through our behaviour.
For people who have difficulties with other forms of communication, behaviour - things that they do - can be the most effective form of communication.

To call something behaviour you need to be able to see it, count it and describe it.
So, a behaviour (running out of the building) is different from an emotion (feeling scared) and also different from a thought/motivation ("get me out of here!").

Behaviour can be positive, helpful and useful to the person.
We sometimes call this adaptive behaviour and it can include skills like asking for help, waiting in a queue, getting on with work, doing chores, going on the trampoline to work off energy, listening to music to calm down.......and many other things.

However, behaviour can be problematic to the individual or to other people around them.
This is sometimes called maladaptive or challenging behaviour.
So-called challenging behaviours are often more extreme versions of quite ordinary behaviours.

These behaviours may occur for the first time by chance or by imitating others. The person may continue the behaviour because it is reinforced, or useful to them. We call this learned behaviour.

The following factors influence whether behaviour is seen as acceptable/appropriate, or not:

The strength of the behaviour (a heavy shove, rather than a gentle nudge; a tantrum that lasts an hour rather than a minute)

The situation in which it occurs (jumping up and down and shouting out in a cinema rather than at a football match)

The consequences of that behaviour (banging a toy on the window as opposed to rearranging the sofa cushions)

The degree of tolerance of other people - (a baby yanks your hair as opposed to your 15-year-old daughter)

The following diagram ( which you can download as a pdf if you wish) shows the many factors that influence our behaviour and that of the people we care for.

You will see that some of these are fixed - age, gender (usually), life experiences for example - but that others can be changed - expectations, physical environment, others' behaviour and reactions, triggers and results of behaviour.
These factors are the ones we need to use in managing, changing and supporting behaviour positively.
The diagram below outlines the different stages of behaviour support planning.

Click on the green boxes to go to guidance on that section of the process.

Where to start

First be clear about the behaviour, or behaviours that you are concerned about.
If there is more than one, you may need to prioritise and decide which to tackle first.

Where ever possible use 'doing' words - hitting, kicking, spitting, sitting down in the middle of the pavement, and so on - rather than thinking in terms of being 'aggressive', naughtiness or "having a meltdown".

Secondly ask the question - does this behaviour need to change?
Behaviour may be challenging because it:

makes you feel unable to manage the situation

is contrary to social norms

interferes with everyday activities

causes stress to others

happens a lot

seems to last a long time

happens when it is hard to deal with - in public or at difﬁcult times

is risky and puts others in danger

You can use the following questions to help you decide/answer this question:

Does it restrict his or her access to important experiences?

How much stress does it cause and for whom?

How frequent is it, how intense and how long does it last?

Is it typical behaviour for the person's developmental age/stage of development?

Completing an ABC record is the next step.

You can download a blank ABC record chart here.

Antecedents are things that proceed the behaviour/happen before the behaviour or are contributory factors.
They can be divided into SETTINGS and TRIGGERS.

SETTINGS
These are things like the environment ...time/place/number of people around but can also be things that affect the person like being tired or hungry.

TRIGGERS
These are more immediate, temporary antecedents...the things that seem to spark off the behaviour, or happen just before. These could be:

noises

the behaviour of another child or adult

being asked to do something

an activity coming to an end

B - Accurate description of the B ehaviour

C - C onsequences/results: what happens next?

When we think about the consequences of behaviour, we are trying to work out what happens as a result of the behaviour. What happens directly after or what happens because the behaviour occurred.

Does the person get attention? Are they given something they might like? Are they given more space to themselves?

Does the behaviour stop something from happening? Is there a specific task, activity or demand that is avoided?

How do other people react or respond to the behaviour?

You can download some example ABC records here.

Working out what the behaviour means

Before planning what to do about a behaviour you want to change, Positive Behavioural Support suggests that you need to spend a bit of time thinking and working out what function or purpose this behaviour is serving for the person.

The ABC records should help you to do this and will be useful in answering some of the questions below.

This will help you to work out the "communicative function" of the behaviour...in other words what is the person trying to say or what need do they want to be met?

It is important to remember also, that the reason a behaviour started in the first place may not be the reason it continues.

This step in behaviour support is sometimes missed out as people are anxious to get on with management strategies. That risks trying out strategies, on a trial and error basis, that are not appropriate so will not work, leading to frustration and disappointment.

That is not to say that there are not some general "good practice" guidelines/hints and tips for managing behaviour in people with Downs's syndrome.

A Functional Analysis will be needed where behaviour is more complex, entrenched or difficult to understand what is causing it and keeping it going.
Working out the function of a behaviour
Basic functions of behaviours that challenge include:
A bit more about functions of behaviour
The same behaviour can serve different functions for different people or different functions for the same person at different times.

Pamela Lewis gives the following example:

"One child (or adult) might scream because she likes the sound. Another child might scream because she likes the attention that results from screaming. Another child might scream to express frustration at what is being asked of her, with no interest in the resulting sound or attention. A child might scream for all those reasons at different times." Pamela Lewis, Achieving Best Behavior for Children with Developmental Disabilities: A Step-by-Step Workbook for Parents and Carers, Jessica Kingsley, 2005.

Some more common functions of behaviour are listed below - please bear in mind that these can overlap:

Discomfort - physiological or environmental (hunger, pain, temperature etc.)

Developmental levels (expectations are either too high or too low)

Seeking rewards - in general this is often involved

Escape/avoidance of a task or a demand

Seeking sensory stimulation e.g. likes the sight of spinning objects, or the feel of water

Avoiding sensory stimulation e.g. dislikes certain sounds, or the feel of tags on shirts

Difficulty with organisation needed to initiate an appropriate activity

Attention seeking/wanting to interact and not knowing how to do this appropriately

Getting a reaction/making something happen (function is control, rather than social attention)

Expressing frustration/anger

Expressing fear

Difficulty waiting

Expressing "Wait! Let me finish!"

Expressing "No!"

Other communication e.g. "I need some help", "I don't understand", "Go away"

Making sense of behaviour

Analysing the ABC charts or other records, and thinking about the possible functions described above should help you to get an idea of what is going on, why the behaviour is happening, what it means to the person with Down's syndrome.

Often it is good to discuss this with others in the family, or school, other carers etc.

It is also helpful to think about exceptions; situations and circumstances where the behaviour does not occur, or where the person manages to respond to triggers in a different way.

This questionnaire can be used to help decide on communicative function (pdf).

Proactive and Reactive Strategies

Proactive strategies are intended to make sure the person has got what they need and want on a day to day basis and also includes ways to teach the person appropriate communication and life skills.

Reactive strategies are designed to keep the person and those around them safe from harm. They provide a way to react quickly in a situation where the person is distressed or anxious and more likely to display challenging behaviour.

A good behaviour support plan has more proactive strategies than reactive ones.

Antecedent (preventative) strategies
Antecedent strategies are those which prevent the behaviour from happening. Over time this leads to new behaviours being practised and old (challenging) behaviours disappearing as they are not being practised. Some prevention strategies to consider include:

Keeping the person engaged with positive activities.

Avoiding some situations for now e.g. busy supermarkets, crowded tube stations.

Removal or avoidance of triggers e.g. make changes to the environment or manage sensory input e.g. ear defenders, use of quiet areas.

Reducing the demands placed on the person.

Giving more structure to the day.

Giving clearer expectations/rules using visual supports, planners and timetables, 'now' and 'next', visual guides and social stories.

Giving advanced warnings and preparation.

Desensitisation - gradual supported exposure to triggers.

Give the person more praise, attention and rewards as a matter of course.

Pre-specified reinforcer - reminding person of rewards to follow e.g. a fun activity.

Preferred item as distractor - a task or item that takes the focus away from the trigger e.g. responsible for carrying something into class after playtime.

Offer choice.

Embed the action that the person is reacting to or finding difficult in a sequence of things you know they like.

Indirect requests...offer of collaboration e.g. "Let's go and...", "You first, then me..."

Replacement (new skills and behaviour) strategies

To do this, we need to ask, "What do we want the person to do instead?"

The focus of this step is on helping the person learn new skills and encouraging more acceptable or constructive behaviours.

It is important to find things for them to do which are adaptive, but which also meet the same needs as the challenging behaviour (i.e. they obtain the same result).

Here is a suggested list of skills that you might consider teaching the person to help them to cope with challenging situations:

Functional communication training - help/escape/finish/bored/attention...

Skills in making and communicating meaningful choices.

Social skills - situations relating to others, doing things together, friendships/relationships. The right thing to do with the right person in the right place.

Sensory activities - support to find alternative ways of gaining the sensory input needed.

Play skills - new ways to play, have fun and keep busy.

Emotional literacy - teach understanding and communicating feelings.

Coping and emotional regulation skills - worries/anxiety, anger/frustration e.g. use of safe place.

When helping people to develop and learn new skills to replace unwanted behaviours it is important to think about their developmental age and stage of development, level of understanding and communication skills.

Bear in mind how people with Down's syndrome learn best so provide lots of visual supports, modelling, developing personal books and films with lots of practice and repetition.

Consequence (changing the results) strategies

Using rewards and reinforcement

Rewards are one of the most powerful tools we have for changing behaviour.

At some level, each of us is aimed at getting more rewards/satisfaction. How long would you carry on going to work if you stopped getting paid at the end of the month? If you smile and say hi to your new neighbour and they turn away and ignore you, are you likely to do it again?

A reward is anything that tends to increase the behaviour that precedes it. We know that challenging behaviours continue to happen because they are being rewarded in some way (even if we can't see it immediately). In Positive Behaviour Support, we sometimes like to call rewards reinforcement.

There are two types of reinforcement - positive and negative reinforcement. Both will increase the likelihood of behaviour that they follow, occurring again in the future. So, both act as rewards for the person, making that behaviour more likely to occur again in the future.

Positive reinforcement is when something desirable (e.g. food, drink, attention, activity, star, smiley face etc.) arrives following the behaviour.

Negative reinforcement is when something undesirable (pain, demands, noise, unwanted social attention) is removed following the behaviour.

Child is screaming and banging her head on the table. Dad picks her up and starts tickling her. She stops crying and starts to giggle.
The child's behaviour is rewarded by a cuddle and tickle from dad. (Positive reinforcement)
Dads behaviour is rewarded as his daughter stops crying and hurting herself. (Negative reinforcement).

In order to be effective, rewards must be:

Meaningful and desirable for the particular person, or motivating

Given frequently, especially at first

Given at the right time, immediately after the desired positive behaviour is best

Given with enthusiasm

Changed if cease to be motivating or person's preferences change.

Selection of reinforcers (rewards):

Need to be individualised, meaningful to the person;

Need to be more powerful than those maintaining the challenging behaviour;

Need to be readily available;

Need to be affordable - stars, stickers can be exchanged for treats like a trip for McDonalds or a toy, or a trip to a play park;

Often, praise and attention are enough but sometimes people need something more tangible; and

May need to be changed sometimes, as can lose power over time.

Occasionally it can be hard to work out what exactly motivates a person, especially if they have very limited communication skills.

The following checklist includes suggestions of all sorts of possible rewards to use. It is a good idea to develop a "Reward Menu" of things that can be used to motivate a particular person with Down's syndrome.

Changing the Consequences (results) of undesirable behaviour

As well as noticing, and providing rewards/reinforcement for positive behaviours, it may be important to change what happens after an undesirable behaviour.

It is important that undesirable behaviours are not rewarded or reinforced by our reaction, or the person getting the thing they want, or getting out of, or away from a task or situation they don't like. The ABC records should help to show if this is happening.

Removing or stopping a reinforcing consequence from a behaviour is called extinction. If the behaviour stops "working" for the person it will eventually extinguish, or fizzle out.

Planned ignoring is a form of extinction, very powerful if we think the behaviour is maintained by the reaction it gets, though sometimes easier said than done!

"Time Out" which may be directing the person to sit in a particular place (chair or step) with no interaction for a few minutes, or turning the TV off for a few minutes, is also a form of extinction. It is saying to the person "you are not going to get anything good out of this behaviour".
NB: It is different from, for example, sending someone to their room, or outside to calm down. Bedrooms and gardens usually have toys/things to do in them. This might be a good strategy for redirection (see below) but it is NOT Time Out.

If a behaviour is not getting the result it used to, a person may often try harder, at first, to get the result so you may see an increase in behaviour to start with. This is called an "extinction burst" and will not be disheartening if you are prepared for it. So sometimes you can expect the behaviour to get worse before it gets better - clearly this would not be appropriate where there are safety issues e.g. hurting self, or running off.

Putting Consequence Strategies together
INTERRUPT -IGNORE- REDIRECT- REWARD

Interrupt - Ignore - Redirect- Reward

The first rule is that no harm should come to anyone. Therefore, aggression, self-injury or severe destructive behaviours should not be allowed to continue.

Not reprimanding the person

No particular attention should be given to the person about the problem behaviour

Redirect at the earliest opportunity with the goal of providing reward for any approximation to positive/desired behaviour.

Interrupt in an 'ignoring' manner as much as possible

Do the minimum to manage the behaviour to stop injury to anyone. This can be achieved by raising forearms to block/protect yourself or quietly 'shadowing' the hands of the person who self-injures.

How to Ignore

No consequences are given which relate directly to the behaviour

Activities continue, do not stop what you are doing

Do not ignore the person only the behaviour

Continue as if behaviour has not taken place

Its purpose is to defuse undesirable behaviour and take away its power

Redirection is a prompt or cue to engage in a behaviour so that a reward can be given

To communicate alternative means of interaction

Your message is "DO THIS INSTEAD"

Purpose is to encourage participation

It communicates that behaviour, which previously stopped interactions or gained inappropriate attention, is no longer effective

It is often better to use physical and gestural prompts with brief verbal cues

Use non-verbal prompts such as pointing, touching materials, touching the person hand/arms to focus the person's attention to the task

Accept any participation by the person and immediately reward this with a positive response (warm verbal comment, physical contact, smiles) and continue assistance towards desired behaviour or task

Learning strengths and challenges associated
with Down's syndrome

People with Down's syndrome tend to learn more easily through 'visual -spatial' information and experiences. They learn particularly well from seeing and doing things and benefit from having language information translated into visual information (e.g. pictures, drawings, photos, visual-spatial grids/sequences, books, films, watching others/a model to copy etc.).

People with Down's syndrome have learning challenges associated with developmental delay (learning disability) and language. For people to change their behaviour, they need to know and remember what they are supposed to do and why, and be motivated to behave in new or different ways. They need to be able to override behaviour they learned in the past. Having a learning disability and language delay makes this even more difficult to do.

We all benefit from support to change behaviour habits. Support can come from the people and the environment around us in many ways. With support, people can learn new behaviours to meet their needs. Over time, these behaviours become their new 'history' of learned behaviour.

Using visual supports, being prepared and practising new behaviours in real situations helps people with Down's syndrome to learn. Knowing about an individual's learning strengths and motivations, and following the steps in this 'Supporting Behaviour' resource will help family members, carers and practitioners understand possible underlying reasons for behaviour and lead to successful outcomes.

Do's and Don'ts of behaviour management - General top tips

Stay Calm

Notice positive behaviour

Ignore negative behaviour as much as possible

Use distraction/redirection

Be consistent

Account for developmental rather than chronological age

Separate immature behaviour from deliberate challenging behaviour

If you are getting stressed or frustrated take a break/change person dealing with the behaviour (if possible)

Smile and be enthusiastic

Give positive praise "Well done", "Nice One", "Good work"

Make eye contact

Get down to the child's level, or equal level for an adult

Do not shout

Be clear and use simple words

Working together to tackle behaviour which is challenging

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What do we mean by behaviour? Behaviour refers to everything that human beings (and animals) DO. We all react to situations and communicate through our behaviour. For people who have difficulties with other forms of communication, behaviour - things that they do - can be the most effective form...

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This is a teaching resource to help people identify their emotions, or feelings each day and to identify what might help them.

There are examples of emotions and feelings and blank sheets so that people can record their own.

There are examples of things that may help and blank sheets so that people can come up with their own ideas.

Most people will find it beneficial to work through the resource with a supporter, or teacher.
Let's talk about feelings
This is a teaching resource to help people learn about emotions, or feelings. It covers:

The words and signs we use to talk about feelings.

What different emotions feel like?

What different feelings look like on people's faces?

What might make people feel different emotions?

Mindfulness
This is a resource to help people understand what "Mindfulness" is and how they might bring mindfulness into their everyday life.

It includes links to a couple of mindfulness activities for people to try.
Stress Bucket
This is a teaching resource to help people understand about getting stressed and good things they can do to help them to be calm again.
Things you can make or buy
This is a resource about things you can make (or buy) to boost self-esteem and to help people feel better if they are feeling a bit low.
Changes that can happen in families
This is a teaching resource to help people to understand some of the changes that can happen in families. It offers reassurance that usually no one is to blame for these events and that they are a part of normal life for many families.
Bullying
This is a teaching resource to help people learn about different types of bullying and what to do if they are being bullied.
Anger
This is a teaching resource about anger; how anger feels and how to deal with it.
Top ten tips for well-being
A quick reminder of ten simple things to do to maintain your well-being
All the resources are available, individually, for FREE from our online shop, and the full collection is available in a single bundle as well.

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Click here to access all the resources for FREE from our shop The link between emotional and physical well-being is well known. Government advice (updated in July 2020) outlines the skills that should be taught to primary and secondary aged pupils, as part of their PHSE curriculum. Our current...

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The quality of life, life expectancy and role in the community for people with Down's syndrome have gradually been transformed as education and support have improved. In fact the opportunities for people with Down's syndrome to lead the lives that they want have never been greater. However, we know that we still have work to do to ensure that people with Down's syndrome have many of the same life chances that the general population take for granted.

Adults with Down's syndrome are leading longer, more healthy, fulfilling and varied lives. Small but increasing numbers are leaving home to live with support in their communities, getting jobs, having busy social lives and enjoying friendships and relationships. Some adults choose to stay with their families and receive a service to meet their needs from Social Services. Alternatively, the person might receive a direct payment from Social Services and they and their family organise their support.

Read about the experiences of some adults

Karen

Karen has just held a party for her friends and family to celebrate the tenth anniversary of moving into her flat. Karen part owns her flat and she has a dedicated team of three staff who support her on a daily basis. A staff member sleeps over each night to make sure that Karen is safe. Karen fills her week with visits to the Gym, college courses in IT, numeracy, crafts and massage, listening to rap music and watching wrestling. Karen travels to and from college on her own using public transport. Karen loves playing football and visiting the Science Museum. Karen finds writing difficult so she dictates her poetry to one of her support workers so that they can write it down for her.

Tom

Tom lives in a residential home with other adults with learning disabilities. Support is on hand day and night if Tom needs it. During the week he enjoys going to a day centre and a Mencap social group. Tom is quite active and he enjoys dancing, swimming and table tennis. Tom adores animals, particularly monkeys, and when he feels comfortable he loves to list the things he likes.

Tessy

Tessy lives with her aunt and she has a little spoken language in Czech and English. She helps her aunt with the cooking and household chores. Tessy loves to make things with her hands and she expresses herself in colours and shapes. During an average week she does yoga, gardening in a herb garden, ceramics classes and glass mosaic classes. Tessy enjoys bird watching, walks and studying nature.

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Here you will find answers to questions that we are often asked. If you do not find what you are looking for, please call our helpline and speak to one of our specialist advisers: +44 (0)333 1212 300 Please click on a question below to expand. For more information, see our families and carers...

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Scouting is an inclusive activity, as a national organisation we aim to be fully inclusive of all people from all backgrounds and of all abilities. We have a desire at Scouts to be welcoming, friendly and supportive, also we have legalities and processes we need to be aware of to support inclusion in scouting. As a manager in Scouting, your role is to support the leaders in your area. Some of them may need support when young people or adults with an autism spectrum disorder join local Scouting.

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Scouts - Autistic Spectrum Disorders FAQ for Managers in Scouting

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Scouting is an inclusive activity, as a national organisation we aim to be fully inclusive of all people from all backgrounds and of all abilities. We have a desire at Scouts to be welcoming, friendly and supportive, also we have legalities and processes we need to be aware of to support inclusion in scouting.

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- Remove distractions where possible this includes being near doors
- Break work into small chunks, one stage at a time
- Use short direct sentences
- Use visual cues to stimulate the brain
- Use a 'secret gesture' to let the young person know if they are interrupting you and they need to listen
- Reward the young person for meeting goals such as an uninterrupted conversation - make it clear what they did right
- Reinforce a code of conduct
- Make sure the young person knows exactly what they did wrong and why
- If hyperactive set a task for the young person e.g. get something from this room
- See if a fidget toy will work to encourage the young person to remain seated if needed

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Learn about ADHD in children and how to help your child with ADHD (or ADD) thrive. Use this guide to get ADHD parenting tips.

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ADHD is a common condition that makes it hard to focus, keep still, and think before acting. Some people with ADHD mainly have trouble with focus. (This is also known as ADD.) ADHD can also impact other skills, including managing emotions.

It's not clear exactly how many people in the United States have ADHD. But estimates are between 5 and 11 percent.

ADHD doesn't just go away as people get older. Most of the time, hyperactivity and impulsivity lessen or disappear by the teen years or a little longer. But trouble with focus usually continues. Some people aren't diagnosed with ADHD until after high school or as adults.

No matter when people are diagnosed with ADHD, there are treatments that can make symptoms more manageable. And there are supports that can make things easier at school and at work.

People with ADHD have trouble with executive function, which is the "management system" of the brain. Because of that, people with ADHD often struggle with:

Managing time

Getting and staying organized

Setting priorities

Managing emotions

Paying attention and remembering things

Shifting focus from one thing to another

Getting started on and finishing tasks

Thinking before saying or doing things

There's one confusing sign of ADHD. People who have trouble focusing most of the time can often "hyperfocus" on tasks or activities they find really interesting.

Signs of ADHD can pop up at any age. Kids can show signs as young as preschool. But many don't show signs until later on, as school gets harder and they have more to juggle. Some people don't realize that what they experience is ADHD until they're in college or working.

The research shows that brain development is very similar. But the areas involved in executive function take longer to develop in people with ADHD. That's why kids with ADHD may act one to three years younger than other kids their age. Research also shows some differences in how the brain functions.

These differences have nothing to do with intelligence. People with ADHD are just as smart as people who don't have it.

Researchers are also looking at the role of genetics. ADHD tends to run in families. A child with ADHD has a one in four chance of having at least one parent who has it. And there's a strong likelihood that another close family member also has ADHD.

There are no tests for ADHD. Instead, evaluators use a variety of tools to determine if a child has ADHD. One is a questionnaire about behavior. Another is a clinical interview.

Here are some types of professionals who may diagnose ADHD:

General health care providers, including pediatricians

Psychiatrists

Developmental pediatricians

Neuropsychologists

Psychiatric nurse practitioners

Clinical psychologists

There are a few types of treatment for ADHD. They include:

Behavior therapy: This type of therapy involves creating a rewards system for changing a child's behavior. It's different fromcognitive behavioral therapy (CBT), which helps people look at their thoughts, emotions, and behaviors, and make positive changes. CBT may be helpful to some people with ADHD, but it's not a treatment for ADHD.

Alternative treatments: There's no shortage of companies that claim to have an all-natural fix to ADHD. Most have no evidence to back up their claims. Learn more about alternative treatments for ADHD.

ADHD doesn't go away. But with the right treatments and supports in school, at home, and at work, people with ADHD can thrive.

Understood is not affiliated with any pharmaceutical company.

ADHD is a biological condition that can impact focus, organization, and self-control.

ADHD is not a problem of laziness or willpower.

With the right support, people with ADHD can thrive.

About the Author

About the Author

The Understood Team

is made up of passionate writers, editors, and community moderators. Many of them learn and think differently, or have kids who do.

Reviewed by

Reviewed by

Thomas E. Brown, PhD

is a clinical psychologist and clinical associate professor of psychiatry at the Keck School of Medicine of USC.

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ADHD is a common condition that makes it hard to focus, keep still, and think before acting. Some people with ADHD mainly have trouble with focus. (This is also known as ADD.) ADHD can also impact other skills, including managing emotions. It's not clear exactly how many people in the United States have ADHD.