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Autistic Anxiety vs. Neurotypical Anxiety | Neurodivergent Insights

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Autistic anxiety and neurotypical anxiety aren’t the same. Dr Neff explores how they differ in origin, experience, and expression, and why this distinction matters.

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Supporting people across all ages to improve sleep, and provides sleep training to professionals in the health, social and corporate sectors.

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Our founding principles are based on the experiences of individuals who have had, are still living with, and have recovered from eating disorders and comorbid mental health conditions.

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In case you missed it - Learn more about our latest acquisition of Talk ED, as your two favourite eating disorder charities unite this Summer! FIRST STEPS to understanding eating disorders For children and

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Jacqueline Parkinson is a Children's Occupational Therapist based in Abbots Langley, Hertfordshire. She is the founder of Magnificent Munchers which specialises in food therapy for children on limited diets often referred to as fussy or picky eaters. The team work with all children from toddlers to teenagers using the SOS (Sequential, Oral, Sensory) approach
At Magnificent Munchers we work with children who have the following eating difficulties:

Limited/decreasing range of foods in their diet (less than 20)

Refuses to eat either whole textures or categories of food

Excessively cries/tantrums when presented with new foods

Gags or vomits when offered or in the proximity of new food

Reacts excessively to food on hands or around face

Children who struggle with social eating e.g. in restaurants with the family

Is your toddler not eating a wide range of foods? Does your child appear to be more than just a picky eater? Does your child have ARFID?

Magnificent Munchers work with children from 2-16 years of age. We offer both individual and group food therapy sessions tailored to meet your child's specific needs. We work with parents/carers helping them understand the steps to eating process by working at their child's pace. With our high staff ratio and specialist therapy knowledge we aim to help children learn to explore a wider variety of tastes and textures and become happy social eaters.

The team, consisting of a Children's Occupational Therapist, Speech and Language Therapist, Dietician and two Therapy Assistants, will work with children with a variety of conditions including those on the Autistic Spectrum and ARFID (Avoidant Restricted Food Intake Disorder).

We aim to offer a flexible approach to therapy to fit in around school/work schedules with some evening and weekend appointments available.
If you are anxious about your child's eating habits, please contact the Magnificent Muncher's team to discuss further.

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Food therapy for fussy eating children from toddlers to teens | Magnificent Munchers

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Is your toddler or teen more than a fussy eater? Magnificent Munchers offer food therapy in Hertfordshire with sessions to suit your child. Contact us now.

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HCT Occupational Therapy Sensory Workshop 

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HCT Occupational Therapy Sensory Workshop 

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From March 2024 the Sensory Pathway is being updated. Schools now only need to attend the 'understanding children's sensory preferences'

Schools understanding children's sensory preferences:

Our understanding sensory preferences information session is for teachers, assistants, and special educational needs coordinators (SENCOs) who would like to know more about children's sensory development. The focus is on sensory development, how sensory preferences are established, and the influence on a child's sensory likes and dislikes. Sessions consider the impact of sensory preferences on everyday activities for children and offer practical advice and strategies that you can implement in your setting.

Summer Date:
Click here for booking information (PDF)
Autumn Dates:
Click here for booking information (PDF) School Open Forum Virtual Advice sessions Flyer
Our Schools Open Forum Virtual Advice sessions occur once per half term and are for teachers, assistants, and special educational needs coordinators (SENCOs) who would like some sensory advice and support for those children who experience sensory differences impacting on their participation in learning/everyday school activities.

These sessions are run as an open forum, where school staff can come along to discuss areas of sensory concerns with a member of the sensory team who will provide advice and support that you can implement in your setting. This is also an opportunity to hear other schools questions and queries and for schools to share ideas of what has worked for them.

Due to the nature of the forums, children and young people will not be referred to by their names.
Click here for booking information (PDF)

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From March 2024 the Sensory Pathway is being updated. Schools now only need to attend the 'understanding children's sensory preferences' Schools understanding children's sensory preferences: Our understanding sensory preferences information session is for teachers, assistants, and special educational needs coordinators (SENCOs) who would like to know more about children's sensory development.

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Hertfordshire SENDIASS is an impartial Special Educational Needs and Disability Information, Advice and Support Service (SENDIASS).

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New Promoting Communication Webinar

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Learn about YOUR ROLE in supporting speech and language development

KEY STAGES of speech and language development

TOP TIPS for promoting speech, language and communication in the early years

FOLLOW communication strategies postcard - click here

Promoting communication webinar

Watch our Promoting Communication webinar

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(Subtitles available).

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Children and young people's speech and language therapy

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New Promoting Communication Webinar Learn about YOUR ROLE in supporting speech and language development KEY STAGES of speech and language development TOP TIPS for promoting speech, language and communication in the early years FOLLOW communication strategies postcard - click here Promoting communication webinar Watch our free instant 15-minute webinar. (Subtitles available).

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Strategies for Selective Eating in children with Autism

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Strategies for Selective Eating in children with Autism

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The neurodiversity support hub is an advice service offering support, signposting and guidance about a whole range of things relating to ADHD and Autism. The phones are answered by a team of parents and carers of neurodivergent children and young people and your child doesn't need a diagnosis for you to use this service.

What kind of things can we help with?

We can:

Explain more about neurodiversity and what it means

Signpost you to the right support

Provide strategies you can use to support your child's development or behaviour

We can help with questions you may have about: We can't help with:

Recommending private assessors

Updates to EHCPs

Fast-tracking assessment or letting you know where you are on the waiting list

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Your guide to ADHD and autism support in Hertfordshire and information about the Neurodiversity Hub support service. Our animation is a speedy guide to the types of support available to you in every aspect of your family's lives.

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special educational needs and disabilities

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The Local Offer lets parents and young people know what special educational needs and disabilities services are available in Hertfordshire, and who can access them.

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The Toolbox | Autism & ADHD Support For Young People

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The Toolbox - Online ADHD and Autism Support for Children and Young People

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NHS - School Advice if your child is Autistic

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NHS - School Advice if your child is Autistic

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Choosing a school for your child

One of the main decisions you'll have to make is the type of school you want your child to go to.

You'll have to decide if you think your child should go to a:

mainstream school - a regular school, where your child may get support from special educational needs staff if they need it

special school - a school for children with special educational needs

This can be a hard decision to make and there might not always be lots of choice where you live.

You can read advice from the National Autistic Society about:

The National Autistic Society education rights service can also give advice about school options by phone or email.

Getting support at a mainstream school

If your child can go to a mainstream school or nursery, you can help them get support if you think they need it.

1. Speak to the nursery or school

Speaking to staff at their nursery or school is the best place to start.

You could speak to:

your child's teacher

special educational needs (SENCO) staff, if the school has them

Talk to them about the needs you think your child has. For example, if they need help with communication, learning or social skills.

2. Ask what support your child can get

Ask the teacher or SENCO what support they can provide.

This may be things like:

extra teaching support for your child

different ways of teaching that are better for your child

separate lessons to help your child improve their skills

This may be enough for some autistic children. Other children may need extra support.

3. Get extra support if your child needs it

If your child needs extra support their school does not usually provide, they'll need an education, health and care plan (EHC plan, or EHCP).

This is a document from your local council. It says what education and health needs your child has and what support they should get.

This can either help:

the school apply for extra money so they can support your child

you apply for a place at a school that's better for your child

Your child does not need to have been diagnosed with autism to get extra support.

How to get extra support

1. Ask your local council for an EHC assessment. The school may be able to do this for you.

2. Have an assessment. The council will speak to you, the school and health professionals to work out what support your child needs.

3. Get a draft plan. You can comment on the plan and add details like the type of school you want your child to go to.

4. Agree the final plan.

The whole process can take a few months. Ask the school what support they can offer while it's happening.

If you do not agree with the council's decision

The council may decide your child does not need an EHC assessment or plan. If this happens, they should tell you why.

If you do not agree with their decision, you have the right to appeal.

You'll be told how to do this when you hear from the council.

Getting a place at a special school

To get a place at a special school, your child will usually need an EHC plan.

As part of an EHC plan, you have the right to tell your council what school you'd like your child to go to.

The council can only refuse this if they think there's a clear reason why the school is unsuitable.

The charity IPSEA has more about choosing a school with an EHC plan.

Where to get help and advice

Getting support for your child can be a long and complicated process.

You can get advice about it from:

It may also help to speak to other parents of autistic children.
Find out where you can get support
Dealing with anxiety about school

Going to school can be an anxious time for any child. Some autistic children might find it very hard.

The National Autistic Society has advice about coping with:

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Advice about school if your child is autistic

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One of the main decisions you'll have to make is the type of school you want your child to go to.

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National Autistic Society - Education information

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National Autistic Society - Education information

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Your Internet Explorer 11 browser is not supported by this site. Please upgrade to a recent browser for the best experience.

In this section you will find information on education for autistic children. Our guides provide advice for parents/carers and teaching professionals.

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Your Internet Explorer 11 browser is not supported by this site. Please upgrade to a recent browser for the best experience. In this section you will find information on education for autistic children. Our guides provide advice for parents/carers and teaching professionals.

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If problem behaviour is causing you or your child distress, or upsetting the rest of the family, it's important to deal with it.

Do what feels right

What you do has to be right for your child, yourself and the family. If you do something you do not believe in or that you do not feel is right, it probably will not work. Children notice when you do not mean what you're saying.

Do not give up

Once you've decided to do something, continue to do it. Solutions take time to work. Get support from your partner, a friend, another parent or your health visitor. It's good to have someone to talk to about what you're doing.

Be consistent

Children need consistency. If you react to your child's behaviour in one way one day and a different way the next, it's confusing for them. It's also important that everyone close to your child deals with their behaviour in the same way.

Try not to overreact

This can be difficult. When your child does something annoying time after time, your anger and frustration can build up.

It's impossible not to show your irritation sometimes, but try to stay calm. Move on to other things you can both enjoy or feel good about as soon as possible.

Find other ways to cope with your frustration, like talking to other parents.

Talk to your child

Children do not have to be able to talk to understand. It can help if they understand why you want them to do something. For example, explain why you want them to hold your hand while crossing the road.

Once your child can talk, encourage them to explain why they're angry or upset. This will help them feel less frustrated.

Be positive about the good things

When a child's behaviour is difficult, the things they do well can be overlooked. Tell your child when you're pleased about something they've done. You can let your child know when you're pleased by giving them attention, a hug or a smile.

Offer rewards

You can help your child by rewarding them for good behaviour. For example, praise them or give them their favourite food for tea.

If your child behaves well, tell them how pleased you are. Be specific. Say something like, "Well done for putting your toys back in the box when I asked you to."

Do not give your child a reward before they've done what they were asked to do. That's a bribe, not a reward.

Avoid smacking

Smacking may stop a child doing what they're doing at that moment, but it does not have a lasting positive effect.

Children learn by example so, if you hit your child, you're telling them that hitting is OK. Children who are treated aggressively by their parents are more likely to be aggressive themselves. It's better to set a good example instead.

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Advice for parents and carers on dealing with difficult behaviour in toddlers and young children, including toddler temper tantrums.

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Autism Central for Parents and Carers | Autism Central

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Autism Central offers a wealth of resources for parents, carers and personal assistants of autistic people in England – from articles and learning materials to signposting you to services and support in your local area.

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We are the UKs leading charity for autistic people and their families. Since 1962, we have been providing support, guidance and advice, as well as campaigning for improved rights, services and opportunities to help create a society that works for autistic people.

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YoungMinds | Mental Health Charity For Children And Young People

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YoungMinds are a mental health charity for children, young people and their parents, making sure all young people can get the mental health support they need.

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If you're feeling overwhelmed, anxious or sad about what's going on in the news, know that you're definitely not alone. Here are some actions we can take to help us cope better through times like this.

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However you're feeling right now, you don't have to face it alone. We're here to support you with your mental health.

Take a look at our resources, information and support, find further help or reach out to one of our volunteers.

Resources for you

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Shout - UK's 24/7 Crisis Text Service for Mental Health Support

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Shout 85258 is the UK's first 24/7 text service for anyone in crisis. Get free, confidential mental health support anytime, anywhere. Text 'SHOUT' to 85258.

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BBC Tiny Happy people- Child Development and Milestones

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BBC Tiny Happy people- Child Development and Milestones

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Child development and milestones - BBC Tiny Happy People

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A collection of films and articles all about the science of child development. Your child is incredible - find out all about their mental development and how they come to understand the world and learn to communicate through play.

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Webinars on Fussy Eating in Children - patientwebinars.co.uk

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Webinars A series of webinars by NHS specialist paediatric dietitians to help guide parents when feeding children who exhibit fussy or restricted eating habits. These webinars have been submitted for BDA endorsement.

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Lots of children go through periods of eating. For many, this phase will pass as the child gradually learn s to accept new foods . F or autistic ch ildren and their families, overcoming eating challenges can be more difficult.
Over two third s of parents of autistic children report that their child is reluctant to try new food s¹ . Moreover, o ther behaviours such as eating or mouthing non-edible items , and extreme food selectivity can make providing sufficient nutrition hard.

Continue below for a range of resources for understanding, identifying and tackling eating challenges.

Understanding eating difficulties

89% of autistic children display some form of difficulty with eating². This can range from selective eating, to anorexia or ARFID (Avoidant/restrictive food intake disorder). Find out more about the common food disorders for autistic people.

Spotting the signs

There are many behavioural and physical signs that might indicate if a person is having issues around eating. This may indicate that they have an eating disorder or they may simply need some additional support. Find out more about what to look out for. Providing early support can be crucial and particularly in young people could help to reduce the impact on their education.

If you are concerned about your child's eating i t's important to talk with your child's GP, paediatrician or a dietitian. This will help to rule out any underlying causes such as gastrointestinal problems and allergies.

How to address eating difficulties

There are a number of things you can do to try and increase variety within a diet and promote healthy eating. Take a look at our resources below to find out what steps you could take.
A small ask...
If you have found any of the information in this section useful, please consider making a contribution to help us create more resources like this.

1. Rogers, L.G., Magill-Evans, J. & Rempel, G.R. Mothers' Challenges in Feeding their Children with Autism Spectrum Disorder-Managing More Than Just Picky Eating. J Dev Phys Disabil 24, 19-33 (2012).
2. Ledford, J. R., & Gast, D. L. (2006). Feeding problems in children with autism spectrum disorders a review. Focus on Autism and Other Developmental Disabilities, 21(3), 153-166

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Lots of children go through periods of eating. For many, this phase will pass as the child gradually learn s to accept new foods . F or autistic ch ildren and their families, overcoming eating challenges can be more difficult.

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Our dedicated sleep service is here to help.

Alongside our Sleep Tips booklet and relevant guides, we also offer one-to-one support. This involves completing an application form for your child and two weeks' worth of sleep diaries which we'll send out to you as long as you come under our criteria for support.

If you need one-to-one support and are a parent/carer or a professional referring a family with their consent to having sleep support, please click the button below to contact the sleep service.

If you have a question or query about our services please email us at [email protected].

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Sleep tips Our Sleep Tips booklet introduces and explains different techniques for you to try that may improve your child's sleep. It covers ten main topics including bedtime routines, daytime napping, comfort objects and moving bedtime backwards or forwards. It gives lots of illustrated hints and tips for putting the...

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With your help, we can keep offering free support to those who need us.

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Teaching your child to use the toilet correctly can be a difficult task, whether they are on the autism spectrum or not. But if your child is autistic, the process of developing a toilet routine can take longer, and involve its own particular challenges. This guide provides some useful steps that will hopefully make your toilet training a success.

When to start

Choose a time when you have few engagements and are feeling relatively stress free. Some indicators of a good time to start are:

if your child has begun to become aware of needing to go to the toilet

if you notice changes in their behaviour patterns, such as appearing distracted or fidgeting when they are wet or have soiled

if they let you know when they need changing

if you have observed that your child is aware that they have started/finished weeing or pooing

if your child has shown an interest in using or used the toilet themselves without being prompted

if your child can avoid having a wee or poo accident for one or two hours at a time (ie has improved bladder/bowel control).

Developing a toileting routine

Remember that independent toileting is the ultimate aim and may take many months but there will be many small steps and successes along the way. As well as physical factors associated with toilet training, there are social factors to consider. It is rare for an autistic child to have the social motivation to want to be like mummy/daddy/friend and use the toilet. After using nappies for a number of years, your child might not see the point in starting to use the toilet. It's important to remember that all children are different and they will not all respond to the same teaching techniques.

Children on the autism spectrum often like routine. You can build upon this desire for predictability to develop a successful toilet training routine.

When changing your child's nappy, do this where the toilet is so they can start relating toileting activities to the bathroom.

Your child may behave differently than normal when their routine is changed so let everyone who cares for them know why there could be a change in behaviour. It is often easier not to use a potty as part of toilet training to avoid a possibly difficult change from potty to toilet.

Ensure everyone working with your child starts toilet training at the same time and follows your agreed approach. Send in any equipment to nursery/school which you use at home, for example a toilet seat they may use to make the seat smaller. Also remember to send spare clothes, plastic bags to put any wet clothes in and wet wipes. It is important that you have clear lines of communication during this time so having a home/school book to share concerns and successes is vital.

Observe your child over a few days to see when they do a wee or a poo. Identifying a regular pattern can help you take your child to the toilet with an increased likelihood of them doing a wee or poo. This then leads to positive reinforcement.

Continue to take your child at set times based on your observations. If they wet themselves at another time, take them to the toilet as quickly as possible and try to get them there so some of the wee goes into the toilet. Ignore the wetting and positively reinforce that the wee has gone into the toilet and continue the rest of the toileting routine.

Use a visual sequence beside the toilet to help your child understand what is expected of them, for example: trousers down, pants down, sit on the toilet, wee/poo in the toilet, wipe (you may need to show how many squares of paper to take), pants up, trousers up, flush toilet, wash hands. The sequence can either be in the form of photographs, pictures or the written word - whatever is most suitable and motivating for your child. You may need to create a way of removing or covering over each symbol as the step is completed to show that it is finished and to move on to the next step. There are some examples of visual supports on the Do2Learn website.

Make sure any pictures or instructions are very clear so there is no misunderstanding. For example, if you are teaching your son to stand and wee in the toilet, show an outline drawing of him standing and weeing in the toilet. If you are teaching sitting, show a picture of him sitting and weeing in the toilet.

Show your child a photo or drawing of the toilet and say 'your child's name, toilet', take them into the toilet, follow your visual sequence for undressing and sit your child on the toilet. Even if they do not open their bowel or bladder, continue to follow the visual sequence as if they had.

Use a laminated visual sequence above the sink at eye level for hand washing.

Teach toileting as a whole routine from communicating the need to go to the toilet, using the toilet, to drying hands, rather than just sitting on the toilet.

Keep the sequence of behaviours the same every time. Often when an activity is anticipated, the child is more receptive to it.

Concentrate on tackling one behaviour at a time; it's very difficult to change two behaviours at once.

Decide whether or not and how to praise your child for successfully following the toileting routine. Some children enjoy and respond to social praise ('well done', or a tickle), others respond better to an object. Some children find praise difficult and keeping a calm, structured routine with a preferred activity after toileting may work better.

Dressing and undressing

Dress your child in comfortable clothes they can easily manage themselves such as elasticated waistbands on trousers and skirts or dresses that are not too long.

Motivate your child to wear underwear by buying pants with their favourite cartoon or television programme characters on them.

Use 'backward chaining' to teach new skills. This involves breaking a skill down into smaller steps, teaching the last stage of the sequence first. So if you were teaching your child to pull up his trousers, you would pull them up to his hips and then he would pull them up to his waist. Next time, you would pull them up to just under his hips and he would pull them over his hips and waist. This is a particularly good way of teaching new skills as it raises your child's self-esteem as they have taken the final step of the task themselves to complete the sequence.

Hand washing

Follow the same steps each time: sleeves up, tap on, wet hands, squirt soap, rub hands together, rinse hands, turn off tap, shake hands, dry hands.

Stand behind your child and physically prompt them if necessary, slowly withdrawing.

Avoid using verbal prompts as your child can become dependent on these without you realising. Instead let your child refer to a visual sequence as a reminder.

You may wish to teach your child to use the cold tap only. Beware that if you teach them to use the hot tap independently at home, when they go into other settings and wash their hands, the water may be too hot and could burn them.

Boys - sit or stand?

When deciding whether to teach a boy to sit or stand to urinate, ask yourself the following questions:

Can they distinguish between when they want to wee and poo?

Do they have the co-ordination, focus and control needed to aim?

If they learn by imitation, is there someone they can watch?

If the answer to any of the above is 'yes', then they are probably able to be taught to stand to urinate. To start teaching them to aim, it can be useful to put a piece of cereal (preferably one they don't eat as this could lead to confusion) down the toilet so they have something to aim for and concentrate on. You can also purchase a variety of fun toilet target stickers online.

Bowel control

Bowel control is usually learnt after bladder control. Some children can find bowel movements very frightening and not understand what is happening. It can help to get a book with pictures to explain the digestion process.

Some children find the feel of a full nappy comforting, and may enjoy the sensory feeling of the weight of the nappy. Find alternative ways to replace these feelings so you can continue toilet training. Give your child a means of requesting the activity eg being wrapped in a warm, heavy blanket and fit it into their routine.

Sit your child on the toilet, keep the nappy on but with a hole cut in the bottom, slowly cut away the nappy each time until they are able to go without the nappy at all. To start with, they will still have the feeling of a security around their waist which in turn will enable them to feel relaxed enough to poo on the toilet.

Habit training

Some children are toilet trained through habit. Habit training is effective for children who may: lack awareness, not understand the significance or meaning related to physical sensations, be limited by decreased or absent physical sensations or have unsuccessfully tried toilet training before.

Habit training involves training the body to go at set times. Take your child to the toilet at set times throughout the day, every day.

As before, observe your child to discover the best times to take them to the toilet.

Make sure your child feels relaxed enough to open their bladder/bowels while they sit on the toilet. Having the tap running in the background can help enable your child to wee for example.

Sometimes having a toy to handle - not one which causes excitement - can be useful to both keep your child on the toilet and relax them. Keep certain toys/books for just when they are sitting on the toilet.

If your child lacks awareness or sensation, they may have to be taught a strategy before getting off the toilet, to avoid accidentally weeing on the floor. Encourage them to slowly count to ten out loud when they have finished weeing before allowing them to get up, or give them a sand timer to look at.

To help your child to independently manage their own toileting routine when they are older, you can buy watches which you can set to vibrate at certain times throughout the day. You can then teach your child when the watch vibrates, they are to go to the toilet.

Environment

Ensure the bathroom is a calm, relaxing environment to encourage independence and success with the complete toileting routine.

Remove all distractions which are not associated with toileting to help your child understand what is expected of them while in the toilet.

Make the bathroom as comfortable as possible, adding foot supports, side rails and a smaller toilet seat if necessary.

Encourage independence by ensuring that everything in the bathroom is at the right level for your child eg soap and towels.

Think about your child's sensory needs and make changes to reduce their anxiety. Does the soap smell too strong for them? Does the noise of the extractor fan bother them? Does the water temperature need to be adjusted? Is the lighting too bright?

Make sure your child can sit comfortably on the toilet with hips and knees flexed at a 90 degree angle and have feet flat on a secure object.

Night-time

Once your child is mostly dry during the day you will be able to start night-time toilet training.

Have a set bedtime routine which does not change with weekends or holidays.

Limit the amount your child eats and drinks before bed, having no fluid an hour before bedtime, but ensuring your child has enough fluid throughout the day.

Take your child to the toilet before they go to bed. They then may need to be taken once during the night. You could fit this in with your routine by taking them before you go to bed.

If they are unable to keep dry during the night, you may need to try different times in the night to take them.

Use products to protect bedding.

Schools and early years settings

Admission to school should not be refused simply because a child has difficulties with continence. A school that does this may be at risk of disability discrimination (alternative legislation operates in Northern Ireland).

Further tips

Giving a drink 10 to 15 minutes before toileting can help increase the chances of your child successfully doing a wee on the toilet but avoid giving too much as this creates an unnatural routine.

Decide if you are going to teach your child to shut the door as part of the whole toileting routine or only in certain situations.

Avoid using childlike terms for toileting as your child may find it difficult to change language later in life.

If your child has a fear of flushing the toilet, you may wish to remove this from the visual sequence and leave it until the end of the routine - after your child has dried their hands. They then may need to stand in the doorway while you flush the toilet and gradually stand closer each time until they are able to flush for themselves. Playing calming music to drown out the noise of the flush or explaining with pictures what makes the noise when the toilet is flushed may also help.

When your child is in a car, ensure they have a protector to sit on to stop the car seat from being soiled by accidents. Avoid drinks before long car journeys.

Be aware that some children will hold onto their wee/poo until they have their nappy put on, for example if they know they always have a nappy on before going in the car they may wait until it is put back to release their bowel/bladder.

A range of absorbent pants and swimwear for older children is available.

Once your child is toilet trained at home, you will want to teach them to use toilets when out. When visiting new places, show your child where the toilets are and use the same routine as you do at home. Use the same picture and toy or book they may have for toileting at home.

Some children smear their poo. Read our guide on smearing for strategies to try (link to new guide in behaviour section).

Further information

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Toileting - a guide for parents and carers

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This guide provides some useful steps to help make toilet training an autistic child a success.

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NICE Guidelines - Bedwetting in under 19s

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NICE Guidelines - Bedwetting in under 19s

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This guideline covers assessing and treating bedwetting in people aged under 19. It aims to reduce bedwetting and the distress this causes by explaining what to ask in an assessment, what advice to provide, and which treatments are effective.

Recommendations

This guideline includes recommendations on:

Who is it for?

Healthcare professionals

Commissioners and providers

People aged under 19 with bedwetting, and their families and carers

Is this guideline up to date?

We checked this guideline in November 2018. We found no new evidence that affects the recommendations in this guideline.

Guideline development process
How we develop NICE guidelines
This guideline was previously called nocturnal enuresis: the management of bedwetting in children and young people.

Your responsibility

The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian.

All problems (adverse events) related to a medicine or medical device used for treatment or in a procedure should be reported to the Medicines and Healthcare products Regulatory Agency using the Yellow Card Scheme.

Local commissioners and providers of healthcare have a responsibility to enable the guideline to be applied when individual professionals and people using services wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with complying with those duties.

Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

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This guideline covers assessing and treating bedwetting in people aged under 19. It aims to reduce bedwetting and the distress this causes by explaining what to ask in an assessment, what advice to provide, and which treatments are effective

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Speech and Language UK: Changing young lives

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We give families the confidence and skills to help their children. If you're concerned about your child's speech and language development, we can help.

We know that it can be hard to know where to start if you are worried about your child's development. If you think your child is having challenges with talking and understanding words, we are here to help you.

Our free resources and services can help with understanding what to look out for, how to get support and even some simple ways you can help your child at home.

Our progress checker will provide short questions you can answer to see how your baby or child is getting on with their talking and understanding of words.

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Help for families - Speech and Language UK: Changing young lives

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We give families the confidence and skills to help their children. Access our free resources and learn more about ways to encourage children's speech and language development.

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IPSEA - Independent Provider of Special Education Advice

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IPSEA - Independent Provider of Special Education Advice

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(IPSEA) Independent Provider of Special Education Advice

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IPSEA (Independent Provider of Special Education Advice) - helping children and young people with special educational needs and/or disabilities (SEND) get the education they are entitled to by law

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Ambitious about Autism is the national charity for autistic children and young people. We stand with autistic children, young people and their families to champion rights, campaign for change and create opportunities.

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Free education resources for teaching young people aged 3-16 years about where food comes from, cooking and healthy eating, and teacher training. - Food A Fact Of Life

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A special formulation of 21 nutrients, Wellkid Smart Chewable is a clever way to safeguard your child’s intake of a wide range of important vitamins.

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Sensory Processing Issues Explained - Child Mind Institute

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When children struggle with their behavior, it can have a negative impact on everyone in the family. Parents know they need to respond, but they often aren't sure what's the best strategy, especially if a child is frequently acting out and nothing seems to work. This guide offers parents a comprehensive look at problem behavior. It covers a variety of topics, including what may be triggering problem behavior, how to improve the parent-child relationship when it becomes strained, what to do if kids are struggling with behavior in school and how to get professional help if you need it.

Why Do Some Kids Struggle With Problem Behavior?

When children have frequent emotional outbursts, it can be a sign that they haven't yet developed the skills they need to cope with feelings like frustration, anxiety and anger. Handling big emotions in a healthy, mature way requires a variety of skills, including:

Impulse control

Emotional self-regulation

Problem solving

Delaying gratification

Negotiating

Communicating wishes and needs to adults

Knowing what's appropriate or expected in a given situation

Other children may seem to struggle more with boundaries and following rules. They may be defiant, or ignore instructions or try to talk their way out of things that aren't optional. You may notice patterns of behavior that seem to crop up at certain times of the day (like bedtime) during certain tasks (like during homework) or with certain people. You also might notice that your child acts out particularly when she is at home but not when she is at school, or vice versa.

Tantrums and other kinds of acting out are often a normal and even healthy part of childhood. They are a sign that a child is becoming more independent - indications that a child is testing boundaries, developing skills and opinions, and exploring the world around them.

But when a child is acting out a lot, it can strain the parent-child relationship, creating regular frustration and resentment that isn't healthy in the family. Whether your child is in the early stages of learning about self-regulation and boundaries, or if your family has been struggling and you are looking for help, this guide is designed to explain more about how kids learn to manage their behavior, what parents can do to aid in the process and how to get more support if you need it.

Tantrums can be a learned behavior

Sometimes parents feel that tantrums and other instances of problem behavior are intentional or manipulative. However, clinicians who specialize in children's behavior agree that tantrums are generally not a voluntary behavior on a child's part - but they may be what is known as a "learned behavior." That means that kids learn that having a tantrum gets them the result that they want.

In other words, while a child who struggles to control her emotions might not be consciously calculating her tantrums, she might resort to them because she hasn't learned a better way to solve problems or communicate her needs. Well-meaning parents often respond to tantrums by trying to fix whatever caused the problem - by comforting the child or giving her whatever she is asking for. Unfortunately, this reinforces the tantrum behavior, making kids more likely to continue having tantrums and less likely to develop more sophisticated ways to manage their feelings.

Responding to Problem Behavior

When kids are acting out parents often feel powerless. You may have tried different techniques for discipline, but without much success. In fact, trying too many different strategies for managing disruptive behavior can sometimes be part of the problem, since kids respond better to firm boundaries that are consistently reinforced. But if you haven't seen progress before now, don't feel discouraged, because parents have more power than they may realize when kids are being oppositional. By using strategies that are informed by child psychologists who specialize in behavior management, you can begin to improve kids' behavior and even improve the parent-child relationship.

This section begins with some general rules of thumb recommended by behavior experts as effective strategies for responding to problem behavior in the moment. Next it examines problem behavior in greater depth, which can be helpful for parents who want to understand more about why kids act out, and how to tackle specific behaviors you would like to change.

Tips for responding in the moment:

Don't give in. Resist the temptation to end your child's tantrum by giving her what she wants when she explodes. Giving in teaches her that tantrums work.

Remain calm. Harsh or emotional responses tend to escalate a child's aggression, be it verbal or physical. By staying calm, you're also modeling for your child the type of behavior you want to see in him.

Ignore negative behavior and praise positive behavior. Ignore minor misbehavior, since even negative attention like reprimanding or telling the child to stop can reinforce her actions. Instead, provide lots of labeled praise on behaviors you want to encourage. (Don't just say "good job," say "good job calming down.")

Use consistent consequences. Your child needs to know what the consequences are for negative behaviors, such as time outs, as well as rewards for positive behaviors, like time on the iPad. And you need to show him you follow through with these consequences every time.

Wait to talk until the meltdown is over. Don't try to reason with a child who is upset. You want to encourage a child to practice negotiating when she's not blowing up (and you're not either).

Targeting specific behaviors

When you are trying to manage disruptive behavior, it is helpful to identify specific behaviors that you are trying to change (or encourage). It's true that when families are feeling overwhelmed sometimes it can seem like every interaction is a struggle. However, identifying specific behaviors is an important first step to effective discipline. Taking behaviors one at a time allows you to be more focused, gain a better understanding of why the behavior is happening, and have a greater sense of control. Of course, there may be multiple behaviors that you would like to change, but evaluating them one by one is important.

Target behaviors should be:

Specific (so expectations are clear to everyone in the family)

Observable

Measurable (so everyone can agree whether or not the behavior happened)

An example of a poorly defined behavior is "acting out" or "being good." A well-defined behavior would be running around the room (bad) or starting homework on time (good).

Before the behavior happens

When you are thinking about a particular behavior that you are targeting, it is important to think about what generally happens before that behavior and may be triggering it. This helps parents understand not only why a child might be acting out but also how anticipating certain triggers might help prevent those behaviors from happening. Parents can also examine the triggers that make positive behaviors (like obeying a command on the first time) more likely.

Potential triggers to avoid

These things often lead to misbehavior.

Assuming your expectations are understood: Kids may not know what is expected of them - even if you assume they do. Demands change from situation to situation and when children are unsure of what they are supposed to be doing, they're more likely to misbehave.

Calling things out from a distance: Tell your children important instructions when you are face-to-face. Directions that are yelled from a distance are less likely to be remembered and understood.

Transitioning without warning: Transitions can be hard for kids, especially if they are in the middle of doing something they enjoy. When kids are given a warning and have a chance to find a good stopping place, transitions can be less fraught.

Asking rapid-fire questions, or giving a series of instructions: Delivering a series of questions or instructions limits the likelihood that children will hear, answer questions, remember the tasks, and do what they've been instructed to do.

Potential triggers to embrace

These are things that can bolster good behavior.

Adjusting the environment: Try to manage environmental and emotional factors that can make it much more difficult for children to rein in their behavior. Things to consider: hunger, fatigue, anxiety or distractions. When it's homework time, for instance, remove distractions like screens and toys, provide snacks, establish an organized place for kids to work and make sure to schedule some breaks.

Making expectations clear: You and your child should be clear on what's expected. Even if he "should" know what is expected, clarifying expectations at the outset of a task helps head off misunderstandings down the line.

Providing countdowns for transitions: Whenever possible, prepare children for an upcoming transition. For example, give her a 10-minute warning when it is time to come to dinner or start homework. Then follow up when there are 2 minutes left. Just as important as issuing the countdown is actually making the transition at the stated time.

Letting kids have a choice: As kids grow up, it's important they have a say in their own scheduling. Giving a structured choice - "Do you want to take a shower after dinner or before?" - can help them feel empowered and encourage them to become more self-regulating.

After the behavior happens

Considering what happens after a targeted behavior is important because consequences can affect the likelihood of a behavior recurring. That is true for consequences that are positive (like getting an extra 10 minutes of screen time) or negative (like getting a time out).

Some consequences are more effective than others. Ideally consequences create structure and help kids understand the difference between acceptable and unacceptable behaviors. However, consequences can also do more harm than good when they are sending the wrong message. Understanding how to use smart and consistent consequences makes all the difference.

Consequences that aren't effective

These types of consequences are common, but they generally don't have the desired effect.

Giving negative attention: It seems counterintuitive, but consequences that seem negative to us (like raising your voice or spanking) can sometimes reinforce the very behavior we are trying to prevent. That's because children value attention from the important adults in their life so much that any attention - positive or negative - is better than none. That's why negative attention can actually increase bad behavior over time. Responding to behaviors with criticism or yelling can also adversely affect children's self-esteem.

Delayed consequences: Immediate consequences are the most effective. Children are less likely to link their behavior to a consequence if there is a lot of time between the two, which means delayed consequences are less likely to actually change a child's behavior.

Disproportionate consequences: Parents can sometimes become so frustrated that they overreact when giving consequences, which is understandable. However, a huge consequence can be demoralizing for children, and they may give up even trying to behave.

Consequences that are accommodating: When a child is slow to doing something you want him to do, like picking up his toys, many parents will become frustrated and just do it themselves. While this reaction is also understandable, it also increases the likelihood that he will dawdle again next time.

Consequences that are effective

Consequences that are more effective begin with generous attention to the behaviors you want to encourage.

Positive attention for positive behaviors:Praising children when you "catch them being good" makes them more likely to repeat that good behavior in the future. Positive attention is also a good thing for the parent-child relationship, improves a child's self-esteem, and feels good for everyone involved.

Ignoring actively: This consequence might seem counterintuitive, but child behavior experts often teach "active ignoring" as an effective behavior management strategy. To perform active ignoring, deliberately withdraw your attention when a child starts to misbehave. As children learn that acting out doesn't get them your attention, they will begin to do it less. An important component of active ignoring is to immediately give a child positive attention as soon as he exhibits behavior you do want to see, like sitting calmly. Of course, this consequence should be used only for minor misbehavior - active ignoring is not appropriate when a child is being aggressive or doing something dangerous.

Reward menus:Rewards are a tangible way to give children positive feedback for desired behaviors. Rewards are most motivating when children can choose from a variety of desirable things: extra time on the iPad, a special treat, etc. Rewards should be linked to specific behaviors and always delivered consistently.

Time outs: Time outs are one of the most effective consequences parents can use, but also one of the hardest to do correctly. It's very important to balance them with other nurturing techniques, like providing positive feedback and modeling emotional regulation for your child. The next section in the guide gives parents tips on how to have a successful time out.

Example: Targeting a specific behavior
Set a specific behavior that you want to target
Stop jumping on the couch
Examine triggers
Your daughter often starts jumping on the couch when you go to change the baby's diaper or give him a bath.

Possible solution: Come up with ways your daughter can "help" you do these tasks. Her assistance may slow you down slightly, but it gives her something positive to do - and it makes her feel like she's still getting your attention. When she helps out, praise her for being such a good big sister.
Examine consequences
Ineffective consequence: Yelling, "I've told you this a million times, Katie, you can't jump on the couch! Why do you keep doing it?!"

Effective consequence: Send to time out immediately.

Why Transitions Trigger Problem Behavior

One common problem behavior trigger for many children is transitions. Whether it's getting ready for bed, or coming to dinner, or putting down the video game controller, in many families transitions can become a flashpoint that everyone learns to dread.

If transitions are a problem for your child, it is important to figure out what about the transition is difficult. Often kids don't like stopping an activity that they are enjoying (like playing on the computer) in order to do something less fun, like getting ready to leave the house. While no one enjoys stopping fun things, some kids struggle with it more than others. That can be a sign that they are still developing emotional self-regulation skills, but it is just one possible cause. Other children struggle to cope with unanticipated changes in schedule, or moving on from something that they feel like they haven't finished.

Struggling with transitions can even be a sign of a mental health disorder in some children. Children with ADHD, autism, anxiety and OCD are all more likely to struggle with transitions.

Techniques to make transitions easier

Once you've narrowed down what you think might be behind your child's resistance to transitions, then you can start brainstorming what you think might help. (Note: If you think your child might have an undiagnosed mental health disorder, taking your concerns to a clinician is important.)

Here are some techniques that you might want to try:

Preview and countdown: Every morning, lay out what the day will look like. Before each transition, give a timeframe and description of what will happen along with countdowns (in 20 minutes, then 10, then 5 it will be time to finish breakfast and head to school). This helps kids prepare emotionally.

Get their attention: For kids who struggle to regulate their attention, make a particular effort to capture theirs. Make eye contact, sit next to them, put your hand on their shoulder, or ask them to repeat back what you have said. It makes them more likely to follow through.

Use music: Songs can help kids (particularly young kids) ease into transitions. The "clean up" song is a popular example of this, but there are many songs that can be found or made up to suit a variety of situations from tying shoes to brushing teeth.

Visual cues: Posting a chart with pictures illustrating what to expect from a particular transition or the steps involved is a good visual reminder for children to fall back on.

Create routines: If there are transitions that your child struggles with every day, like going to bed, build some consistency and structure into that transition. For example, when it's close to bedtime, your child can pick one last thing she wants to do. Then, you both go upstairs to brush teeth and read a story, then it's lights out. Doing this routine consistently helps kids know what to expect and makes the transition easier.

Use rewards: Rewards can be an effective tool to use for difficult transitions until children have gotten used to them. Parents can use stickers, snacks, or a point system that leads to tangible rewards.

Appropriate consequences: If a transition isn't going well, think about what consequences you are (or aren't) giving. Yelling isn't an effective consequence, but active ignoring or a time out might be.

Use praise: When a child does follow through with a transition, make sure you give him some enthusiastic labeled praise to recognize his behavior. For example: "I really liked how you handed over the iPad right away and started brushing your teeth. Now we have more time to read!"

Skills: How to Do a Time Out

Critics of time outs argue that they can be emotionally isolating for kids, but research shows that they are effective and do not cause children harm. (For more on the debate around time outs, read our full article on the topic.) However, it's very important to use them as just one technique in a nurturing, supportive parenting strategy. Be sure to balance use of time outs with lots of praise for kids' positive behaviors. It's also important to manage your own stress so that kids can learn emotional regulation from your positive example.

The point of a time out isn't to shame or punish your child, but to diffuse an emotional situation and help your child learn to manage frustration and regulate his own behavior. Using a time out is also a clear way to communicate that a particular behavior is unacceptable.

Many parents have tried time outs before with varying degrees of success. To be most effective, time outs need to be done consistently and follow certain steps. Here are some guidelines to follow if you are learning how to use time outs, or want to troubleshoot your technique.

Use advance warning: Kids need to understand which behaviors are linked to which consequences. Work with your child to establish which behaviors (like hitting or not complying with an instruction from you) lead to a time out so she knows what to expect.

Establish a pre-determined place: Designating a special chair, or a place on the stairs, also helps a child know what to expect. It's a good idea to label the time out chair just that, and not "the naughty chair" or something similar. Time outs work better when they are focused on teaching children how to behave, not on punishing them.

Use a quick response: When a kid misbehaves in one of the ways you have discussed, make sure the following time out is immediate, and that you state the reason: "No hitting. Go to time out." Be specific, brief, and unemotional. This helps ensure that the child is able to link her action with its consequence. Delayed consequences are ineffective because kids tend to feel you are just being punitive.

Keep it brief: A standard formula for time outs is one minute per year of age. Some experts recommend a timer so a child can see that the time is being measured.

Keep it calm: The goal in a time out is for kids to sit quietly. Some experts recommend not starting the allotted time until your child is quiet. Others feel this is too hard for young children. They require that the child be completely quiet for 5 seconds before ending the time out. This way kids learn to associate good behaviors with the end of the time out and it sends the message that yelling and screaming during a time out won't work.

Pay no attention: Kids in time out should be ignored - no talking to them or about them, even if they're whining, crying or protesting. By withdrawing your attention during the time out, you're sending the message that misbehaving is not the way to get what they want.

Consistency is key: It's tempting to put kids in time out whenever they're acting inappropriately or pushing your buttons, but using time outs randomly makes it more difficult for kids to make the connection between specific misbehaviors and their consequences. Also, it is important that the time out occurs each and every time the specific target behavior occurs. If not, you are encouraging the child to think that he might be able to get away with it.

No rewarding stimuli: In the time out chair the child should have no access to television, electronic devices, toys or games. If you're away from home, pick any spot that removes the child from distracting stimulation.

If a child won't stay in time out: If a child breaks the rules by leaving the time out chair too soon, put him in a backup time out area that he cannot escape from (like a bedroom where there aren't any rewarding stimuli such as television, toys or games). Briefly explain that he must stay there for one minute and be calm and quiet before he is allowed to leave. Once he does that he should be returned to the time out chair, and the time he must stay there is restarted. If he leaves the chair again, the cycle repeats. Your child should learn quickly that it's in his best interest to stay in the chair until the time is up.

After the time out

When kids are given time outs for not complying with your instructions, once a time out is finished, they should be asked to complete whatever task they were asked to do before the time out. This helps them understand that time outs aren't escape routes.

Once the time out is over, you want to resume giving them attention, tuning in to whatever they are doing/working on/playing so that you can "catch them being good" and specifically praise them for a positive behavior. For example, if your child completes her time out and then she plays gently with the dog, you'd want to let her know what she was doing right ("I love how nicely you're playing with the dog! You are using such nice gentle hands!") This is reassuring your child that although she had to go to time out, she also is completely capable of doing good and positive things that make you proud and loving toward her.

Skills: How to Give Effective Instructions

Children will be more likely to understand and comply with your instructions if you follow these guidelines:

Be direct. Make statements rather than asking questions: "Please sit down," as opposed to "Are you ready to get out your homework?"

Be close. Give instructions when you are near your child, rather than calling out from across the room.

Use clear and specific commands. Instead of "Go ahead," say, "Please go start your reading assignment."

Give age-appropriate instructions. Speak to your child at a level he will understand. If your child is younger, keep things simple and use words you know he knows: "Please pick up the ball." With older children, it's important to be clear without being patronizing.

Give instructions one at a time. Especially for kids who have attention challenges, try to avoid giving a series of instructions: "Please put on your sneakers, get your lunch off the kitchen counter, and meet me in the front hall."

Keep explanations simple. Giving a rationale can increase the likelihood children will listen to a command, but not if the commands gets lost in it. For instance: "Go get your coat on because it's raining and I don't want you to catch a cold." Instead, try: "It's raining and I don't want you to catch a cold. Go get your coat on."

Give kids time to process. After you give an instruction, wait a few seconds, without repeating what you said. Children then learn to listen to calm instructions given once rather than learning that they don't need to listen because the instructions will be repeated.

Improving the Parent-Child Relationship

One of the most unpleasant side effects of behavioral problems is the toll they take on the family dynamic. When a child has chronic behavior issues parents often aren't enjoying the time they spend with their child. This can be both frustrating and guilt-inducing. Children are also negatively affected when they receive frequent criticism or pick up on their parent's irritation, which can lead to resentment and may damage their self-esteem.

Improving the parent-child relationship should be a priority for all families dealing with chronic problem behavior. To that end, try to increase the number of interactions you have with your child that are positive and don't promote conflict. For example:

Use behavior management strategies that reinforce what you do want to see (like giving clear instructions in a neutral tone of voice or using lots of labeled praise) instead of comments that are critical or focus on what you don't want to see.

Pay attention to your own emotions and look for healthy ways to deal with stressful situations without escalating them. Use your own emotional self-regulation skills or give yourself a time out if you need a moment to cool down.

Like in any relationship you want to nurture, think about how you can build on (or create) meaningful bonds. Are there common interests you can cultivate? New relationship rituals you can establish?

Set aside a small amount of time every day to be present and nonjudgmental with your child.

How to establish daily quality time

Even a small amount of time set aside reliably every day can become something children and parents learn to look forward to. This should be a time for positive connection, without rules or commands, to help everyone in the family defuse stress and appreciate each other's company. This should be considered special time and should not be contingent on a child's good behavior. Here are some tips for success:

Aim for 5 minutes per day with younger kids, 15 minutes with teens

Let your child choose an activity she enjoys and you join in

Actively listen and let her lead the conversation

Validate her choices and interests

Focus on giving positive attention to good behavior

Ignore minor misbehavior

Avoid directing the activity or criticizing

Helping Kids Deal With Big Emotions

Some children act out because they have a hard time regulating their own emotions. This is a common problem for young children who haven't yet developed the ability to cope with big emotions in a constructive way. Some children continue to struggle with self-regulation as they get older. Parents and teachers may notice that they seem particularly sensitive and have outsized emotional reactions compared to their siblings or peers.

The good news is that self-regulation is a skill that can be taught like any other, and parents can play a big role in helping kids learn how to handle their emotions, even very big emotions. Here are some techniques for helping kids calm down instead of act out.

Developing emotional IQ

Taking the time to notice and label emotions helps kids begin to pay attention to how they are feeling. This is important because paying attention to our emotions is the first step to learning how to manage them. Sometimes just articulating an emotion helps to defuse it. Too often we try to pretend we aren't feeling negative emotions until it's too late and we are feeling terrible. Acknowledging a negative feeling can make it seem less powerful and helps you begin to think constructively about what to do with that feeling.

Parents can help teach children to do this by modeling it in their own behavior. For example, if you are upset because you forgot something at the grocery store, share that feeling: "I'm so frustrated right now! I forgot to get milk!" Then, after you've acknowledged how you feel, you can model coping and problem solving skills. You might say, "I'm going to take some deep breaths to calm down - that often helps me." Then once you're feeling better, you can say, "Now how can I solve this problem?" and brainstorm ideas.

Children will begin to pick up on the skills that you are modeling for them, but they might also need some extra support as they begin to learn how to deal with their emotions. If you notice your child is beginning to look upset, ask her to describe how she is feeling. Can she label it?

Just make sure if your child tells you that she's feeling sad, or anxious, or angry, you don't immediately try to talk her out of it. Sometimes hearing "Oh, it isn't that bad!" can make kids feel like their emotions are wrong and inadvertently teach them that they shouldn't share how they are feeling. Instead, you can validate the emotion ("Yes, that does sound frustrating" or "You do look disappointed") and then encourage healthy ways of dealing with that feeling.

Heading off big emotions

Another important part of a child learning to consciously label his emotions is that it encourages him to start paying attention to how he feels, which means that he might notice an emotion earlier, before it starts to feel overwhelming.

Parents can sometimes be blindsided by the strong emotions children show during tantrums. But kids don't go from calm to sobbing on the floor in an instant - even if it seems like that. Emotions build over time, like a wave. Kids can learn to manage those emotions that seem overwhelming by noticing and labeling them earlier, before that wave gets too big.

Many kids benefit from ranking how strong their emotions are on a scale of 1 to 10, with 1 being calm and 10 being furious. You can model doing this, too. When you are feeling frustrated because you forgot to get milk at the grocery store, you might announce that you're at a 4. It might feel silly to do this at first, but it teaches kids to pause and notice how they are feeling. For kids who appreciate visual aids, something like a "feelings thermometer" might help.

When to get help

Most children have occasional tantrums or meltdowns. Acting out when it's time to go to bed or stop playing a game is par for the course. But when kids are having tantrums often, or it seems like they can't control their temper a lot of the time, you may be seeing something more extreme than typical problem behavior.

Here are some signs to look out for:

When problem behavior is interfering with his ability to make friends or get along with other kids.

When problem behavior is causing a lot of conflict at home and disrupting family life

When your child feels like she can't control her anger, and it is making her feel bad about herself

When his behavior is causing trouble at school with his teachers or his fellow students

When her behavior is dangerous to herself or others

If you are worried about your child's behavior and are having a hard time managing it on your own, making an appointment with a clinician who has expertise in children's mental health can be very helpful. A clinician can perform a comprehensive evaluation to determine whether your child may have an undiagnosed mental health disorder that is contributing to her behavior issues, or recommend specific strategies or treatments that might be helpful.
For more information about how to find a clinician who can help, read the Child Mind Institute's Parents Guide to Getting Good Care.
Possible causes and diagnoses

Below is a list of some mental health disorders and other challenges that may be associated with disruptive behavior.

Attention-deficit hyperactivity disorder (ADHD)

Children with ADHD find it unusually difficult to concentrate on tasks, pay attention, sit still and control impulsive behavior. While disruptive behavior is not a symptom of ADHD itself, it is often the result of ADHD symptoms. Inattention and impulsivity can make it very difficult for kids to tolerate tasks that are repetitive, boring, or take a lot of effort. Because of this, children with ADHD are frequently overwhelmed with frustration, and throwing a shoe or pushing someone or yelling "shut up!" can be the result of their impulsivity. Some kids with ADHD can also develop negative behavior patterns, which are a response to years of finding themselves in conflict with adults.

Oppositional defiant disorder (ODD)

Children with ODD have a well-established pattern of behavior problems, with symptoms including arguing with authority figures, refusing to follow rules, blaming others for their mistakes, being unusually angry and irritable, and more. All children can have these symptoms from time to time. What distinguishes ODD from normal oppositional behavior is how severe it is, and how long it has been going on for.

Disruptive mood dysregulation disorder (DMDD)

Children with DMDD experience frequent, severe temper outbursts that seem grossly out of proportion to the situation at hand. In between tantrums they are chronically irritable. Their disruptive behavior is a result of their very big emotions and poor self-regulation skills. Children with DMDD often feel very apologetic after a tantrum is over.

Anxiety

Children who seem angry and defiant may be severely anxious. When children are having a hard time coping with situations that cause them distress, they may lash out. This may happen when the demands at home or school put a pressure on them that they can't handle. In an anxiety-inducing situation, your child's "fight or flight" instinct may take hold - she may have a tantrum or refuse to do something to avoid the source of acute fear.

Trauma

Children who have been traumatized frequently mask their pain with behavior that is aggressive. As a result of their trauma they may be struggling with poor emotional self-regulation, negative thinking, and be overly alert to dangers - and more likely to jump into their "fight or flight" response in an effort to protect themselves.

Learning problems

Children who act out repeatedly in school or during homework time may have an undiagnosed learning disorder. They may be feeling frustrated and ashamed because they are struggling to do things that look easy for other kids, and they don't know why. Rather than ask for help, they may rip up assignments or act out to create a diversion from their real issues.

Sensory processing issues

Some children have trouble processing the sensory information they are getting from the world around them. Children who are under- or over-sensitive to stimulation can often feel uncomfortable, anxious, distracted and overwhelmed, which can frequently lead to disruptive behavior.

Autism

Children on the autism spectrum tend to be rigid - needing consistent routine to feel safe - and unexpected changes can lead to them having a tantrum. Autistic children can also struggle with sensory issues that leave them feeling overwhelmed. Some autistic children may also lack the language and communication skills to express what they want or need.

Parent training programs

Parent training programs are designed to bolster the skills parents may need for managing a child's problem behavior and improve the parent-child relationship. These programs are led by psychologists and social workers and are evidence-based, which means they have been thoroughly tested and found to be effective for many families.

Below is a list of different kinds of parent training, including what makes them different and which families they may work best for.

Parent-Child Interaction Therapy (PCIT)

Parents and children both participate in PCIT sessions, during which a clinician teaches them skills to interact in a positive, productive way. It is effective for kids between the ages of 2 and 7, and usually requires 14 to 17 weekly sessions.

In PCIT, parents receive live coaching (via a bug in the ear) from a therapist who watches from behind a one-way mirror as they and their child perform a series of tasks, and parents practice specific responses to both desired and undesired behavior.

Parent Management Training (PMT)

In PMT, which is for children ages 3 to 13, parents are usually seen without the child present, although children may be asked to participate in some sessions. Skills to deal more effectively with challenging behaviors are taught and modeled by the therapist and then role-played with parents. After each session, parents are expected to practice the skills at home. Families usually participate in at least 10 sessions.

Since PMT is appropriate for all ages, it's a good choice when kids are too old for PCIT. It can also be a good option for families where the parent-child relationship is strong, but children might be struggling with things like anxiety, extreme impulsiveness or explosive anger.

Defiant Teens

Defiant Teens is for parents of teenagers who are 13-18 years old. The first half of this program involves only parents, and focuses on teaching more effective tools for interacting with their teenager, specifically for handling noncompliance or defiant behavior. But since teenagers are more autonomous than younger children and less influenced by their parents' guidance, the program also includes training for the adolescent to help him become a participant in changing the family dynamic.

In the second half, parents and teenagers are both trained in problem-solving communication. The aim is to provide family behavioral resources to help each family member develop more effective problem-solving, negotiation and communication skills and to correct any unreasonable beliefs that might be impeding their interactions.

Positive Parenting Program (Triple P)

Triple P's focus is on equipping parents with information and skills to increase confidence and self-sufficiency in managing child behavior. It can be utilized with a wide age range of children from toddlerhood through adolescence. With Triple P families can participate in different levels of intervention according to their needs. In some sessions clinicians will meet one-on-one with parents to discuss skills and strategies, and in some sessions kids with be included and the therapist will be provide live coaching.

The Incredible Years

The Incredible Years offers small-group-based training for parents of kids from infants through age 12. The programs are broken into four age groups (baby, toddler, preschool and school age) and they range from 12 to 20 weeks.

The program starts with a focus on improving parent-child relationships and positive attachment before moving on to consistent routines, rules and limit-setting. Finally it covers child management strategies such as ignoring, redirection, logical and natural consequences, time to calm down and problem-solving.

For children from four to eight years old, Incredible Years offers children's groups that focus on helping them acquire emotion regulation strategies and social skills. Research shows that the kids' group works well at improving pro-social behavior and decreasing problem behaviors. Parents find that they learn not only from therapists but from other fellow parents in the group.

Medication

Parent training and behavior therapy are considered a more effecting and longer lasting way to help children learn to manage their difficult emotions and rein in disruptive behavior. But medications are sometimes used as an adjunct to behavioral therapy. Anti-psychotic medications like Abilify (aripiprazole) and Risperdal (risperdone), which have been shown to reduce aggression and irritability, may be used in cases where a child is at risk of being removed from the school or home. Stimulant medication may be used if a child has excessive impulsivity, including those who have an ADHD diagnosis. Antidepressants (SSRIs) may be helpful if a child has underlying depression or anxiety.

It is important to talk with your doctor about any concerns you may have about your child's treatment plan, progress or any side effects that you may be seeing. A good clinician will be ready to discuss the symptoms you are seeing and explain potential options for changing dosage or medication. If you don't feel that your child's doctor is taking your concerns seriously, or your doctor is not following best practices for changing dosage, or adding new medications, you should get a second opinion.

If you believe your child should stop taking a particular medication, make sure you tell your doctor, and discuss the pros and cons. Don't make adjustments or withdraw the medication without consultation. Many medications should be reduced gradually, and children should be monitored for side effects of withdrawing too quickly.

Note about Risperdal

Risperdal can have serious side effects, including substantial weight gain and metabolic, neurological and hormonal changes that can be harmful. Children taking Risperdal or another atypical antipsychotic should be monitored by their doctors regularly over the course of treatment. Before treatment begins, they should be tested to establish baselines for height, weight, vital signs and levels of prolactin and blood fats and sugar. During the first few months of treatment, a child's levels should be measured frequently. If the child is using the medication long-term, he should continue to be monitored on a yearly basis.

Behavior Issues in School

For kids who struggle with their behavior in the classroom, establishing some school-specific behavior management strategies is important.

The first step is often asking the school to provide a functional behavior assessment. The goal of an FBA is to gather more information about when and why your child is acting out in class. This information is then used to come up with a plan for how to help. A school psychologist or behavioral specialist typically leads the FBA, and may speak to you, your child's teachers and your child as part of the assessment, as well as do some in-class observation.

Determining which specific things that your child struggles with is important. Just like in behavior management at home, it helps to get as much information as possible about the real-life situations that seem to lead to disruptive behavior, paying attention to what happens immediately before, during and after the behavior. Paying attention to when your child isn't acting out can also be informative.

Once this information has been gathered and analyzed, the school psychologist or behavioral specialist can work on creating a behavior intervention plan (or BIP) with ideas for preventing problem behaviors and rewarding positive behavior. This may include different teaching strategies, different consequences for misbehavior or changes to typical routines. Checking in periodically to monitor the effectiveness of these strategies (and make updates accordingly) is important.

How parents can support school behavior goals at home

Parents can also play a role in helping reinforce good behavior at school. You might tell your child's teacher that you want to be a partner in helping improve your child's behavior and select one or two goals at a time to work on, like turning in homework and not calling out in class, for example. Then you can ask the teacher to give you periodic reports on your child's progress. You don't want to overwhelm the teacher, but if you get a progress report every few days or every week then you can help reinforce the school's goals by either rewarding good school behavior at home or setting up appropriate consequences.

For example, if you hear that your child is doing a good job turning in his assignments, you might give him some extra screen time that weekend in recognition of his efforts. If he's doing a particularly good job then you might give him a bigger reward, like an outing to his favorite restaurant. Conversely, if you get a report that he isn't doing his homework, you might let him know that he won't get any screen time for the first two days of the upcoming week because he needs to prioritize homework.

For more information about working with schools on behavior issues, see our recommended reading list in the next section.

This guide was last reviewed or updated on August 3, 2023.

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When children struggle with their behavior, it can have a negative impact on everyone in the family. Parents know they need to respond, but they often aren't sure what's the best strategy, especially if a child is frequently acting out and nothing seems to work. This guide offers parents a comprehensive look at problem behavior.

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Is there a link between stammering, tics and Tourette Syndrome? Read our guide and learn how to get help if you’re worried.

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Tics are sudden, quick movements or sounds that you do repeatedly and involuntarily. Learn more about what they are and types of tic disorders.

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Children & Young People’s Mental Health Coalition

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Home | ADD-vance - The ADHD & Autism Trust, Hertfordshire

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ADD-vance is a Hertfordshire based charity that supports families affected by ADHD, Autism or a related condition and the professionals who support them.

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Angels supports families of children with Autistic Spectrum Condition and/or ADHD. We were formed by, and are led by, parents whose children face similar challenges.
Angels is an experience-led charity, based in Hertfordshire, which provides individualised, professional expertise and advice. We work alongside parents to build understanding and to empower them to hear their child's voice. Our key aim is to maximise the individual potential of each child and young person.

Group meetings, workshops and individual support for parents/ carers

Find support

Share ideas, experiences and concerns

Reduce isolation

Help your child reach their potential

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WELCOME TOANGELS SUPPORT GROUPAngels supports families of children with Autistic Spectrum Condition and/or ADHD. We were formed by, and are led by, parents whose children face similar challenges.Angels is an experience-led charity, based in Hertfordshire, which provides individualised, professional expertise and advice.

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Supporting a family member, friend or neighbour who has health needs can be rewarding but also comes with challenges. You may need help finding services, you may need a break, or you may just need a…

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Families in Focus is a Hertfordshire-based community interest company, which provides training information and therapeutic and emotional support to parents.

Parent courses

Our parenting courses and workshops are available for ALL parents of children aged two to 11 years and include a range of topics to help support and inform parents, such as sleep solutions, managing anger in your family, and the complete guide to parenting.

SEND support

We offer support for parents living with children with special educational needs and disabilities, autism, ADHD and all neuro-diverse conditions, inclusive of those awaiting assessment or diagnosis. Sign up to courses, workshops, and Parent Network SEND support and information groups.

"I wanted to send you a personal message to thank you for the course you just ran on parenting children with SEND. I have found it immeasurably helpful and feel so grateful and lucky to have been able to attend it. You are both so knowledgeable and supportive."

Parent attendee from Complete Guide to Parenting Children with SEND course

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Families in Focus - Looking forward together

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Families in Focus is a Hertfordshire-based community interest company, which provides training information and therapeutic and emotional support to parents. Our parenting courses and workshops are available for ALL parents of children aged two to 11 years and include a range of topics to help support and inform parents, such as sleep solutions, managing anger in your family, and the complete guide to parenting.

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Potential Kids - learning, social and sports opportunities

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Potential Kids - learning, social and sports opportunities

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Welcome to Potential Kids Potential Kids is an award winning charity based in Welwyn/Hatfield which provides learning, social and sports opportunities to Neurodivergent children / young people (Autism, ADHD, Dyslexia, Dyspraxia, Tourette Syndrome amongst other conditions). Explore our activities Our Vision To nurture and embrace neurodiversity, whilst supporting our community to reach their potential. Our ... Read more

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SPACE supports families of children and young people who are autistic, have ADHD or other neurodiverse conditions. No diagnosis is necessary.

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SPACE for Neurodiversity

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Children and Young People’s Mental Health Services (CYPMHS)

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Specialist Children and Young People’s (CYP) mental health services are delivered across the whole of Hertfordshire. These services were previously known as Child and Adolescent mental health services (CAMHS).

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Click one of the sections below:

Triage and Assessment

"Is there a waiting list to be seen by PALMS?"

Unfortunately, there is a wait to receive assessment and intervention from PALMS.

When the referral has been accepted by PALMS, the family will be offered an initial assessment Appointment (IAA). The purpose of the IAA is to consider the needs of the child and family, the related goals and to ensure PALMS is an appropriate service to support the current needs. In addition, other services are identified when some of the needs cannot be met within the remit of PALMS.

Following the IAA, a pathway is agreed with the family and if PALMS is an appropriate service the intervention(s) will be explained. Family and professionals can contact PALMS directly if there are any concerns and/or changes in need that they would like to discuss prior to the intervention beginning.

"Do children need to have a diagnosis before they can be referred to PALMS?"

PALMS offers intervention to children who have a diagnosis of moderate to severe learning disability and / or autism which has a moderate to severe impact on cognitive functioning who meet the criteria for the remit of the service, PALMS also accept referrals for children who are waiting for an autism assessment where it is highly likely that the diagnosis of autism will be confirmed and they meet the criteria for the remit of PALMS.

"Will PALMS meet my child at the Initial Assessment Appointment (IAA)?"

The first appointment is called the Initial Assessment Appointment (IAA).

We appreciate that some appointments can be difficult for children and young people and that you may wish to have sensitive conversations about the concerns at home. We would like to meet both yourself and your child at the initial assessment and will work with you to ensure that this experience is as positive as possible. If you anticipate that attending the initial assessment will cause significant stress or upset for your child/young person, please contact our team to discuss the options. You can also contact us to let us know in advance if there are any adjustments that may be helpful.

"Do PALMS contact the family when their referral has been accepted?"

Once a referral is accepted by PALMS, the family, referrer and GP (if not the referrer) will receive a letter advising of the next steps.

If the referral is not accepted, a letter will be sent to the referrer to explain why this referral was not accepted. The family are always sent a copy of this letter. Signposting to alternative services and support are included in this letter so that more appropriate services can be accessed without delay.

If the referral is not accepted and the family have additional information that they understand would indicate that PALMS is an appropriate service, they are very welcome to contact us directly to provide this information.

If you believe that you have been referred to PALMS but have not received any correspondence from us, please talk to the referrer initially to ensure that this referral has been made. If they confirm it has then please contact PALMS.

"What happens at the IAA?"

During this assessment, the clinician(s) will aim to gather an in depth understanding of what would be most beneficial to support your child and your input will be invaluable to this process. This includes: identifying the goals from accessing PALMS; ensuring PALMS is the most appropriate service to support these goals; discussing what intervention looks like and will require from the family; and, identifying any alternative signposting.

Following the IAA you will receive a summary letter that will set out the care plan and explain what the suggested pathway is for your child. This intervention plan will be continually reviewed with you by your allocated PALMS' clinician.

"Do PALMS prescribe medication?"

As a service, PALMS are committed to reducing the usage of medication prescribed to children and young people with a learning disability, autism, or both. This commitment is in line with the STOMP and STAMP initiatives which have been developed by NHS England.

Whilst there may be times when medication is a useful intervention to support a child, in line with best practice guidelines other therapeutic interventions are always provided first with the aim that medication is not needed. If medication is required, the prescriber will work hard to ensure that this is prescribed for the minimum duration necessary.

PALMS do not provide medication as a sole intervention.

"Do I need to access PALMS before I can have input from social care?"

No. A referral can be made to social care at any time, without having input from PALMS.

"Do PALMS assess and prescribe medication for ADHD?"

PALMS do not assess for or provide medication for ADHD.

If your child requires an assessment for ADHD, you should speak to your child's paediatrician or see your GP in the first instance. They will be able to refer you to the correct service within Hertfordshire.

"Do PALMS only see children who are in crisis?"

PALMS is not a crisis service. However, PALMS have an Intensive Intervention Team who provide Intensive Intervention and Priority Assessments (within 5 working days) as part of the Hertfordshire joint crisis offer.

Please do not contact us in an emergency. This may delay you receiving the help that is needed.
Please contact 999 or take your child/ young person to A&E if you do not believe that the situation can be safely managed. The Hertfordshire Mental Health Helpline is also available 24/7 on 0800 6444 101 or by contacting 111 and selecting option 2. Hertfordshire Social Care can be contacted by dialling 0300 123 4043 24/7.
"How can I contact PALMS?"

PALMS principally operates between 07.00-19.00 Monday to Friday.

Our administration team are available 08.30-17.30 Monday to Friday

Please contact us on: 01727 582122 or via email: hct.palms@nhs.net

We will respond to your query within 5 working days.

Intervention

"Will I have to attend a PALMS' intervention group before receiving an intervention?"

PALMS provides different intervention pathways to support the child and their families. This includes intervention groups which are an effective and evidence based intervention.

Each pathway aims to offer an individualised plan that is suitable to the needs of the child. Parents/carers do not have to attend an intervention group unless it is assessed as being an appropriate intervention. Intervention groups are stand alone and evidence based and it is anticipated that no further interventions are required following attendance at an intervention group.

"Are the intervention groups offered by PALMS parenting courses?"

The intervention groups offered by PALMS are direct interventions and not parenting courses though most often, our intervention groups are attended by parents. PALMS' intervention groups do not focus on 'parenting' though parents/carers do learn strategies that will enable the intervention and support the whole family.

Currently, three intervention groups are provided. These are: Feeding Intervention Group, Positive Behaviour Support (PBS) Intervention Group, and Sleep Intervention Group.

"What can I expect from the intervention group that PALMS has offered me?"

Through the group intervention process families will be allocated two clinicians who will develop an individualised bespoke intervention plan in collaboration with families for each child. This plan is implemented at home; supported by the clinicians who will provide both follow up telephone calls and outreach sessions.

PALMS always view families as the experts on their child. By meeting in a small group forum (no more than 8 families), families have the opportunity to share and hear from others who are facing similar challenges alongside working collaboratively with PALMS' clinicians.

"Will PALMS work with my child's school?"

PALMS recognises the importance of a whole system approach when supporting a child. Whilst it is recognised that Education is an important part of every child's life that can significantly impact on well-being, PALMS are not commissioned to work in or for schools. However, we believe it is essential to work collaboratively with schools, teachers and SEND professionals to share ideas, understanding and strategies to support the child successfully in this environment. We are also required to contribute to SEND processes such as Education, Health Care Plans (EHCP's) if this is relevant to your child.

"Is PALMS a 'behaviour' service?"

PALMS provide intervention for children who have a diagnosis of moderate to severe learning disability and/or autism which has a of moderate to severe impact on cognitive functioning. PALMS is one of the CYP Mental Health services in Hertfordshire who provide intervention at the getting more help level for a variety of emotional, behavioural, and mental health difficulties.

Scan the QR code for PALMS Criteria:

"Will PALMS work with other services who are supporting my child?"

PALMS provides evidence based practice and therefore joint and collaborative working with children, their families, other professionals, agencies, and organisations is essential. Working collaboratively with the network surrounding a child provides opportunities for sharing knowledge, experiences, and expertise to achieve the best outcomes for the child.

"My allocated clinician from another service referred me for a specific intervention e.g. Psychiatry, why am I not receiving this intervention?"

Professional input and intervention pathways are allocated according to the clinical needs of the child following assessment by the PALMS multi-disciplinary team. PALMS provides different intervention pathways to support the child's clinical needs. Their intervention plan will be continually reviewed with you by your allocated PALMS' clinician.

Intervention: Groups and pathways

"Do PALMS offer individual work to children/young people?"

PALMS offer individual work with children/young people based on their clinical needs. PALMS also work with parents/carers, the wider family and supporting professionals.

"Do PALMS offer a 'Parent as Therapist' model of intervention?"

The 'Parent as Therapist' model is one of the evidence based approaches implemented by PALMS. The evidence for this approach highlights the importance of primarily working with systems supporting children who have Autism Spectrum Disorder and/or a Learning Disability rather than solely provide individual intervention with the child. This approach recognises the huge amount of knowledge that parents/ carers hold about their children, the knowledge and skills professionals hold, and how both contributions play a key role in the success and sustainability of all interventions we provide.

To support any intervention, even when working directly with a child, PALMS requires parents/carers and families to develop understanding, skills and strategies, to ensure the success and sustainability of the intervention.

Does PALMS offer virtual appointments?

Yes, PALMS provide virtual video appointments when this is clinically appropriate. As part of the intervention the clinician and family develop a contract to understand what the intervention will look like going forward, a discussion regarding the remit and appropriateness of virtual appointments is had as part of this.

PALMS provide face to face sessions in a variety of community environments, such as clinic, home or school.

Will I see a Psychiatrist in PALMS?

As with all professionals within PALMS, Psychiatry input is allocated according to the clinical needs of the child following assessment by the multi-disciplinary team. If you think that psychiatry support would be beneficial to your child this should be discussed with your PALMS' clinician in the first instance.

As a service, PALMS are committed to reducing the usage of medication prescribed to children and young people with a learning disability, autism, or both. This commitment is in line with the STOMP and STAMP initiatives which have been developed by NHS England (NHSE).

Whilst there may be times when medication is a useful intervention to support a child, in line with best practice guidelines other therapeutic interventions are always provided first with the aim that medication is not needed. If medication is required, the prescriber will work hard to ensure that this is prescribed for the minimum duration necessary.

PALMS does not provide medication/psychiatry as a sole intervention.

Discharge, transitions and signposting

"Is PALMS the only service who support children with Autism/Learning Disability?"

PALMS is one of the many services in Hertfordshire that support children with Autism/ Learning Disabilities. PALMS works collaboratively with these services to ensure that the most appropriate service(s) are accessible when it is needed.

If you need to discuss PALMS' criteria before making a referral, please contact PALMS directly on: 01727 582122.

For most up to date information on where you can access other local services, please scan QR code:

Website (Local offer): https://www.hertfordshire.gov.uk/microsites/Local-Offer/The-Hertfordshire-Local-Offer.aspx

Hertfordshire County Council: 0300 123 4043 or https://www.hertfordshire.gov.uk

"Can my child be re-referred to PALMS if we've been discharged?"

We know that it is possible that needs change as children develop, and therefore PALMS do accept re-referrals for those concerns that are within the remit of PALMS.

"Is PALMS a long-term service who will be involved until my child turns 18?"

PALMS is not a long-term service. We understand that our CYP have lifelong needs, however we offer targeted interventions based on a child's specific needs and goals at the time of assessment. From the point of being accepted into PALMS, we will be working towards discharge. PALMS interventions are evidence based, goal focussed and time-bound. Our aim is to empower families to continue independently with the sustainable ideas and interventions developed during your time with PALMS.

A typical journey through PALMS can look like this:

Families are offered an initial assessment where goals are discussed and agreed, an outline of what is required of families to access PALMS is provided and to ensure PALMS is the most appropriate service.

Families are offered an intervention in line with the goals that are within the service remit.

Goals will be reviewed throughout the intervention to work toward discharge.

Discharge can be agreed for a number of reasons, including:

Progress on goals

Agreement that this is not the right time for intervention

A number of sessions have been missed by the child or family in accordance with the Do Not Attend (DNA) and cancellation policy.

Another service has been identified as being more appropriate to offer the required intervention.

Transition to adult services.

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Click one of the sections below: "Is there a waiting list to be seen by PALMS?" Unfortunately, there is a wait to receive assessment and intervention from PALMS. When the referral has been accepted by PALMS, the family will be offered an initial assessment Appointment (IAA).

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Working together with your child’s school - A guide for parents and carers

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Working together with your child’s school - A guide for parents and carers

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Many parents tell us they’re not always confident in dealing with challenging aspects of their 4-8 year old’s behaviour, so here’s our guide to help with this.

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Advice, guidance and useful resources about autism and anxiety.