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Child Mental Health Support |Bridge the Gap| Derby England | Emotional Literacy

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A C.I.C supporting child mental health & family wellbeing, online and locally in Derby. We support the mental health of chiildren, parents and teachers. Our services and support are accessible and proactive. Friendly, supportive community and team. Early Intervention - Never judged, always heard.

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Jan Bond, Health and well-being programme manager (towerhamlets.gov.uk)

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What are ACEs? - Help Children Live Better

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Adverse Childhood Experiences (ACEs) are stressful events occurring in childhood. They can include violence, parental abandonment through separation, and abuse.

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Our vision is to provide appropriate training for schools,communities and organisations so that they become trauma informed and mentally healthy places for all.

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Adverse Childhood Experiences (ACEs) Training

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Gain a deep understanding of ACEs and their lifelong effects, while learning trauma-informed interventions to help those affected.

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Your actions could make the difference for a child between a future of happiness and a future of chaos, says Lorraine Jenkin...
Most people feel anecdotally that people who have had a tough childhood tend to have a tough adulthood: things that happen to us as children shape us - positively and negatively - and affect our future choices and behaviours.

However, it is only recently being appreciated how tight the correlation is between the number of Adverse Childhood Experiences (ACEs) and the health and wellbeing of adults.

What are ACEs?

ACEs are listed as children experiencing physical, sexual or emotional abuse, or growing up in a household in which there is alcohol or drug abuse, mental illness, criminality (particularly incarceration), domestic violence or parental separation.

Each one of these things is counted as a single ACE. Some children will obviously have multiple ACEs.

Certain levels - and periods - of stress are considered to be normal and indeed good for us. They teach children to cope with uncomfortable situations and build long-term resilience. However, extreme or prolonged stress changes a child at a cellular level.

Constant heightened awareness raises cortisol and adrenaline and so body chemistry becomes different compared to a child who has the occasional isolated incident to contend with.

The original ACEs research (at Kaiser Permanente, 1995-97) recognised this and found that adults who have four or more ACEs are much more likely to have poor adult health - debilitating conditions such as cancer, heart disease or diabetes.

Those with six or more ACEs have life expectancies 20 years less than their peers with none.

They are also less likely to be able to cope with everyday life without resorting to activities that inflicted the ACEs on them in the first instance: substance abuse, violence, criminality, domestic abuse, mental illness and abusive behaviours, thus continuing the cycle for their own families.

The correlation is so strong that the government is seeking to not only tackle the ACEs happening in the first place, but also educate professionals who work with children to spot those suffering and seek assistance for them - both to buffer against the ACEs and build resilience within them.

This will be multifaceted: health visitors, early years practitioners and teachers, police, fire fighters, doctors and nurses.

If you consider that the death of a woman through domestic abuse costs the government £1.8 million (Home Office statistics), then you can see the financial (let alone moral) worth of investing to prevent it.

Professional support

As professionals who work with children, you will be aware of your requirements to report to social services instances of abuse, for example.

However, many children's problems are long-running and would not necessarily be considered a reportable offence: having a parent with a mental illness, would not (necessarily) be considered a dangerous situation for a child.

However, couple that with the other parent not coping and so self-medicating with prescription pills, and endless abusive arguments between the parents that eventually ends in parental separation, and suddenly you have a child with four ACEs.

These problems are compounded for the child due to the chaos that often surrounds such behaviours: the family budget spent on alcohol rather than food, an over-medicated parent slumped on the sofa instead of reading stories for bedtime, neglect regarding the washing of clothes and bodies, and certainly no energy left for introducing exciting vegetable dishes.

A child could very quickly feel isolated or shunned by peers and so the problems are multiplied.

Constantly alert to danger, a child (and then adult) loses the ability to rationalise the severity of the threat, and so everything can be seen as a problem needing a serious reaction: this makes a child unpopular and someone to be avoided.

Fortunately, there are actions that can buffer a child against the impact of ACEs and build resilience within them. Children who have many interests outside of the home (if it is the home that is affecting them) can lessen the consequences of their ACEs.

It's not only that time spent away from the source of pain and fear lessens the occurrence, but the mind being occupied with pleasurable things can allow the brain respite from the adrenaline and cortisol, and so lessen the cellular changes.

If a child can have at least one available adult who is 'on their side', then they can weather the storm much better.

Therefore, even if there are problems within the home, if at least one parent is maintaining structures, continuity and support, then the impact of ACEs can be reduced.

Some children, sadly, won't have this and their home is a place of fear or chaos. That means that their supportive adults in, for example, their nursery or school, become even more crucial.

What you can do

Assign the identified children a stable key person, rather than likely shorter-term placements. Persist in encouraging and giving the skills for friendships - for those children, no one else may be doing this.

Children with high numbers of ACEs need to be independent much more than their peers will. Singing or engaging in crafts lifts the soul and the ability to spend hours with mates kicking a football around will provide a place for that child to go, so start it young.

Educate parents about ACEs if you can: hand out leaflets from health visitors and be more urgent with the stable relatives of the children who might be suffering.

If Granny understands that the role she needs to play is far greater than expected, then she can be the buffer between the child and the ACEs and make the difference to not only her grandchild, but her future generations.

Alert health visitors if confidentiality allows it, or urge the stable adult to do so. For those children moving up to school, inform teachers of their ACE scores to ensure no break in pressure to build resilience and to get help.

Working with children is always an important job, but for those children who have four or more ACEs, your actions could be making the difference between a future of happiness and a future of chaos.
Lorraine Jenkin is an author who has been involved in childcare for several years.

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How to support children with ACEs in early years settings | A Unique Child | Teach Early Years

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Your actions could make the difference for a child between a future of happiness and a future of chaos, says Lorraine Jenkin... Most people feel anecdotally that people who have had a tough childhood tend to have a tough adulthood: things that happen to us as children shape us - positively and negatively - and affect our future choices and behaviours.

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Childhood Trauma and the Brain animation and accompanying educational materials for professionals and carers supporting children and young people.

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The ADHD Foundation Neurodiversity Charity - an integrated health and education service.

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What Is ADHD? Symptoms & Meaning

ADHD stands for attention deficit hyperactivity disorder, a complex brain disorder that impacts approximately 11% of children and almost 5% of adults in the U.S. ADHD is a developmental impairment of the brain's executive functions. People with ADHD have trouble with impulse-control, focusing, and organization.

Neuroscience, brain imaging, and clinical research tell us a few important things: ADHD is not a behavior disorder. ADHD is not a mental illness. ADHD is not a specific learning disability. ADHD is, instead, a developmental impairment of the brain's self-management system. Both adults and children can be diagnosed with ADHD.

ADHD Symptoms

What are the signs of being ADHD? Common ADHD symptoms include:

ADHD symptoms vary by individual. You or your child may experience all or just some of the above symptoms, along with others detailed in the DSM-V.
[ADHD Directory: Find an ADHD Specialist or Clinic Near You]
Many patients and clinicians describe ADHD as an iceberg, where most symptoms lay hiding under the surface - out of sight but ever present. If you think you or a loved one might have ADHD, take one of our free, anonymous tests below to see if you should seek a formal diagnosis.

What Are the 3 Types of ADHD?

The Diagnostic and Statistical Manual of Mental Disorders (DSM) previously identified three types of ADHD:

Primarily hyperactive-impulsive type

Primarily inattentive type (formerly called ADD)

Primarily combined type

Primarily Hyperactive-Impulsive ADHD

People with primarily hyperactive-impulsive ADHD act "as if driven by a motor" with little impulse control - moving, squirming, and talking at even the most inappropriate times. They are impulsive, impatient, and interrupt others.

Primarily Inattentive ADHD (Formerly ADD)

People with the inattentive subtype of ADHD have difficulty focusing, finishing tasks, and following instructions. They are easily distracted and forgetful. They may be daydreamers who lose track of homework, cell phones, and conversations with regularity.

Experts believe that many children with the inattentive subtype of ADHD may go undiagnosed because they do not tend to disrupt the learning environment.
[Free Download: An In-Depth Guide to Inattentive ADHD]
Primarily Combined Type ADHD

Individuals with combined-type ADHD display a mixture of all the symptoms outlined above. A physician will diagnose patients with this Combined Type ADHD, of they meet the guidelines for Primarily Inattentive ADHD and Primarily Hyperactive-Impulsive ADHD. That is, they must exhibit 6 of the 9 symptoms identified for each sub-type.

How Do Physicians Diagnose the Type of ADHD?

These subtypes are now considered "presentations" in the most recent version of the DSM, the DSM-V. Researchers determined that people often move from one subtype to another. For example, a child may present as primarily hyperactive-impulsive in preschool, and lose much of the hyperarousal in adolescence to fit the primarily inattentive presentation. In college and adulthood, the same individual may transition to combined presentation.

The subtypes were primarily based on overt behavioral symptoms, and ignored less visible symptoms like emotional dysregulation, cognitive patterns, and sleep difficulties. Behavioral symptoms imperfectly capture the defining features of ADHD. Non-behavioral characteristics are increasingly recognized in research and diagnosis.

What Are the Symptoms of Each ADHD Subtype?

The symptoms of ADHD are spelled out in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), which lists nine symptoms that suggest ADHD-Primarily Inattentive and nine that suggest ADHD-Primarily Hyperactive/Impulsive. A child may be diagnosed with ADHD only if he or she exhibits at least six of nine symptoms from one of the lists below, and if the symptoms have been noticeable for at least six months in two or more settings - for example, at home and at school. What's more, the symptoms must interfere with the child's functioning or development, and at least some of the symptoms must have been apparent before age 12. Older teens and adults may need to consistently demonstrate just five of these symptoms in multiple settings.
What Are the 9 Symptoms of ADHD - Primarily Inattentive Type?

Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or during other activities (e.g., overlooks or misses details, work is inaccurate).

Often has difficulty sustaining attention in tasks or play activities (e.g., has difficulty remaining focused during lectures, conversations, or lengthy reading).

Often does not seem to listen when spoken to directly (e.g., mind seems elsewhere, even in the absence of any obvious distraction).

Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (e.g., starts tasks but quickly loses focus and is easily sidetracked).

Often has difficulty organizing tasks and activities (e.g., difficulty managing sequential tasks; difficulty keeping materials and belongings in order; messy, disorganized work; has poor time management; fails to meet deadlines).

Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (e.g., schoolwork or homework; for older adolescents and adults, preparing reports, completing forms, reviewing lengthy papers).

Often loses things necessary for tasks or activities (e.g., school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile telephones).

Is often easily distracted by extraneous stimuli (for older adolescents and adults, may include unrelated thoughts).

Is often forgetful in daily activities (e.g., doing chores, running errands; for older adolescents and adults, returning calls, paying bills, keeping appointments)

Take the Self-Test: Symptoms of Inattentive ADHD in Children

Take the Self-Test: Symptoms of Inattentive ADHD in Adults

What Are the 9 Symptoms of ADHD - Primarily Hyperactive-Impulsive Type?

Often fidgets with or taps hands or feet or squirms in seat.

Often leaves seat in situations when remaining seated is expected (e.g., leaves his or her place in the classroom, in the office or other workplace, or in other situations that require remaining in place).

Often runs about or climbs in situations where it is inappropriate. (Note: In adolescents or adults, may be limited to feeling restless.)

Often unable to play or engage in leisure activities quietly.

Is often "on the go," acting as if "driven by a motor" (e.g., is unable to be or uncomfortable being still for extended time, as in restaurants, meetings; may be experienced by others as being restless or difficult to keep up with).

Often talks excessively.

Often blurts out an answer before a question has been completed (e.g., completes people's sentences; cannot wait for turn in conversation).

Often has difficulty waiting his or her turn (e.g., while waiting in line).

Often interrupts or intrudes on others (e.g., butts into conversations, games, or activities; may start using other people's things without asking or receiving permission; for adolescents and adults, may intrude into or take over what others are doing)."

Take the Self-Test: Symptoms of Hyperactive & Impulsive ADHD in Children

Take the Self-Test: Symptoms of Hyperactive & Impulsive ADHD in Adults

What Causes ADHD?

The causes of ADHD remain somewhat unclear. Research suggests that genetics and heredity play a large part in determining who gets ADHD. However, scientists are still investigating whether certain genes, especially ones linked to the neurotransmitter dopamine, play a defined role in developing ADHD.

Additional research suggests that exposure to certain chemicals may increase a child's risk of having ADHD.

ADHD is not caused by bad parenting, too much sugar, or too many video games. ADHD is a brain-based, biological disorder. Brain imaging studies and other research show many physiological differences in the brains of individuals with ADHD.

How is ADHD Diagnosed?

There is no single test for ADHD. To make a diagnosis, your doctor will assess for any ADHD symptoms exhibited by you or your child in the past six months. They will also do a physical exam and review your medical history to rule out any other medical or psychiatric conditions that could be causing symptoms.

Your doctor or specialists will perform an assessment using the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), which details the symptoms listed above.

ADHD Diagnosis in Children

A child may be diagnosed with ADHD only if he or she exhibits at least six of nine symptoms outlined in DSM-V, and if the symptoms have been noticeable for at least six months in two or more settings - for example, at home and at school. What's more, the symptoms must interfere with the child's functioning or development, and at least some of the symptoms must have been apparent before age 12. Most children with ADHD receive a diagnosis in elementary school.

When diagnosing a child, your doctor or specialist may also review school records and questionnaires completed by your child's teacher and/or caretakers. They will likely talk with and observe your child, as well as conduct screening for learning disabilities. They will also rule out other conditions that share similar symptoms to ADHD.

ADHD Diagnosis in Adults

Older teens and adults may need to consistently demonstrate just five of these symptoms in multiple settings. For an adolescent or adult to receive a diagnosis of ADHD, the symptoms need to have been present before the age of 12. Symptoms must also not be better explained by another disorder.

ADHD in Children

According to the Centers for Disease Control and Prevention, 1 in 10 children between the age of 5 and 17 receive an ADHD diagnosis, making ADHD one of the most common childhood neurodevelopmental disorders in the U.S.

The symptoms of ADHD are often identified at school, as many children with ADHD have difficulty succeeding in a classroom setting. While teachers cannot diagnose ADHD, they are often the first to suspect ADHD in children as the symptoms typically affect school performance or disrupt the rest of the class.

Many symptoms of ADHD can be typical childhood behaviors, so it can be difficult to know if a child is displaying ADHD symptoms. Children with primarily hyperactive-impulsive ADHD may initially be seen as disruptive or misbehaving, as they are often hyper, impulsive, and impatient, and may interrupt at inappropriate times.

Boys are more than twice as likely as girls to receive an ADHD diagnosis, in part because ADHD is still wrongly considered a male disorder and because boys are more likely than girls to exhibit outward signs of hyperactivity.

Adult ADHD

ADHD is diagnosed in roughy 4.4% of the adult population in the U.S., although this figure is thought to be underreported, as up to 85% of children with ADHD are at risk for having the disorder as adults, and only 10.9% of adults with ADHD receive treatment.

Untreated ADHD in adults can negatively impact many aspects of life, including work, relationships, and mental health. Symptoms such as trouble managing time, impatience, disorganization, forgetfulness, and mood swings can all cause problems for an individual not actively taking steps to manage their ADHD.

Adult ADHD seldom exists alone. Roughly 60% to 70% of adults with ADHD have a comorbid disorder , such as anxiety, mood disorder, or substance abuse. If you suspect you may have adult ADHD, consult with your doctor or mental health professional about diagnosis and treatment so you can improve your well-being and quality of life.

ADHD Treatment

The best treatment strategies for ADHD are multimodal ones - combinations of several different, complementary approaches that work together to reduce symptoms. For one person, this ideal combination may include ADHD medication, nutrition, exercise, and behavioral therapy. For another, it may mean taking ADHD supplements and vitamins, practicing mindfulness, and spending lots of time outdoors in nature. More and more, pediatric and adult patients are pairing stimulant medication with digital therapies like EndeavorRx, which is available by prescription for patients age 8 to 12, or pinpointed apps like EndeavorOTC, a new mobile video game designed to improve focus in adults with ADHD.

Finding the right ADHD treatments - and managing them - takes research, planning, organization, and persistence. Early on, talk with your child's doctor about your options.

ADHD Medication

For children aged 6 and over or adults, medication may be an important part of the treatment plan. Finding the right medication to manage ADHD typically involves some trial and error but can lead to a significant reduction in symptoms.

The two main types of medication used to treat ADHD are stimulants and non-stimulants.

Central nervous system (CNS) stimulants, like Ritalin or Adderall, are the most prescribed ADHD medications. These ADHD medications work by increasing the amounts of the chemicals dopamine and norepinephrine in the brain, which help with focus. There are three categories of stimulant medications:

Short-acting (taken a few times a day)

Intermediate-acting (taken less often)

Long-acting (taken one a day)

If stimulants cause problematic side effects, or simply are not effective, your doctor may suggest trying a non-stimulant medication, like Strattera or Intuniv.

Non-stimulant ADHD medications are considered second-line or third-line treatments because the level of benefits and response rates are significantly lower. Meaning, stimulant medications are more effective at relieving symptoms for a larger percentage of people.

ADHD medications can have many benefits, as well as side effects. The decision to manage ADHD symptoms with medication can be a difficult one. Learn more about the risks and benefits of stimulants and non-stimulants, medication options, how to gauge effectiveness, and more.

What Is the Definition of ADHD?

"Attention deficit" is, some experts assert, a misleading name. "Attention deregulation" might be a more accurate description since most people with ADHD have more than enough attention - they just can't harness it in the right direction at the right time with any consistency. And so individuals with ADHD hyperfocus and lose track of time, or misplace their keys, or blurt out an unrelated thought when their focus breaks free from its chains.

Understanding ADHD: Next Steps

Sources

¹ "Data & Statistics." Centers for Disease Control and Prevention. Ed. Center for Disease Control. Centers for Disease Control and Prevention, 14 Feb. 2017. Web. 14 Mar. 2017.
² Association, American Psychiatric, ed. Diagnostic and Statistical Manual of Mental Disorders: DSM-5. Washington: American Psychiatric, 2014.
³ Association, American Psychiatric, ed. Diagnostic and Statistical Manual of Mental Disorders: DSM-5. Washington: American Psychiatric, 2014.
⁴ Thapar, Anita, and Evangelia Stergiakouli. "An Overview on the Genetics of ADHD." Xin li xue bao. Acta psychologica Sinica (Aug. 2008) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2854824/
⁵ Philip J. Landrigan, Jordan Slutsky. Are Learning Disabilities Linked to Environmental Factors? Learning Disabilities Worldwide. https://www.ldworldwide.org/environmental-toxins
⁶ Dovey, Dana. "Doctors May Soon Be Able To Diagnose ADHD With An MRI Scan." Medical Daily. IBT Media Inc., 30 Apr. 2014. Web. 14 Mar. 2017.
⁷ https://www.(d(.gov/nchs/fastats/adhd.htm
⁸ https://www.(d(.gov/nchs/fastats/adhd.htm
⁹ Kessler, R. C., Adler, L., Barkley, R., Biederman, J., Conners, C. K., Demler, O., Zaslavsky, A. M. (2006). The Prevalence and Correlates of Adult ADHD in the United States: Results from the National Comorbidity Survey Replication. American Journal of Psychiatry. 163, 716-723.
¹⁰ Donzelli, G., et al."The Association between Lead and Attention-Deficit/Hyperactivity Disorder: A Systematic Review." International Journal of Environmental Research and Public Health. January 2019, 16:3. doi: 10.3390/ijerph16030382

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What Is ADHD? Attention Deficit Hyperactivity Disorder in Children and Adults

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ADHD (attention deficit hyperactivity disorder) is a neurological disorder that impacts the parts of the brain that help us plan, focus on, and execute tasks. ADHD symptoms vary by sub-type - inattentive, hyperactive, or combined - and are often more difficult to diagnose in girls and adults.

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Attachment Disorders Explained | 5 Types, Causes & Signs

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Explore the types, causes, and signs of attachment disorder in children and learn how to foster healthy emotional bonds.

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This free course, Attachment in the early years, covers theory and research in the area of attachment in early childhood. In the 1950s, John Bowlby was the first person to develop a theory about...

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Introduction

What is attachment theory and why is it important?

Attachment is a clinical term used to describe "a lasting psychological connectedness between human beings" (Bowlby, 1997). In particular, attachment theory highlights the importance of a child's emotional bond with their primary caregivers. Disruption to or loss of this bond can affect a child emotionally and psychologically into adulthood, and have an impact on their future relationships.

Only specially trained and qualified professionals should assess a child's attachment style. However, it's important for all adults working with children to understand what attachment is and know how to help parents and carers become attuned to their child's needs. You might do this by working with them directly, or by signposting families to other appropriate services. In the long term, this can help improve wellbeing and provide positive outcomes for both the child and their caregivers.

Understanding attachment in the early years

Children can form attachments with more than one caregiver, but the bond with the people who have provided close care from early infancy is the most important and enduring (Bowlby, 1997).

It's important that parents and carers are attuned and responsive to their baby's needs and are able to provide appropriate care. This includes recognising if their baby is hungry, feeling unwell or in need of closeness and affection (Howe, 2011).

Forming an attachment is something that develops over time for a child, but parents and carers can start to form an emotional bond with their child before they are born. Sometimes a parent or carer may have difficulty forming this bond, for example if they are experiencing mental health issues or don't have an effective support network.

On this page, you'll find information on:

why attachment is important

how children develop attachment

attachment issues, insecure and secure attachment and behaviours to look out for

how trauma can affect attachment

how you can support parents and carers to develop a bond with their child.

Need specific information?

Our information specialists are here to help you find research, guidance and best practice.

References

Bowlby, John (1997) Attachment and loss. Volume 1: attachment. London: Pimlico.
Bowlby, John (1997) Attachment and loss. Volume 1: attachment. London: Pimlico.
Howe, David (2011) Attachment across the lifecourse: a brief introduction. Basingstoke: Palgrave Macmillan.

Stages of attachment

Stages of attachment

The first two years of a child's life are the most critical for forming attachments (Prior and Glaser, 2006).

During this period, children develop an 'internal working model' that shapes the way they view relationships and operate socially. This can affect their sense of trust in others, self-worth and their confidence interacting with others (Bowlby, 1997).

When are attachments formed?

Attachments are formed in different ways during the phases of a child's development.

Antenatal (before birth)

During the antenatal period, parents and carers can form a bond with their child. Any bonds formed before birth can have a positive impact on the relationship between babies and their caregivers once the child is born (Condon and Corkindale, 1997).

Birth until 6 weeks

This is sometimes referred to as the pre-attachment phase because the baby doesn't appear to show an attachment to any specific caregiver. However, parents and carers who provide a nurturing environment and are responsive to their babies needs can lay the foundation for secure attachments to form (Bowlby, 1997).

6 weeks until 6-8 months

During this stage of their development, a baby might start to show a preference for their primary and secondary caregivers (often the mother and father).

6-8 months until 18 months-2 years

During this period a child begins to show a strong attachment to their primary caregivers. Babies start to develop separation anxiety during this phase and can become upset when their caregiver leaves, even for short periods (Bowlby, 1997).

18 months - 2 years onwards

At this point children are likely to become less dependent on their primary caregiver, particularly if they feel secure and confident the caregiver will return and be responsive in times of need (Bowlby, 1997).

References

Prior, V. and Glaser, D. (2006) Understanding attachment and attachment disorders: theory, evidence and practice. London: Jessica Kingsley. Condon, J. T. and Corkindale, C. (1997)
Bowlby, John (1997) Attachment and loss. Volume 1: attachment. London: Pimlico.

The correlates of antenatal attachment in pregnant women. British Journal of Medical Psychology. Cambridge University Press, 70 (4): 359-372. Bowlby, John (1997) Attachment and loss. Volume 1: attachment. London: Pimlico.
Bowlby, John (1997) Attachment and loss. Volume 1: attachment. London: Pimlico.
Bowlby, John (1997) Attachment and loss. Volume 1: attachment. London: Pimlico.

Types of attachment

Types of attachment

A child's need for attachment is part of the process of seeking safety and security from their caregiver.

What does secure attachment look like?

In secure caregiver-child relationships, the caregiver is usually sensitive and tuned in to the child's needs. They are able to provide care that is predictably loving, responsive and consistent.

Young children who have formed a secure attachment to their caregiver may display the following patterns of behaviour during times of stress or exploration:

proximity maintenance - wanting to be near their primary caregiver

safe haven - returning to their primary caregiver for comfort and safety if they feel afraid or threatened

secure base - treating their primary caregiver as a base of security from which they can explore the surrounding environment. The child feels safe in the knowledge that they can return to their secure base when needed

separation distress - experiencing anxiety in the absence of their primary caregiver. They are upset when their caregiver leaves, but happy to see them and easily comforted when they return

Benefits of secure attachment

When caregivers react sensitively to ease their child's distress and help them regulate their emotions, it has a positive impact on the child's neurological, physiological and psychosocial development (Howe, 2011).

Children with secure attachments are more likely to develop emotional intelligence, good social skills and robust mental health (Howe, 2011).

Effects of insecure attachment

Not receiving comfort and security in the early years can have a negative effect on children's neurological, psychological, emotional and physical development and functioning (Newman, 2015).

Babies and young children who have attachment issues may be more likely to develop behavioural problems such as attention deficit hyperactivity disorder (ADHD) or conduct disorder (Fearon et al, 2010).

Children who have attachment issues can have difficulty forming healthy relationships when they grow up. This may be because their experiences have taught them to believe that other people are unreliable or untrustworthy (Bowlby, 1997).

Adults with attachment issues are at a higher risk of entering into volatile relationships and having poor parenting skills, behavioural difficulties and mental health problems (Howe, 2011).
> Find out more about how trauma affects child brain development
Further reading

Take a look at our reading list on child attachment.
> View the reading list on the NSPCC Library catalogue

Attachment issues

Attachment issues

Factors affecting attachment

Some circumstances can make it more challenging for a child and their caregivers to form a pattern of secure attachment. These may include:

abuse, maltreatment and trauma experienced by the parent or child

parental mental health difficulties

parental substance misuse

the child having multiple care placements

parents being separated from their baby just after birth, for example if the baby is receiving neonatal care

stress such as having a low income, being a single parent, or being a young parent

bereavement or loss of another caregiver that a child had an attachment with

Signs that a child may have attachment issues

Children's behaviour can be influenced by a wide range of circumstances and emotions.

Indicators that a baby or toddler might not have a secure attachment with their caregiver will emerge as a pattern of behaviour over time, particularly during moments of stress or exploration. This pattern might include:

being fearful or avoidant of a parent or carer

becoming extremely distressed when their carer leaves them, even for a short amount of time

rejecting their caregiver's efforts to calm, soothe, and connect with them

not seeming to notice or care when their caregiver leaves the room or when they return

being passive or non-responsive to their carer

seeming to be depressed or angry

not being interested in playing with toys or exploring their environment

As children with attachment issues get older, these behaviour patterns might evolve. As well as being evident during times of stress, some behaviours may start to become obvious at other times. These may include the child:

finding it difficult to ask for help

struggling to form positive relationships with adults and peers

struggling to concentrate

struggling to calm themselves down

both demanding and rejecting attention or support at the same time

becoming quickly or disproportionately angry or upset, at times with no clear triggers

appearing withdrawn or disengaged from activities

daydreaming, being hyperactive or constantly fidgeting or moving

(Mentally Healthy Schools, 2020).

If you think a child may have attachment issues, you should refer them to a suitably trained health and social care professional for a full assessment. You should follow your organisation's procedures to make a health and social care referral, or contact your local authority children's social care services.

References

Bowlby, John (1989) The making and breaking of affectional bonds. London: Routledge. Mentally Healthy Schools (2020)
Howe, David (2011) Attachment across the lifecourse: a brief introduction. Basingstoke: Palgrave Macmillan.
Attachment and child development. [Accessed 09/11/2020].

Trauma and attachment

Trauma and attachment

The signs of attachment issues can be similar to indicators that a child is experiencing other challenges, such as:

This means it's important to consider everything that's going on in a child's life and make sure they and their family are provided with appropriate support.

Think about all your previous experiences with the child and their caregivers, to help you build a clear picture of their relationships and recognise any concerning patterns of behaviour.

The impact of trauma and attachment

Children who have experienced abuse, neglect and trauma might develop coping strategies that can make it more complicated to recognise attachment issues.

For example, one sign of secure attachment is that children see their caregiver as a secure base to explore from. But children who have experienced neglect, for example, might display independent behaviour in order to protect themselves from the emotional pain of not having their needs met (Marvin et al, 2002).

It is also possible for a child to develop an attachment to someone who is maltreating them (Blizard & Bluhm, 1994).

As well as affecting attachment, experiencing trauma can have an impact on a child's brain development. Children might need extra support to help strengthen the architecture of their brain.
> Find out more about how trauma affects child brain development
What to do if you're worried that a child is experiencing or at risk of abuse or neglect
If a child is in immediate danger, call the police on 999.
If you're worried about a child but they are not in immediate danger, you should share your concerns.

Follow your organisation's child protection procedures without delay. These should provide clear guidelines on the steps you need to take if a child discloses abuse. They will state who in your organisation has responsibility for safeguarding or child protection and who you should report your concerns to.

Contact your local child protection services. Their contact details can be found on the website for the local authority the child lives in.

Contact the police. They will assess the situation and take the appropriate action to protect the child.

Contact the NSPCC Helpline on 0808 800 5000 or by emailing help@nspcc.org.uk. Our child protection specialists will talk through your concerns with you, give you expert advice and take action to protect the child as appropriate. This may include making a referral to the local authority.

> Find out more about recognising and responding to abuse
If your organisation doesn't have a clear safeguarding procedure or you're concerned about how child protection issues are being handled in your own, or another, organisation, contact the Whistleblowing Advice Line to discuss your concerns.
> Find out about the Whistleblowing Advice Line on the NSPCC website
When you're not sure

The NSPCC Helpline can help when you're not sure if a situation needs a safeguarding response. Our child protection specialists are here to support you whether you're seeking advice, sharing concerns about a child, or looking for reassurance.

Whatever the need, reason or feeling, you can contact the NSPCC Helpline on 0808 800 5000 or by emailing help@nspcc.org.uk

Our trained professionals will talk through your concerns with you. Depending on what you share, our experts will talk you through which local services can help, advise you on next steps, or make referrals to children's services and the police.
> Find out more about how the NSPCC Helpline can support you

Supporting children and families

Supporting children and families

Building positive relationships

It's important for anyone who works with children and families to support parents and carers in building positive relationships with their child. Having positive interaction and play with caregivers can help a child's brain to develop healthily.
> See our early years resources which you can share with parents and caregivers
Video feedback programmes can also be used by specially trained social care professionals to help caregivers improve their interactions with their child. This involves caregivers being filmed when they are interacting with their child and then watching the recording with a trained practitioner, who gives them feedback and helps them build on their strengths.

Support for parents and carers

If parents are struggling with their own issues, it may make it harder for them to bond with their child and provide consistant and responsive care. They may have:

experienced abuse of trauma themselves

drug and/or alcohol dependencies

mental health issues.

> Find out more about parental mental health > Learn more about parental substance misuse
Services for children and families

The NSPCC has many services that children and families can be referred to, from supporting parents and carers in taking care of their children to preventing sexual abuse and overcoming abuse.

Our services might be suitable for children and families you are working with:

Pregnancy in Mind helps parents who are at risk of or experiencing mild to moderate anxiety and depression during pregnancy. The service helps build parents' capacity to provide sensitive, responsive care to their babies and keep these skills developed postnatally and as their children develop
Browse for more services
Further reading

Take a look at our reading list about child attachment interventions, support and treatment.
> View the list on the NSPCC Library catalogue
Supporting children's mental health

Children with attachment issues may have problems expressing or controlling their emotions and forming positive relationships, which might affect their mental health.

It's important to make sure children and young people have access to mental health support.
> Find out more about child mental health > See the NSPCC's advice for parents and carers on how to support their child's mental health
Childline

If a child or young person needs confidential help and advice you can always direct them to Childline. Calls to 0800 1111 are free and children can also contact Childline online. Children under the age of 12 can be directed to the Childline Kids website.

We also have a series of posters and wallet cards you can download for free. These can be printed and displayed in your setting to encourage children to contact Childline if they need to talk.

Introduction

What is attachment theory and why is it important?

Attachment is a clinical term used to describe "a lasting psychological connectedness between human beings" (Bowlby, 1997). In particular, attachment theory highlights the importance of a child's emotional bond with their primary caregivers. Disruption to or loss of this bond can affect a child emotionally and psychologically into adulthood, and have an impact on their future relationships.

Only specially trained and qualified professionals should assess a child's attachment style. However, it's important for all adults working with children to understand what attachment is and know how to help parents and carers become attuned to their child's needs. You might do this by working with them directly, or by signposting families to other appropriate services. In the long term, this can help improve wellbeing and provide positive outcomes for both the child and their caregivers.

Understanding attachment in the early years

Children can form attachments with more than one caregiver, but the bond with the people who have provided close care from early infancy is the most important and enduring (Bowlby, 1997).

It's important that parents and carers are attuned and responsive to their baby's needs and are able to provide appropriate care. This includes recognising if their baby is hungry, feeling unwell or in need of closeness and affection (Howe, 2011).

Forming an attachment is something that develops over time for a child, but parents and carers can start to form an emotional bond with their child before they are born. Sometimes a parent or carer may have difficulty forming this bond, for example if they are experiencing mental health issues or don't have an effective support network.

On this page, you'll find information on:

why attachment is important

how children develop attachment

attachment issues, insecure and secure attachment and behaviours to look out for

how trauma can affect attachment

how you can support parents and carers to develop a bond with their child.

Need specific information?

Our information specialists are here to help you find research, guidance and best practice.

References

Bowlby, John (1997) Attachment and loss. Volume 1: attachment. London: Pimlico.
Bowlby, John (1997) Attachment and loss. Volume 1: attachment. London: Pimlico.
Howe, David (2011) Attachment across the lifecourse: a brief introduction. Basingstoke: Palgrave Macmillan.

Stages of attachment

Stages of attachment

The first two years of a child's life are the most critical for forming attachments (Prior and Glaser, 2006).

During this period, children develop an 'internal working model' that shapes the way they view relationships and operate socially. This can affect their sense of trust in others, self-worth and their confidence interacting with others (Bowlby, 1997).

When are attachments formed?

Attachments are formed in different ways during the phases of a child's development.

Antenatal (before birth)

During the antenatal period, parents and carers can form a bond with their child. Any bonds formed before birth can have a positive impact on the relationship between babies and their caregivers once the child is born (Condon and Corkindale, 1997).

Birth until 6 weeks

This is sometimes referred to as the pre-attachment phase because the baby doesn't appear to show an attachment to any specific caregiver. However, parents and carers who provide a nurturing environment and are responsive to their babies needs can lay the foundation for secure attachments to form (Bowlby, 1997).

6 weeks until 6-8 months

During this stage of their development, a baby might start to show a preference for their primary and secondary caregivers (often the mother and father).

6-8 months until 18 months-2 years

During this period a child begins to show a strong attachment to their primary caregivers. Babies start to develop separation anxiety during this phase and can become upset when their caregiver leaves, even for short periods (Bowlby, 1997).

18 months - 2 years onwards

At this point children are likely to become less dependent on their primary caregiver, particularly if they feel secure and confident the caregiver will return and be responsive in times of need (Bowlby, 1997).

References

Prior, V. and Glaser, D. (2006) Understanding attachment and attachment disorders: theory, evidence and practice. London: Jessica Kingsley. Condon, J. T. and Corkindale, C. (1997)
Bowlby, John (1997) Attachment and loss. Volume 1: attachment. London: Pimlico.

The correlates of antenatal attachment in pregnant women. British Journal of Medical Psychology. Cambridge University Press, 70 (4): 359-372. Bowlby, John (1997) Attachment and loss. Volume 1: attachment. London: Pimlico.
Bowlby, John (1997) Attachment and loss. Volume 1: attachment. London: Pimlico.
Bowlby, John (1997) Attachment and loss. Volume 1: attachment. London: Pimlico.

Types of attachment

Types of attachment

A child's need for attachment is part of the process of seeking safety and security from their caregiver.

What does secure attachment look like?

In secure caregiver-child relationships, the caregiver is usually sensitive and tuned in to the child's needs. They are able to provide care that is predictably loving, responsive and consistent.

Young children who have formed a secure attachment to their caregiver may display the following patterns of behaviour during times of stress or exploration:

proximity maintenance - wanting to be near their primary caregiver

safe haven - returning to their primary caregiver for comfort and safety if they feel afraid or threatened

secure base - treating their primary caregiver as a base of security from which they can explore the surrounding environment. The child feels safe in the knowledge that they can return to their secure base when needed

separation distress - experiencing anxiety in the absence of their primary caregiver. They are upset when their caregiver leaves, but happy to see them and easily comforted when they return

Benefits of secure attachment

When caregivers react sensitively to ease their child's distress and help them regulate their emotions, it has a positive impact on the child's neurological, physiological and psychosocial development (Howe, 2011).

Children with secure attachments are more likely to develop emotional intelligence, good social skills and robust mental health (Howe, 2011).

Effects of insecure attachment

Not receiving comfort and security in the early years can have a negative effect on children's neurological, psychological, emotional and physical development and functioning (Newman, 2015).

Babies and young children who have attachment issues may be more likely to develop behavioural problems such as attention deficit hyperactivity disorder (ADHD) or conduct disorder (Fearon et al, 2010).

Children who have attachment issues can have difficulty forming healthy relationships when they grow up. This may be because their experiences have taught them to believe that other people are unreliable or untrustworthy (Bowlby, 1997).

Adults with attachment issues are at a higher risk of entering into volatile relationships and having poor parenting skills, behavioural difficulties and mental health problems (Howe, 2011).
> Find out more about how trauma affects child brain development
Further reading

Take a look at our reading list on child attachment.
> View the reading list on the NSPCC Library catalogue

Attachment issues

Attachment issues

Factors affecting attachment

Some circumstances can make it more challenging for a child and their caregivers to form a pattern of secure attachment. These may include:

abuse, maltreatment and trauma experienced by the parent or child

parental mental health difficulties

parental substance misuse

the child having multiple care placements

parents being separated from their baby just after birth, for example if the baby is receiving neonatal care

stress such as having a low income, being a single parent, or being a young parent

bereavement or loss of another caregiver that a child had an attachment with

Signs that a child may have attachment issues

Children's behaviour can be influenced by a wide range of circumstances and emotions.

Indicators that a baby or toddler might not have a secure attachment with their caregiver will emerge as a pattern of behaviour over time, particularly during moments of stress or exploration. This pattern might include:

being fearful or avoidant of a parent or carer

becoming extremely distressed when their carer leaves them, even for a short amount of time

rejecting their caregiver's efforts to calm, soothe, and connect with them

not seeming to notice or care when their caregiver leaves the room or when they return

being passive or non-responsive to their carer

seeming to be depressed or angry

not being interested in playing with toys or exploring their environment

As children with attachment issues get older, these behaviour patterns might evolve. As well as being evident during times of stress, some behaviours may start to become obvious at other times. These may include the child:

finding it difficult to ask for help

struggling to form positive relationships with adults and peers

struggling to concentrate

struggling to calm themselves down

both demanding and rejecting attention or support at the same time

becoming quickly or disproportionately angry or upset, at times with no clear triggers

appearing withdrawn or disengaged from activities

daydreaming, being hyperactive or constantly fidgeting or moving

(Mentally Healthy Schools, 2020).

If you think a child may have attachment issues, you should refer them to a suitably trained health and social care professional for a full assessment. You should follow your organisation's procedures to make a health and social care referral, or contact your local authority children's social care services.

References

Bowlby, John (1989) The making and breaking of affectional bonds. London: Routledge. Mentally Healthy Schools (2020)
Howe, David (2011) Attachment across the lifecourse: a brief introduction. Basingstoke: Palgrave Macmillan.
Attachment and child development. [Accessed 09/11/2020].

Trauma and attachment

Trauma and attachment

The signs of attachment issues can be similar to indicators that a child is experiencing other challenges, such as:

This means it's important to consider everything that's going on in a child's life and make sure they and their family are provided with appropriate support.

Think about all your previous experiences with the child and their caregivers, to help you build a clear picture of their relationships and recognise any concerning patterns of behaviour.

The impact of trauma and attachment

Children who have experienced abuse, neglect and trauma might develop coping strategies that can make it more complicated to recognise attachment issues.

For example, one sign of secure attachment is that children see their caregiver as a secure base to explore from. But children who have experienced neglect, for example, might display independent behaviour in order to protect themselves from the emotional pain of not having their needs met (Marvin et al, 2002).

It is also possible for a child to develop an attachment to someone who is maltreating them (Blizard & Bluhm, 1994).

As well as affecting attachment, experiencing trauma can have an impact on a child's brain development. Children might need extra support to help strengthen the architecture of their brain.
> Find out more about how trauma affects child brain development
What to do if you're worried that a child is experiencing or at risk of abuse or neglect
If a child is in immediate danger, call the police on 999.
If you're worried about a child but they are not in immediate danger, you should share your concerns.

Follow your organisation's child protection procedures without delay. These should provide clear guidelines on the steps you need to take if a child discloses abuse. They will state who in your organisation has responsibility for safeguarding or child protection and who you should report your concerns to.

Contact your local child protection services. Their contact details can be found on the website for the local authority the child lives in.

Contact the police. They will assess the situation and take the appropriate action to protect the child.

Contact the NSPCC Helpline on 0808 800 5000 or by emailing help@nspcc.org.uk. Our child protection specialists will talk through your concerns with you, give you expert advice and take action to protect the child as appropriate. This may include making a referral to the local authority.

> Find out more about recognising and responding to abuse
If your organisation doesn't have a clear safeguarding procedure or you're concerned about how child protection issues are being handled in your own, or another, organisation, contact the Whistleblowing Advice Line to discuss your concerns.
> Find out about the Whistleblowing Advice Line on the NSPCC website
When you're not sure

The NSPCC Helpline can help when you're not sure if a situation needs a safeguarding response. Our child protection specialists are here to support you whether you're seeking advice, sharing concerns about a child, or looking for reassurance.

Whatever the need, reason or feeling, you can contact the NSPCC Helpline on 0808 800 5000 or by emailing help@nspcc.org.uk

Our trained professionals will talk through your concerns with you. Depending on what you share, our experts will talk you through which local services can help, advise you on next steps, or make referrals to children's services and the police.
> Find out more about how the NSPCC Helpline can support you

Supporting children and families

Supporting children and families

Building positive relationships

It's important for anyone who works with children and families to support parents and carers in building positive relationships with their child. Having positive interaction and play with caregivers can help a child's brain to develop healthily.
> See our early years resources which you can share with parents and caregivers
Video feedback programmes can also be used by specially trained social care professionals to help caregivers improve their interactions with their child. This involves caregivers being filmed when they are interacting with their child and then watching the recording with a trained practitioner, who gives them feedback and helps them build on their strengths.

Support for parents and carers

If parents are struggling with their own issues, it may make it harder for them to bond with their child and provide consistant and responsive care. They may have:

experienced abuse of trauma themselves

drug and/or alcohol dependencies

mental health issues.

> Find out more about parental mental health > Learn more about parental substance misuse
Services for children and families

The NSPCC has many services that children and families can be referred to, from supporting parents and carers in taking care of their children to preventing sexual abuse and overcoming abuse.

Our services might be suitable for children and families you are working with:

Pregnancy in Mind helps parents who are at risk of or experiencing mild to moderate anxiety and depression during pregnancy. The service helps build parents' capacity to provide sensitive, responsive care to their babies and keep these skills developed postnatally and as their children develop
Browse for more services
Further reading

Take a look at our reading list about child attachment interventions, support and treatment.
> View the list on the NSPCC Library catalogue
Supporting children's mental health

Children with attachment issues may have problems expressing or controlling their emotions and forming positive relationships, which might affect their mental health.

It's important to make sure children and young people have access to mental health support.
> Find out more about child mental health > See the NSPCC's advice for parents and carers on how to support their child's mental health
Childline

If a child or young person needs confidential help and advice you can always direct them to Childline. Calls to 0800 1111 are free and children can also contact Childline online. Children under the age of 12 can be directed to the Childline Kids website.

We also have a series of posters and wallet cards you can download for free. These can be printed and displayed in your setting to encourage children to contact Childline if they need to talk.

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Attachment and child development | NSPCC Learning

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Explains why attachment is important as well as the different stages. Includes information on types of attachment, attachment issues and the effect of trauma.

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Our introductory course about Attachment Theory is ideal for those working with children. Buy now!

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Compass Changing Lives is staffed by a fantastic team of friendly and experienced people who are passionate about supporting children and young people’s mental health. Meet the team and find out a little more about us here.

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When kids have dyscalculia, it impacts how well they learn and do math in school. But having poor number sense and other math skills can also lead to all sorts of challenges in daily life.

For example, kids with dyscalculia may have trouble with amounts, time, distance, speed, counting, mental math, and remembering numbers. Those difficulties can show up in ways you might not expect or recognize as being related to math.

Here are 10 surprising ways dyscalculia can impact kids.

About the author

Reviewed by

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Dyscalculia can impact kids in unexpected ways. Here are 10 surprising behaviors you may see in your child with dyscalculia.

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Lots of kids struggle with math, but for some the difficulties go beyond a little bit of frustration. If your child's math troubles are serious - and persistent - they may be a sign of a learning disorder called dyscalculia.

Dyscalculia is a term used to describe specific learning disabilities that affect a child's ability to understand, learn, and perform math and number-based operations.

Though research on prevalence is limited, it's estimated that between 5 and 7% of elementary school aged children may have dyscalculia. It's also currently thought that dyscalculia occurs equally in both genders.

No. Not all difficulties in math class - even serious ones - are caused by dyscalculia. Disorders like dyslexia, visual or auditory processing, ADHD, and others can also impact a child's ability to meet expectations in completing math problems. It's also possible for kids who do have dyscalculia to have other learning disabilities as well. Many do.

A young child with dyscalculia may:

Have difficulty recognizing numbers

Be delayed in learning to count

Struggle to connect numerical symbols (5) with their corresponding words (five)

Have difficulty recognizing patterns and placing things in order

Lose track when counting

Need to use visual aids - like fingers - to help count

And as math becomes a major part of the school day, kids with dyscalculia are likely to:

Have significant difficulty learning basic math functions like addition and subtraction, times tables and more

Be unable to grasp the concepts behind word problems and other non-numerical math calculations

Have difficulty estimating how long it will take to complete a task

Struggle with math homework assignments and tests

Have difficulty keeping at grade-level in math

Struggle to process visual-spatial ideas like graphs and charts

The impact of dyscalculia doesn't stop when math class ends. The disorder can also affect kids outside of school. Children with dyscalculia also:

Have trouble remembering numbers such as zip codes, phone numbers, or game scores

Struggle with money matters such as making change, counting bills, calculating a tip, splitting a check or estimating how much something will cost.

Have difficulty judging the length of distances and how long it will take to get from one location to another

Struggle to remember directions

Have a hard time telling left from right

Get easily frustrated by games that require consistent score keeping, number strategies or counting

Have difficulty reading clocks and telling time

The biggest sign of a specific learning disorder is a notable discrepancy between ability and aptitude. A kid with dyscalculia may preform well in other subjects - such as English or history - but have very low grades in math and math-based classes.

In the DSM-5, dyscalculia is called "specific learning disability with impairment in mathematics," but "dyscalculia" is still an accepted term and is used by schools and learning specialists.

There is no specific test for dyscalculia. Taking the following steps can help you get your child the help and accommodations he needs.

Visit your doctor: Rule out any medical issues such as hearing or vision impairment that could be impacting your child's learning process.

Consult with your teacher: Ask your child's math teacher to note the areas where he has the most trouble, and any and all strategies that help.

Ask about other areas: It's estimated that as many as half of kids with dyscalculia also have another learning issue. Understanding your child's complete learning profile will help you advocate for his needs

Consult a specialist: Once you've done the groundwork, talk to a learning professional who can evaluate your child and give you specific feedback on how to help.

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How to Spot Dyscalculia - Child Mind Institute

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When math difficulties mean something more - what are the signs, symptoms causes and condition of dyscalculia, for parents and educators.

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Listen to this insightful podcast to learn about dyscalculia and help ensure that those impacted by this learning difficulty receive support.

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Developmental co-ordination disorder (DCD), also known as dyspraxia, is a condition affecting physical co-ordination. It causes a child to perform less well than expected in daily activities for their age, and appear to move clumsily.
This topic is about DCD in children, although the condition often causes continued problems into adulthood.

Find out more about DCD in adults.

Symptoms of DCD

Early developmental milestones of crawling, walking, self-feeding and dressing may be delayed in young children with DCD. Drawing, writing and performance in sports are also usually behind what is expected for their age.

Although signs of the condition are present from an early age, children vary widely in their rate of development. This means a definite diagnosis of DCD does not usually happen until a child with the condition is 5 years old or more.

Find out more about symptoms of DCD in children.

When to seek medical advice

If you're concerned about your child's health or development, talk to a GP or health visitor, or speak to a nurse, doctor or special educational needs co-ordinator (SENCO) at your child's school.

They may refer your child to an occupational therapist, paediatrician, or another health professional who can assess them and try to identify any developmental problems.

Find out more about diagnosing DCD in children.

Causes of DCD

Doing co-ordinated movements is a complex process that involves many different nerves and parts of the brain.

Any problem in this process could potentially lead to difficulties with movement and co-ordination.

It's not usually clear why co-ordination doesn't develop as well as other abilities in children with DCD.

However, a number of risk factors that can increase a child's likelihood of developing DCD have been identified.

These include:

being born prematurely, before the 37th week of pregnancy

being born with a low birth weight

having a family history of DCD, although it is not clear exactly which genes may be involved in the condition

the mother drinking alcohol or taking illegal drugs while pregnant

Treating DCD

There's no cure for DCD, but a number of therapies can help children to manage their problems.

These include:

being taught ways of do activities they find difficult, such as breaking down difficult movements into smaller parts and practicing them regularly

adapting tasks to make them easier, such as using special grips on pens and pencils so they are easier to hold

Although DCD does not affect how intelligent a child is, it can make it more difficult for them to learn and they may need extra help to keep up at school.

Treatment for DCD will be tailored to your child and usually involves a number of different healthcare professionals working together.

Although the physical co-ordination of a child with DCD will remain below average, this may be less of a problem as they get older and develop coping strategies. Some children may continue to have problems.

However, difficulties in school - particularly producing written work - can become much more prominent and require extra help from parents and teachers.

Find out more about treating DCD in children.

Dyspraxia or DCD?

While many people in the UK use the term dyspraxia to refer to the difficulties with movement and co-ordination that first develop in young children, this term is used less often by healthcare professionals.

Instead, most healthcare professionals use the term developmental co-ordination disorder (DCD) to describe the condition.

This term is generally preferred by healthcare professionals because dyspraxia can have several meanings.

For example, dyspraxia can be used to describe movement difficulties that happen later in life because of damage to the brain, such as from a stroke or head injury.

Some healthcare professionals may also use the term specific developmental disorder of motor function (SDDMF) to refer to DCD.

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Developmental co-ordination disorder (dyspraxia) in children

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Read about developmental co-ordination disorder (DCD), also known as dyspraxia, a condition that affects physical co-ordination.

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Dyspraxia Foundation is a registered charity that supports individuals and families affected by developmental Dyspraxia. They have a public Help line and provide advice to individuals, teachers and professionals.

They have some excellent resources, such as Dyspraxia In the Workplace: A guide for Employers, which is very helpful. Please see their website directly to see their full range of published material.

They also run conferences for Adults with Dyspraxia and have active support groups nationally.

Web: www.dyspraxiafoundation.org.uk

Email: dyspraxia@dyspraxiafoundation.org.uk

The assessment answered all the questions we had concerning our daughter's difficulties, it allows us to move forwards. It has been such a relief to have a diagnosis so we can fully understand our daughter.
J.Durdey (2023)

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Today's episode is about dyspraxia, a developmental disorder which is most often associated with challenges related to motor coordination but is also often marked by disorganization, clumsiness and poor short-term memory. My guest, Victoria Biggs, knows first-hand what it's like to grow up with dyspraxia. When she was sixteen years old, she actually wrote a book to help teens like her get through adolescence called Caged in Chaos: A Dyspraxic Guide to Breaking Free.

Vicky is a university research fellow and lecturer, a teacher in a school for children with trauma-related mental health problems, a writer, and a story. In addition to having dyspraxia, Vicky is also autistic. In our conversation today, Vicky talks us through her own story of growing up with dyspraxia and shares her personal insights on how parents and teachers can better support dyspraxic children.

About Victoria: My name is Victoria Biggs. I usually go by Vicky. I'm a university research fellow and lecturer, a teacher in a school for children with trauma-related mental health problems, a writer, a storyteller, and the property of a cat named Lottie. I'm also autistic and dyspraxic.

When I was sixteen years old, I wrote a book called Caged in Chaos: A Dyspraxic Guide to Breaking Free, a light-hearted guerrilla guide to adolescence and everything it throws at you. Since it came out I've been a regular guest speaker and trainer on autistic spectrum disorders, dyspraxia, and other specific learning difficulties (SpLD). Whoever you are - a parent of a struggling child, a teacher wondering how to support the SpLD students in your class, or a person with SpLD yourself - I hope you will find something useful and encouraging on my site. Learn more here.
THINGS YOU'LL LEARN FROM THIS EPISODE:

The primary challenges children and teens with dyspraxia face while growing up

Practical tips for supporting teens with dyspraxia

What Victoria believes schools and society can do better to support kids with learning differences

How Victoria's experience with dyspraxia has influenced her as a special education teacher

The most important considerations for parents of newly diagnosed dyspraxic children
RESOURCES MENTIONED:

Victoria Biggs professional / academic website

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TPP 174: Victoria Biggs Shares Her Story of Being Dyspraxic

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Today's episode is about dyspraxia, a developmental disorder which is most often associated with challenges related to motor coordination but is also often marked by disorganization, clumsiness and poor short-term memory. My guest, Victoria Biggs, knows first-hand what it's like to grow up with dyspraxia.

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Before announcing the final episode of 2024, I just wanted to say a big heartfelt thank you to you, our wonderful listeners! It has been another remarkable year with 51 episodes recorded, 19 new guest speakers, 100,000 downloads and a nasen award to celebrate our achievements. Thank you for being part of this journey!

This week, we dive into the concept of relational practice - a powerful approach that emphasises treating others as we wish to be treated, fostering equality, and mutual respect. I'm thrilled to welcome two new guests to the podcast: Beth Elkins, Headteacher, and Ian Thorsteinsson, Executive Principal of Gretton School.

In this episode, 'The power of relational practice in an autism setting', Beth and Ian discuss how changing the culture of a school can support the reduction of behaviours of concern and create a thriving learning environment. They share insights on the essence of relational practice and discuss the implementation.

Key takeaways include:

The significance of shifting away from traditional hierarchical models in education.

Strategies for creating a supportive environment that encourages intrinsic motivation.

Insights on managing behaviour through understanding rather than punishment.

Accommodations for autism are not always clear for professionals, listen to this episode to hear how relational practice allows connection, communication and change in the most powerful of ways.

Wishing you a very Merry Christmas and a well-deserved break! I look forward to returning in the New Year with an exciting lineup of guest speakers and more great content.

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The Power of Relational Practice in an Autism Setting

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My guests this week are Beth Elkins & Ian Thorsteinsson from Gretton School. They share insights on relational practice & its implementation.

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Autism: Joe’s personal experiences and advice for professionals

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Joining Dale this week is Joe Fautley, a project co-ordinator at the Council for Disabled Children. Joe is autistic, has dyspraxia & anxiety.

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Dyspraxia and Handwriting with Kim Griffin from the SENDcast

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In this week’s podcast we discuss relation between Dyspraxia and Handwriting with special guest Kim Griffin.

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The National FASD website is a vital resource for information and support related to Fetal Alcohol Spectrum Disorder, offering guidance and support.

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FASD Network is an organisation that specialises in providing information, support and training on FASD. It was founded in 2011 in the Durham Tees Valley region which is an area that includes: Durham, Stockton-on-Tees, Middlesbrough, Hartlepool, Darlington and Redcar & Cleveland. Our work has since expanded into the north to include Northumbria, Tyneside and Wearside and also to the south to cover the Yorkshire, Hull and East Riding areas. Whilst we have a UK wide remit to press for change, our particular focus is on the Northern regions and we firmly believe that local services are best delivered by local people and local organisations.
Key Services
We provide support groups for families who are raising children with FASD on a termly basis. We also admin a closed Facebook group called FASD UK which provides daily peer to peer input for families which in turn breaks isolation and offers timely solutions to daily needs. If you are raising a child with FASD in the North East and Yorkshire then please click on this link to register with us so we can add you to the mailing list. ﻿
We provide bespoke training for organisations requiring further knowledge about FASD and how to support individuals and families more effectively. Training is regularly delivered to foster carers, adopters, kinship carers, birth families, social workers, alcohol professionals, midwives, health visitors, early years workers, teachers, police, policy makers, paediatricians and broader health agencies.
Please contact us to discuss your training requirements.

REGISTRATION ﻿

Strategic Development
We work with a range of partners to examine structural service deficits in the UK and advocate for change. Inter-disciplinary networks facilitate the ongoing development of strategic objectives to address this public heath concern and improve outcomes for people affected by FASD.

We conduct our own research and work with multi-agency partners to develop research opportunities which will address knowledge gaps and promote funding of services which are currently absent. If you are interested in research then please get in touch and let us know how we can partner with you.
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UK Based Foetal Alcohol Spectrum Disorder Family Support and Training Organisation.

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Dr. Jennifer Shields & Dr. Sarah Brown discuss Fetal Alcohol Spectrum Disorder (FASD) with freelance journalist Jo Carlowe.

FASD is the most common preventable non-genetic cause of neurodevelopmental disorders in the UK. FASD is an umbrella term used to describe the range of effects that can occur in an individual with prenatal alcohol exposure. These effects can have lifelong implications including physical, mental, behavior, and/or learning issues.

You can listen to this podcast directly on our website or on the following platforms; SoundCloud, iTunes, Spotify, CastBox, Deezer, Google Podcasts and Radio.com (not available in the EU).

Transcript

Intro Speaker: This podcast is brought to you by the Association for Child and Adolescent mental health, ACAMH for short. You can find more podcasts and other resources on our website www.acamh.org and follow us on social media by searching ACAMH.

Interviewer: Hello. Welcome to the in conversation podcast series for the Association for Child and Adolescent mental health or ACAMH for short. I'm Jo Carlowe, a freelance journalist with a specialism in Psychology. Today I'm interviewing principal clinical psychologist Dr. Jennifer Shields and consultant paediatrician Dr. Sarah Brown of the Scottish government fetal alcohol advisory and support team. Jennifer and Sarah will be giving us an overview on fetal alcohol spectrum disorder, FASD, which is the most common preventable non-genetic cause of neurodevelopmental disorders in the UK. Welcome Jennifer and Sarah. Can you start by introducing yourselves?

Dr. Sarah Brown: Hello. My name is Sarah Brown and I work alongside Jen in Ayrshire.

Dr. Jennifer Shields: And hi I'm Jennifer Shields. I'm a clinical psychologist based in this fetal alcoholic advisory support team.

Interviewer: Fantastic, and fetal alcohol spectrum disorder is an umbrella term for several diagnoses related to prenatal exposure to alcohol what precisely does FASD encompass?

Dr. Sarah Brown: So people may be more familiar with the term fetal alcohol syndrome, which was first described the late 1960s and 1970s seventies and that really described a syndrome where the were marked physical features such as small head, poor growth and quite distinct facial features. However, a bit like autism over the years we have realized it's much more of a broader spectrum and FASD would refer to the whole spectrum of conditions which for the vast majority in fact ninety percent have none of the physical features that you would see in the first described people alcohol syndrome group. So only ten percent would have different facial features, ninety percent of those affected by FASD have no physical features.

Dr. Jennifer Shields: According to other international classification systems, people might have heard of FASD under the diagnostic term of a new developmental disorder fetal alcohol exposed. And so that's just a different way of saying the same thing but FASD is the more recognized term.

Interviewer: Right? Thank you. There's always debate about whether or not women should drink during pregnancy. And I know in two thousand and sixteen the UK chief medical officer changed the guidance to say no alcohol should be consumed in pregnancy. So when you're talking about prenatal exposure to alcohol leading to FASD. Just how much drinking is harmful?

Dr. Jennifer Shields: To me it's a bit like drinking and driving, it's people realize that they shouldn't drink and drive because it increases your risk, and people accept that quite readily, however, when it comes to pregnancy and drinking those same risks the more you the more you more alcohol you drink during a pregnancy the higher the alcohol exposure to the pregnancy, the more likely you are of having FASD, but just because you drink during pregnancy doesn't mean that you will necessarily have an affected child. And that's what makes the messaging really really difficult.

We are certainly not advocating that people drink any alcohol in pregnancy and the arguments around what is the safe limit, is a bit like we're not having a similar conversation about what is the least number of cigarettes that you can smoke in pregnancy. It's because alcohol is so wrapped into our culture that people feel that we should be able to find the safe floor limit. But the evidence would tell us that we don't know what's safe and that's what makes the advice to be on the safest possible side of the advice being given as it's no alcohol, no risk.

Interviewer: Can you start by giving some details of the types of congenital anomalies that one sees caused by exposure to alcohol in the womb?

Dr. Jennifer Shields: So I think you can probably put these down into structural anomalies and maybe kind of more functional anomalies. In terms of the structure anomalies people may be familiar with the facial features which I mentioned briefly earlier, and that is the thinner blood that we note from new slightly smaller eye openings. We also know that alcohol can increase your risk of having a congenital heart abnormality and also differences within the way that your brain is developing. So you might have a very thin or absent corpus callosum. These are just the structural abnormalities that we can see and there's more than I've mentioned here. But what is common across all those affected previously by alcohol is the neurodevelopmental consequences of fetal alcoholic exposure.

Dr. Sarah Brown: Yeah, and in terms of the functional differences it might not be that these differences in the brain wiring would show up in a brain scan for example, but what we see are marked differences in how children are able to process information, protect extensity information, to remember to be able to problem-solve and so there's lots of thinking and cognitive problems that can be picked up through certain psychological assessments.

Interviewer: Right and how might it manifest in terms of behavioral issues?

Dr. Jennifer Shields: Yeah, so I think what's interesting about if you esteem and you think about the types of children who might present at a Child and Adolescent Mental Health Service, for example, a lot of these children are presenting with distress, and that distress might appear like significant behavioral difficulties through refusal, not wanting to remain in the classroom. They may have meltdowns at home, may lash out and and you know be verbally abusive and and seem to have meltdowns a lot of the time and sometimes this is a real relationship to how the brain is functioning and and how it might not be conducive to learning in a mainstream classroom environment where it's quite noisy. There's lots going on lots, to be filtered out, these children have very similar sensitive problems to that kids who are autistic and they have lots of learning and behavioral differences to other neurotypical children. And it just depends on them meeting a clinician who has the range of lenses in order to understand that this could be a potential explanation.

Interviewer: So what other signs are there to alert health professionals to the presence of FASD?

Dr. Sarah Brown: There are the facial features which may be picked up when a child is younger or in primary school. The main thing is taking a good alcohol history, which is something that I think people need to put more training in.

Dr. Jennifer Shields: Yeah. I mean, I guess just echoing what Sarah said about ninety percent of these children won't have facial features. The presence of an alcohol history, so that could come from a conversation that the ACAMH clinician is meeting with a family for the first time you'll might be able to ask a series of questions about pre-pregnancy lifestyle in a conversational way, not just asking did you drink in pregnancy? Because that normally illicits a "yes or no" response. Mainly a "no" response, actually asking about when somebody realized they were pregnant what the lifestyle was like up until then, what their diet, stress, smoking, alcohol or other drug taking status was, but in a very sort of conversational way and that is the sign that would alert you to the possibility of FASD. But as we said not all alcohol in most pregnancies lead to FASD.

Interviewer: And how well-trained are health professionals in asking those types of questions in what sounds like it has to be a non-judgmental way?

Dr. Sarah Brown: I think it's getting better. But I think you would agree Jen, there's a large piece of work needing done probably across many specialties within health, but also within multi-agency teams and really and education to raise the awareness and be able to speak about alcohol exposed pregnancies in our non-judgmental, non-stigmatizing manner, and I think the first step that would be embedded in our curriculums across professional groups regarding FASD in terms of awareness raising, but in particular taking that sense of alcohol history regardless of the assessment process that you think you might be needing to do. So if a child is brought in for an autism assessment I still think there's merit in taking a good alcohol history as part of your your developmental process.

Interviewer: In my intro I described FASD as the most common preventable non-genetic cause of neurodevelopmental disorders in the UK. Just how big is this problem? What is the prevalence?

Dr. Sarah Brown: Well, there is, I have to be upfront and say there's a lack of research in this area, I guess we've got the problem where there's no data. There's no problem. There's no action. And therefore there's not been a lot of impetus to get data unless until fairly recently, but there has now been in the last year Sharon Maguire and colleagues in Bristol did a screenings study. So this isn't about diagnostic outcomes, but from screening a large cohort of individuals as part of a previous study their estimates lie between six percent and seventeen percent. That sounds like a very high number, but when we look at the biological data that we have from a Glasgow based study which looked at meconium and biomarkers of alcohol, they found that forty percent of the children born had alcohol biomarkers and actually fifteen percent had those biomarkers to a very high level which indicated routine drinking in pregnancy to levels that would be teratogenic to a fetus. So it's a big issue that we need to confront.

Interviewer: I'm wondering whether people with FASD are unaware of what is happening to them and why they have the issues they have?

Dr. Sarah Brown: A really good question. I think a lot of the time the individuals that we've spoken with, in particular the adult community tell us that they're very aware that things are different for them, that they don't seem to fit this world like they see their peers coping with school and relationships and independent living and particularly for teenagers these individuals are very self-aware that things aren't right. And the consequence is that they have misunderstood presentations to see cams or mental health services at large and and receive interventions for things in like merging anxiety at really underpinning reason for that, difference is something new development and it's not been understood.

Interviewer: How is FASD diagnosed, when it all goes right. What happens?

Dr. Sarah Brown: So I think it would depend on the age of the individual. If a wee one is born and we know that there has been a high level of alcohol exposure during pregnancy. It may have a small head circumference, it may have facial features and that's something that can be detected you know at birth or shortly thereafter, and appropriate diagnoses depending on the timing and the family situation. It may be potentially diagnosed by that point. I was say for the vast majority it's later on during either childhood or into adulthood and that would depend on their physical presentation. But also the new developmental presentation. We certainly see children presenting at different ages and it seems to relate to when the kind of environment becomes slightly less supportive. So it might be going from preschool years and Nursery into primary one or reception think in England. Equally when it gets about middle school, middle primary school and children are being expected to do a little bit more for themselves, that might be where there's a bigger gap growing between them and their peer groups.

And again to secondary school, that's a big time for referral simply because the environment is not as supportive. You don't have a single classroom. You've got to get yourself around schools. So once the concern has been flagged up and if we have a positive alcohol history, then that is actually referred in boring your developmental assessment. And as part of that new development assessment, we would look to see what we think is the most likely cause that you would with any presenting industrial illness as an edit or is the psychologist?

And I think that if you felt that alcohol was a significant contributing factor, then we would involve our wider multiple disciplinary team. When the child is I mean, it's very difficult to do this I would say under the age of five even maybe seven depending on the child's ability. So it's often kind of that middle primary school age where they present, and at that point if they were having difficulties learning to ride a bike or are quite clumsy. You can catch a ball, tie their shoelaces, if it was functional difficulties related to their fine motor, gross motor skills. We would ask our colleagues in occupational therapy to see the child and assess them.

Dr. Jennifer Shields: For me having an assessment of their language standardized assessment can be very very useful. We know that the children, young people are often able to express themselves very, well. It may not be entirely age appropriate as to the peer group, but it is good enough that you wouldn't necessarily pick up on there being a big difference in the content or structure of their language, but that can often mask a difficulty with understanding language and they can be very lost within busy settings and busy classrooms and more complex instructions. So for me referring on to speech and language therapy to get a good understanding of both their core language skills, and the pragmatics of their language is really really important.

My role as a pediatrician is to look for I suppose the underlying cause or any associated health conditions. So for me, it's great examining whether they have any birthmarks, any structural abnormalities, if their head size is appropriate for their age. If they have any facial features. And but also thinking about any inherited vulnerability, so any genetic contributions that may make a child more prone to having some learning difficulties or difficulties with education or mental health issues. Another line of my work is in children who are care experienced. These are children who've been in the looked after in accommodated service, and often the histories that you have for these children are very patchy and the understanding they have of their family makeup or their family history can be lacking. I think it's particularly important for this group to ensure that there's not been a small inherited micro-deletion or duplication, which is the one small change in your genetic material, because that may offer an explanation as to why their parents struggle to meet their needs. And that might be in addition to a prenatal alcohol exposure because of moms difficulties, and knew what she was facing in life. So I think it's all about piecing together information as a pediatrician about that medical history and health history and any head injuries or severe illnesses really that might also have contributed to a new developmental picture. I think that one of the biggest kind of pieces of work is by my colleagues in Psychology and although Jane is the principal local psychologist for this we do work within a team where we have the skills within a cam psychology department who can all work with these these young people.

Interviewer: Right, you've described best practice, but how good are clinicians and other health professionals at making a correct diagnosis? Does that good practice happen enough?

Dr. Jennifer Shields: Well at the minute, I think it's fair to see that there are only two main centers or health boards that are providing that systematic approach to FASD assessment, and there are pockets of good practice happening in other health boards. But it's just new and emerging within their new developmental pathways. And so to my knowledge in Surrey and borders there's the national FASD center. Run by Dr. Raja Mukherjee and partners in Psychology. And he's also a consultant psychiatrist for a number of new developmental conditions, so, he's a very suddenly spread resource I must say. And there's ourselves in NHS Ayrshire and Arran but within Scotland we've been trying to encourage other health boards, and they are doing as I said pockets of assessment here and there for fetal alcohol spectrum disorders. Generally in a multi-disciplinary neuro developmental pathway approach. It's not specialist centres like you have in Surrey in England. So I feel like we have got a long way to go, but the fact that Scotland have now produced signed guidelines so it's sort of the move to the nice guidelines in England and we understand now in England there will be a nice quality standard for FASD which I hope will promote in clinicians and health professionals to get training to make the correct diagnosis because I think the risk of misdiagnosis is high and I think the further risks as a society of us to know what to identifying this will have huge impact on prevention or the lack of prevention.

Interviewer: So if the condition is misdiagnosed, mistaken, perhaps for autism spectrum disorder or ADHD. What harm is caused by that misdiagnosis?

Dr. Jennifer Shields: Well I think for some of those children there will be benefits of being understood as having a typical neurodevelopment and certainly, you know, children can benefit from stimulant medication, but perhaps for children with FASD there are going to be brain areas that are affected beyond social communication, social interaction that aren't identified and therefore the interventions that follow will not fit the profile of that child. And similarly, if children are misdiagnosed as having ADHD, and actually the reason for their distractibility, fidgetyness and impulsivity is coming from more a brain structured place rather than a neuro chemical place then potentially these children will have medication that has limited efficacy and certainly even in the kids that have FASD and ADHD there are different medications. That would be your first line medication that is different to general pathway for ADHD management.

But I mean, I'm a psychologist speaking about this but I've learned a lot from psychologists and psychiatrists who work in the FASD field and I hope I'm doing a good enough job to represent your thinking on that. But I think it's about accurate diagnosis coming from a good understanding of the profound strengths of different difficulties. If you think it's autism or ADHD, then you're going to be missing a large part of the picture.

Interviewer: So what happens when a correct diagnosis is made how are children with FASD and their families helped and perhaps you can talk about some of the existing interventions?

Dr. Jennifer Shields: Yes. So I think the correct diagnosis also comes as part of a bigger picture of the correct understanding of the brain profile. So for example, if a child has got language comprehension difficulties that are now eliminated by speech and language therapy that their motor difficulties are understood, that we can see that their executive function is very difficult for them to control and pulsivity, for example, there's a whole range of environmental and and multi-disciplinary interventions that would affect that profile. It's really about making sure the child gets the right understanding and sometimes very simple environmental adaptations in the school environment can have a huge benefit to the child. So bringing down the sensory stimulus changing the position in class, the teacher knowing about the comprehension problems, knowing about the motor difficulties, seeing that impulsivity in a different light as our brain based problem, not just behavior, can change the responses of others, the understanding of the family and can provide a meaningful lens by which the child's behaviors, distress and emotions can be understood. So there's lots of things that we can do for these children, but it does follow the correct profile and diagnosis being constructed.

Interviewer: What does the research show us with regard the efficacy and effectiveness of the existing support and interventions for children with FASD?

Dr. Jennifer Shields: The broad strokes of that is that the earlier that you identify and diagnose with appropriate the better the outcomes are for children, because people understand them, they are able to adapt the environment, adapt communication and offer support where appropriate. So, basically the evidence states if you're able to provide that understanding in the diagnosis before the age of eight, then you have got the greater ability to augment the trajectory of that child and steer them away from the negative outcomes, which can be you know, disengagement from school, addiction problems, homelessness, unemployment, and I guess generally being misunderstood for much of their adult lives. These children function at a different level to their chronological age.

So, as Sarah said adjusting expectations can have a huge meaning to families and to the individuals themselves and our adult community, tell us that that being understood is the most important bit. And actually that is what helps them to find a new self-identity, self-concept and does reduce the likelihood of mental health problems because in those who aren't identified 95% will have mental health difficulties. So it's as much as trying to promote the positive and harness the strengths and also trying to diminish all the barriers that lie in the way of the child and to avoid those negative outcomes.

Interviewer: If it is known that there has been prenatal alcohol exposure. Is there anything that can be done preventatively to reduce the risk of FASD?

Dr. Sarah Brown: I think the most important thing is to recognize if you're pregnant. Even if you have been drinking stopping drinking any further alcohol is extremely beneficial.

Dr. Jennifer Shields: The other thing is that the children that the research that we know about these children indicates that if you're able to offer stability particularly from an attachment perspective having care givers who are attuned, that they are these children protected from any trauma or further victimization because a lot of these children do have those complexities, but they don not cause the degree of neuro developmental difference as you know attachment trauma, and I went to be clear on that. But if there is to be harm reduction it is stopping alcohol at the earliest point ensuring the pregnancies are well supported, that the diet is good and in mom-to-be and that yeah, those those early years that is well supported as possible.

Interviewer: Right, and talking about research are either of you working on any specific trials or projects with regards FASD that you'd like to share?

Dr. Jennifer Shields: Yes so our teams looking to be much more active in the research fields, we're looking to build up evidence on the neurodevelopmental profiles of these children using all the results of the multi-disciplinary team assessments. But I think most importantly we are looking to hear the voices of those who have the lived experience and what we want to find out is perspectives on FASD diagnosis from the perspective of birth moms, from adoptive parents, from the individuals themselves who have FASD and to see what they think about how our future services should be shaped. So that's our priority for our team We are also going to be writing up papers on our service evaluation that we conducted in NHS Ayrshire and Arran, and we've also got interesting genetic findings that Sarah is looking to explore. So but with our partners in FASD, we've got some parenting intervention work that we're looking at and we're also excited to hear our colleagues are looking at active case ascertainment in England, which I think will be really helpful in terms of being able to get people that definitive answer of how prevalent FASD is in the UK. So there's lots happening, but we need lots more people to be interested in FASD and to help take that forward.

Interviewer: With regards the near future, what else is needed either in terms of research or policy that you would like to see come to fruition?

Dr. Sarah Brown: I think that what I would like to see is this been given a much higher recognition and platform within governments and also within the research communities of universities. The funding that is attributable to FASD is very very minimal and it is an area where we need so much more research and for it to be seen as being the priority that it needs to be in terms of improving the kind of social economic outlook for not just individuals, but also society and the damage that alcohol can do prenatally. And I think to me that would be be something that we all need to work on to get it on to the agendas of policy makers, funders and people who develop curriculums for all the relevant and professionals involved in care of young people and adults.

Interviewer: That's great, we've covered an awful lot. Is there anything else you'd like to add perhaps as a takeaway message for those listening to this podcast?

Dr. Sarah Brown: I mean I think for me I always say to people when I'm giving a lecture that if you don't remember anything else from this apart from no alcohol, no risk. If you protect any future pregnancies that you have from prenatal alcohol exposure. If you can spread that message with your family members, nieces, nephews, boyfriends, husbands. I mean to me it's about everyone playing their part in the prevention message. And it's as simple as if you're drinking don't drive. If your drinking it should be that you avoid pregnancy and ensuring that contraceptive options are explored both for the young people we work with and for anybody really in the community and I think that no alcohol, no risk message needs to be really used in lots of the contacts we have with people both socially and professionally.

Dr. Jennifer Shields: Yeah and for me, I think for me it's FASD is everybody's business whether you work or are a researcher in criminal justice, in addiction and mental health, in child and young people's health. Whether you work in cardiac or whether you work in a clinic that's for for something else. This has got to be on your radar. It's affecting so many people in so many different ways and many of which we don't understand that we can't allow this to just be something that child mental health or paediatric departments need to be involved in. This has got to be everybody's business and prevention is key. And for those that are affected. They just want to be seen. They describe themselves as hidden in plain sight and they require identification, diagnosis and support like any other child and we just need to make sure we upskill as many people as we can and raise awareness of FASD and that's why we thought this podcast would be a great thing to do and if people are able to share that then we would be very grateful.

Interviewer: Right, fantastic it's been really fascinating. Thank you Dr.Jennifer Shields and Dr.Sarah Brown for your enlightening overview of fetal alcohol spectrum disorder. For more details visit the ACAMH website www.acamh.org and Twitter at ACAMH. ACAMH is spelt ACAMH.

Outro: This podcast was brought to you by the Association for Child and Adolescent mental health, ACAMH for short.

ENDS
Principal Clinical Psychologist for the Scottish Government Fetal Alcohol Advisory and Support Team (FAAST) based in NHS Ayrshire and Arran. Principal Educator for Autism (NHS Education Scotland)
Following two years working for the West Dunbartonshire Acquired Brain Injury Service, Dr. Shields completed her Doctorate in Clinical Psychology at the University of Glasgow. Alongside her clinical post within the Child & Adolescent Mental Health Service in North Ayrshire, she also completed a Post Graduate Diploma in Paediatric Clinical Neuropsychology at University College London. Dr. Shields has a longstanding interest in neurodevelopmental conditions and acquired brain injury. She was a member of the working group for the SIGN Guideline for Autism (145) and is currently a member of the working group for the SIGN Guideline for FASD.
Consultant Paediatrician, Rainbow House Child Development Centre, NHS Ayrshire & Arran
Dr Brown has longstanding interests in advocating for the needs of Looked After and Accommodated Children and is the Lead Paediatrician for LAAC Health within Ayrshire. Dr Brown is the Lead Clinician for the Scottish Government Fetal Alcohol Advisory and Support Team and is committed to supporting the nationwide development of FASD services and improving clinician confidence in the diagnosis of FASD. She regularly teaches and presents at conferences on Fetal Alcohol Spectrum Disorders and is a member of the FASD SIGN Guideline Group.

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In Conversation... Fetal Alcohol Spectrum Disorder (FASD) - ACAMH

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Dr. Jennifer Shields & Dr. Sarah Brown discuss Fetal Alcohol Spectrum Disorder (FASD), the most common preventable non-genetic cause of neurodevelopmental disorders in the UK.

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Introduction

One of the causes of physical disabilities and learning disabilities in children is Foetal Alcohol Sydrome (FAS). This is a pattern of disabilities that can develop in a baby as it grows in the womb. It happens because the pregnant mother drinks alcohol. FAS is one of a group of conditions. The whole group is called foetal alcohol spectrum disorders (FASDs). Other conditions within this range are:

Alcohol-related birth defects (ARBDs)

Partial foetal alcohol syndrome (pFAS)

Alcohol-related neuro-developmental disorder (ARND)

Babies born with FAS have a set group of symptoms. These can include different shapes to their faces, restricted development and some mental difficulties. People with the other conditions in the spectrum may not have this exact match of problems. They have some of them, or other problems because of alcohol consumed before their birth.

A baby in the womb (foetus) gets all its nourishment from its mother's bloodstream. Alcohol in the mother's blood can pass through the placenta to the baby's blood. So if a pregnant mother drinks alcohol, it passes through the baby too. Alcohol is a toxic substance, so it can poison the developing foetus. In the nine months in the womb, the baby develops and forms. Poisons in the blood can damage the baby. The damage depends on which part is developing at that time. The brain is continually forming, so it can be damaged at any stage of pregnancy. In the first three months the organs are developing. So, this is the time when the heart, eyes, and kidneys might be harmed. Later, when the foetus is growing fast, alcohol can slow this down.

FAS and FASD only occur in babies born to mothers who drink alcohol during pregnancy. It is not known exactly how much alcohol is safe in pregnancy but heavy drinking and binge drinking are more likely to cause damage to the baby. Not every mother who drinks heavily in pregnancy has a baby with FAS. So there seem to be other factors that make it more likely to happen. These may include genetics, mother's general health and diet, stress, mother's age and whether the mother smokes or not.

FAS is entirely preventable. Women should be advised that if they are pregnant or planning a pregnancy that they shouldn't drink alcohol. It is not known exactly how much alcohol it is safe to drink in pregnancy so it is safest not to drink any at all. However, there is no definite evidence that small amounts of alcohol cause harm. National Institute for Health and Care Excellence (NICE) guidelines in the UK advise that if you are pregnant, do not drink at all if possible.

In the UK nobody is sure exactly how common FAS is. This is because it is difficult to diagnose. Also, there is no system for reporting it. It is known, however, that FAS is one of the most common reasons for children to have mental or behavioural problems.

FAS has three classic groups of abnormality:

(a) Differences in face shape including:

A small head.

The groove between the nose and lip is flattened.

A thin upper lip.

A flat bridge of the nose, which tends to be short and upturned.

Drooping eyelids (ptosis).

A 'railroad track' shape to the outer part of the ears.

Small eyes that are closer together.

Skin folds of the upper eyelids (epicanthic folds).

(b) Developmental delay with small size and low weight, with children growing up to be shorter than average adults.

(c) Mental and behavioural difficulties

These happen because alcohol damages the brain as it forms. They can include:

Lower-than-average IQ.

Hyperactivity.

Difficulty with paying attention.

Memory problems.

Difficulty with seeing the consequences of one's own actions.

Poor judgement.

Impulsive behaviour and not being able to control impulses.

Poor problem-solving skills.

Difficulty understanding things like time, money, and maths.

Difficulty getting on with other people, immature behaviour, aggressive behaviour.

Speech and language delay.

Problems sucking and feeding in the newborn (and sometimes symptoms of alcohol withdrawal).

There may also be some of the other problems from the whole range of FASD. These include:

Poor hearing or vision.

Abnormalities of the valves of the heart.

Kidney problems or genital abnormalities.

Bone and joint problems.

There is no test for FAS. It can only be diagnosed by spotting the typical features. Also by suspecting or knowing the mother may have drunk alcohol during pregnancy. Tests might be done to check there is no other reason for the abnormalities. Diagnosis can only be undertaken by a trained medical practitioner. FAS may not be detected at birth but can become apparent later in life and carries lifelong implications.

There is no particular treatment. Babies with FAS and FASD will have the problems for the rest of their lives. However, if the condition is picked up early, they will suffer the effects less. They can be helped and understood.

There is no cure for FAS so babies born with it will be affected throughout their lives and may experience a wide range of difficulties in relation to education, socialising, and behavioural difficulties. Getting the diagnosis of FAS right is good for the child. If it is known what is wrong with them, they can be helped. If the diagnosis is made early they can access special help. They will have fewer problems if they are in a loving and understanding family. All different agencies working with children and families, including health, social care, schools etc. can help children and adults with FAS.

Further Guidance

Further information and guidance on FAS can be found on the following websites:

The NSPCC has published a report All Babies Count: Spotlight on Drugs and Alcohol which includes research into FAS and is useful reading for practitioners. Also, the All Party Parliamentary Group for FASD published a report in December 2015 on the picture of FASD in the UK and other related documents.

There are support groups with provide guidance, help and support to families affected by FAS.

Community Care published an article on FASDs in September 2016.

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One of the causes of physical disabilities and learning disabilities in children is Foetal Alcohol Sydrome (FAS). This is a pattern of disabilities that can develop in a baby as it grows in the womb. It happens because the pregnant mother drinks alcohol. FAS is one of a group of conditions.

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Find out about fetal alcohol spectrum disorder, which is a range of mental and physical problems that can affect a child if their mother drinks alcohol while pregnant.

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FASD is a spectrum disorder. This means that everyone who has FASD may display the symptoms in different ways.

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Support for Parents from Action For Children

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Supporting a child with PDA (pathological demand avoidance)

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Pathological Demand Avoidance (PDA) is where someone avoid everyday demands. It is widely considered to part of the autism spectrum.

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PDA Society - Pathological Demand Avoidance

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When you’re wondering whether to seek a diagnosis for yourself or your child, it can feel like a huge and emotional decision.

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SENDcast Sessions are a new way for schools to access high quality CPD from SEND experts brought to you by the SENDcast. It's the same great guests featured on our weekly podcast, delivering focused 1-hour online training sessions on a wide range of SEND topics.

SENDcast Sessions provide schools with in depth content that can be accessed forever. Build a library of online CPD that your school can continue to use in the future - choose from over 100 training sessions!

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An Introduction to PDA with special guest Clare Truman

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This week Dale is joined by Clare Truman to give SENDcast listeners an introduction to Pathological Demand Avoidance (PDA).

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In this week’s podcast we discuss how to support PDA with Freelance Education Consultant Clare Truman

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Relationship dynamics with children with PDA

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Beth and Ian explore various aspects of parenting children with PDA, sharing personal experiences, professional insights, and practical advice that can make a significant difference for parents, teachers and children.

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What is Pathological Demand Avoidance (PDA)?

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Harry J. Thompson was born in Edgware and grew up in Barnet in north London. He is currently based in London, UK. An avid reader & researcher, Harry speaks publicly and is heavily involved in projects & research on all topics around neurodiversity and autism; namely, Pathological Demand Avoidance, a behavior profile within the Autism Spectrum.

Harry began to write the first draft of his book in 2015. After connecting with many autistic & PDA families, he pivoted his direction and completed his book in about 6 weeks, a memoir entitled the PDA Paradox: The Highs and Lows of My Life on a Little-Known Part of the Autism Spectrum, published in February 2019. He launched his YouTube channel in 2017.

Harry has been elected to a Fellowship of the Royal Society of Arts (FRSA), in recognition of his work in the field of PDA, and also in recognition of the publication of his book.

BACKGROUND READING

The PDA Paradox, PDA, Harry's website, Harry's YouTube channel, Harry's Facebook page

Download a transcript of episode 54, made possible by supporters in our Patreon family. Click to join them.

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Episode 54: Understanding Pathological Demand Avoidance - The Neurodiversity Podcast

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Pathological Demand Avoidance is a newer concept for many in the US, but it's old hat for Harry Thompson.

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learning disabilities

Sensory Processing in Young People with a Learning Disability and/or ASD

We use our sensory systems to understand the world around us. We process information through our senses and decide on how to respond to the things we are experiencing. Sensory systems that absorb information about the world around us are:

The last 3 sensory systems - touch, proprioception and vestibular - help us to feel in tune with our world and to feel grounded as a person.

Learning how to process sensory-based information as it is received can be challenging for all of us at times, but more challenging for a child with a learning disability. We have to filter out what things are important and what things to ignore. For instance, if we hear our name being called, we respond to this, even though there may be other sounds in the room that could distract us. Some children have difficulty with this filtering process.

Many of these behaviours are not uncommon, but sometimes they can be persistent and impact on quality of life:

Running out of busy places when there are lots of visuals and/or sounds present.
This may be a child who cannot cope with processing so many different things at one time.

Seeking lots of physical movement through the day.
This may be a child who needs more information into their muscle and movement systems, to tell them where they are in space.

Sensitivity to light touch.
Your child may be very sensitive to unexpected or light touch and have an anxious response to it.

Seeking heavy touch and hugs.
Your child may seek lots of heavy touch, through hugs for example, to get more input to their touch system. This can be calming for them.

Difficulty with posture and co-ordination.
This may represent a child whose muscle and movement systems are not as efficient.

Being overloaded by visual or sound input.
This may affect their ability to concentrate

THINGS TO THINK ABOUT
Consider patterns of behaviour. Reasons may be many and varied, but among them may be some of the following:

Your child may be trying to feed a sensory system that they are not so good at registering.

You may also find that if your child receives too many stimuli, they reach an overload state and this can lead to a state of high anxiety.

Often children instinctively know what they need, and may be giving you clues as to what sensory input they are seeking, or what they are unable to cope with.

Think about what things your child may be sensitive to; such as light touch or hair brushing.

If your child is seeking more input, see if there are ways to support your child through sensory based activities that "feed" sensory needs in the right way (e.g. movement breaks between sedentary activities).

You may find that your child seeks certain sensory stimulation - this may be an attempt to "kick start" a system that is not as active as the child needs it to be.

Challenging behaviour can have a sensory based cause, but can increase with secondary gains (e.g. avoiding an activity). It can be challenging to work out what is motivating a child to display these behaviours, and what has become more important as an additional gain for the child. Sometimes it helps just to try and understand why a child may behave in the way that they do. Looking at behaviours using a sensory viewpoint can help you to understand why your child reacts to certain things (e.g. sensitivity to clothing).

COMMON QUESTIONS
Q : Is my child trying to feed a sensory system by increasing the input to it?
Answer: Maybe, but do not stop them from feeding this system, try and find acceptable ways they can do this.

Q: Is my child defensive of certain sensory inputs?
Answer: They may have difficulty filtering input to their sensory systems. Be gentle in gradually increasing their tolerance. Seek advice if you are concerned.

Q: Is the environment contributing to my child's sensory difficulties?
Answer: Look at ordering the environment so it is not overloading them. Break down the elements that might be affecting them, and reduce the stimulus (e.g. putting away toys into boxes reduces visual overload).

Q: How can I reduce the impact of sensory over load?
Answer: The use of weight bearing or heavy muscle activity can calm a child before a challenging event/activity.

CONSIDER SEEKING HELP:
If you feel that your child has ongoing difficulties or challenging behaviours that are affecting their ability to cope with their environment and every day activities, please talk to your Paediatrician, Social Worker, or School about further sources of support.

The Sensory Integration Network provides courses and online resources related to sensory integration.
Website

'The Out of Sync Child' by Carol Stock Kranowitz
Website

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

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

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

Derbyshire Area Sensory Needs Processing Package
DCC Local area can now offer a 'bundle' of resources to support the SPN of children & young people which will be of especial interest to schools, colleges and early years' settings. Please click on the following link to learn more and to read the statement from DCC:
Website

Derbyshire County offer local support for pupils in school who may have sensory processing needs

Sheffield Children's Hospital provide a number of helpful sensory processing strategies

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We use our sensory systems to understand the world around us. We process information through our senses and decide on how to respond to the things we are experiencing.

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NHS Tayside CYP Occupational Therapy Service

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PARENT - Daily Occupations and Sensory Processing Training

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Free online sensory processing course for teachers, assistants and parents

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GriffinOT's free sensory course gives an introduction to the senses and sensory processing. It helps educators and parents to understand sensory behaviours.

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If your child has strong reactions to tastes, sounds, or the feel of certain items, you may wonder why this happens. For instance, why are new shoes so unbearable that your child yells and pulls them off? What makes the supermarket so overwhelming that even a quick trip leads to a meltdown?

When kids have outbursts or get upset by things in the environment, it's often because of sensory processing challenges. (Some people use the term sensory processing disorder.) Their brains have trouble managing the information that comes in from the senses. That includes the five main senses: taste, smell, sound, touch, and sight. It also includes three senses that impact body and space awareness and movement.

What are sensory processing challenges?

There are two types of sensory challenges, and many kids have both. The most common type is oversensitivity. Kids get overwhelmed by the information that comes in through their senses. (This is called sensory overload.) And they try to avoid sensations that they can't tolerate.

Common triggers include:

The other type of sensory challenge is undersensitivity. With this type, kids don't get enough input from the environment. So, they seek more sensory stimulation.

Kids with these challenges don't always have the same reaction to input. They may be oversensitive to some sensations and undersensitive to others. Their reactions can also change based on where they are and what's going on around them.

Sensory processing challenges aren't a diagnosis on their own. But they often co-occur with two conditions: ADHD and autism. Sensory challenges may also co-occur with anxiety.

Dive deeper

Signs of sensory processing challenges

The signs you might see depend on two things. The first is the trigger - the sensory input that's overwhelming your child. The second is the type of sensory challenge your child has.

Sensory avoiding

Kids who are sensory avoiding may have extreme reactions to a wide range of triggers. The overload they feel can lead to sensory meltdowns. Here are some signs you might see in your child:

Is easily overwhelmed by people and places

Seeks out quiet spots in noisy, crowded environments

Is easily startled by sudden noises

Is bothered by bright light

Refuses to wear itchy or otherwise uncomfortable clothing

Avoids touching people or hugging them

Has a strong reaction to the texture or smell of certain foods

Refuses to try new foods and has a very limited diet of preferred foods

Gets upset about small changes in routine and transitioning from one activity or environment to another

Avoids trying new things

Sensory seeking

Kids who are sensory seeking often have a need for movement. They may seek out input like spicy or sour tastes and physical contact and pressure. Here are other signs you might see:

Constantly touches objects

Plays roughly and takes physical risks

Has a high tolerance for pain

Often squirms and fidgets

Is constantly on the move

Invades other people's personal space

Often gets distracted or feels anxious

Is clumsy and uncoordinated

Dive deeper

Trouble with other senses

Sensory information isn't limited to the traditional five senses. There are three other senses that kids can also struggle with.

The first is called interoception. This sense helps us understand and feel what's going on in our bodies. Kids who have trouble with this sense may have a harder time with toilet training or have an unexpected threshold for pain.

The second of these senses is body awareness (proprioception). And the third is spatial awareness (the vestibular sense). Trouble with these senses can sometimes affect movement.

Finding out if your child has sensory processing challenges

There are a few tests that can help identify sensory processing challenges. They include checklists like the Sensory Profile or the Sensory Processing Measure (SPM). Some therapists are also trained in the Evaluation in Ayres Sensory Integration (EASI).

But the behaviors that come with these challenges are very visible and clear without testing. It's important to observe your child and take notes to share with professionals. They can more accurately tell you what's behind the behaviors.

The professionals who often identify sensory challenges are occupational therapists (OTs). They also work with kids who have them. Other professionals who may identify challenges:

Pediatricians

Developmental-behavioral pediatricians

Psychologists, including neuropsychologists

School evaluators

Physical therapists and speech therapists

Supports and treatment for sensory processing challenges

There are no medications for sensory processing challenges. But OTs help kids find ways to be less overwhelmed by sensory input.

For instance, they might create what's called a sensory diet. This is a tailored plan of physical activities. It helps kids learn to calm themselves and regulate their behavior and emotions. And that makes them more open to learning and socializing.

Here are some things that might be included in a sensory diet:

Some of these activities are heavy work, a type of activity that pushes or pulls against the body and can be calming for many kids.

Kids with sensory challenges may also be able to get help at school. They might be able to get OT services or accommodations through a 504 plan. (If your child has an IEP for another reason, it could include accommodations for sensory challenges, too.)

Classroom accommodations or supports to help kids with sensory processing challenges might include:

Allowing your child to take exercise breaks to self-regulate

Providing a quiet space to work or earplugs for noise sensitivity

Telling your child ahead of time about a change in routine

Seating your child away from doors, windows, or buzzing lights

Allowing your child to use a fidget

Dive deeper

Ways to help your child manage the challenges

Dealing with the unexpected behaviors that come with sensory challenges can be hard on the whole family. But once you know what's causing them, it gets easier to know how to help. There are lots of strategies you can use at home and on the go:

It's important to find support for yourself, too. Join our Wunder community to connect and share strategies with other parents.

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Understanding sensory processing challenges in your child

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Sensory processing challenges make it hard to manage information that comes in through the senses. Kids may overreact and under-react to sensations. Learn more about sensory processing issues.

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What is Sensory Processing Disorder and how it might affect your child?

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Learn what sensory processing disorder is and how differences with processing sensory information affect attention, behavoiur and learning.

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Sensory Processing Disorder (SPD) Explained

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Allison Davies, Brain Care Specialist and sensory and behavioural expert, talks about all things Sensory Processing Disorder, or SPD. With info on everything from how to tell if your child might have SPD to how you can help them if they do, Allison gives us the lowdown, with some bonus personal insights as an adult with SPD.

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Tourettes Action is a support and research charity working to improve the lives of people living with Tourette Syndrome. Our services include online live-chat and email support, a befriender network, information, webinars, events and resources.

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Tourette Syndrome (for Parents) - Nemours KidsHealth

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Tourette syndrome is a condition that causes uncontrolled sudden, repetitive muscle movements and sounds known as tics.

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Find out about Tourette syndrome, a condition that causes tics, including its symptoms, treatment and causes.

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Tics are sudden, rapid and repeated body movements or sounds that serve no purpose and are involuntary (children and young people are not doing them by choice).

The movements - called motor tics - can affect anywhere in the body although most typically affect the head and neck. Common examples of motor tics include rapid blinking, twitches in the neck and nose wrinkling. The sounds - called vocal tics - commonly involve sniffing, tutting or throat clearing noises.

Tics can be simple - involving just one muscle or making a noise - like the examples above. Tics can also be complex - lots of muscles moving together or spoken words - for example jumping on the spot or repeating words. Some tics can be hard to distinguish from normal movements whereas others can be very noticeable to other people.

Although tics vary from person to person, they often share certain traits.

Tics often occur more frequently in predictable settings or situations. Some children will have lots of tics when watching TV or playing video games, others will experience more tics at home than at school. Although these situations are different from child to child most families can pick out the context in which their child is most likely to tic.

Children and young people often get a 'premonitory urge', an odd or unpleasant sensation, that builds up until the child tics which relieves the sensation. Some children describe this as a sense of pressure, or like the feeling then get if they need to cough or scratch an itch. Other children find it very difficult to describe.

Although tics are involuntary in the sense that people do not choose to do them, they often are able to suppress or 'hold in' a tic if they feel they need to. This does not stop the urge building up and people often find it hard to supress a tic for extended periods of time.

It can be hard to describe what it feels like to have a tic, but try the following exercise:

Try to not blink, for as long as you can. The longer you don't blink, the more you want to blink, and that feeling is like what it feels like to have an urge to tic.

Here are some examples of tics:
Motor Tics
1. Simple Movements (Involving a Single Muscle Group)

These are quick, involuntary movements that engage only one muscle group:

Nose wrinkling

Head twitching or bobbing

Eye blinking

Shoulder shrugging

Arm jerking

2. Complex Movements (Involving Multiple Muscle Groups)

These involve coordinated actions using more than one muscle group:

Touching objects repeatedly

Skipping

Facial grimacing while sticking the tongue out

Hopping

Mimicking others' movements

Vocal Tics
1. Simple Vocal Tics (Involving One Simple Sound)

These tics are brief and involve a single sound:

2. Complex Vocal Tics (Meaningful Speech)

These tics involve more structured speech patterns and can include:

Repeating words and phrases out of context (which may include socially unacceptable words or phrases)

Echoing others' speech (echolalia)

Calling out words or phrases

Swearing (coprolalia)

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Tics and Tourette's Syndrome | Common Health Issues - Child 5 to 11 years | Healthier Together

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Advice and guidance on Tics and Tourette's Syndrome for Common Health Issues - Child 5 to 11 years.

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Discussing Tourette’s in the Education System with Lucy Toghill

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In this week’s podcast Dale talks to Lucy Toghill about Tourette’s Syndrome and how it is handled within the education system.

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Let’s talk about Tourette’s with Ione Georgakis

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In this week’s podcast Dale talks to Ione Georgakis about Tourette Syndrome Awareness Month - May 15th to June 15th.

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Transforming Health and Wellbeing for Everyone

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Supporting Autistic Children in the Classroom | National Autistic Society | Twinkl

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The new MOOC will help parents and carers of children with autism.

A new massive, open, online course (MOOC) designed and delivered by psychologists at the University of Bath launches this week for Autism Awareness Week, aiming to help parents and teachers of children on the autism spectrum.

The free course, 'Good Practice in Autism Education' which is offered by academics in the University's Centre for Applied Autism Research, is conducted online over four-weeks.

It is designed to give parents, carers and teachers more information on educational requirements of children on the autism spectrum, to reflect on what constitutes good practice in autism education settings, and to compare specific examples of good practice in autism education.

In view of the current situation many parents now find themselves in, home-schooling children, the researchers behind the MOOC hope it can give parents with autistic children practical tips on getting through the next few months and beyond.

Director of the Centre for Applied Autism Research, Professor Mark Brosnan, explained: "The course has been designed to be accessible to the whole autism community. As well as a wide range of useful information and resources, there are discussion forums for parents and teachers to share their experiences with each other.

"In light of recent events, the course starts with top tips and a discussion around supporting children on the autism spectrum's learning at home".

Over four-weeks, participants will learn more about autism and intellectual disabilities, developing an inclusive curriculum and good practice in autism education. It will also provide an opportunity to share good practice with other learners.

You can access and sign up for the free, online course, which starts on Monday 30 March, via https://www.futurelearn.com/courses/autism-education. There are no prior educational requirements.

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University of Bath launches free online autism course to help parents and teachers

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A new massive, open, online course (MOOC) designed and delivered by psychologists at the University of Bath launches this week for Autism Awareness Week, aiming to help parents and teachers of children on the autism spectrum. The free course, 'Good Practice in Autism Education' which is offered by academics in the University's Centre for Applied Autism Research, is conducted online over four-weeks.

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The new MOOC will help parents and carers of children with autism.

A new massive, open, online course (MOOC) designed and delivered by psychologists at the University of Bath launches this week for Autism Awareness Week, aiming to help parents and teachers of children on the autism spectrum.

The free course, 'Good Practice in Autism Education' which is offered by academics in the University's Centre for Applied Autism Research, is conducted online over four-weeks.

It is designed to give parents, carers and teachers more information on educational requirements of children on the autism spectrum, to reflect on what constitutes good practice in autism education settings, and to compare specific examples of good practice in autism education.

In view of the current situation many parents now find themselves in, home-schooling children, the researchers behind the MOOC hope it can give parents with autistic children practical tips on getting through the next few months and beyond.

Director of the Centre for Applied Autism Research, Professor Mark Brosnan, explained: "The course has been designed to be accessible to the whole autism community. As well as a wide range of useful information and resources, there are discussion forums for parents and teachers to share their experiences with each other.

"In light of recent events, the course starts with top tips and a discussion around supporting children on the autism spectrum's learning at home".

Over four-weeks, participants will learn more about autism and intellectual disabilities, developing an inclusive curriculum and good practice in autism education. It will also provide an opportunity to share good practice with other learners.

You can access and sign up for the free, online course, which starts on Monday 30 March, via https://www.futurelearn.com/courses/autism-education. There are no prior educational requirements.

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University of Bath launches free online autism course to help parents and teachers

# data[].attributes.attachment_link.description
A new massive, open, online course (MOOC) designed and delivered by psychologists at the University of Bath launches this week for Autism Awareness Week, aiming to help parents and teachers of children on the autism spectrum. The free course, 'Good Practice in Autism Education' which is offered by academics in the University's Centre for Applied Autism Research, is conducted online over four-weeks.

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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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Parent Guide for Working Together with Your Child's School

Elective Home Education in England

The impact of Covid-19 on home education guidelines and useful links to relevant legislation.

Top Tips, Strategies and Resources for Parents

A collection of 10 practical strategies and additional tips to support parents of autistic children and young people.

A guide to help parents navigate equality law, rights and entitlements when their autistic child is excluded or at risk of exclusion from school

This resource outlines the legal duties the Equality Act 2010 places on your child's school in relation to the exclusion of disabled pupils.

The examples given relate specifically to autistic pupils and are intended to help you and your child's school avoid disability discrimination claims, where possible.

Exclusions

Advice and support on exclusions, explore the Autism Education Trust Exclusions resources

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Are you a parent or care of an autistic child or young person looking for guidance and advice? Explore our Parent Resources.

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3 OF THE BIGGEST AUTISM MYTHS

"Autistic people have poor social skills"

Autistic people have social skills. We need to stop perpetuating the narrative that Autistic people have social deficits. When Speech and Language Therapists carry out assessments on Autistic children they need to consider that the assessments are based on neurotypical (NT) language and communication developmental norms. Pragmatics is a field built upon NT styles of communication and so we cannot and should not assume Autistic people have pragmatic language impairments.

Forcing NT social skills on Autistic people leads to:

The rationale behind teaching Social Skills is so that Autistic people learn how to socialise in the 'real world' (with NTs...) so they can make friends and live fulfilling lives. But often the result is the opposite. Telling them that in order to make friends and be successful in life they must change who they are and act differently is extremely damaging. It teaches them to mask. Having to adopt the social skills of NTs makes Autistic people feel more isolated, insecure, depressed, and anxious because they feel they have act less autistic if they want to be accepted. It doesn't result in long-lasting meaningful friendships - it results in friendships that are surface-level, one-sided, less meaningful, and ultimately leave the Autistic person feeling misunderstood and burnt out due to the exhaustion of mimicking NTs. As a marginalised group of people Autistics have been historically socially rejected, bullied, and excluded since being young children - even when they try and adopt the social skills of NTs and act like everyone else. Social Skills training teaches them they must fit in, blend in, and they learn that it's not OK to be who they are.

A lot of people reading this might be thinking "ok, this sounds interesting, I get it. But wait, Autistic children have to be prepared for the 'real world' and live in society like we do. We have to teach them these skills. Everyone else has to do it, that's just life". My response to this is - It is OK to teach autistic people about how neurotypical people interact and communicate. In fact, it's important we do this because they're likely going to be encountering these interactions in their daily lives - for their own emotional and physical safety it's important they know what to expect in these interactions so that when misunderstandings happen, they know how to manage these, and don't place the blame on themselves.

In addition - assuming 'we' and 'everyone else' are NT, then no, it's not the same.

Autistic people are neurologically different and are living in a world that's not set up for them. This means that NT people do not experience the daily struggles and barriers that Autistic people do on a daily basis. NTs don't have to mask like Autistics do because they haven't experienced years of social trauma whereby masking is a conditioned response as a way to self-protect. NTs don't need to do this. And if they do 'mask' it is not to the same detriment or cost on their mental, emotional, sensory, physical health. They don't have sensory overload and meltdowns due to suppressing personality and physical traits that are deemed as socially undesirable. They don't have to spend hours/days/weeks attempting to re-charge from constant social interaction demands. They don't experience the damage to self-esteem. They don't have to suppress their stimming, echolalia, communication style or special interests. They don't have to force eye-contact to the point where it's physically painful or anxiety-inducing. They don't have to give up their authenticity in order to be accepted.

Autistic people have BETTER social engagement when they are with other Autistic people

"Social interaction is relational - it relies on the communication partner's skills as much as it does on the autistic person's" - (Sasson et al., 2017)

Communication is a 2-way street. Misunderstandings that happen in a conversation are not solely down to 1 individual - The Double Empathy Problem (Dr. Damian Milton)

Autistic children show better social engagement when they are with other Autistic children, compared to when they're with NT peers - (Kasari et al., 2015)

​

Autistic people share information just as successfully as NT people. Autistic people "have the skills to share information well with one another and experience good rapport, and that there are selective problems when autistic and non-autistic people are interacting" - (Crompton et al., 2020)

Autistic people disclosed more about themselves to other autistic people compared to non-autistic people. "Results suggest that social affiliation may increase for autistic adults when partnered with other autistic people, and support reframing social interaction difficulties in autism as a relational rather than an individual impairment" - (Morison et al., 2020)

"Neurotypical peers are less willing to interact with those with autism based on thin slice judgments" - (Sasson et al., 2017)

​Just as much as we teach Autistic children about what NT social skills look like, it's imperative we teach NT children what Autistic social skills look like, and to ACCEPT differences. We need to allow autistic people to communicate in the way that they prefer and let them be who they truly are.

"Autistic people lack empathy"

Whilst I'm not denying that some Autistic people lack empathy (as with any group of people), it has been theorised for decades that being Autistic = having no empathy. Autistic people actually feel things so intensely that it is overwhelming. Some of the most empathic people I know are Autistic. Being hypersensitive to stimuli in the environment means that other people's emotions can be exhausting (see 'Sensory Processing'). Social reciprocity can be too demanding when an Autistic person is trying to process so much stimuli whilst managing language processing / executive functioning difficulties. However, to NTs, this is often misinterpreted as a communication deficit or coldness.

The Double Empathy Problem proposed by Dr. Damian Milton (an Autistic researcher / academic) states that empathy is a relational, transactional process and so a conversation is a 2-way street. The misunderstandings that occur between a neurotypical and an autistic person happens to both people. The mutual incomprehension is shared by both sets of people; the non-autistic AND Autistic person. A neurotypical person will not understand how an autistic person experiences the world and does not communicate the way an Autistic person does.

Yet, it's Autistic people who are labelled as having social impairments and given treatment to force them to understand non-autistics better, instead of teaching NTs the communication styles of Autistic people. NTs communicate in very different ways. E.g. in my experiences, NT individuals have a greater tendency to drop hints and assume the other person knows what they are thinking based on little information (mind reading) and then expect them to know what response to give. I often find myself having to ask multiple follow-up questions to what a NT says, especially when I am asked a question. They often impose their ideas of what's socially acceptable and do not consider what is going on in the mind of the Autistic person in these exchanges. '.

Autistic people experience constant communication breakdowns with people in the community because of the differences in communication styles. Many NTs will claim they have superior social skills than Autistics. But this is simply not true. There are MANY NTs who lack empathy and have poor social skills. NTs don't say what they mean, leave room for different interpretations, are vague in what they say, and then when autistic people ask questions for clarification, the NT treats them like they're the one with the problem. When we say "I don't know what you mean", or "I don't understand", it's just as much the responsibility of the NT to clarify the misunderstanding and communicate clearly. NTs say Autistic people lack the ability to perspective-take, have rigid inflexible thinking. Yet it's often NTs that have inflexible thinking and don't perspective-take with Autistic people.

"Autistic people lack a Theory of Mind (ToM)"

ToM is said to be 'the ability to put yourself in another person's shoes' and it is impaired in Autistic people (or non-existent), however, it has been widely misunderstood for decades and completely de-bunked. The ToM conceptcomes from a false-belief (deception) test designed in the 1980s called The Sally-Anne test. Clinical Psychologist Simon Baron-Cohen and colleagues designed the test in order to assess a child's ToM. They found that the Autistic children failed this test whereas the neurotypical children passed it. Baron-Cohen formulated the "mindblindness" theory (an inability to know what others are thinking) and his findings led to this theory being used as the framework for decades of research and interventions regarding autism. It's taught on college courses and degree programs.

It's not enough to demonstrate that the child can predict the outcomes of others. To follow it the child must follow the actions of 2 characters in a narrative, has to know that Sally could not have seen the switching of objects, and has to understand the exact meaning of the question. So if you are a child with language difficulties, has problems sequencing, has anxiety, attentional difficulties, they could easily fail.

In the study only 20 Autistic children and 27 neurotypical children were included, or, as Baron-Cohen described, "NORMAL CHILDREN". To draw such conclusions from a small number of participants is concerning especially since it sparked a generation of theories and assumptions.

... and it draws conclusions based on the researchers' experiences of the world. Which is a neurotypical experience and so they do not know how it feels to experience the world as an Autistic person

5) The ToM 'deficit' cannot account for the 2 sets of people failing to understand each other

6) ToM might be delayed in some Autistic children but that doesn't mean it never exists

What's interesting is that a slightly altered version of the test was conducted with autistic children whereby a reward was offered for the correct answer, and this drastically improved the results (74% of children passed this test, whereas only 13% passed the original test). And there has since been a newer theory: ToM can be separated into affective empathy (inferring people's emotions) and cognitive empathy (inferring people's beliefs). Whilst some Autistic people score lower on cognitive measures, it has been found that they score no differently on affective measures compared to non-Autistics.

SOURCES

Milton, D. E. M. (2012). On the ontological status of autism: The 'double empathy problem'. Disability & Society, 27(6), 883-887.

"Speaking of autism" (2020). - The double empathy problem: Link

Sasson, N., Faso, D., Nugent, J. et al. Neurotypical Peers are Less Willing to Interact with Those with Autism based on Thin Slice Judgments. Sci Rep 7, 40700 (2017). https://doi.org/10.1038/srep40700

Kasari C, Dean M, Kretzmann M, Shih W, Orlich F, Whitney R, Landa R, Lord C, King B. Children with autism spectrum disorder and social skills groups at school: a randomized trial comparing intervention approach and peer composition. J Child Psychol Psychiatry. 2016 Feb;57(2):171-9. https://pubmed.ncbi.nlm.nih.gov/26391889/

Crompton CJ, Ropar D, Evans-Williams CV, Flynn EG, Fletcher-Watson S. Autistic peer-to-peer information transfer is highly effective. Autism. 2020;24(7):1704-1712.

Morrison KE, DeBrabander KM, Jones DR, Faso DJ, Ackerman RA, Sasson NJ. Outcomes of real-world social interaction for autistic adults paired with autistic compared to typically developing partners. Autism. 2020 Jul;24(5):1067-1080.

Peterson, C., Slaughter, V., Peterson, J., Premack, D. (2013). "Children with autism can track others' beliefs in a competitive game. Link

The Sally-Anne test. Baron-Cohen, Simon; Leslie, Alan M.; Frith, Uta (October 1985). "Does the autistic child have a "theory of mind"? - Link

Mutual (Mis)understanding: Reframing Autistic Pragmatic "Impairments" Using Relevance Theory Citation: Williams GL, Wharton T and Jagoe C (2021) Mutual (Mis)understanding: Reframing Autistic Pragmatic "Impairments" Using Relevance Theory. Front. Psychol. 12:616664. doi: 10.3389/fpsyg.2021.616664 link

# data[].attributes.attachment_link.title
The 3 biggest autism myths | AutisticSLT

# data[].attributes.attachment_link.description
"Autistic people have poor social skills". "Autistic people lack empathy". "Autistic people lack a Theory of Mind". Why everything you've been told about ToM is wrong. Learn about 'The Double Empathy Problem', outdated research, and why the Sally-Anne test has been de-bunked.

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Podcast #2: Emotional regulation, behaviour and autism with Adem Cetindamar

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In this podcast episode, Steph and Adem discuss emotional regulation strategies for children and young people with autism.

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About the Author

Professor Courtenay Norbury is Professor of Developmental Disorders of Language and Communication at Psychology and Language Sciences, University College London. She is the Director of the Literacy, Language and Communication (LiLaC) Lab and a Fellow of the Royal College of Speech and Language Therapists.

She obtained her PhD in Experimental Psychology at the University of Oxford, working with Professor Dorothy Bishop on the overlapping language profiles that characterise autism spectrum disorder and 'specific' language impairment. Professor Norbury's current research focuses on language disorders and how language interacts with other aspects of development. She is leading SCALES, a population study of language development and disorder from school entry. She is also a founding member of the RADLD campaign.

Developmental Language Disorders (DLD)

Developmental language disorder (DLD) is diagnosed when a child's language skills are persistently below the level expected for the child's age. In DLD, language deficits occur in the absence of a known biomedical condition, such as autism spectrum disorder or Down syndrome, and interfere with the child's ability to communicate effectively with other people. Expressive language is characterised by non-specific words and short simple sentences to express meanings beyond the age at which children may be using more complex language. For example, when typical children can say 'that boy cuts shapes out paper with sharp scissors', the child with DLD might say 'him doing cuts' to express the same idea. Though such limitations of expressive language are readily apparent, for many children, understanding of language (receptive language) is also a challenge. Language disorders emerge in early childhood, have a significant impact on everyday social interactions or educational progress, and persist throughout the school years and into adulthood.

Aspects of language may be variably impaired and include:

Phonology (speech sounds)

Semantics (vocabulary)

Syntax (grammar) and morphology (endings on words that express grammatical relationships, like past tense -ed in English)

Discourse (narrative, conversation)

Pragmatics (social communication, inferencing, figurative language)

The exact cause of DLD is not known, but it is likely that there are several interacting genetic and environmental factors, rather than one single identifiable cause.

Behavioural interventions are the most common approach to treating DLD. Such interventions are typically carried out by speech-language therapists, though in some instances therapy may be delivered by parents or education staff under the supervision of the speech-language therapist. These interventions can significantly enhance a child's ability to communicate and can increase competence in specific areas of language, but, as yet, there is no cure for DLD.

Introduction

The terminology for children's language problems has been extremely variable and confusing, with many different labels being used by different professional groups (D. V. M. Bishop, 2017). In the UK, education services include DLD under the umbrella term SLCN, or speech, language and communication needs. In research, 'specific language impairment' or SLI was the term most commonly used, but there has been growing recognition that language is rarely selectively impaired and considerable controversy about the use of non-verbal IQ scores in diagnosis and treatment decisions. For example, children with non-verbal IQ scores below 85 are frequently excluded from research studies (Reilly et al., 2014) and denied access to specialist clinical services (Dockrell, Lindsay, Letchford, & Mackie, 2006).

The lack of consistency in terminology has been directly linked to poor public awareness of DLD (D.V.M. Bishop, 2010). To address this issue, the CATALISE consortium recently undertook a Delphi exercise to achieve consensus on diagnostic terms and criteria (D. V. M. Bishop, Snowling, Thompson, Greenhalgh, & and the, 2017). This cross-disciplinary panel of experts recommended the term Developmental Language Disorder, to denote a problem with language that stems from atypical developmental processes (as opposed to acquired brain damage, as in stroke or head injury) and to convey the serious nature and potential long term consequences of language deficits. DLD includes SLI, but allows for more variable non-verbal cognitive abilities. Including 'disorder' in the diagnostic label also provides consistency with other neurodevelopmental conditions such as 'autism spectrum disorder' or 'attention deficit hyperactivity disorder'.

Language is a multi-faceted system and it is likely that children will show variable patterns of skill and deficit. Efforts to identify sub-types of language disorder have generally not been successful and many large scale studies report that assessments of different language domains tend to load on a common language factor (Tomblin & Zhang, 2006). The current recommendation is that clinicians outline the particular child's profile of strength and deficit, recognising that this profile may change over time.

Phonology/speech sounds: Phonology is concerned with the rules that govern how sounds are combined together in words. Children with phonological deficits may fail to distinguish between certain speech sounds, such as 't' and 'k', so that 'cat' is produced as 'tat'. While these sorts of phonological errors are common in typically developing toddlers, some error patterns are atypical (e.g. replacing 't' with 'k' so that 'cat' becomes 'kak'), and most errors resolve by the time children are 4-5 years old (Bowen, 2015). Persistent phonological deficits may reduce intelligibility of speech and difficulties identifying and manipulating speech sounds within words (phonological awareness) is associated with difficulties learning to read.

Grammar/syntax: Grammar refers to the rules that govern how to combine words into sentences (syntax) and how to combine parts of words together such as adding grammatical endings to verbs like -ing or -ed (morphology). Grammar is often a disproportionate area of deficit for children with DLD. For instance, a child with DLD may say 'him walk to school', instead of 'he walked to school with his friends yesterday'. Comprehension of sentences can also be affected, especially when word order does not convey who did what to whom. For instance, there may be difficulty understanding sentences like 'the boy was chased by the girl' as children with DLD may interpret this as the boy doing the chasing.

Semantics: Semantics refers to children's ability to understand the meaning of words and how words are related to one another. Children with DLD often have difficulties learning new words. They may therefore have limited vocabularies and the words they do know may not have the same depth of understanding seen in children with typical language development (McGregor, Oleson, Bahnsen, & Duff, 2013).

Discourse and Pragmatics: Discourse refers to longer stretches of connected language, like conversation and narrative. Children with DLD very often have deficits in narrative (i.e. telling a story in a logical, coherent sequence) (Gillam et al., 2018) and may find it difficult to maintain the thread of conversation. Pragmatics refers to the appropriate use of language in social contexts. Pragmatic deficits may manifest as poor at turn-taking in conversation, maintaining the topic of conversation, or being able to repair conversations that breakdown by asking for clarification. Pragmatics may also refer to the comprehension and use of linguistic forms that rely on context to disambiguate meaning, for example, non-literal language like metaphors and idioms, or making an inference (Adams, 2002).

Prevalence

Prevalence estimates of DLD may vary depending on the severity criteria for language, and whether or not non-verbal ability is used as an exclusion criterion. The most recent UK population study (Norbury et al., 2016) yielded a prevalence estimate at age 5-6 years of 7.58%, equivalent to two children in every Year 1 class. An additional 2.34% of children met criteria for language disorder, but also had intellectual disability and/or another known biomedical condition, such as autism or Down syndrome. The functional impact of DLD was evident in that only 12% of children identified as having DLD met early curriculum targets.

While clinical reports suggest more boys are affected, epidemiological studies have not identified sex differences in prevalence (Norbury et al., 2016; Tomblin et al., 1997). This suggests that girls may be under-identified in community settings.

DLD rarely occurs in isolation and children with DLD are at increased risk for a range of co-occurring conditions including:

Attention deficit hyperactivity disorder (ADHD)

Motor deficit (e.g. Developmental Co-ordination Disorder)

Reading disorders (including both dyslexia and reading comprehension deficits)

Speech sound disorders

Social, emotional, and behaviour problems

In adolescence, children with a history of DLD are twice as likely as peers without language disorder to experience internalising, externalising, and ADHD-type psychopathologies (Yew & O'Kearney, 2013) and approximately 1/3 of adolescents referred to tertiary child and adolescent mental health services have previously unidentified language disorder (Cohen et al., 1998).

From school entry DLD is persistent and characterised by parallel rates of language growth relative to peers (Law, Tomblin, & Zhang, 2008; Norbury et al., 2017). As a consequence, there is currently little evidence that children with DLD are able to narrow the language gap with typically developing peers. Young people with DLD are therefore more likely to leave school with fewer academic qualifications (Snowling, Adams, Bishop, & Stothard, 2001) , and may experience on-going problems with employment, intimate relationships, and mental health (Conti-Ramsden, Durkin, Toseeb, Botting, & Pickles, 2018; Johnson, Beitchman, & Brownlie, 2010).

What we already know

Causes

A common perception in the general public is that DLD results from poor parenting and a lack of appropriate language input during development. While there are social gradients in language, such that DLD is more common in areas of socio-economic disadvantage (Law, Charlton, Dockrell, Gascoigne, McKean, & Theakston, 2017), it is in fact a much more complicated picture.

There is strong consensus that DLD is heavily influenced by genetic factors (D. V. M. Bishop, 2006). This evidence comes from twin studies, in which two twins are growing up together in the same household. These studies capitalise on the fact that there are two different kinds of twins; identical twins, who share the same genes, and non-identical (fraternal) twins who are genetically different. The question twin studies try to answer is 'how similar are twins on measures of language?' As all twins are exposed to the same home environment, differences in the strength of similarity between identical and fraternal twins is suggestive of genetic influence. Numerous studies have shown that while non-identical twins may differ radically in their language skills, identical twins tend to be much more similar in language ability. Of course, there can be some variation in the severity and persistence of DLD in identical twins, indicating that non-genetic factors (such as chance experiences, differences in school or peer experiences, illness, etc.) affect the course of disorder, but it is unusual to find a child with DLD who has an identical twin with typical language.

The recognition that genetic factors play a role also informs us about environmental circumstances. Many children with DLD will grow up to be adults with DLD. They will likely have lower levels of literacy and educational attainment (Snowling et al. 2001) and this may result in fewer opportunities to obtain high paying jobs (Conti-Ramsden et al. 2018; Johnson et al. 2010). Reading books to children or verbal communication may not come naturally to some parents of children with DLD. Thus, although there is considerable evidence that DLD is more common in children from socio-economically disadvantaged backgrounds, but this likely reflects both genetic and environmental vulnerabilities (D. V. Bishop, 2014).

Just because genetic factors are important does not mean that we are powerless to intervene. Parent language input and conversation, education, and specialist language interventions can all make meaningful improvements to children's language and communication skills.

Diagnosis and assessment

Longitudinal studies consistently demonstrate stability in language status from school entry, with greater instability when children are identified in the pre-school years (Bornstein, Hahn, & Putnick, 2016; McKean et al., 2017). More specifically, about 40% of children identified with language delay by age 4 have spontaneously resolved by school entry (D. V. Bishop & Edmundson, 1987). Early language skills predict small amounts of variance in later language ability (Duff, Reen, Plunkett, & Nation, 2015) and therefore universal screening is not recommended as it is not reliable enough and identifies too many false positives (D. V. Bishop, Snowling, Thompson, Greenhalgh, & consortium, 2016).

Consideration of multiple risk factors may improve identification (Christensen, Taylor, & Zubrick, 2017). Risk factors associated with persistent DLD include:

Family history of language or literacy deficits

Socio-economic disadvantage

Poor maternal education

Lower non-verbal cognitive abilities

Early developmental delays

DLD in the classroom may be difficult to notice if the child is quiet and able to follow the actions of other children in the classroom, without truly understanding the language or instructions. Teachers are more likely to notice obvious speech problems and/or behaviour difficulties, difficulties learning core curriculum content, and problems with learning how to read. Children presenting with such difficulties in the classroom should be referred for a language assessment.

Speech-language therapists are the primary professionals charged with assessment and diagnosis of DLD in the UK, though a multi-disciplinary team may be required for differential diagnosis of an associated biomedical condition. Associated conditions may include:

autism spectrum disorder (ASD)

sensori-neural hearing loss

neurodegenerative conditions

brain injury

acquired epileptic aphasia in childhood

genetic conditions such as Down syndrome

cerebral palsy

intellectual disability

Diagnosis of DLD requires the following:

The child has significant language deficits relative to age expectations that create obstacles to communication or learning in everyday life,

The child's language problems are persistent and unlikely to resolve by five years of age,

The problems are not associated with a known biomedical condition, as listed above

Diagnosis will involve parent/carer interview of family history, observation of the child's language and communication strategies in everyday contexts, and direct assessment of language skills using standardised assessment. Tomblin (Tomblin et al., 1997) proposed that assessment focus on the EpiSLI criterion: five composite scores representing performance in three domains of language (vocabulary, grammar, and narration) and two modalities (comprehension and production); clinicians may rely more heavily on omnibus tests of language, and measures of narrative ability have been shown to have good prognostic ability (D. V. Bishop & Edmundson, 1987). Cut-off scores on these measures are arbitrary, though typically children scoring in the lowest 7-10% on two or more composite scores are identified as having DLD. Test scores should always be considered in relation to functional impact (i.e. how language is impacting on school, social relationships, and self-esteem) in the diagnostic process.

Treatment

Currently, treatment for DLD is variable and many common approaches lack a sound evidence base. Service delivery may be focused on 'tiers' or 'levels' of intervention, including Universal approaches designed to benefit all children (e.g. specific training packages for education staff focused on enhancing language development), Targeted interventions that may be aimed at children with less severe deficits and carried out by non-specialist providers, and Specialist services in which SLTs provide direct and/or individualised treatments to children with the most-significant needs (Ebbels, McCartney, Slonims, Dockrell, & Norbury, 2018).

Large scale, high-quality randomised controlled trials are still relatively uncommon in the field and this makes it difficult to assess clinical efficacy (see Law, Dennis, Charlton, 2017, Cochrane Review protocol for overview). Children's language will improve over time, and without controlled studies, it can be hard to know how much of observed change is down to a specific treatment approach (cf. (Wake et al., 2011). In general, trials show significant, positive treatment effects for direct interventions with specific language targets including vocabulary, expressive grammar, and some elements of narrative and discourse (see Ebbels et al. 2018 for a summary). Receptive language skills appear much more resistant to treatment. Large scale studies of targeted language interventions show more variable outcomes (Bleses et al., 2017) and at best, modest treatment effects (Burgoyne, Gardner, Whiteley, Snowling, & Hulme, 2017; Fricke et al., 2017). Available evidence suggests that interventions in which education staff are asked to be the main delivery agents of SLT intervention, without on-going monitoring and support from specialist services (i.e. the "consultative" approach) are not effective (McCartney, Boyle, Ellis, Bannatyne, & Turnbull, 2011).

The take home message seems to be that children with DLD can learn aspects of language that they are specifically taught, but this learning rarely generalises to other aspects of language or other academic/developmental skills. In addition, changing a language trajectory remains challenging and is likely to take considerable time and on-going effort.

Areas of uncertainty

Despite recent advances in understanding the biological basis of DLD, we are still a long way from understanding how various genetic risk factors influence brain development, how differences in brain development affect learning, and why these differences would have disproportionate effects on language learning (Krishnan, Watkins, & Bishop, 2016). Nor do we fully understand how genetic and environmental influences interact to yield the heterogeneous profile of DLD that we see.

We don't know whether or how language disorders could be prevented, in part because early assessment of language is less reliable and therefore not strongly predictive of later language ability (Bornstein & Putnick, 2012). Many practitioners and policy makers advocate for early intervention, but a large percentage of young children will make significant language improvement without intervention. Prioritising the under-5s could therefore result in treating large numbers of typically developing children and divert precious therapy resources from children with persistent language learning needs (Norbury, 2015). On the other hand, resolving language disorder after the age of 4 is challenging. We need to know if there is an optimal age to intervene, and whether there may be periods later in development when intensive intervention may be particularly beneficial.

We know that children with DLD are at increased risk for poor social, emotional, and behavioural outcomes. We don't understand the mechanisms that underpin this risk but school failure (Tomblin, Zhang, Buckwalter, & Catts, 2000), variable education provisions (Bao, Brownlie, & Beitchman, 2016), poor peer negotiating skills (Im-Bolter, Cohen, & Farnia, 2013) and poor emotion recognition/regulation (Salmon, O'Kearney, Reese, & Fortune, 2016) are all potential candidates. Given the large numbers of children with DLD presenting to CAMHS services, we urgently need to know how children with DLD access 'talking therapies' and what modifications to standard psychological treatments are required to ensure maximum benefit for children with DLD and their families.

Our intervention evidence base is improving all the time, but we are still a long way from understanding what kinds of interventions work best, when, and for whom. In general, short periods of intervention may be sufficient to teach new vocabulary or grammatical forms (Ebbels, van der Lely, & Dockrell, 2007), but making significant improvements to a child's overall language function is likely to take considerable time and sustained input (McCartney, 2017). We do not know the impact of common co-occurring conditions, such as general cognitive deficits, attention deficits, motor deficits, on response to treatment, or whether improvements in language functioning generalise to other aspects of development (e.g. improved social skills, behaviour, academic attainment).

Providing the dosage necessary to make significant change in language proficiency remains an on-going challenge given limited therapeutic resources. Robust studies of on-line or computerised interventions for language are almost non-existent and urgently needed to evaluate whether such approaches could supplement face-to-face interventions.

What's in the pipeline?

Previously, brain imaging studies of DLD have focused on the integrity of left hemisphere language regions in the developing brain. More recently, researchers have focused on neural circuits involved in learning and memory, particularly circuits involved in learning motor sequences and statistical regularities in language input (Krishnan, Watkins & Bishop, 2016). Such studies could elucidate how interventions might circumvent language learning obstacles, either by increasing input, or providing more explicit cues to learning.

Many children with DLD are not referred to clinical services, or may wait a long time for speech-language therapy assessment. While speech-language therapists have traditionally been employed by the NHS, more and more education services are buying therapy time directly. Therapists working in collaboration with education staff may facilitate more direct links between the child's language needs and how these impact social and academic demands of the classroom.

There is increasing recognition that children with DLD grow up to be adults with considerable language needs. To date there has been little research on this population and few, if any, services to support them. Researchers and stakeholders are now exploring ways to identify these adults and what they require in terms of skills development, employment, and mental health.

Useful resources and websites

Afasic: Parent-focused charity for families of children with DLD.

The Communication Trust: The What Works database is a searchable database of commonly used intervention programmes and a rating of the quality of evidence available for that programme.

ICAN: Communication charity providing information and support to the children's workforce
Royal College of Speech Language Therapists
speechBITE: Australian database curating published trials of intervention and treatment efficacy searchable by language domain

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Ebbels, S. H., van der Lely, H. K., & Dockrell, J. E. (2007). Intervention for verb argument structure in children with persistent SLI: a randomized control trial. J Speech Lang Hear Res, 50(5), 1330-1349. doi:10.1044/1092-4388(2007/093)

Fricke, S., Burgoyne, K., Bowyer-Crane, C., Kyriacou, M., Zosimidou, A., Maxwell, L., . . . Hulme, C. (2017). The efficacy of early language intervention in mainstream school settings: a randomized controlled trial. J Child Psychol Psychiatry, 58(10), 1141-1151. doi:10.1111/jcpp.12737

Gillam, S. L., Olszewski, A., Squires, K., Wolfe, K., Slocum, T., & Gillam, R. B. (2018). Improving Narrative Production in Children With Language Disorders: An Early-Stage Efficacy Study of a Narrative Intervention Program. Lang Speech Hear Serv Sch, 49(2), 197-212. doi:10.1044/2017_LSHSS-17-0047

Im-Bolter, N., Cohen, N. J., & Farnia, F. (2013). I thought we were good: social cognition, figurative language, and adolescent psychopathology. J Child Psychol Psychiatry, 54(7), 724-732. doi:10.1111/jcpp.12067

Johnson, C. J., Beitchman, J. H., & Brownlie, E. B. (2010). Twenty-year follow-up of children with and without speech-language impairments: family, educational, occupational, and quality of life outcomes. Am J Speech Lang Pathol, 19(1), 51-65. doi:10.1044/1058-0360(2009/08-0083)

Krishnan, S., Watkins, K. E., & Bishop, D. V. (2016). Neurobiological Basis of Language Learning Difficulties. Trends Cogn Sci, 20(9), 701-714. doi:10.1016/j.tics.2016.06.012

Law, J., Tomblin, J. B., & Zhang, X. (2008). Characterizing the growth trajectories of language-impaired children between 7 and 11 years of age. J Speech Lang Hear Res, 51(3), 739-749. doi:10.1044/1092-4388(2008/052)

Law, J., Charlton, J., Dockrell, J., Gascoigne, M., McKean, C. and Theakston, A. (2017). Early Language Development: Needs, provision, and intervention for preschool children from socio-economically disadvantaged backgrounds: A Report for the Education Endowment Foundation.

Law J, Dennis JA, Charlton JJV. Speech and language therapy interventions for children with primary speech and/or language disorders. Cochrane Database of Systematic Reviews 2017, Issue 1. Art. No.: CD012490. DOI: 10.1002/14651858.CD012490.

McCartney, E. (2017). Commentary: So was it worth it? A commentary on Fricke et al. and Hagen et al. (2017). J Child Psychol Psychiatry, 58(10), 1152-1154. doi:10.1111/jcpp.12796

McCartney, E., Boyle, J., Ellis, S., Bannatyne, S., & Turnbull, M. (2011). Indirect language therapy for children with persistent language impairment in mainstream primary schools: outcomes from a cohort intervention. Int J Lang Commun Disord, 46(1), 74-82. doi:10.3109/13682820903560302

McGregor, K. K., Oleson, J., Bahnsen, A., & Duff, D. (2013). Children with developmental language impairment have vocabulary deficits characterized by limited breadth and depth. Int J Lang Commun Disord, 48(3), 307-319. doi:10.1111/1460-6984.12008

McKean, C., Wraith, D., Eadie, P., Cook, F., Mensah, F., & Reilly, S. (2017). Subgroups in language trajectories from 4 to 11 years: the nature and predictors of stable, improving and decreasing language trajectory groups. J Child Psychol Psychiatry, 58(10), 1081-1091. doi:10.1111/jcpp.12790

Norbury, C. F. (2015). Editorial: Early intervention in response to language delays-is there a danger of putting too many eggs in the wrong basket? J Child Psychol Psychiatry, 56(8), 835-836. doi:10.1111/jcpp.12446

Norbury, C. F., Gooch, D., Wray, C., Baird, G., Charman, T., Simonoff, E., . . . Pickles, A. (2016). The impact of nonverbal ability on prevalence and clinical presentation of language disorder: evidence from a population study. J Child Psychol Psychiatry, 57(11), 1247-1257. doi:10.1111/jcpp.12573

Norbury, C. F., Vamvakas, G., Gooch, D., Baird, G., Charman, T., Simonoff, E., & Pickles, A. (2017). Language growth in children with heterogeneous language disorders: a population study. J Child Psychol Psychiatry, 58(10), 1092-1105. doi:10.1111/jcpp.12793

Reilly, S., Tomblin, B., Law, J., McKean, C., Mensah, F. K., Morgan, A., . . . Wake, M. (2014). Specific language impairment: a convenient label for whom? Int J Lang Commun Disord, 49(4), 416-451. doi:10.1111/1460-6984.12102

Salmon, K., O'Kearney, R., Reese, E., & Fortune, C. A. (2016). The Role of Language Skill in Child Psychopathology: Implications for Intervention in the Early Years. Clin Child Fam Psychol Rev, 19(4), 352-367. doi:10.1007/s10567-016-0214-1

Snowling, M. J., Adams, J. W., Bishop, D. V., & Stothard, S. E. (2001). Educational attainments of school leavers with a preschool history of speech-language impairments. Int J Lang Commun Disord, 36(2), 173-183.

Tomblin, J. B., Records, N. L., Buckwalter, P., Zhang, X., Smith, E., & O'Brien, M. (1997). Prevalence of specific language impairment in kindergarten children. J Speech Lang Hear Res, 40(6), 1245-1260.

Tomblin, J. B., & Zhang, X. (2006). The dimensionality of language ability in school-age children. J Speech Lang Hear Res, 49(6), 1193-1208. doi:10.1044/1092-4388(2006/086)

Tomblin, J. B., Zhang, X., Buckwalter, P., & Catts, H. (2000). The association of reading disability, behavioral disorders, and language impairment among second-grade children. J Child Psychol Psychiatry, 41(4), 473-482.

Wake, M., Tobin, S., Girolametto, L., Ukoumunne, O. C., Gold, L., Levickis, P., . . . Reilly, S. (2011). Outcomes of population based language promotion for slow to talk toddlers at ages 2 and 3 years: Let's Learn Language cluster randomised controlled trial. BMJ, 343, d4741. doi: 10.1136/bmj.d4741

Yew, S. G. K., & O'Kearney, R. (2013). Emotional and behavioural outcomes later in childhood and adolescence for children with specific language impairments: meta-analyses of controlled prospective studies. Journal of Child Psychology and Psychiatry, 54, 516-524. . doi: 10.1111/jcpp.12009

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DLD - Developmental Language Disorder - ACAMH

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Developmental language disorder (DLD) is diagnosed when a child's language skills are persistently below the level expected for the child's age. In DLD, language deficits occur in the absence of a known biomedical condition, such as autism spectrum disorder or Down syndrome, and interfere with the child's ability to communicate effectively with other people.

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Types of SLCN Types of difficulties There is a range of speech, language and communication needs (SLCN). The types of SLCN are usually described rather than labelled with a medical sounding name. Speech and Language Therapists and other professionals may use a range of terms to describe different types and/or combinations of speech, language and communication needs.

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Developmental Language Disorder Podcast with Wendy Lee

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This week’s podcast is looking at Developmental Language Disorder or DLD, what it is, why it is so unknown and to raise awareness.

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This short, video-based online course provides an introduction to Down's Syndrome and dispels some of the most popular myths.

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A person with Down syndrome will have some degree of learning disability, but the level of ability will be different for each individual.

A child with Down syndrome might take longer than other children their age to reach certain Certain means you are sure about something. milestones and to develop certain skills. They may also need ongoing support for different aspects of their life when they become an adult.

As with other conditions associated with learning disability, every person with Down syndrome is an individual and, with the right support and opportunities, can lead a happy and fulfilling life.

People with Down syndrome will typically have some level of learning disability and characteristic physical features.

There are some health problems associated with Down syndrome, such as heart problems and difficulties with sight and hearing, but these will not affect everyone with the condition.

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Down syndrome Down syndrome, also known as Down's syndrome, is a type of disability. People with Down syndrome may find it hard to learn new things and may need support. They may have more problems with their health too.

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Sign up for a FREE monthly SEND newsletter here
This list was last updated - 04/05/2020

Announcements

Contents

Speech sound resources

Language resources

Understanding and using - 'except', 'unless', 'but not', 'if' - Game - 1 | Game - 2

Understanding and using concepts 'Same' and 'different' - Language link

Describing items using categories, what they're used for, or labeling features of them - Language link

Speech and language activity resources and information

Or, download each board separately below:
Credit: Do-It solutions
Occupational Therapy (OT) resources and information

Visuals and visual timetable resources

AAC resources

Free communication boards - and instructions

Signing resources

Signing Hands - Signed stories On Mon-Fri 10.30am join Signing Hands, on | YouTube or Zoom for some daily fun

Visual impairment resources

Literacy resources - Dyslexia and learning difficulties

Reader Pen - A pen scanner for those with reading difficulties - that reads text out aloud in English/Spanish/French - Free 14 day trial - Sign up here

CrickerSoft - Reading and writing software for all abilities - Free during this period

Phonic reading games for all children, including those who cannot read or have dyslexia. Email: trugs@readsuccessfully.com for 20% off using cv2020 -

Free Phonics resources for children with SEND - Ann Sullivan (you might be asked to create a free account to access the resources)

Maths/numeracy resources

Down Syndrome resources

ADHD, autism

Foetal Alcohol Syndrome

Learning activities and resources for a range of additional needs

Life skills

First News- a newspaper for young people to get them thinking and talking about current affairs in a non-threatening way

Fun, engaging, online & offline activities

Rocket kids club - Everyone can watch and be part of our Rocket Kids Club Shows broadcasting live every Friday

Virtual Tours - Virtual online tours - including zoos, landmarks in foreign countries, etc.

Aquarium - Georgia aquarium allowing you to tour under the sea

Movement and exercise

Fine motor: Kim Griffrin, Occupational Therapist - Daily fine motor activities families can follow along to at 11am on Facebook - the videos will also be available on Griffin OT-YouTube

Concentration and behaviour resources

Simple, positive behaviour support resource. Plus a resource to help improve motivation in structured tasks - No experience required, includes simple, step-by-step instructions and resources for those who:

struggle with impulsivity

display negative reactions to rules and routines

struggle to regulate their emotions during structured and unstructured tasks

who require a high level of adult support within structured tasks for attention, engagement and to complete tasks.

FREE weekly webinars from on managing behaviour/stress/autism among other topics. Email admin@studio3.org to book & to find out what's coming up this week.

The challenging behaviour foundation - info on 'Restrictions on Contact with Family' and FAQs 'Coronavirus and the Law' both in collaboration with a Barrister to help with guidance throughout the coming weeks

Anxiety, emotions and coping with change
Credit: Julie Rayner, Irish Psychotherapy association Download PDF

Video/visual breathing exercise to calm stress -YouTube

Information for parents, carers, and schools

FREE weekly webinars from on managing behaviour/stress/autism among other topics. Email admin@studio3.org to book & to find out what's coming up this week.

Adaily SEND Q&A session to answer any questions in the Education Matters group on FaceBook (UK) - Simpson Millar

Educational Adviser, Gareth Morewood shares well wishes and useful resources on behalf of the entire S3 community during this uncertain time period: Audio recording here

Sharing notice

The links in this list to the Speech Link and Language link website are all Copywritten to, Speech Link Multimedia Ltd

They do not give permission to: Upload the files to other websites/file sharing facility / Sell the files or printed versions of the files / Email the files or post them on social media

They do give permission to:Download and print the files for your own use/email or post a link to the files only

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FREE Speech and language, OT, and many other SEND resources for families and schools

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Sign up for a FREE monthly SEND newsletter here This list was last updated - 04/05/2020 Announcements An inclusive skills/child-led curriculum for young people with additional needs and for those who might be struggling to engage with work at home - free for families.

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GIRL UNMASKED – Autistic Masking, School and Mental Health

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In this week’s podcast we discuss the upcoming book ‘Girl Unmasked: How Uncovering My Autism Saved My Life’ with author Emily Katy

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What is Dyslexia? - The Dyslexia Association

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Dyslexia is a learning difficulty that primarily affects the skills involved in accurate and fluent word reading and spelling. Characteristic features of dyslexia are difficulties in phonological awareness, verbal memory and verbal processing speed. Dyslexia occurs across the range of intellectual abilities. It is best thought of as a continuum, not a distinct category, and there are no clear cut-off points. Co-occurring difficulties may be seen in aspects of language, motor coordination, mental calculation, concentration and personal organisation, but these are not, by themselves, markers of dyslexia. A good indication of the severity and persistence of dyslexic difficulties can be gained by examining how the individual responds or has responded to well-founded intervention.

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Michael Rosen talks in depth about dyslexia: what it is, how to understand it and useful advice for parents and teachers, with expert Professor Maggie Snowling CBE, President of St John's College, Oxford.
Producer Beth O'Dea.

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Michael Rosen talks in depth about dyslexia with expert Professor Maggie Snowling.

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Children each learn and develop at their own pace, and reading is no different from other skill building. It's common for kids to find reading challenging at one point or another. But if learning to read becomes an ongoing struggle that leaves a child falling behind their peers, it's possible that they have a learning disorder known as dyslexia.

Dyslexia is most commonly associated with trouble learning to read. It affects a child's ability to recognize and manipulate the sounds in language. Kids with dyslexia have a hard time decoding new words, or breaking them down into manageable chunks they can then sound out. This causes difficulty with reading, writing and spelling. They may compensate by memorizing words, but they'll have trouble recognizing new words and may be slow in retrieving even familiar ones.

Dyslexia is not a reflection of a child's intelligence - in fact it's defined as a gap between a student's ability and achievement. Some youngsters with dyslexia are able to keep up with their peers with extra effort at least for the first few grades. But by the third grade or so, when they need to be able to read quickly and fluently in order to keep up with their work, they run into trouble.

With help and strategies for compensating for their weakness in decoding, students with dyslexia can learn to read and thrive academically. But dyslexia is not something one grows out of.

How common is dyslexia?

It is estimated that as many as one in five kids has dyslexia, and that 80 to 90 percent of kids with learning disorders have it. Sally Shaywitz, MD, co-director of the Yale Center for Dyslexia and Creativity, notes that many children go undiagnosed as struggles in school are incorrectly attributed to intelligence, level of effort or environmental factors.

Although experts used to say that dyslexia occurred more often in boys than in girls, current research indicates that it affects boys and girls equally.

A young person with dyslexia may:

Struggle with learning even simple rhymes

Have a speech delay

Have trouble following directions

Repeat or omit short words such as and, the, but

Find it difficult to tell left from right

In school, children with dyslexia are likely to:

Have difficulty sounding out new words

Lack fluency compared to other children their age

Reverse letters and numbers when reading (read saw as was, for example)

Find it difficult to take notes and copy down words from the board

Struggle with rhyming, associating sounds with letters, and sequencing and ordering sounds

Stumble and have difficulty spelling even common words; frequently they will spell them phonetically (hrbr instead of harbor)

Avoid being called on to read out loud in front of classmates

Become tired or frustrated from reading

Dyslexia affects children outside of school as well. Kids with dyslexia may also:

Find it difficult to decode logos and signs

Struggle when trying to learn the rules to games

Have difficulty keeping track of multi-step directions

Struggle with getting the hang of telling time

Find it especially challenging to learn another language

Become incredibly frustrated, which can effect their mood and emotional stability

Social and emotional impacts of dyslexia

Dyslexia affects a lot more than reading - it can also impact a child socially. "A dyslexic person who has word-finding difficulties can have trouble with their expressive language," says Scott Bezsylko, the executive director of Winston Preparatory School, which specializes in teaching kids with learning disorders. "That has a social impact, in addition to your difficulties with reading and writing, that make you feel not so good about yourself."

Kids with dyslexia - particularly those who have yet to be diagnosed - often suffer from low self-esteem because they worry that there is something wrong with them, and are often accused of not trying hard enough to learn to read. "A lot of our work with dyslexic kids is to help them rediscover that they are smart and capable," notes Beszylko, "because they've stopped believing in themselves."

How is dyslexia diagnosed?

If your child isn't meeting expectations for reading, as parents you can ask the school district to perform an evaluation and share the results with you. The evaluation will test your child's intellectual capacity and reading skills, to see if there is an achievement gap. It should also rule out other potential causes like environmental factors or hearing impairment.

The school should then make recommendations on how they can support your child and maximize her learning.

If you are unhappy with the quality of the evaluation, you can also secure a private evaluation by a psychologist, a neuropsychologist, a reading specialist, a speech and language therapist, an educational evaluator or a school psychologist. This external evaluation can also be used to advocate for your child and get the accommodations and services she might need.

When should a child be evaluated?

Dyslexia can begin to reveal itself at a young age, and there are preschool evaluations that look at the child's awareness of the sounds that make up words, and ability at word retrieval. However, Matthew Cruger, PhD, a clinical neuropsychologist at the Child Mind Institute, suggests waiting until kids are at least six years old and have had some formal instruction in reading to seek out a formal evaluation.

But Dr. Shaywitz notes that as soon as a gap between intelligence and reading skills is apparent - and evidence shows it can be seen in first grade - it's a good idea to get help. Schools sometimes encourage parents to wait until the third grade to see if their child truly needs an intervention, but Dr. Shaywitz argues that the earlier intervention is important not only to help kids catch up but to boost their fragile self-image, which is damaged by continuing struggle in school and comparisons with peers.

How to help kids with dyslexia

A dyslexia diagnosis does not mean your child will never learn to read. Dr. Cruger says there are a number of programs that can help, which might include these features:

Multi-sensory instruction in decoding skills

Repetition and review of skills

Intensity of intervention - that is, more than being pulled out of class once a week for extra help

Small group or individual instruction

Teaching decoding skills

Drilling sight words

Teaching comprehension strategies, to help kids derive meaning from what they're reading

Reading programs that been shown to help kids with dyslexia include:

Dr. Cruger points out that traditional tutoring may actually be counter-productive for a child with dyslexia, particularly if it is not a positive experience. "If the child hates the experience of reading help, it's not helpful," Dr. Cruger notes. "And it's not treating the source of the problem, the decoding weakness."

Instead, Dr. Cruger emphasizes that one of the most important ways to help kids with dyslexia is to make them more comfortable reading. This can be done in part by celebrating even small victories and accomplishments, while focusing less on correcting their errors.

Accommodations for kids with dyslexia

Kids with demonstrated dyslexia are eligible for accommodations in school. "Dyslexia robs a person of time," Dr. Shaywitz explains, "and accommodations give the time back to her." Accommodations may include:

Extra time on tests

A quiet space to work

The option to record lectures

The option to give verbal, rather than written, answers (when appropriate)

Elimination of oral reading in class

Exemption from foreign language learning

Other ways to support a child with dyslexia

One of the best ways to support a child with dyslexia - or any child who is struggling - is to encourage those activities that they like and feel good at, whether it is music, joining a sports team or anything else that helps build her confidence.

To help reinforce that dyslexia is not a marker of intelligence, it can also be helpful to talk about successful people - like Whoopi Goldberg and Steven Spielberg - who have also been diagnosed with dyslexia.

Other things that may help your child with dyslexia include:

Listening to audio books as an alternative to reading

Typing on a computer or tablet instead of writing

Apps that can make learning fun by turning decoding into a game

Using a ruler to help kids read in a straight line, which can help keep them focused

Emotional support

Dyslexia can result in frustration, embarrassment, avoidance and low self-esteem as a result of difficulties performing tasks that seem to come naturally to others. Demystifying the learning disorder with your child can help him develop the tools - and resilience - necessary to manage it, both in school and in social circumstances. Some things you can do to help include:

Discuss the specific challenges that result from dyslexia: "You know how you have a hard time reading signs or copying notes from the board? That's dyslexia."

Acknowledge their effort and celebrate hard work, even if there are still mistakes: "I know how difficult that reading homework was. I am so proud of how hard you tried."

Help them recognize their strengths: "You showed such great sportsmanship and teamwork in the soccer game the other night, and that was a great goal you scored!"

Combat negative self-talk: If your child starts saying things like, "I'm just stupid," don't ignore it. Instead, check out these ideas for helping kids who are too hard on themselves.

Frequently Asked Questions

How does dyslexia work?

How common is dyslexia?

What helps students with dyslexia?

What are the signs of dyslexia?

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Understanding Dyslexia - Child Mind Institute

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Find out how to recognize dyslexia, the most common learning disability. The Child Mind Institute on how to help kids who have trouble learning to read.

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Educator Center Overview - Microsoft Learn Educator Center

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

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The British Dyslexia Association is the voice for the 10% of the population that are dyslexic

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Helen is a dyslexia expert and consultant and is the co-vice chair of the British Dyslexia Association. In this episode we are discussing identifying dyslexia – why does it matter?

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SENDcast Sessions are a new way for schools to access high quality CPD from SEND experts brought to you by the SENDcast. It's the same great guests featured on our weekly podcast, delivering focused 1-hour online training sessions on a wide range of SEND topics.

SENDcast Sessions provide schools with in depth content that can be accessed forever. Build a library of online CPD that your school can continue to use in the future - choose from over 150 training sessions!

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How does dyslexia impact in the classroom?

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In this episode Jane Craig and Samantha Buttle join us from Dyslexia Sparks, a charity supporting schools, parents and individuals with dyslexia.

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For education professionals | National Deaf Children’s Society

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Advice and guidance for educators working with deaf children at any age.

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We’re here for every deaf child with any level of hearing loss. We believe nothing should hold deaf children back.

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There are some ups and downs to navigate when you're the only kid in school with hearing loss. Hear what it takes to go mainstream and what accommodations are needed.