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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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ADHD is the most common neurodevelopmental disorder in childhood, affecting around five per cent of children and about two and a half per cent of adults worldwide. There's a common stereotype of a boy running around the classroom, but ADHD is actually much more complicated. And, often, more problematic than that. As well as being an issue itself, ADHD has been proven time and time again, to be a risk factor for issues with mental health. As well as educational and employment problems in later life. As well as other issues, such as substance abuse and getting into trouble with the authorities. In our course-

Understanding ADHD- we cover four broad areas: One, what is ADHD? What do we mean by symptom? And, what's a disorder? Two, what's it like to live with ADHD? Three, what do we know about the causes or risk factors, both genetic and environmental? And four, treatment- both pharmaceutical and non-pharmaceutical. Many of our students are teachers, educators more generally, or parents themselves. And, consequently, we have included practical, evidence-based content throughout this course. So, alongside the latest research, we'll also follow the journey of several families who have children with ADHD, who join us to speak about when they first realised something wasn't right, right through to diagnosis and treatment. We also speak with a number of professionals who work with children with ADHD.

And when you hear these stories, you'll see that it's clear that whilst we are making progress, there's still some room for improvement. And we'll also address some of the controversies of ADHD. Like, why medication is often the go-to treat. The issue of side effects and the role of diet. So, join us over the next four weeks, as we take an evidence-based, practical tour through ADHD.

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Understand ADHD - Online Course | King's College London

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Explore the latest research about ADHD including ADHD diagnosis, treatment and ADHD symptoms with this online ADHD course from King's College London.

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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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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

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The 3 biggest autism myths | AutisticSLT

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"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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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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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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Avon and Wiltshire Mental Health Partnership NHS Trust

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Attachment is the deep connection made between a child and their main caregiver in the early years of life.

This connection helps you feel safe, capable and loved, giving you confidence to explore new things and manage different situations. A strong connection is vital to help you develop your social, emotional and intellectual needs.

Sometimes, strong attachments do not form or can get disrupted due to different reasons. This might be because your main caregiver has become unwell and is less able to care for you.

Emotional and behavioural difficulties can develop when you feel less safe and secure, causing what is known as insecure attachment or attachment disorder.

Signs and symptoms

You might notice some of the following difficulties with insecure attachment or attachment disorder:

Difficulty controlling and expressing your emotions, such as anger.

No smiling or response when interacting with adults.

Using extreme measures to gain attention.

Finding it hard to trust people and to build positive relationships.

Disliking change and feeling the need to be in control of situations.

Struggling to show affection and disliking being touched.

Difficulties at school, including poor concentration, relationships with friends and teachers, disruptive behaviour and often getting into trouble.

Low self-esteem and feeling unloved.

Engaging in self-injury.

Developing drug or alcohol use.

Diagnosis

If you think you, your child or young person you care for might be experiencing attachment problems, it is helpful to make notes on the following before you seek further support:

Behavioural problems and/or emotional issues you have seen.

Personal history, for example, details relating to the pregnancy, birth and early stages of the child's life.

Medical history, any medication, or significant injuries/illnesses.

Any major life changes or stresses your family has gone through.

Mental health and wellbeing support for people with attachment difficulties

If you already have a diagnosis of attachment difficulties or you are waiting for an assessment to be diagnosed, there are lots of services to support you with your mental health and wellbeing.

People with attachment difficulties can experience all the things that others without the condition may struggle with, like anxiety or low mood.

CAMHS supports people with attachment difficulties who also have other mental health problems. Visit here for further information about the support you might need.

If you are concerned that you, your child or young person you care for is showing attachment difficulties, Childline offers support to anyone under 19 years through telephone chat, one-to-one counsellor chat and email support. Contact 0800 11 11.
Mental health and wellbeing support agencies that everyone can access

The Mix: offers support to anyone under 25 years on anything that's troubling them. They have free email support, webchat support and a short-term counselling service. Contact 0808 808 4994.

Creative Youth Network: offers advice and support, no matter what your situation or background.

Off The Record: sign up to groups such as Resilience Lab or Mind Aid to learn more about anxiety and develop some coping strategies. Sign up to groups or one-to-one therapy with a professional. Or instead, build your confidence and interpersonal skills through Pro Real, their virtual reality-based form of counselling.

Kooth: join an online mental wellbeing community and talk to a trained counsellor through their chat function. Visit the online forum for peer support and to hear from others experiencing similar difficulties.

For families and carers of people with attachment difficulties

Looking after a child or young person with attachment difficulties is a challenging experience. The most important approach is to make a child or young person feel safe and seek support from trusted people around you.

You can help a child or young person feel safe and secure by:

setting consistent limits and boundaries, clearly explaining why they are in place.

remaining patient, calm and non-judgemental.

being physically and emotionally available.

being curious and sensitive to their thoughts and feelings.

repairing relationships following any difficult times.

creating opportunities for success to increase self-esteem.

providing praise for effort and achievement. Be specific with this praise.

allowing opportunities for one-to-one attention.

engaging in activities or work together.

Reading resources

The Explosive Child, by Ross W. Greene.

Feelings and Emotions: Feeling Angry, by Katie Douglas.

A series of books on attachment, written by Sir John Timpson CBE.

Further information

For professionals supporting people with attachment difficulties

Caring for a child or young person with attachment difficultiesis a challenging experience. The most important approach is to make a child or young person feel safe and seek support from trusted people around you. We recommend reading the following resource for helpful information: Advice on Adverse Childhood Experiences.

You can help a child or young person feel safe and secure by:

setting consistent limits and boundaries, clearly explaining why they are in place.

remaining patient, calm and non-judgemental.

being physically and emotionally available.

being curious and sensitive to their thoughts and feelings.

repairing relationships following any difficult times.

creating opportunities for success to increase self-esteem.

providing praise for effort and achievement. Be specific with this praise.

allowing opportunities for one-to-one attention.

engaging in activities or work together.

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Attachment difficulties :: Avon and Wiltshire Mental Health Partnership NHS Trust

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Skip to main content Skip to accessibility tools Attachment is the deep connection made between a child and their main caregiver in the early years of life. This connection helps you feel safe, capable and loved, giving you confidence to explore new things and manage different situations.

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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

Sources

Adams, C. (2002). Practitioner review: the assessment of language pragmatics. J Child Psychol Psychiatry, 43(8), 973-987.

Bao, L., Brownlie, E. B., & Beitchman, J. H. (2016). Mental health trajectories from adolescence to adulthood: Language disorder and other childhood and adolescent risk factors. Dev Psychopathol, 28(2), 489-504. doi:10.1017/S0954579415001054

Bishop, D. V. (2014). Ten questions about terminology for children with unexplained language problems. Int J Lang Commun Disord, 49(4), 381-415. doi:10.1111/1460-6984.12101

Bishop, D. V., & Edmundson, A. (1987). Language-impaired 4-year-olds: distinguishing transient from persistent impairment. J Speech Hear Disord, 52(2), 156-173.

Bishop, D. V., Snowling, M. J., Thompson, P. A., Greenhalgh, T., & consortium, C. (2016). CATALISE: A Multinational and Multidisciplinary Delphi Consensus Study. Identifying Language Impairments in Children. PLoS One, 11(7), e0158753. doi:10.1371/journal.pone.0158753

Bishop, D. V. M. (2006). What Causes Specific Language Impairment in Children? Curr Dir Psychol Sci, 15(5), 217-221. doi:10.1111/j.1467-8721.2006.00439.x

Bishop, D. V. M. (2010). Which neurodevelopmental disorders get researched and why? PLoS One, 5(11), e15112. doi:10.1371/journal.pone.0015112

Bishop, D. V. M. (2017). Why is it so hard to reach agreement on terminology? The case of developmental language disorder (DLD). Int J Lang Commun Disord, 52(6), 671-680. doi:10.1111/1460-6984.12335

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Bowen, C. (2015). Children's speech sound disorders, 2nd Edition. Oxford: Wiley-Blackwell.

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Dockrell, J. E., Lindsay, G., Letchford, B., & Mackie, C. (2006). Educational provision for children with specific speech and language difficulties: perspectives of speech and language therapy service managers. Int J Lang Commun Disord, 41(4), 423-440. doi:10.1080/13682820500442073

Duff, F. J., Reen, G., Plunkett, K., & Nation, K. (2015). Do infant vocabulary skills predict school-age language and literacy outcomes? J Child Psychol Psychiatry, 56(8), 848-856. doi:10.1111/jcpp.12378

Ebbels, S. H., McCartney, E., Slonims, V., Dockrell, J. E., & Norbury, C. F. (2018). Evidence-based pathways to intervention for children with language disorders. Int J Lang Commun Disord. doi:10.1111/1460-6984.12387

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

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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

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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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The following are links to resources recommended by people within the Down Syndrome community:

General information, advice, and support

DanceSyndrome An inclusive arts charity providing a range of opportunities for individuals and organisations to work with them through inspiring workshops, leadership training and performances. Regular session take place across the North West of England but they also perform at events across the UK. Twitter:@DanceSyndrome

Making Chromosomes count- a new magazine for the Down Syndrome community. You can visit the website to subscribe and receive your copy of Down Syndrome Community News and please get in touch with them if you would like to feature in future newsletters.

Stepping stones: A collection of stories detailing the challenges, opportunities, tears and joy of raising a child with Down Syndrome

Education

Going To School a book created by the Cornwall Down Syndrome Support Group. This is an inclusive book for preschool/reception year children that features pictures of the school day and includes images of children with Down Syndrome going about their school day alongside their typical peers. Read the ChatterPack review of the book here This 27 page Makaton download accompanies the book and includes all the signs and symbols to support communication around the school day plus visual timetable, etc
Speech, language, communication and literacy skills

Cartersyard phonics: Carter's Yard Phonics Flashcards are a set of 64, interactive 'talking' flashcards that are used in classrooms throughout the UK. The fun, engaging, multi-sensory cards are the perfect phonics accessory for home and school. Discount code to use at checkout: 2VC3HY9H

Shape coding - Introduction to Shape Coding by its creator, Susan Ebbels

Teaching number skills and concepts:

discusses the use of Numicon number teaching materials with children with Down syndrome. The theory underlying the design of the materials is discussed, the teaching approach and methodology are described and evidence supporting effectiveness is outlined

Training and consultancy services

LETS Go! provides specialist consultancy services for children with Down syndrome. We offer Down syndrome specific training, information, support and services for families, education providers, professionals, and organisations.

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Resources to support children, young people and adults with Down Syndrome

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The following are links to resources recommended by people within the Down Syndrome community: General information, advice, and support A book from Wouldn't Change a Thing For new parents of children with Down Syndrome, but many schools and organisations have requested a copy. We fund these for free for new parents, support groups and maternity units.

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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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At a glance

Dysgraphia refers to a challenge with writing.

It impacts skills like handwriting, typing, and spelling.

There are many ways people with dysgraphia can improve their writing skills.

Dysgraphia is a term that refers to trouble with writing. Many experts view dysgraphia as challenges with a set of skills known as transcription. These skills - handwriting, typing, and spelling - allow us to produce writing.

Trouble expressing your thoughts in writing isn't formally recognized as part of dysgraphia. That's a learning disability known as written expression disorder. But when people struggle with transcription, it can get in the way of thinking about ideas and how to convey them.

For example, people with dysgraphia may write more slowly than others. That can affect how well they express themselves in writing. Plus, they tend to have trouble with spelling because it's hard for them to form letters when they write.

Dysgraphia isn't a matter of intelligence. The challenges are often caused by trouble with motor skills. Those skills can improve with help. And people with dysgraphia may also be eligible to use accommodations at work or at school.

About the author

About the author

The Understood Team is made up of passionate writers and editors. Many of them have kids who learn and think differently.

Reviewed by

Reviewed by

Charles A. MacArthur, PhD is a professor emeritus of special education. He researches writing instruction, self-regulated strategies, and assistive technology.

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Dysgraphia is a writing challenge that affects skills like handwriting, typing, and spelling. It's not technically a learning disability, but it can affect learning.

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Children with dysgraphia struggle to write, often causing them to experience emotional stress and anxiety. Because they have good verbal skills, parents and teachers expect them to write at the same level as they speak; when they don't, they may be mistakenly thought of as lacking motivation or careless.

Dysgraphia can occur alone, or in children who also have dyslexia, other language disorders, or ADHD.

Causes

Writing is a complex process. It involves working memory and shifting among tasks that include generating ideas, thinking of words and word meaning, organizing good sentences, planning, and self-monitoring-all executive functions. Difficulty in any of the basic language or motor skills or in the executive functions needed to combine them end with the same result: problems with written expression.

In addition, difficulty controlling fine motor skills, sequencing the hand movements needed to write, or controlling spatial accuracy can cause non-language based dysgraphia.

Treatment

It is critical to identify the underlying problems resulting in dysgraphia; there might be more than one. An Occupational Therapist using a multi-sensory approach can address problems with handwriting, motor sequencing or visual spatial skills. A Speech and Language Therapist or a Special Education teacher can help with language-based problems such as the mastery of grammar, word usage, sequencing, and composition of sentences. A Special Education teacher will work with tools such as a graphic organizer, thought bubbles, and other strategies to help deal with specific executive function problems.

Accommodations are often needed to help dysgraphic children handle written work, including reduction of the load of writing in class and in homework, extended time to produce written work, and assistive technology to allow dictation.

Most dysgraphic children benefit from being allowed to use a keyboard and a word processing program, which reduces motor demands and allows them to edit and reorganize written work. Since writing is difficult, children benefit from Smart Boards on laptops or tablets to record writing on the board, and accommodations for note taking, such as using another student's notes or a study guide/outline of lecture information provided by the teacher. Many children with dysgraphia are allowed to use alternative methods to demonstrate knowledge rather than written exams.

Demands for written expression are constant across every subject and increase in every grade. Even in early grades, teachers need to be sensitive to dysgraphia when assigning projects to produce posters to be hung on the classroom walls or to write letters correctly on the lines. Children with dysgraphia need encouragement and remediation; there is nothing more discouraging than getting a paper back filled with red circles, corrections, and criticism.
Marcia Eckerd is an evaluator, consultant, and therapist who specializes in working with children with NLD and autism-spectrum disorders.
Related Smart Kids Topics

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Children with dysgraphia struggle to write, often causing them to experience emotional stress and anxiety. Because they have good verbal skills, parents and teachers expect them to write at the same level as they speak; when they don't, they may be mistakenly thought of as lacking motivation or careless.

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Or click on your preferred podcast player link!

Welcome to the show notes for Episode 31 of the OT Schoolhouse Podcast.

Just when Dyslexia seemed to be the new buzzword in IEP meetings, Dysgraphia and Dyscalculia joined in on the fun. Dysgraphia, especially, has cemented itself into the confines of the Occupational Therapy world. If there is an IEP team using the word Dysgraphia, there is sure to be an OT evaluation to follow.

In this episode of the OT Schoolhouse Podcast, Jayson interviews the author of the Handwriting Brain-Body DisConnect, Cheri Dotterer, MS, OTR/L.

Cheri has been an Occupational Therapist for over 20 years. Much of that time has been serving students who have been referred to her for handwriting concerns. With that said, it was her own children's struggles that really got her into studying Dyslexia, Dysgraphia, and Dyscalculia.

Listen in on this episode to learn how Cheri defines Dysgraphia and explains what the six types of Dysgraphia are. She also shares how we as OTs can help students to overcome some of the problems they face by using the Motor Learning Model and The Sensory Integration Model.

Quick reminder: Links to Amazon.com and other websites on this page may be affiliate links. Affiliate links benefit the OT Schoolhouse at no additional cost to you. I appreciate your support by using these links.

The below references were mentioned throughout Episode 31

Handwriting Brain-Body DisConnect:

Adaptive teaching techniques to unlock a child's dysgraphia for the classroom and at home

By Cheri Dotterer, MS, OTR/L

Be sure to subscribe to the OT Schoolhouse email list & get access to our free downloads of Gray-Space paper and the Occupational Profile for school-based OTs.

Have any questions or comments about the podcast? Email Jayson at Jayson@otschoolhouse.com

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OTS 31: Unpacking Dysgraphia Featuring Cheri Dotterer, MS, OTR/L

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Episode 31 of the OT Schoolhouse Podcast

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Dysgraphia is a Greek word. The base word graph refers both to the hand’s function in writing and to the letters formed by the hand. The prefix dys indicates

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

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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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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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In this episode we are debunking 10 myths about dyslexia with specialist Louise Selby, shedding light on the misunderstanding in education.

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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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British Sign Language - Learn BSL Online

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The fast, easy, & effective way to learn BSL. Our online British Sign Language course is fun, & flexible. Ideal as level 1 revision & beginners.

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Help your child cope with hearing loss at primary school with expert advice from the National Deaf Children's Society.

According to the National Deaf Children's Society, there are around 50,000 deaf or hearing impaired children in the UK.

If your child is one of them, it's natural to have concerns about how their deafness will affect them - and ensuring they get a suitable education is likely to be one of your top priorities.

'It can be a daunting experience when you first find out your child has a hearing loss, as most parents have no experience of deafness,' says Colin Brook of the National Deaf Children's Society.
'However, there are a range of services, professionals and groups that can offer you and your child support.'

What causes deafness?

There are many sorts of hearing impairment that can affect children, with a variety of causes.

Sensorineural deafness, or nerve deafness, is a hearing loss in the inner ear. This usually means that the cochlea isn't working effectively, and is permanent.

Auditory neuropathy spectrum disorder (ANSD) occurs when sounds are received normally by the cochlea, but become disrupted as they travel to the brain.

Conductive deafness happens when sound can't pass efficiently through the outer and middle ear into the inner ear. This is often caused by blockages such as wax in the outer ear, or fluid in the middle ear, which is known as glue ear and affects eight out of 10 children by the age of 10. Conductive deafness is usually temporary, but can be permanent.

Deafness can affect one ear only (referred to as unilateral deafness, one-sided hearing loss or single-sided deafness), or both ears (bilateral hearing loss).

How deafness is managed will depend on the type and its causes. For example, glue ear often clears up on its own, although some children have minor surgery to insert grommets, which help prevent fluid build-up.

Children with more severe or enduring deafness may need hearing aids or hearing (cochlear) implants.

How deafness affects children at school

Although many deaf children thrive at school, hearing loss can have a big impact.

Analysis by the National Deaf Children's Society shows that deaf children struggle at every stage of their education: fewer than half reach the expected standard in Key Stage 2 English and maths SATs, compared to three quarters of other children.

And under half eventually leave education with two or more A levels, compared to almost two thirds of hearing students.

Some of the problems they may encounter include:

Difficulty hearing and understanding their teacher. For example, not all deaf children are able to lip read, and even if they can, only 30-40% of spoken English is distinguishable by lip reading.

Problems with classroom acoustics. Background noise can affect children's ability to hear, and certain sounds, like the buzz from fluorescent lighting, can cause interference with hearing aids and implants.

Speech, language and literacy difficulties, including problems picking up phonics.

Lack of resources. Because schools operate on such tight budgets, they may be unable to provide all the equipment and support deaf children need, such as one-to-one support and assistive technology.

Tiredness and irritability caused by the extra concentration they have to put in at school.

Needing time off for appointments, which leaves them having to catch up on missed work.

Social and emotional difficulties, including embarrassment about drawing attention to their issues, which can affect their learning, challenges in communicating with other children and forming friendships, and even bullying.

Choosing a school for a deaf child

According to the National Deaf Children's Society, 78% of deaf children attend mainstream schools, 6% attend mainstream schools with extra resources such as a specialist unit, 3% attend deaf schools and 12% attend other special schools.

You might wonder how your child will cope in a mainstream school, but very few deaf children have no useful hearing at all. Most can hear some sounds at certain frequencies and loudness, and with the use of hearing aids or implants, they are often able to hear more sounds.

This means that the majority of deaf children can be educated in a mainstream school, with the right support. Indeed, mainstream schools can't refuse a child a place on the grounds of their additional needs.

Alternatively, you could consider a special school that caters for children with a range of special needs, including deafness. This might be your preferred option if your child has an additional need, such as autism or a developmental delay, or if you feel their hearing loss would be better catered for.

There are also over 20 specialist schools for deaf children in the UK.

When it comes to choosing a school for your child, you'll want to weigh up lots of factors including:

The severity of your child's hearing loss and how it affects them.

How they communicate.

What sort of resources and support a school can offer, such as providing assistive technology or having staff members who can use sign language.

Whether the school has a specialist unit that might benefit your child, for example a speech and language unit.

The size of the school and average class sizes.

The classroom environment and acoustics.

Whether there are, or have been, other deaf children at the school.

The location of the school: special schools may not be as local, and some deaf schools are residential.

It's vital to visit the schools you're interested in, and speak to the person who will have responsibility for your child's needs. In a mainstream school, this is likely to be the special educational needs coordinator (SENCO).

If your child has hearing loss, you may want to have them assessed by the local authority for an Education, Health and Care Plan (EHCP) or, in Scotland, a Coordinated Support Plan (CSP).

This sets out the type of support and intervention that must be provided, by law, to meet your child's needs.

Your child is likely to need an EHCP or CSP to gain a place at a special school or deaf school. Having an EHCP or CSP also means that they must be allocated a place at your first choice of mainstream school.

Supporting deaf children at school

Whatever school your child attends, it's vital that they get the right support. This is especially true of mainstream schools that may have little experience of provision for deaf children.
Your child's individual needs should be discussed with the school, and you should be involved in working out how they can be supported.
Some of the ways in which schools can support children with hearing loss include:

Providing equipment such as a radio aids (a microphone worn by the teacher that work with hearing aids or implants) or a soundfield system to help them hear their teachers.

Providing support from a dedicated member of staff, for example a Teacher of the Deaf (ToD), communication support worker (CSW) or learning support assistant (LSA).

Improving the acoustics of the school or classroom, for instance by reducing background noise, and fitting carpets and curtains to help prevent echoing.

Training staff to teach in a deaf-friendly way, for example not turning away when talking, making sure your child has understood tasks, and making sure videos used in class have subtitles.

Allocating your child a 'hearing buddy' who can help to make sure they've understood instructions and rules, for example in PE when they may not be wearing their hearing aids or implants.

Ensuring your child sits at the front of the class: hearing technologies have an optimal range of one to three metres.

Providing a quiet space in the school where your child can go to communicate with their friends, for example at lunchtime.

Making referrals to secondary services such as speech and language therapy or educational psychology if necessary.

Helping staff and other children learn to communicate through signing, such as British sign language (BSL) or Sign Supported English (SSE).

Meeting with you regularly to discuss your child's needs, progress and any concerns. It's important to involve your child in conversations about how they can be supported, if possible.

You might want to put together a 'personal passport' that details things like how your child communicates, how to get their attention, what they can and can't hear, and any technology they use.

This will help your child's teacher and other staff (including those outside school, such as club leaders) to support them as best they can.

If there's a problem

If you're unhappy with how your child's needs are being provided for, book a meeting with their class teacher, SENCO and any other staff who are directly involved with their learning and/or wellbeing.
It's useful to look at the school's SEN policy - available on their website - to inform yourself of how they meet the needs of pupils with additional needs.
If the school is failing to follow its own policy, you can raise this as an issue and, if you're not satisfied with the response, escalate it to the school governor who has responsibility for SEN provision.

The National Deaf Children's Society also has a helpline (0808 800 8800) and live chat service that can provide free independent advice.

'I work with the school to find solutions'

Tracy Holtom is mum to Stephen, nine, who has profound bilateral hearing loss.
Stephen was given bilateral cochlear implants at the age of four. His preferred method of communication is spoken English; his oral speech is right for his chronological age, although we do use Makaton and some basic BSL as well, especially when introducing new topics or contexts.

It was always felt that Stephen would manage in a mainstream setting with the right support, so we chose our local school and I went to see the headteacher before submitting his application to ensure that they could facilitate his needs in a sympathetic and understanding manner.

Stephen gets 20 hours of one-to-one support per week, but that leaves him with 90 minutes without support each day. He was given funding by the local authority for a radio aid that makes it clearer for him to hear what his teacher says: useful in a classroom where there's lots of background noise.

All staff have undertaken deaf awareness training and Stephen himself did a presentation on clear communication, and produced posters and visual aids to help. I've also been into school to run some basic sign language and social skills sessions with his classmates.

We do have many hurdles. Stephen becomes frustrated easily, and finds it difficult to make and maintain friendships. He suffers with anxiety and gets scared when he can't hear clearly or work out what's going on.

Unfortunately, people see that Stephen has cochlear implants and forget that he is still deaf and has to use so many other strategies just to keep up with a simple conversation. This means I have to keep going back into school, raising issues and working with them to find solutions.

I'd advise other parents of deaf children to remember that nobody knows your child like you do. You are their advocate, so if you think something isn't right, question it.

Don't be afraid to tell the professionals if you think something won't work for your child, but also share your strategies and successes with them, educate them and work closely with them.

Also, make sure you take care of yourself so you can support your child, so ask for help, use support networks and don't take no for an answer.
The National Deaf Children's Society provides free, impartial, independent advice on all aspects of deafness in children, including choosing a school, making sure your child is well supported, and dealing with issues like bullying. To speak to an advisor, contact the helpline (0808 800 8800) or use the live chat service.

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Managing deafness and hearing impairments at school

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Help your child cope with hearing loss at primary school with expert advice from the National Deaf Children's Society. According to the National Deaf Children's Society, there are around 50,000 deaf or hearing impaired children in the UK.

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*General section about Social, Emotional & Mental Health needs

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*General section about Social, Emotional & Mental Health needs

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The social and emotional development, mental health, and wellbeing of children have become critical issues, with a crisis now widely recognised. NHS Digital reports that 1 in 5 children face mental health challenges, and we continue to see alarming rates of exclusions and suspensions, even in primary schools.

It's clear that a strategic approach to prioritising children's social and emotional literacy, health, and wellbeing is essential for school improvement and positive outcomes.

In this episode, Clare Williams, author and creator from Hamish & Milo Wellbeing Resources discusses 'Creating an SEMH inclusive school', highlighting the pressing need for schools to adopt practices that foster social, emotional, and mental health (SEMH) support for ALL students, not just those with SEND.

Hamish & Milo advocate for inclusive, relational practices while ensuring that staff have access to evidence-based resources, qualitative CPD training, impact measurement tools, and opportunities for collaboration with parents.

Clare focuses on the 8 Public Health England Principles to promote a whole school approach:

1. Leadership and management

2. Ethos and environment

3. Curriculum and teaching and learning

4. Enabling student voice

5. Staff development

6. Identifying need and monitoring impact

7. Targeted support

8. Working with parents and carers

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Clare Williams highlights the pressing need for schools to adopt practices that foster SEMH support for ALL students.

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Wellbeing For Children: Confidence And Self-Esteem

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Zones of Regulation with occupational therapist Kim Griffin

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In this episode we welcome back Kim Griffin to the show to discuss person-centred approaches, and how the framework provides strategies to help children understand how they can control their emotions and improve their ability to problem solve conflicts.

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Hello and welcome to my resource blog for all things related to positive child mental health, SEND and staff wellbeing.

These areas have always been of interest to me throughout my 23 years in education and has been at the heart of the various roles and further postgraduate learning I have undertaken in that time. I have noticed over my time in education a marked increase in mental health issues in children and colleagues in various institutions. As professionals, we are never short of work supporting children and families in this area.

I am also the editor of Teacher toolkit ( https://www.teachertoolkit.co.uk/author/l-how/) and I have behind me a wealth of experience writing academically for qualifications. Currently I hold NPQH, MA Education with SEND and Mental Health focus, NASENCO award, FCCT and Elklan Speech and Language award. I have also undertaken training in Trauma in Education and accreditation and coaching qualification.

Through my SENCO work, I have been training new SENCOs with SEND Station as well as developing my own SENCO training programs. I am a practicing SENCO for one day a week as well.

Looking forward, I am now really keen to diversify my writing further, continuing to add to my already popular blog, as well as building my consultancy work in supporting schools and teachers. As a mum of two primary school children, I can appreciate first hand the pressure children, educators and parents are under!

If you want to know a bit more about what I'm about, this article was written about me:
https://inspodaily.co.uk/2021/04/23/mental-health-blog-advice-positive-young-minds/
Any feedback and comments on posts are gratefully received and I am also happy to take requests of area you are struggling with so just ping me a message or look on my consultancy page to see what's on offer.

Thanks for reading,

Lynn How

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Hello and welcome to my resource blog for all things related to positive child mental health, SEND and staff wellbeing. These areas have always been of interest to me throughout my 23 years in education

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Introduction to Social, Emotional and Mental Health Needs

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Welcome to ACAMH

Our vision: Sharing best evidence, improving practice. We aspire for ACAMH to become a major portal, access point for anyone seeking the most expertly digested understanding and interpretations of the best evidence available.

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The Association for Child and Adolescent Mental Health (ACAMH)

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The Association for Child and Adolescent Mental Health (ACAMH) provides information, training and evidence to health professionals.

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Designed with flexibility in mind, these online courses allow you to study from the comfort of your home, requiring just a few hours of study per week, so why not apply today to start your learning journey with us.

Please use the handy search button below to explore our full range of free online courses. Once you've found something that you're interested in, just complete our Apply Online application link below, and we'll get you started on your chosen course within the next 3 days.

Whether you seek to bolster your professional prospects, navigate life's transitions with confidence, or fulfil continuing professional development requirements, our selection of free courses have you covered. The benefits go beyond professional development! You'll also gain invaluable insights to nurture your own well-being and that of those around you, be it supporting a family member, guiding a friend, mentoring a colleague, or empowering your child's growth.

Rest assured, you won't be alone, all of our course tutors are industry experts in their specialised fields providing unwavering support and guidance throughout your chosen course, ensuring you have everything you need to succeed.

You'll be provided with an interactive learning account containing the course materials to aid your learning journey. And the best part? No exams or tests to worry about, just a seamless path to personal growth and career advancement.

We offer a whole host of different free online qualifications, from sharpening office and business skills to fostering mental health awareness and personal well-being, our courses cover the realms of education, training, health, and social care. You'll be amazed at what's available!

Please use our handy search button below to explore our free online courses. Once you've found something that you're interested in, just complete an online application and we'll get you started.
For a limited time, we are offering every learner a £50.00 Amazon gift voucher on completion of these selected qualifications: If you have any questions at all, please email freecourses@bpc.ac.uk
We have over 25 free online courses varying in duration, ranging from 8 to 21 weeks. Please note: these courses are government-funded on the condition that the course is completed. If you fail to engage and complete your course, you will be liable to pay a £125.00 administrative fee.

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Unlock your potential and pave the way for a brighter future by enrolling on one of our FREE nationally recognised online qualifications today!

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*Speech, language and communication needs

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*Speech, language and communication needs

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Speech and Language UK: Changing young lives

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Skip to content

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

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

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

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

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

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

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Herefordshire and Worcestershire Health and Care NHS Trust

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What is SLCN?

Speech, language and communication needs (SLCN) is the term given to describe the extensive range of needs related to all aspects of communication - from understanding others to forming sounds, words and sentences to expressing ideas and emotions and using language socially.

It is estimated that 10% of all children have long term or persistent speech, language and communication needs (SLCN) - the most prevalent special educational need identified by primary schools. In Worcestershire this figure is equivalent to 12,000 children and young people aged 0-19 years, with over 6,000 children and young people known to the Speech and Language Therapy Service. Some schools in deprived areas of Worcestershire have identified 50% of all 5 year olds entering school with delayed receptive language skills.

Download the Worcestershire SLCN Pathway Fact Sheets [PDF] using the links below
2.1 What is SLCN [pdf] 2.2 What is the impact of SLCN [pdf] 2.3 SLCN and SEN [pdf]
Useful links

The Communication Trust is a coalition of nearly 50 voluntary and community organisations with expertise in speech, language and communication. The Trust raises awarenesss of SLCN, promotes best practice amongst the children's workforce and provides an extensive range of information about SLCN.

The SEND Gateway is an online portal offering professionals free, easy access to high quality information, resources and training for meeting the needs of children with SEND.

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Herefordshire and Worcestershire Health and Care NHS Trust

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Supporting children with SLCN in Mainstream schools

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In this week’s podcast Dale is joined by Wendy Lee to discuss how schools can support children with Speech, Langauge and Communication Needs (SLCN)

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About Speech, Language & Communication Needs Speech, language and communication underpin everything we do – making our needs known, expressing our likes and dislikes, interacting with others and building relationships. We often take these skills for granted, but many children struggle to communicate. They have speech, language and communication needs…

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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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On this page, you'll find information on a wide range of issues that are important to blind and partially sighted young people.

School life and planning ahead

Our school life and planning ahead section covers choosing subjects, exams and study skills, after-school clubs and activities as well as how to start planning for life after school and moving on to college or work.

Leaving home

Moving out of home for the first time? Whether you are off to college or university or just taking those first steps to living independently, we can help you get prepared. You will find information on getting around and developing mobility skills as well as money management and learning useful cooking tips from students!

Starting college

If you are thinking about going to college then have a look at our starting college section. Find information on choosing the right college for you, what support is available at college and funding advice. You will also find useful study tips and hear about other student's experiences of starting college.

Starting university

There are lots to think about before going to university. You need to find the right course, get clear on application processes and it's handy to know where you can get financial help. Read on and you will discover lots of practical support for anything from choosing the right university and funding advice to how to make the most of student life!

Starting work

Starting work may seem daunting, but this section will help you to identify the people who can advise you about career choices, help with interview preparation, give guidance about work experience and volunteering and advise about the support mechanisms available, such as the Access to Work scheme.

Free time

Not sure what to do in your free time? Find ideas and inspiration and learn about what other young people are doing. From sports and hiking to reading and going to the cinema, there is something for everyone!

Transition guides

We've created handy guides for blind and partially sighted young people who are about to move into higher education and work.

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On this page, you'll find information on a wide range of issues that are important to blind and partially sighted young people. Our school life and planning ahead section covers choosing subjects, exams and study skills, after-school clubs and activities as well as how to start planning for life after school and moving on to college or work.

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Life with a Visual Impairment: Theo's Story | BBC Teach

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In this episode, we talk about common adjustments teachers make in the classroom to support students who are blind or vision impaired. Students who are blind have complete or near-complete vision loss. Students with vision impairment have decreased ability to see.

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Exploring common issues faced by blind and partially sighted students, and tips for achievement in the classroom
It is estimated that around 25,000 children and young people in England and Wales have a sight impairment that requires specialist education support. Of these, more than 60 per cent are educated in mainstream schools where their requirements might not be so easy to address. As many as half of young people with a sight impairment also have additional disabilities. So how can schools ensure that blind and partially sighted learners are best supported?

According to the Royal National Institute of Blind People (RNIB), severe visual impairment or blindness can substantially delay early childhood development and learning. Even a moderate visual impairment can have a notable impact. So what are the learning issues that schools should consider?

The main functional effects of visual impairment include central or peripheral vision loss, poor image sharpness, low contrast sensitivity or adaptability to light, and impaired eye movement or colour loss; but not all visual impairment is the same. A person's "functional revision" is a key concept here, referring to what can be seen, rather than what can't.

Adopting this mindset allows educators to consider how a learner's level of useful vision can be maximised. Considering the practical implications for the individual learner is vital; the distinctions in their educational needs will have a direct impact on the teaching and learning approaches required.

Blind learners

Educationally blind learners have a level of sight that is insufficient to learn visually, and so rely on their other senses. Distinguishing between those who have had some past sight and those who have never seen, may influence the visual concepts they can understand.
Questions to consider:

how much sight, if any, does the learner have and how useful is it?

how competent is the student with Braille and tactile skills?

what experience of vision does the learner have, if any?

how competent is the student in moving around the classroom independently?

Partially sighted learners

Partially sighted learners still work primarily through the visual medium, and make up the majority of learners with visual impairment. Their needs vary considerably and many work with normal print, which can create difficulties as their needs may be underestimated.
Questions to consider:

is the student's level of sight stable or variable and under what conditions?

is the learner's field of vision restricted?

what size/style of print is comfortable for the student?

does the learner have particular preferences for the learning environment, in terms of, for example, lighting or choice of seat?

Impact on learning

Stevie Wonder said, "Just because a man lacks the use of his eyes, doesn't mean he lacks vision." This is an important lesson; we may be inclined subconsciously to have different expectations of academic achievement for learners with visual impairment, but there is no direct correlation between visual impairment and intelligence. Most learners with visual impairment have the same range of intelligence and abilities as their sighted peers, just with additional barriers. More than a third will have some additional needs that may affect their learning.

Of course, additional barriers can affect a number of areas, such as the speed of working, communication skills (particularly reading or writing), environmental and spatial awareness, and social interaction, with a reduced ability to recognise body language and facial expressions. As a result, students can suffer from lower self-confidence which can have a negative impact on learning.

What is needed to succeed?

Inclusion is key to the successful education of students with visual impairment. According to The Centre for Studies in Inclusive Education, inclusive education means disabled and non-disabled young people learning together in ordinary school provision, with appropriate networks of support. They should have access to the same information, at the same time and, if possible, in the same way to participate in and enjoy mainstream settings to the best of their abilities, whatever their needs. Leoni Masterson, qualified teacher of the visually impaired (QTVI) at Linden Lodge School, explains: "Blind and visually impaired students face barriers to learning. If we can break down these barriers through tactile resources, we are promoting inclusion. They can take part in activities they've not been able to before."

In mainstream settings, it is important to make the most of specialist support that is available. Many mainstream educators will not have the skill set to teach specialist areas such as Braille, but QTVIs can visit and work closely with schools to advise how to meet children's needs through inclusive teaching and learning methodology. Each local authority has a vision impairment service which includes at least one QTVI.

Educators should also consider what they can do to enrich the learning process. As Leoni notes, "Visually impaired and blind children need a rich learning environment as sometimes they miss out on the visual clues." Sighted children's learning is constantly reinforced by things such as colours, shapes, people and landscapes. These give us a wealth of information subconsciously. Learners with visual impairment have reduced opportunities for incidental learning, so it is important to include as much multi-sensory learning in the classroom as possible, such as touch or smell. Also consider that visual and spatial concepts need more explanation; many learners with visual impairment struggle with concepts such as brighter versus darker, or telling which object is bigger at a glance.

Social inclusion is also important. Helen Keller said that "The chief handicap of the blind is not blindness, but the attitude of seeing people towards them." To reduce the risk of the student being ostracised by peers, consider the Circle of Friends approach, designed to enhance inclusion in a mainstream setting. It creates a support network for the student, with a peer group encouraged to look at their own behaviour, and understand the behaviour and difficulties of the student with visual impairment, in order to develop strategies and practical solutions to help them. In time, this can close the gap whilst strengthening core social skills.

Tips and ideas for the classroom

The classroom environment can have a significant impact on the success of teaching and learning. On top of dealing with core health and safety issues, it is important to consider the room's sensory nature. Your school might have had an audit conducted by a QTVI to suggest improvements, but here are some questions to consider for your classroom:

is the space clear and tidy to allow easier movement?

are frequently used resources kept in the same accessible place, and labelled?

is the level of lighting right for the learner?

are learners with visual impairment sitting close to a power source if they are using accessible ICT devices?

do you use real objects to support your teaching?

have you allowed adequate space for any special equipment or large print resources to be stored and used?

Accessible resources

Jennifer Williamson, resources technician at Joseph Clarke School, highlights the importance of accessible resources: "For students who have visual impairment, it is really important to strengthen their learning; therefore, learning materials need to be interesting enough to engage them."

Consider the issue of time for both staff and students. Visually impaired learners will often require extra time to process information and complete tasks, so using the simplest formats can help them. Make sure you and any support staff have the time to modify materials to include, for example, larger print or bolder colours. Providing both a print and a digital copy can be useful as this can be further adapted by the student to suit, if needed.

If you don't have time to modify items, look out for pre-created versions; a wide range of Braille materials, audio-visual resources, and tactile pictures and diagrams is available from various educational suppliers.

Role of access technology

Access technology has enormous potential for supporting learners with visual impairment across different ages and abilities. Assistive technology, such as audio-visual devices or software, allows students to work at their own pace and, with the right training, often independently. Technology isn't a magic wand, though; to be a success, it requires the right device, training and time. When this is achieved, students can take control of part of their learning journey, improving not only their academic progress, but also their self-confidence in learning and wider life.

If we can metaphorically open our eyes to the specific needs of visually impaired students, and take the time to recognise the impact they have on their learning and social integration, we can take the first steps towards making education an inclusive process.

Further information

Robene Dutta is Managing Director at educational publisher Mantra Lingua:
www.mantralingua.com

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Supporting the visually impaired learner * SEN Magazine

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Exploring common issues faced by blind and partially sighted students, and tips for achievement in the classroom

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Supporting colour blindness, learn the truth behind common misconceptions, the impact it has & practical strategies to support individuals.

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Removing barriers to education: A toolkit for supporting children and young people experiencing Emotionally Based School Avoidance (EBSA)

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Essentials: Understanding Children With Emotionally Based School Avoidance (EBSA)

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How to support children with EBSA (Emotionally Based School Avoidance)

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The latest episode of Thrive's  Connected podcast  focuses on Emotional Based School Avoidance, a term used to describe children and young people who experience challenges in attending school due to negative feelings such as anxiety. In the podcast, Dom Sagar, Thrive's Relationship Manager for the North and Central England, explains that this is usually associated with emotional and physical distress presenting as a reluctance to attend school or absconding from lessons within the settings - leading to reduced attendance.

The last year that there is a 'tsunami' of cases of EBSA, in many cases exacerbated by the Covid-19 pandemic, with many parents and teachers struggling to support children. In the podcast, Dom considers how educators can use the BBC reported Thrive Approach ® to help children who are affected and explains the neuroscience that lies behind EBSA.

"It can be really difficult for adults to understand that the behaviour they are seeing is not personal or even cognitive. It's about the child using survival strategies that have served them in the past. The behaviour we see on the outside is very different to the emotions that the child is feeling on the inside. The key to it is understanding what's driving the behaviours and where these responses are coming from so that adults can empathise with what's going on for that child," she said.

As well as outlining the importance of a relationship with a trusted adult to create a place of safety and containment, Dom also suggests strategies that could help classroom staff to respond to children that are affected. Things like visual timetables, peer buddy schemes, sensory boxes, quiet places and 'now and next' exercises can all help to support children with transitions within the school day.

"When children start to feel emotionally safe in relationships and they feel someone is seeing them and hearing them, then you see children begin to have the capacity to regulate their emotions and to move to a more cognitive level. There, they are able to make choices about how they respond to situations, rather than reacting to something they find overwhelming," added Dom.

And to read more about EBSA and strategies that may help teachers to support children and parents have a look at:

Over to you

Reduced anxiety and behavioural incidents. Calmer classrooms filled with engaged leaners. Improved relationships with parents and carers. These are just some of the outcomes reported by settings embedding Thrive's whole-school approach to mental health and wellbeing. Are you ready to join them? Click here to get started.

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Announcing new podcast episode about emotional based school avoidance | The Thrive Approach

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The latest episode of Thrive's  Connected podcast  focuses on Emotional Based School Avoidance, a term used to describe children and young people who experience challenges in attending school due to negative feelings such as anxiety.

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PODCAST: School Anxiety: Starting The School Day Right

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In this episode, I explore three Rs for starting the school day right for children who are struggling to attend

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Compass Changing Lives provides prevention and early intervention emotional wellbeing and mental health support to Children, Young People and Families across Derby & Derbyshire.

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Support for families and early help - Derbyshire County Council

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There are a number of reasons why extra help is sometimes needed. Getting the right information, advice and support at the right time can help.

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Derbyshire Information, Advice and Support Service (DIASS) provides independent information, advice and support to children and young people with special educational needs and disabilities (SEND), as well as their parents and carers.

We aim to help parents and carers increase their involvement in the education of their children and ensure that they have access to information and advice about issues relating to a child or young person's health and social care.

The service is impartial, confidential, and works at arm's length from the local authority. Our advice is free and accessible to all parents of children with SEND. We also offer support for children and young people with SEND.

We can also support you with:

the law around SEND

health and social care in relation to special educational needs provision

personal budgets

education health care plans (EHCP)

information on the Local Offer (services and provision available for those with SEND)

transition post 16 - preparing for adulthood

resolving any disagreements

The Children and Families Act 2014 and the SEND code of practice are intended to strengthen the participation of parents, children and young people.

Please note that the service is currently operating and support workers are available. Due to current COVID-19 (Coronavirus) restrictions we cannot offer face to face support. However parents, carers, children and young people can contact us through email and telephone.

Find out how Derbyshire's Local Authority are supporting vulnerable children, young people and families during the coronavirus outbreak.

The Council for Disabled children has some useful information about COVID 19 (Coronavirus) and schools.

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Welcome to the Derbyshire Information, Advice and Support Service for SEND

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Derbyshire Information, Advice and Support Service (DIASS) provides independent information, advice and support to children and young people with special educational needs and disabilities (SEND), as well as their parents and carers.

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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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Transforming Health and Wellbeing for Everyone

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We will agree with you the most helpful way to communicate with you. This may be face to face, by telephone, video call, email, text message or a posted letter, and this may change depending on what we need to communicate.

We try to use telephone and email as much as possible as this is the quickest and safest way to get important information to you. It also allows us to help the environment and to save money. Patients and their families may request paper copies of information but these may take longer to reach you.

Emails:

When sending emails, we must make sure we are doing so securely. We will check we have the correct email address for you, by sending a 'test email' first. We will wait for your reply before sending any further information

If you are the patient or parent of a patient under 18:

We will ask your consent before sending you any emails. We will also check you are happy for us to send you patient-identifiable information by email. Although our own email system (NHSmail) is secure, we cannot guarantee that information will still be secure once it arrives in your inbox. Your confidentiality may be at risk if your email account is hacked, or if you forward the email on.

If you are another professional:

We will send emails to other NHS professionals and to addresses ending in .gov.uk using NHS mail as this is fully encrypted end-to-end.

We will send emails to any other professionals as follows:

We will only send to a professional, work email address. We cannot send patient-identifiable information to other professionals via a personal email address (hotmail, gmail, yahoo etc). If you are in an education setting, please let us know the single preferred contact address for your setting.

We send emails using Egress, a secure online server, fully integrated with NHSmail.

You will receive an email inviting you to click a link to view the email (and any attachments) on the online Egress server. Please click the link.

On the landing page, you will be invited to either login (if you already have an Egress account) or register for a free account.

Once registered/logged in, you will be able to view the email and any attachments.

You can download any attachments and save these to your own system, and then print off or forward them to other appropriate staff as indicated on the cc list (or with our additional consent for anyone not already on the cc list).

You cannot download or forward the email itself.

Please do not forward the email invitation to another email address. It will only be accessible via the email address we originally sent it to. Forwarding will trigger an automated request for additional permissions which we may not be able to action. Instead, if another person needs to see the email (rather than just the attachment), please reply to ask us to re-send the email to the new person. We will then send it direct to them and they will need to go through the process above.

If you have any difficulties, please contact the service on 01773 525079.

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Our therapists, practitioners, assistants and admin support workers work together to deliver high quality services for adults and children who have speech, language and communication difficulties; eating, drinking and swallowing difficulties (dysphagia). We work with adults and children, throughout Derbyshire and Derby City.

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Occupational therapy :: Derbyshire Community Health Services

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Occupational therapists identify the problem areas that patients may have in their everyday lives and help them to work out practical solutions to regain or improve their independence and wellbeing within the home, work and social life.

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Helping and supporting children and young people with special educational needs and disabilities.

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Derbyshire Healthcare NHS Foundation Trust

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The single point of access online referral form is for GPs and primary care professionals in health, education and local government to contact the SPOA team in order to request support for children and young people with emotional and behavioural problems in the Derby city and south Derbyshire area only.

Please keep a copy of any information submitted through this form, in case you need to refer to it or resubmit it.

If you have any issues completing the form, please email dhcft.spoa@nhs.net

If the referral is for a neurodevelopmental concern, please refer using the form on our Neurodevelopmental Pathway page.

Services for children in north Derbyshire

CAMHS in north Derbyshire is provided by Chesterfield Royal Hospital NHS Foundation Trust - see their for further information.

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Single point of access referral form :: Derbyshire Healthcare NHS Foundation Trust

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The single point of access online referral form is for GPs and primary care professionals in health, education and local government to contact the SPOA team in order to request support for children and young people with emotional and behavioural problems in the Derby city and south Derbyshire area only.

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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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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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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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The EEF is an independent charity dedicated to breaking the link between family income and educational achievement.

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Executive functioning - Support for schools and settings

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Executive function (EF) describes a group of mental processes which work together to help someone to plan, focus and shift attention, be aware of time,