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Conditions

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Developmental Conditions

Sensory Processing Disorder

What is it?

Sensory processing disorder is a condition in which the brain has trouble receiving and responding to information that comes in through the senses. Formerly referred to as sensory integration dysfunction, it is not currently recognized as a distinct medical diagnosis.

Sensory processing is divided into eight main types:

Proprioception: This is the “internal” sense of awareness you have for your body. It’s what helps you maintain posture and motor control, for example. It’s also what tells you about how you’re moving and occupying space.

Vestibular: This term refers to the inner ear spatial recognition. It’s what keeps you balanced and coordinated.

Interoception: This is the sense of what’s happening in your body. It may be best understood as how you “feel.” This includes whether you feel hot or cold and whether you feel your emotions.

Five senses: Lastly, there are the 5 common senses. Touch, hearing, taste, smell, and sight.

Sensory issues have previously been called a sensory processing disorder. The disorder, however, isn’t officially recognized by the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5).

What causes Sensory Processing Disorder?

Sensory issues occur when a child has a difficult time receiving and responding to information from

Sensory issues have previously been called a sensory processing disorder. The disorder, however, isn’t officially recognized by the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5).

How Sensory Processing Disorder Affects Children?

Common symptoms of sensory processing issues may include hyperactivity, frequently putting things in their mouth and resisting hugs. Unfortunately, not a great deal is known about sensory issues or why some children experience them but not others.

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Prenatal screening and diagnosis?

It’s not clear what causes sensory issues in children. It’s also not clear if this can occur on its own. Some doctors and healthcare providers believe it to be a symptom of another issue, not its own issue. However, despite not being an official disorder, some research has shed light on which kids are more likely to develop sensory issues and why.

Getting help?

Sensory issues aren’t an official condition. That means there is no formal criteria for a diagnosis.

Instead, doctors, educators, or healthcare providers who work with children who have issues with processing sensory information work off what they see in the child’s behaviour’s and interactions. Generally, these sensory issues are highly visible. That makes a diagnosis easier.

In some cases, professionals may use the Sensory Integration and Praxis Tests (SIPT) or the Sensory Processing Measure (SPM). Both of these tests can help healthcare providers and educators better understand a child’s sensory functioning.

Developmental Conditions

Autism Spectrum Disorder (ASD)

What is it?

Autism spectrum disorder (ASD) is a complex neurodevelopment disorder, characterized by social impairments, communication difficulties, and restricted, repetitive, and stereotyped patterns of behaviour.

Prior to reclassification through the DSM-5 in 2015, classical ASD was considered the most severe form of ASD, while other conditions along the spectrum considered milder included; Asperger syndrome, childhood disintegrative disorder and pervasive developmental disorder not otherwise specified (usually referred to as PDD-NOS).  Although ASD varies significantly in character and severity, it occurs in all ethnic and socioeconomic groups and affects every age group.  Experts estimate that six children out of every 1,000 will have an ASD.  Males are four times more likely to have an ASD than females.

What causes Autism Spectrum Disorder?

Scientists aren’t certain about what causes ASD, but it’s likely that both genetics and environment play a role.  Researchers have identified a number of genes associated with the disorder.  Studies of people with ASD have found irregularities in several regions of the brain.  Other studies suggest that people with ASD have abnormal levels of serotonin or other neurotransmitters in the brain.  These abnormalities suggest that ASD could result from the disruption of normal brain development early in foetal development caused by defects in genes that control brain growth and that regulate how brain cells communicate with each other, possibly due to the influence of environmental factors on gene function.  While these findings are intriguing, they are preliminary and require further study.  The theory that parental practices are responsible for ASD has long been disproved.

What role does inheritance play?

Twin and family studies strongly suggest that some people have a genetic predisposition to autism.  Identical twin studies show that if one twin is affected, there is up to a 90 percent chance the other twin will be affected.  There are a number of studies in progress to determine the specific genetic factors associated with the development of ASD.  In families with one child with ASD, the risk of having a second child with the disorder is approximately 5 percent, or one in 20.  This is greater than the risk for the general population.  Researchers are looking for clues about which genes contribute to this increased susceptibility.  In some cases, parents and other relatives of a child with ASD show mild impairments in social and communicative skills or engage in repetitive behaviours.  Evidence also suggests that some emotional disorders, such as bipolar disorder, occur more frequently than average in the families of people with ASD.

How Autism Spectrum Disorder affects children?

  1. Symptoms must be present in the early developmental period
  2. Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning
  3. These disturbances are not better explained by intellectual disability (intellectual developmental disorder) or global developmental delay

Severity levels for autism spectrum disorder

  • Level 3 – Requiring very substantial support (severe)
  • Level 2 – Requiring substantial support (moderate)
  • Level 1 – Requiring support (mild)

What are some common signs of autism?

The hallmark feature of ASD is impaired social interaction.  As early as infancy, a baby with ASD may be unresponsive to people or focus intently on one item to the exclusion of others for long periods of time.  A child with ASD may appear to develop normally and then withdraw and become indifferent to social engagement.

Children with ASD may fail to respond to their names and often avoid eye contact with other people.  They have difficulty interpreting what others are thinking or feeling because they can’t understand social cues, such as tone of voice or facial expressions, and don’t watch other people’s faces for clues about appropriate behaviour.  They lack empathy.

Many children with ASD engage in repetitive movements such as rocking and twirling, or in self-abusive behaviour such as biting or head-banging.  They also tend to start speaking later than other children and may refer to themselves by name instead of “I” or “me.”  Children with ASD don’t know how to play interactively with other children.  Some speak in a sing-song voice about a narrow range of favourite topics, with little regard for the interests of the person to whom they are speaking.

Medical problems associated?

  1. Autism Spectrum Disorder Diagnostic Criteria
  2. Persistent deficits in social communication and social interaction across multiple contexts:
  3. Deficits in social-emotional reciprocity
  4. Deficits in nonverbal communicative behaviours used for social interaction
  5. Deficits in developing, maintaining, and understanding relationships
  6. Restricted, repetitive patterns of behaviour, interests, or activities
  7. Stereotyped or repetitive motor movements, use of objects, or speech
  8. Insistence on sameness, inflexible adherence to routines, or ritualized patterns
  9. Highly restricted, fixated interests that are abnormal in intensity or focus
  10. Hyper- or hypo reactivity to sensory input or unusual interests in sensory aspects of the environment

Prenatal screening and diagnosis?

ASD varies widely in severity and symptoms and may go unrecognized, especially in mildly affected children or when it is masked by more debilitating handicaps.

Very early indicators that require evaluation by an expert include:

  • no babbling or pointing by age 1
  • no single words by 16 months or two-word phrases by age 2
  • no response to name
  • loss of language or social skills
  • poor eye contact
  • excessive lining up of toys or objects
  • no smiling or social responsiveness.

Later indicators include:

  • Impaired ability to make friends with peers
  • Impaired ability to initiate or sustain a conversation with others
  • Absence or impairment of imaginative and social play
  • Stereotyped, repetitive, or unusual use of language
  • Restricted patterns of interest that are abnormal in intensity or focus
  • Preoccupation with certain objects or subjects
  • Inflexible adherence to specific routines or rituals.

Getting help?

Health care providers will often use a questionnaire or other screening instrument to gather information about a child’s development and behaviour.  Some screening instruments rely solely on parent observations, while others rely on a combination of parent and doctor observations.  If screening instruments indicate the possibility of an ASD, a more comprehensive evaluation is usually indicated.

A comprehensive evaluation requires a multidisciplinary team, including a psychologist, neurologist, psychiatrist, speech therapist, and other professionals who diagnose children with ASDs.  The team members will conduct a thorough neurological assessment and in-depth cognitive and language testing.  Because hearing problems can cause behaviours that could be mistaken for an ASD, children with delayed speech development should also have their hearing tested.

Children with some symptoms of an ASD but not enough to be diagnosed with classical autism are often diagnosed with PDD-NOS.  Children with autistic behaviours but well-developed language skills are often diagnosed with Asperger syndrome. Much rarer are children who may be diagnosed with childhood disintegrative disorder, in which they develop normally and then suddenly deteriorate between the ages of 3 to 10 years and show marked autistic behaviours.

Do symptoms of autism change over time?

For many children, symptoms improve with treatment and with age.  Children whose language skills regress early in life—before the age of 3—appear to have a higher-than-normal risk of developing epilepsy or seizure-like brain activity.  During adolescence, some children with an ASD may become depressed or experience behavioural problems, and their treatment may need some modification as they transition to adulthood.  People with an ASD usually continue to need services and supports as they get older, but many are able to work successfully and live independently or within a supportive environment.

How is autism treated?

There is no cure for ASDs.  Therapies and behavioural interventions are designed to remedy specific symptoms and can bring about substantial improvement.  The ideal treatment plan coordinates therapies and interventions that meet the specific needs of individual children.  Most health care professionals agree that the earlier the intervention, the better.

Medications

Doctors may prescribe medications for treatment of specific autism-related symptoms, such as anxiety, depression, or obsessive-compulsive disorder.  Antipsychotic medications are used to treat severe behavioural problems.  Seizures can be treated with one or more anticonvulsant drugs.  Medication used to treat people with attention deficit disorder can be used effectively to help decrease impulsivity and hyperactivity.

Developmental Conditions

Pervasive Developmental disorder – Non-Otherwise Specified (PDD-NOS)

What is it?

PDD-NOS may be thought of as “sub threshold autism,” or a diagnosis one can give a person who has “atypical symptomatology.” In other words, when someone has autistic characteristics but some of their symptoms are mild, or they have symptoms in one area (like social deficits), but none in another key area (like restricted, repetitive behaviours), they may be given the PDD-NOS label.

What causes PDD-NOS?

In the DSM-IV Criteria for a Diagnosis of Pervasive Developmental Disorder Not Otherwise Specified, PDD-NOS is covered in a single paragraph, which mainly asserts what it is not:

“This category should be used when there is severe and pervasive impairment in the development of reciprocal social interaction associated with impairment in either verbal or nonverbal communication skills or with the presence of stereotyped behaviour, interests, and activities, but the criteria are not met for a specific Pervasive Developmental Disorder, Schizophrenia, Schizotypal Personality Disorder, or Avoidant Personality Disorder. For example, this category includes “atypical autism” – presentations that do not meet the criteria for Autistic Disorder because of late age at onset, atypical symptomatology, or sub threshold symptomatology, or all of these.”

American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., rev.). Washington DC: Author. (Pg. 84)

Prenatal screening and diagnosis?

When might a person receive a diagnosis of PDD-NOS?

That will vary, of course, but in one study, researchers found that those with PDD-NOS could be placed in one of three very different subgroups:

A high-functioning group (24%) who resembled people with Asperger syndrome but had transient language delay or mild cognitive impairment (such that they could not receive the Asperger diagnosis which requires no speech or cognitive delay).

  • A group (24%) who resembled people with autism but who had a late age of onset, or otherwise did not meet the criteria for autism.
  • A group (52%) who were autistic-like but displayed fewer stereotyped and repetitive behaviours.

Getting help?

Some parents may prefer the label PDD-NOS, feeling it is less stigmatizing than “autism,” while others may find agencies and providers have less of an understanding of the label, making it harder to access services. In any case, an individual diagnosed with PDD-NOS, like individuals diagnosed with autism or Asperger syndrome, can benefit from early intervention, education services and an Individual Education Program (IEP).

In order to determine what treatments and interventions will be most effective for an individual with PDD-NOS, a thorough assessment of all symptoms must be done. The evaluation must examine a wide variety of factors including behavioural history, current symptoms, communication patterns, social competence and neuropsychological functioning.

An individual with PDD-NOS may have completely different strengths and challenges than another individual with the same diagnosis. One treatment that is the most significant and most effective for one child may be completely unnecessary and ineffective for another. As a result, treatments and interventions must be very individualized based on the information gathered from the thorough assessment.

“A treatment method or an educational method that will work for one child may not work for another child. The one common denominator for all of the young children is that early intervention does work, and it seems to improve the prognosis.” – Temple Grandin

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Developmental Conditions

Asperger’s Syndrome

What is it?

Asperger syndrome (AS) is a developmental disorder that is characterized by:

  • Limited interests or an unusual preoccupation with a particular subject to the exclusion of other activities
  • repetitive routines or rituals
  • peculiarities in speech and language, such as speaking in an overly formal manner or in a monotone, or taking figures of speech literally
  • socially and emotionally inappropriate behaviour and the inability to interact successfully with peers
  • problems with non-verbal communication, including the restricted use of gestures, limited or inappropriate facial expressions, or a peculiar, stiff gaze
  • clumsy and uncoordinated motor movements

What causes Asperger’s Syndrome?

Is it genetic? Current research points to brain abnormalities as the cause of AS.  Using advanced brain imaging techniques, scientists have revealed structural and functional differences in specific regions of the brains of normal versus AS children.  These defects are most likely caused by the abnormal migration of embryonic cells during foetal development that affects brain structure and “wiring” and then goes on to affect the neural circuits that control thought and behaviour.

For example, one study found a reduction of brain activity in the frontal lobe of AS children when they were asked to respond to tasks that required them to use their judgment.  Another study found differences in activity when children were asked to respond to facial expressions.  A different study investigating brain function in adults with AS revealed abnormal levels of specific proteins that correlate with obsessive and repetitive behaviours.

Scientists have always known that there had to be a genetic component to AS and the other ASDs because of their tendency to run in families. Additional evidence for the link between inherited genetic mutations and AS was observed in the higher incidence of family members who have behavioural symptoms similar to AS but in a more limited form.  For example, they had slight difficulties with social interaction, language, or reading.

A specific gene for AS, however, has never been identified.  Instead, the most recent research indicates that there are most likely a common group of genes whose variations or deletions make an individual vulnerable to developing AS.  This combination of genetic variations or deletions will determine the severity and symptoms for each individual with AS.

How Asperger’s Syndrome Affects Children?

Parents usually sense there is something unusual about a child with AS by the time of his or her third birthday, and some children may exhibit symptoms as early as infancy.  Unlike children with autism, children with AS retain their early language skills.  Motor development delays – crawling or walking late, clumsiness – are sometimes the first indicator of the disorder.

The incidence of AS is not well established, but experts in population studies conservatively estimate that two out of every 10,000 children have the disorder.  Boys are three to four times more likely than girls to have AS.

Studies of children with AS suggest that their problems with socialization and communication continue into adulthood.   Some of these children develop additional psychiatric symptoms and disorders in adolescence and adulthood.

Although diagnosed mainly in children, AS is being increasingly diagnosed in adults who seek medical help for mental health conditions such as depression, obsessive-compulsive disorder (OCD), and attention deficit hyperactivity disorder (ADHD).  No studies have yet been conducted to determine the incidence of AS in adult populations.

Adapted from the Diagnostic and Statistical Manual of Mental Disorders IV and the International Classification of Diseases.

What are some common signs or symptoms?

The most distinguishing symptom of AS is a child’s obsessive interest in a single object or topic to the exclusion of any other.  Some children with AS have become experts on vacuum cleaners, makes and models of cars, even objects as odd as deep fat fryers.  Children with AS want to know everything about their topic of interest and their conversations with others will be about little else.  Their expertise, high level of vocabulary, and formal speech patterns make them seem like little professors.

Children with AS will gather enormous amounts of factual information about their favourite subject and will talk incessantly about it, but the conversation may seem like a random collection of facts or statistics, with no point or conclusion.

Their speech may be marked by a lack of rhythm, an odd inflection, or a monotone pitch.  Children with AS often lack the ability to modulate the volume of their voice to match their surroundings.  For example, they will have to be reminded to talk softly every time they enter a library or a movie theatre.

Unlike the severe withdrawal from the rest of the world that is characteristic of autism, children with AS are isolated because of their poor social skills and narrow interests.  In fact, they may approach other people, but make normal conversation impossible by inappropriate or eccentric behaviour, or by wanting only to talk about their singular interest.

Children with AS usually have a history of developmental delays in motor skills such as pedalling a bike, catching a ball, or climbing outdoor play equipment.   They are often awkward and poorly coordinated with a walk that can appear either stilted or bouncy.

Many children with AS are highly active in early childhood, and then develop anxiety or depression in young adulthood.  Other conditions that often co-exist with AS are ADHD, tic disorders (such as Tourette syndrome), depression, anxiety disorders, and OCD.

Prenatal screening and diagnosis?

The diagnosis of AS is complicated by the lack of a standardized diagnostic screen or schedule.  In fact, because there are several screening instruments in current use, each with different criteria, the same child could receive different diagnoses, depending on the screening tool the doctor uses.

To further complicate the issue, some doctors believe that AS is not a separate and distinct disorder.  Instead, they call it high-functioning autism (HFA), and view it as being on the mild end of the ASD spectrum with symptoms that differ — only in degree — from classic autism.  Some clinicians use the two diagnoses, AS or HFA, interchangeably.  This makes gathering data about the incidence of AS difficult, since some children will be diagnosed with HFA instead of AS, and vice versa.

Most doctors rely on the presence of a core group of behaviours to alert them to the possibility of a diagnosis of AS. These are:

  • abnormal eye contact
  • aloofness
  • the failure to turn when called by name
  • the failure to use gestures to point or show
  • a lack of interactive play
  • a lack of interest in peers

Some of these behaviours may be apparent in the first few months of a child’s life, or they may appear later.  Problems in at least one of the areas of communication and socialization or repetitive, restricted behaviour must be present before the age of 3.

The diagnosis of AS is a two-stage process.  The first stage begins with developmental screening during a “well-child” check-up with a family doctor or paediatrician.  The second stage is a comprehensive team evaluation to either rule in or rule out AS.    This team generally includes a psychologist, neurologist, psychiatrist, speech therapist, and additional professionals who have expertise in diagnosing children with AS.

The comprehensive evaluation includes neurologic and genetic assessment, with in-depth cognitive and language testing to establish IQ and evaluate psychomotor function, verbal and non-verbal strengths and weaknesses, style of learning, and independent living skills.    An assessment of communication strengths and weaknesses includes evaluating non-verbal forms of communication (gaze and gestures); the use of non-literal language (metaphor, irony, absurdities, and humour); patterns of inflection, stress and volume modulation; pragmatics (turn-taking and sensitivity to verbal cues); and the content, clarity, and coherence of conversation.  The physician will look at the testing results and combine them with the child’s developmental history and current symptoms to make a diagnosis.

Getting help - Are there treatments available?

The ideal treatment for AS coordinates therapies that address the three core symptoms of the disorder:  poor communication skills, obsessive or repetitive routines, and physical clumsiness.  There is no single best treatment package for all children with AS, but most professionals agree that the earlier the intervention, the better.

An effective treatment program builds on the child’s interests, offers a predictable schedule, teaches tasks as a series of simple steps, actively engages the child’s attention in highly structured activities, and provides regular reinforcement of behaviour.  This kind of program generally includes:

  • social skills training, a form of group therapy that teaches children with AS the skills they need to interact more successfully with other children
  • cognitive behavioural therapy, a type of “talk” therapy that can help the more explosive or anxious children to manage their emotions better and cut back on obsessive interests and repetitive routines
  • medication, for co-existing conditions such as depression and anxiety
  • occupational or physical therapy, for children with sensory integration problems or poor motor coordination
  • specialized speech/language therapy, to help children who have trouble with the pragmatics of speech – the give and take of normal conversation
  • parent training and support, to teach parents behavioural techniques to use at home

Do children with AS get better? What happens when they become adults?

With effective treatment, children with AS can learn to cope with their disabilities, but they may still find social situations and personal relationships challenging.  Many adults with AS are able to work successfully in mainstream jobs, although they may continue to need encouragement and moral support to maintain an independent life.

Why is it called Asperger syndrome?

In 1944, an Austrian paediatrician named Hans Asperger observed four children in his practice who had difficulty integrating socially.  Although their intelligence appeared normal, the children lacked nonverbal communication skills, failed to demonstrate empathy with their peers, and were physically clumsy.  Their way of speaking was either disjointed or overly formal, and their all-absorbing interest in a single topic dominated their conversations. Dr Asperger called the condition “autistic psychopathy” and described it as a personality disorder primarily marked by social isolation.

Asperger’s observations, published in German, were not widely known until 1981, when an English doctor named Lorna Wing published a series of case studies of children showing similar symptoms, which she called “Asperger’s” syndrome.  Wing’s writings were widely published and popularized.  AS became a distinct disease and diagnosis in 1992, when it was included in the tenth published edition of the World Health Organization’s diagnostic manual, International Classification of Diseases (ICD-10), and in 1994 it was added to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), the American Psychiatric Association’s diagnostic reference book.

Developmental Conditions

Language and communication disorders

What is it?

When a person is unable to produce speech sounds correctly or fluently, or has problems with his or her voice, then he or she has a speech disorder. Difficulties pronouncing sounds, or articulation disorders, and stuttering are examples of speech disorders.

What is childhood apraxia of speech?

Childhood apraxia of speech (CAS) is a motor speech disorder. Children with CAS have problems saying sounds, syllables, and words. This is not because of muscle weakness or paralysis. The brain has problems planning to move the body parts (e.g., lips, jaw, tongue) needed for speech. The child knows what he or she wants to say, but his/her brain has difficulty coordinating the muscle movements necessary to say those words.

What are speech sound disorders?

Most children make some mistakes as they learn to say new words. A speech sound disorder occurs when mistakes continue past a certain age. Every sound has a different range of ages when the child should make the sound correctly. Speech sound disorders include problems with articulation(making sounds) and phonological processes(sound patterns).

What is dysarthria?

Dysarthria is a motor speech disorder. The muscles of the mouth, face, and respiratory system may become weak, move slowly, or not move at all after a stroke or other brain injury. The type and severity of dysarthria depend on which area of the nervous system is affected.

Some causes of dysarthria include stroke, head injury, cerebral palsy, and muscular dystrophy. Both children and adults can have dysarthria.

What is stuttering?

Stuttering affects the fluency of speech. It begins during childhood and, in some cases, lasts throughout life. The disorder is characterized by disruptions in the production of speech sounds, also called “dysfluencies.” Most people produce brief dysfluencies from time to time. For instance, some words are repeated and others are preceded by “um” or “uh.” Dysfluencies are not necessarily a problem; however, they can impede communication when a person produces too many of them.

In most cases, stuttering has an impact on at least some daily activities. The specific activities that a person finds challenging to perform vary across individuals. For some people, communication difficulties only happen during specific activities, for example, talking on the telephone or talking before large groups. For most others, however, communication difficulties occur across a number of activities at home, school, or work. Some people may limit their participation in certain activities. Such “participation restrictions” often occur because the person is concerned about how others might react to dysfluent speech. Other people may try to hide their dysfluent speech from others by rearranging the words in their sentence (circumlocution), pretending to forget what they wanted to say, or declining to speak. Other people may find that they are excluded from participating in certain activities because of stuttering. Clearly, the impact of stuttering on daily life can be affected by how the person and others react to the disorder.

What is a language-based learning disability?

Language-based learning disabilities are problems with age-appropriate reading, spelling, and/or writing. This disorder is not about how smart a person is. Most people diagnosed with learning disabilities have average to superior intelligence.

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What are some signs or symptoms of a language-based learning disability?

Dyslexia has been used to refer to the specific learning problem of reading. The term language-based learning disability, or just learning disabilities, is better because of the relationship between spoken and written language. Many children with reading problems have spoken language problems.

What causes a language-based learning disability?

We don’t know what causes many communication disorders and impairments. Some communication problems might have genetic links. Sometimes children have communication disorders and no other developmental concerns. Sometimes children have communication disorders along with other health or developmental conditions.

How a language-based learning disability affects children?

The child with dyslexia has trouble almost exclusively with the written (or printed) word. The child who has dyslexia as part of a larger language learning disability has trouble with both the spoken and the written word. These problems may include difficulty with the following:

  • Expressing ideas clearly, as if the words needed are on the tip of the tongue but won’t come out. What the child says can be vague and difficult to understand (e.g., using unspecific vocabulary, such as “thing” or “stuff” to replace words that cannot be remembered). Filler words like “um” may be used to take up time while the child tries to remember a word.
  • Learning new vocabulary that the child hears (e.g., taught in lectures/lessons) and/or sees (e.g., in books)
  • Understanding questions and following directions that are heard and/or read
  • Recalling numbers in sequence (e.g., telephone numbers and addresses)
  • Understanding and retaining the details of a story’s plot or a classroom lecture
  • Reading and comprehending material
  • Learning words to songs and rhymes
  • Telling left from right, making it hard to read and write since both skills require this directionality
  • Letters and numbers
  • Learning the alphabet
  • Identifying the sounds that correspond to letters, making learning to read difficult
  • Mixing up the order of letters in words while writing
  • Mixing up the order of numbers that are a part of math calculations
  • Spelling
  • Memorizing the times tables
  • Telling time

Prenatal screening and diagnosis?

Preschool children (3 to 5 years old) with language disorders may have trouble understanding and talking.

Some children have problems with understanding, also called receptive language. They may have trouble:

  • Understanding what gestures mean
  • Following directions
  • Answering questions
  • Identifying objects and pictures
  • Taking turns when talking with others

Some children have problems talking, also called expressive language. They may have trouble:

  • Asking questions
  • Naming objects
  • Using gestures
  • Putting words together into sentences
  • Learning songs and rhymes
  • Using correct pronouns, like “he” or “they”
  • Knowing how to start a conversation and keep it going

Many children have problems with both understanding and talking and some children also have trouble with early reading and writing, such as:

  • Holding a book right side up
  • Looking at pictures in a book and turning pages
  • Telling a story with a beginning, a middle, and an end
  • Naming letters and numbers
  • Learning the alphabet

Medical problems associated?

Communication Disorders are problems of childhood that affect learning, language, and/or speech. Expressive Language Disorder, Phonological Disorder, Receptive-Expressive Language Disorder, and Stuttering are all types of Communication Disorders. Certain characteristics are common to all Communication Disorders.

Getting help?

Children with language problems often need extra help and special instruction. Speech-language pathologists can work directly with children and their parents, caregivers, and teachers.

Having a language or speech delay or disorder can qualify a child for early intervention external icon (for children up to 3 years of age) and special education services (for children aged 3 years and older). Schools can do their own testing for language or speech disorders to see if a child needs intervention. An evaluation by a healthcare professional is needed if there are other concerns about the child’s hearing, behaviour, or emotions. Parents, healthcare providers, and the school can work together to find the right referrals and treatment.

Developmental Conditions

Auditory Processing Disorder

What is it?

Children with APD often do not recognize subtle differences between sounds in words, even when the sounds are loud and clear enough to be heard. These kinds of problems usually occur in background noise, which is a natural listening environment. So, children with APD have the basic difficulty of understanding any speech signal presented under less-than-optimal conditions.

What causes Auditory Processing Disorder

The causes of APD are unknown. But evidence suggests links to head trauma, lead poisoning, and chronic ear infections. Because there are many different possibilities, even combinations of causes each child must be assessed individually.

How Auditory Processing Disorder Affects Children?

Children with APD are thought to hear normally because they can usually detect pure tones that are delivered one by one in a very quiet environment (such as a sound-treated room). Those who can normally detect sounds and recognize speech in ideal listening conditions are not considered to have hearing difficulties.

However, the ability to detect the presence of sounds is only one part of the processing that occurs in the auditory system. So, most Children with APD do not have a loss of hearing sensitivity but have a hearing problem in the sense that they do not process auditory information normally.

If the auditory deficits aren’t identified and managed early, many of these children will have speech and language delays and academic problems.

Medical problems associated?

Symptoms of APD can range from mild to severe and can take many different forms. If you think your child might have a problem processing sounds, consider these questions:

  • Is your child easily distracted or unusually bothered by loud or sudden noises?
  • Are noisy environments upsetting to your child?
  • Does your child’s behaviour and performance improve in quieter settings?
  • Does your child have difficulty following directions, whether simple or complicated?
  • Does your child have reading, spelling, writing, or other speech-language difficulties?
  • Is abstract information difficult for your child to comprehend?
  • Are verbal (word) math problems difficult for your child?
  • Is your child disorganized and forgetful?
  • Are conversations hard for your child to follow?

APD is an often-misunderstood problem because many of the behaviours noted above also can appear in other conditions like learning disabilities, attention deficit hyperactivity disorder (ADHD), and even depression. Although APD is often confused with ADHD, it is possible to have both. It is also possible to have APD and specific language impairment or learning disabilities.

Prenatal screening and diagnosis?

Audiologists (hearing specialists) can determine if a child has APD. Although speech-language pathologists can get an idea by interacting with the child, only audiologists can perform auditory processing testing and determine if there really is a problem.

Some of the skills a child needs to be evaluated for auditory processing disorder don’t develop until age 7 or 8. Younger Children’s brains just haven’t matured enough to accept and process a lot of information. So, many Children diagnosed with APD can develop better skills with time.

Once diagnosed, Children with APD usually work with a speech therapist. The audiologist will also recommend that they return for yearly follow-up evaluations.

Problem Areas for Children with CAPD

The five main problem areas that can affect both home and school activities in Children with APD are

  1. Auditory Figure-Ground Problems: when a child can’t pay attention if there’s noise in the background. Noisy, low-structured classrooms could be very frustrating.
  2. Auditory Memory Problems: when a child has difficulty remembering information such as directions, lists, or study materials. It can be immediate (“I can’t remember it now”) and/or delayed (“I can’t remember it when I need it for later”).
  3. Auditory Discrimination Problems: when a child has difficulty hearing the difference between words or sounds that are similar (COAT/BOAT or CH/SH). This can affect following directions, and reading, spelling, and writing skills, among others.
  4. Auditory Attention Problems: when a child can’t stay focused on listening long enough to complete a task or requirement (such as listening to a lecture in school). Children with CAPD often have trouble maintaining attention, although health, motivation, and attitude also can play a role.
  5. Auditory Cohesion Problems: when higher-level listening tasks are difficult. Auditory cohesion skills — drawing inferences from conversations, understanding riddles, or comprehending verbal math problems — require heightened auditory processing and language levels. They develop best when all the other skills (levels 1 through 4 above) are intact.

Getting help?

Strategies applied at home and school can ease some of the problem behaviours associated with APD. Because it’s common for Children with CAPD to have difficulty following directions, for example, these tactics might help:

  • Since most Children with APD have difficulty hearing amid noise, it’s very important to reduce the background noise at home and at school.
  • Have your child look at you when you’re speaking.
  • Use simple, expressive sentences.
  • Speak at a slightly slower rate and at a mildly increased volume.
  • Ask your child to repeat the directions back to you and to keep repeating them aloud (to you or to himself or herself) until the directions are completed.
  • For directions that are to be completed at a later time, writing notes, wearing a watch, and maintaining a household routine also help. General organization and scheduling also can be beneficial.
  • It’s especially important to teach your child to notice noisy environments, for example, and move to quieter places when listening is necessary.

Other strategies that might help:

  • Provide your child with a quiet study place (not the kitchen table).
  • Maintain a peaceful, organized lifestyle.
  • Encourage good eating and sleeping habits.
  • Assign regular and realistic chores, including keeping a neat room and desk.
  • Build your child’s self-esteem.
  • Be sure to keep in regular contact with school officials about your child’s progress. Children with APD aren’t typically put in special education programs. Instead, teachers can make it easier by:
  • altering seating plans so the child can sit in the front of the room or with his or her back to the window
  • providing additional aids for study, like an assignment pad or a tape recorder
  • One of the most important things that both parents and teachers can do is to acknowledge that CAPD is real. Symptoms and behaviours are not within the child’s control. What is within the child’s control is recognizing the problems associated with APD and applying the strategies recommended both at home and school.
  • A positive, realistic attitude and healthy self-esteem in a child with APD can work wonders. And Children with APD can go on to be just as successful as other classmates. Although some children do grow up to be adults with APD, by using coping strategies as well as techniques learned in speech therapy, they can be very successful adults.

Developmental Conditions

Developmental Coordination disorder (DCD)/ Dyspraxia

What is it?

Developmental coordination Disorder / Dyspraxia is an immaturity of the organisation of movement. The brain does not process information in a way that allows for a full transmission of neural messages. A person with dyspraxia finds it hard to plan what to do, and how to do it.

Dyspraxia often comes with language problems, and sometimes a degree of difficulty with perception and thought. Dyspraxia does not affect a person’s intelligence, but it can cause learning difficulties, especially for children.

Experts say that about 10% of people have some degree of dyspraxia, while approximately 2% have it severely. 4 out of every 5 children with evident dyspraxia are boys. If the average classroom has 30 children, there is probably one child with dyspraxia in almost each classroom.

The English medical word dyspraxia comes from:

The Greek word dyspraxia comes from the Greek word Praxis, meaning “to practice; (concretely) an act; by extension, a function”. The Greek word Praxis comes from an older Greek word Prassein (prattein), meaning “”to pass through, experience, practice”.

What causes it?

Scientists do not know what causes it. Experts believe the person’s nerve cells that control muscles (motor neurons) are not developing correctly. If motor neurons cannot form proper connections, for whatever reasons, the brain will take much longer to process data. Unfortunately, for many sufferers, there is no obvious cause.

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How it affects children?

In very early childhood, the child may take longer than other children to:

  • Sit
  • Crawl (some never go through crawling stage)
  • Walk
  • Speak
  • Stand
  • Become potty trained (get out of diapers/nappies)
  • Build up vocabulary
  • Speak in a clear and articulate way. Many parents of very young children with dyspraxia say they cannot understand what they are trying to say a lot of the time

Later on, the following difficulties may become apparent:

  • Problems performing subtle movements, such as tying shoelaces, doing up buttons and zips, using cutlery, handwriting.
  • Many will have difficulties getting dressed.
  • Problems carrying out playground movements, such as jumping, playing hopscotch, catching a ball, kicking a ball, hopping, and skipping.
  • Problems with classroom movements, such as using scissors, colouring, drawing, playing jig-saw games.
  • Problems processing thoughts.
  • Difficulties with concentration. Children with dyspraxia commonly find it hard to focus on one thing for long.
  • The child finds it harder than other children to join in playground games.
  • The child will fidget more than other children.
  • Some find it hard to go up and downstairs.
  • A higher tendency to bump into things, to fall over, and to drop things.
  • Difficulty in learning new skills – while other children may do this automatically, a child with dyspraxia takes longer. Encouragement and practice help enormously.
  • Writing stories can be much more challenging for a child with dyspraxia, as can copying from a blackboard.

The following are also common at pre-school age:

  • Finds it hard to keep friends
  • Behaviour when in the company of others may seem unusual
  • Hesitates in most actions, seems slow
  • Does not hold a pencil with a good grip
  • Such concepts as in, out, in front of are hard to handle automatically

Later on, in Childhood

  • Many of the challenges listed above do not improve, or do so very slightly
  • Tries to avoid sports and physical education
  • Learns well on a one-on-one basis, but nowhere near as well in class with other children around
  • Reacts to all stimuli equally (not filtering out irrelevant stimuli automatically)
  • Mathematics and writing are difficult
  • Spends a long-time getting writing done
  • Does not follow instructions
  • Does not remember instructions
  • Is badly organised

Prenatal screening and diagnosis?

A diagnosis of dyspraxia can be made by a clinical psychologist, an educational psychologist, a paediatrician, or an occupational therapist. Any parent who suspects their child may have dyspraxia should see their GP (general practitioner, primary care physician), or a special needs coordinator first.

When carrying out an assessment, details will be required regarding the child’s developmental history, intellectual ability, and gross and fine motor skills:

  • Gross motor skills: refers to how well the child uses his/her large muscles that coordinate body movement. This includes jumping, throwing, walking, running, and maintaining balance.
  • Fine motor skills: this refers to how well the child can use his/her smaller muscles. Activities which require fine motor skills include tying shoelaces, doing up buttons, cutting out shapes with a pair of scissors, and writing.

The assessor will need to know when and how developmental milestones, such as walking, crawling, speaking were reached. The child will be screened for balance, touch sensitivity, and variations on walking activities.

Getting help?

Although dyspraxia is not curable, with time the child can improve. However, the earlier a child is diagnosed, the better and faster his/her improvement will be. The following specialists most commonly help people with dyspraxia.

An occupational therapist will first observe how the child manages with everyday functions both at home and at school. He/she will then help the child develop skills specific to activities which may be troublesome.

Speech and language therapy

The speech and language therapist will first carry out an assessment of the child’s speech, and then help him/her communicate more effectively.

Perceptual motor training

This involves improving the child’s language, visual, movement, and auditory skills. A series of tasks, which gradually becoming more advanced, are set. The aim is to challenge the child so that he/she improves, but not so much that it becomes frustrating or stressful.

Active Play

Experts say that active play, any play that involves physical activity, which can be outdoors or inside the home, gets the motor activity going in children. Play is a way children learn about the environment and about themselves, and particularly for children aged 3 to 5; it is a crucial part of their learning.

Active play is where a very young child’s physical and emotional learning, their development of language, their special awareness, the development of what their senses are, all come together.

The more children are involved in active play, the better they will become at interacting with other children successfully.

Parents, uncles and aunts, and other adults can also become involved with a child’s active play, however, sometimes they should take a step back and let the children really explore so they can try out their own understanding of the world. The risk of negative things happening to children if they play outside are far smaller than the risks of negative things happening to them if they don’t, such as obesity, poor socialization with other children, and having less fun. It is only by taking risks that children learn the importance of, say, holding on tight, and correcting themselves.

Parents who have a child with dyspraxia need to balance the risks of negative things happening outside, with the enormous benefits that active play has to offer. Deciding what this balance is depends on many factors, such as the severity of the child’s dyspraxia, the outside environment, etc.

Developmental Conditions

Difficulties with Attention Motor Planning and Perception (DAMP)

What is it?

DAMP is an accepted term in Australia to describe children who present with a mixture of coordination, attention, emotional, speech and sensory perception deficits, including receptive and expressive communication difficulties.

What causes DAMP?

There is no known cause for DAMP. Studies indicate that certain areas in the brain (frontal cortex) responsible for attention, monitoring behaviour, and planning, takes longer to mature in these children. The role of the cerebellum in DAMP has not yet been investigated. More boys than girls have been diagnosed with DAMP.

How DAMP Affects Children?

They may experience receptive communication difficulties such as having poor social understanding and difficulty appreciating the thoughts and feelings of others. They can have trouble making sense of what they hear and also have poor comprehension of written materials when reading.

Children may have expressive communication difficulties.

They may internally know what they want to say, on the level of ‘feeling’ however have significant difficulty putting this in words verbally in order to clearly express themselves. They may have difficulty with emotional control, and some may also have stuttering difficulties related to this. The modulation of voice volume and pitch may also be affected. Children require encouragement, understanding and emotional support as they navigate life with DAMP.

Prenatal screening and diagnosis?

DAMP may include coordination difficulties that express themselves in poor balance, gross and fine motor control. Children may hesitate or stumble on steps, escalators, or when the ground is uneven, and visibility is poor.

They may appear awkward and noisy when running, experience falls, collisions or accidents frequently, find tasks such as swimming, dance, or riding a bike difficult to learn. Activities of daily living such as tying shoelaces may be difficult, and they may often spill food when eating. Children may also have perception problems related to coordination in space, for example have difficulty understanding how to draw, write and read, or misjudging body positions and the location of body parts in space. DAMP symptoms experienced vary significantly from one individual to another.

Parents may observe some attention difficulties. Children may have difficulty being still and concentrating. Activities and tasks may consistently remain unfinished. Despite a desire to do it (sometimes), they may have considerable difficulty completing homework, especially if they are in an even slightly distracting environment (such as if a sibling is entering or leaving the room or a TV is on in the background). They may appear uncomfortable when sitting and prefer slouching or lying down to do academic tasks.

Getting help?

Occupational Therapy approaches and activities that can support the child and/or their carers include:

  • Expanding abilities: Developing a broad range of skill areas.
  • Social stories: Providing ideas and education around social story development.
  • School transition: Advocating and professionally supporting the transition to school and liaising with teachers, as required.
  • Visual cues can be used to support routine and to introduce new, or a change in tasks.
  • Motor development delay: If there is a delay in motor development, determine the current age level of a child’s abilities.
  • Devise goals: Setting functional goals in collaboration with the child, parents and teachers so that therapy has a common focus beneficial to everyone involved.
  • Educating parents, carers and teachers about DCD, the age-appropriate skills a child should be demonstrating and providing management strategies/ideas to assist the child in the home, at school and in the community.
  • Physical skills: Providing ways/ideas to promote physical activity and participation in team/group activities.
  • Task involvement: Providing alternative ways to encourage task engagement.
  • Direct skill teaching through a task-based approach.
  • Sensory Processing: Enhancing sensory processing in order to gain better attention to task.
  • Underlying skills: Developing the underlying skills necessary to support whole body (gross motor) and hand dexterity (fine motor) skills, such as providing activities to support:
  • Balance and coordination
  • Strength and endurance
  • Attention and alertness
  • Body awareness
  • Movement planning
  • Break tasks into smaller component tasks
  • Provide breaks during and between tasks
  • Provide explicit step by step instructions
  • Use simple language and instructions that are concise
  • Allow longer timeframes in which to complete tasks
  • Have regular exercise and physical activity breaks throughout the day
  • ‘Chunk’ tasks into smaller, manageable components
  • Have a good knowledge of the child’s strengths and weaknesses and areas of extreme interest
  • Use of learning aids (including electronic spellers and dictionaries, word processors, talking calculators, books on tape).

Developmental Conditions

Global developmental Delay (GDD)/ intellectual Disability (ID)

What is it?

Babies and children usually learn important skills such as sitting up, rolling over, crawling, walking, babbling (making basic speech sounds), talking and becoming toilet trained as they grow up. These skills are known as developmental milestones and happen in a predictable order and usually at a fairly predictable age. While all children reach these stages at different times, a child with developmental delay may not reach one or more of these milestones until much later than expected.

A child may be described as having global developmental delay (GDD) if they have not reached two or more milestones in all areas of development (called developmental domains).

These areas are:

  • motor skills: either gross motor skills like sitting up or rolling over and fine motor skills, for example picking up small objects
  • speech and language: which also includes babbling, imitating speech and identifying sounds, as well as understanding what other people are trying to communicate to them
  • cognitive skills: the ability to learn new things, process information, organise their thoughts and remember things
  • social and emotional skills: interacting with others and development of personal traits and feelings, as well as starting to understanding and respond to the needs and feelings of others.

What causes GDD?

The most common causes of GDD are problems with the child’s genes or chromosomes, for example Down syndrome or Fragile X syndrome. Sometimes, problems with the structure or development of the brain or spinal cord may be the reason for a child having GDD.

Other causes can include prematurity (being born too early), childhood infection (for example meningitis) or metabolic diseases, such as having an underactive thyroid gland (hypothyroidism) or other problems affecting babies before they are born. Toxic (poisonous substances) such as alcohol in the case of fetal alcohol syndrome can also contribute. For some children, the cause of the GDD is never identified.

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OTFC Letter J

How GDD Affects Children?

As they grow, children’s developments will be assessed regularly and if they aren’t meeting the expected development milestones and levels of abilities, they may be then referred to OTFC Group for furthermore specialist assessment. It is likely a paediatrician (children’s doctor) will see your child and if they suspect GDD they may ask questions regarding the child’s progress. They may look at a child’s development (checking out what exactly a child is able to do and when they became able to) and carry out medical tests to try to identify a cause for the developmental difficulties.

Some families will be referred to a genetics service to see if there is a genetic cause for the difficulty.  Some children may be referred to further specialists such as psychologists, speech and language therapists or occupational therapists for further evaluations.

Prenatal screening and diagnosis?

This will depend on the underlying cause of the GDD. Infections are never inherited, although an infected mother can pass on an infection to her unborn child or during the birth. Down syndrome, the most common identifiable cause of significant developmental delay, is a condition caused by a change in the chromosomes so that there is one too many.

However, it is usually not inherited – the main risk factor being increasing maternal age.  Conversely fragile X syndrome, the most common identifiable cause of inherited developmental delay is always passed on from one or other parent who may be unaware that they are at risk of doing so.

Prenatal diagnosis is dependent on the underlying cause of the condition. If there is a strong family history of individuals having GDD, then your GP should refer you to a genetics specialist to discuss testing.

Getting help?

Some children who do not reach developmental milestones may catch up later. Sometimes this happens without any additional support and these children have no permanent problems and go on to develop as expected.

Some children will require additional support to allow them to catch up with other children. Support may be with speech and language therapy, physical therapy, occupational therapy or other methods of support. Special educational input is a common and useful support. Your doctor or paediatrician will be able to discuss the type of support that is right for your child and how to go about getting it.  Children and young people with generalised developmental delay experience higher rates of emotional and behavioural difficulties than other children, so some of them may benefit from seeing a clinical child psychologist or a child and adolescent psychiatrist.

As a parent, it is natural to want to find ways to help your child develop as much as you can. You may want to speak to your GP, nurse or health visitor about strategies.

Some children may never catch up with the expected development milestones. This could be because there is an underlying condition that has not been diagnosed yet. For some families it can take many years to get a firm diagnosis or reason why their child is behind others.

Developmental Conditions

Congenital Hypotonia

What is it?

Congenital hypotonia is a medical term used to refer to poor muscle tone that’s present at birth (congenital). Depending on the underlying cause, hypotonia can appear at any age. It’s not a disease but a sign of an underlying problem.

What causes Congenital Hypotonia?

Causes include central nervous system and muscle disorders. Sometimes, the cause can’t be determined. Signs and symptoms of hypotonia include:

  • Floppy appearance
  • Significant weakness
  • Little or no head control
  • Hypotonia doesn’t affect intelligence. But it may delay development of large-muscle movement and coordination (gross motor skills).

Some children are born with hypotonia that isn’t related to a separate condition. This is called benign congenital hypotonia. A specialist at OTFC Group can assist with physical, occupational, and speech therapy to help your child gain muscle tone and stay on track with development.

How Congenital Hypotonia Affects Children?

Typical symptoms include general weakness and flaccidity of the muscles (reduced strength and endurance). Depending on the underlying disease, different sets of muscles may be involved. In infants, hypotonia often results in:

  • Poor suckling (and chewing)
  • Inability to lift the head, rolling instead of crawling
  • Weak cry
  • Physical passivity
  • The child feels like a sack of jelly when you pick it up – he or she wants to slide out of your hands
  • When the mouth muscles are involved, drooling and speech difficulties can occur in children.
  • Hypermobility of joints (how far back can you bend your fingers?). Hypotonic children often find it comfortable to sit in the “W” position and other painful or contortionist looking postures.
  • Poor reflexes
  • Delayed physical milestones (“Developmental Delay”)
  • Constipation for those whose bowel muscles are affected

Medical problems associated?

The outcome in any particular case depends largely on the nature of the underlying disease. Typically, the hypotonia does not get much worse, and sometimes improves. Usually, life expectancy is not seriously threatened. Hypotonia does not intrinsically affect intelligence, though a number of underlying diseases may have adverse effects on one or more aspects of cognition.

Prenatal screening and diagnosis?

Hypotonia may be diagnosed at birth. In some cases, however, you may not notice your child’s condition until they’re older. An indicator is that your child isn’t meeting developmental milestones. Schedule regular appointments for your child with a doctor. Be sure to mention any concerns you have about your child’s progress. Your doctor will assess your child’s development and run tests if they have concerns. Tests may include blood tests and MRI and CT scans.

If you notice sudden signs of the condition in a person of any age, seek emergency medical care.

Getting help?

There is currently no known treatment or cure for most (or perhaps all) causes of BCH. Physical, occupational, and speech therapies are often recommended and used, with very good results.

Physical therapy is used to improve fine motor control and overall body strength, whilst occupation and speech-language therapy to help with breathing, speech and swallowing difficulties. Ankle/foot orthoses are sometimes used for weak ankle muscles.

Hypotonic, passive babies may need extra stimulation. Toddlers and children with speech difficulties may benefit greatly by using sign language within the family until speech has become intelligible by the family.

Parents of a child with BCH cope with many stresses. Their lives change immediately with the birth of the child. The child does not develop at the same rate as his peers. Parents may not recognize or may deny that there is a problem with their child.

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