ADHD (Attention deficit Hyperactivity Disorder)

This complex neurodevelopmental condition often results in children being labelled as ‘naughty’ or ‘trouble makers’. ADHD individuals often find it hard concentrating on tasks, may be disruptive, overactive and impulsive. Impulsive actions can impact negatively on peer and family relationships.

If you have persistent concerns about a child/young person’s difficulties

Educational professionals should discuss concerns with parents/carers and vice versa. Interventions to support child/young person should be initiated without delay. Advice/ support should be sought from health professional within school e.g. a school nurse, occupational therapist (if available).

Evidence to support a formal referral to a family doctor or pediatrician may include relevant screening forms e.g. SNAP-IV (www.adhd.net/snap-iv-form.pdf) Strengths and difficulties questionnaire/SDQs-freely downloadable from internet www.sdqinfo.com.
It may be helpful to include any relevant useful current/past school reports/observations and educational psychologists assessments (if available).

Schools/educational institutions may also ask advice from a specialist ADHD nurse if appropriate.

AUTISM SPECTRUM DISORDER/ASD (Including Aspergers Syndrome)

ASD affects individuals differently and may be difficult to spot until too late.  Individuals have difficulties in the area of social and communication skills. Children may show repetitive or obsessive behaviours during play and interests/ hobbies may seem restrictive. There may be very low tolerance to changes in routines without prior warning. Peers may complain of individuals showing poor empathy. Children with this disorder may also exhibit challenging behaviours, over react to minor situations and display extreme emotional outbursts and anxiety.  ASD individuals may be over sensitive to some environmental stimuli e.g. sounds, smells, touch etc. Older children may dominate friendships and sometimes challenge authority figures at school and college. Common jokes, riddles and metaphors may be misunderstood by individuals with ASD.

If you have persistent concerns about a child/young person’s difficulties

Educational professionals should discuss concerns with parents/carers and vice versa.

Interventions to support child/young person should be initiated without delay.

Advice/ support should be sought from health professional s within schools e.g. school nurse, speech/occupational therapists if available.

Evidence to support a formal referral to a family doctor/GP or Paediatrician may include relevant screening forms e.g.  strengths and difficulties questionnaire/ SDQs-freely downloadable from internet (http://www.sdqinfo.com).

The Childhood Autism Screening Test/CAST (A 39 item parent questionnaire developed by the Autism Research Centre in Cambridge for assessing the severity of ASD symptoms in children) is a useful screen for ASD.

Include any relevant useful current/past school reports, school observations and educational psychologist assessments (if available).

AUDITORY PROCESSING DISORDER (APD)

In this disorder, individuals have difficulties processing what is said to them despite having normal hearing. It is very easy to confuse APD with ADHD as individuals can appear inattentive.

If you have persistent concerns about a child/young person’s difficulties

Educational professionals should discuss concerns with parents/carers and vice versa.

Interventions to support child/young person should be initiated without delay.

Advice/ support should be sought from health professional s within schools e.g. school nurse if available.

Evidence to support a formal referral to a family doctor/GP or Paediatrician may include relevant screening forms e.g.strengths and difficulties questionnaire/ SDQs-freely downloadable from internet (http://www.sdqinfo.com).

Include any relevant useful current/past school reports, school observations and educational psychologist assessments (if available).

DYSPRAXIA/DEVELOPMENTAL COORDINATION DISORDER (DCD)

Individuals with dyspraxia or DCD may struggle with normal day to day activities people take for granted. Information not properly processed by the brain can affect movement, language and perception. Dyspraxia is sometimes known as Developmental Coordination Disorder. Children and young people may have difficulties in PE and sport, writing and organizational skills. Dyspraxia is associated with a number of neurodevelopmental disorders e.g. ADHD, ASD/Asperger’s Syndrome and dyslexia.

If you have persistent concerns about a child/young person’s difficulties

Educational professionals should discuss concerns with parents/carers and vice versa

Interventions to support child/young person should be initiated without delay

Advice/support should be sought from health professional s within schools e.g. School Nurse, Physio/Occupational therapists if available.

Evidence to support a formal referral to a family doctor/GP or Paediatrician may include relevant screening forms e.g.  strengths and difficulties questionnaire/ SDQs-freely downloadable from internet (http://www.sdqinfo.com).

Include any relevant useful current/past school reports, school observations and educational psychologist assessments (if available).

DYSLEXIA

Individuals with dyslexia struggle with writing, reading and spelling. Dyslexia is a specific learning disability. In the UK, dyslexia is generally assessed and managed by Educational Psychologists or Specialist Teachers and not Paediatricians or Child Psychiatrists. Health Specialists will address developmental or medical aspects of the child’s difficulties e.g. associated ADHD, ASD, general learning difficulties, dyspraxia and so on.

If you have persistent concerns about a child/young person’s difficulties

Educational professionals should discuss concerns with parents/carers and vice versa

Interventions to support child/young person should be initiated without delay

Advice/ support should be sought from Specialist Teachers / Education Psychologist for assessment and management of dyslexia and health professional s within schools e.g. school nurse, speech/occupational therapists if there are concerns about co-existing   developmental difficulties.

Evidence to support a formal referral to a family doctor/GP or Paediatrician may include relevant screening forms e.g. strengths and difficulties questionnaire/ SDQs-freely downloadable from internet (http://www.sdqinfo.com). Include any relevant useful current/past school reports, school observations and educational psychologist assessments (if available).

If you have persistent concerns about a child/young person’s difficulties

Educational professionals should discuss concerns with parents/carers and vice versa

Interventions to support child/young person should be initiated without delay

Advice/support should be sought from health professional s within schools e.g. School Nurse, Physio/Occupational therapists if available.

Evidence to support a formal referral to a family doctor/GP or Paediatrician may include relevant screening forms e.g.  strengths and difficulties questionnaire/ SDQs-freely downloadable from internet (http://www.sdqinfo.com).

Include any relevant useful current/past school reports, school observations and educational psychologist assessments (if available).

TICS AND TOURETTE SYNDROME

Tics are sudden involuntary movements and vocalizations.

In Tourette  syndrome, individuals have both vocal and motor tics. Tourette syndrome is an inherited neurobiological condition found in all social classes. There’s no known cure for the disorder.

Motor tics may involve the head, face and eyes and can change in frequency and intensity involving several parts of the body. Vocal tics include throat clearing, yelping, sniffing and tongue clicking.

Tics may become very complex and involve jumping, touching people and making inappropriate gestures or saying socially unacceptable words.

Complex symptoms can have severe consequences on a child’s/ young person’s education and social functioning. ADHD is commonly associated with Tourette Syndrome.

If you have persistent concerns about a child/young person’s difficulties

Educational professionals should discuss concerns with parents/carers and vice versa

Interventions to support child/young person should be initiated without delay

Advice/ support should be sought from health professional s within schools e.g. school nurse if available.

Evidence to support a formal referral to a family doctor/GP or Paediatrician may include relevant screening forms e.g.strengths and difficulties questionnaire/SDQs-freely downloadable from internet (http://www.sdqinfo.com).

Include any relevant useful current/past school reports, school observations and educational psychologist assessments (if available).

SELECTIVE MUTISM

Children with selective mutism have normal speech but are anxious about speaking in certain social situations e.g. school or in public places. Very often children can speak normally at home or to close members of the family. Sometimes children may converse freely with peers but not teachers. Many factors including emotional, psychological and social may lead to the development of selective mutism. It is important for adults to know that selective mutism is an anxiety response that requires support and not pressure or criticism.

If you have persistent concerns about a child/young person’s difficulties

Educational professionals should discuss concerns with parents/carers and vice versa.

Interventions to support child/young person should be initiated without delay.

Advice/ support should be sought from a specialist teacher or educational psychologist, health professionals within schools e.g. school nurse and speech and language therapist if available.

Evidence to support a formal referral to a family doctor/GP or Paediatrician may include relevant screening forms e.g.strengths and difficulties questionnaire/ SDQs-freely downloadable from internet (http://www.sdqinfo.com).

Include any relevant useful current/past school reports, school observations and educational psychologist assessments (if available).

HEARING PROBLEMS (GLUE EAR)

Glue ear is a common cause of hearing difficulties in very young children. Hearing loss may occur in one or both ears and be worse on some occasions. The child can appear inattentive or be in their ‘own world’. Glue ear may be associated with ear ache and discharge. Affected children may speak loudly, turn up the TV volume or keep asking people to repeat instructions. Children who are not identified early may struggle with accessing learning, social interaction and may exhibit challenging behaviours.

If you have persistent concerns about a child/young person’s difficulties

Educational professionals should discuss concerns with parents/carers and vice versa

Interventions to support child/young person should be initiated without delay

Advice/ support should be sought from health professionals within schools e.g. school nurse and speech therapists and audiologists if available.

Evidence to support a formal referral to a family doctor/GP or Paediatrician may include relevant screening forms e.g. strengths and difficulties questionnaire/ SDQs-freely downloadable from internet (http://www.sdqinfo.com).

Include any relevant useful current/past school reports, school observations and educational psychologist assessments (if available).

If you have persistent concerns about a child/young person’s difficulties

Educational professionals should discuss concerns with parents/carers and vice versa.

Interventions to support child/young person should be initiated without delay.

Advice/ support should be sought from a specialist teacher or educational psychologist, health professionals within schools e.g. school nurse and speech and language therapist if available.

Evidence to support a formal referral to a family doctor/GP or Paediatrician may include relevant screening forms e.g.strengths and difficulties questionnaire/ SDQs-freely downloadable from internet (http://www.sdqinfo.com).

Include any relevant useful current/past school reports, school observations and educational psychologist assessments (if available).

SENSORY PROCESSING DISORDER (SPD)

Individuals with SPD experience difficulties with processing sensations coming from the body and environment. Unusual responses to touch, taste, smell, movement and visual stimuli should alert professionals to SPD.

There may be oversensitivity to touch resulting in the affected person loathing or preferring certain clothing. Some children may be reluctant to take showers, cut their hair/ nails, wear socks/shoes and brush their teeth.

Children with auditory or hearing sensory dysfunction may overreact to everyday sounds frequently covering their ears. Some may crave intense loud sounds and even speak in a loud voice.

Children with visual dysfunction may become overexcited when there’s too much to look at or simply ignore things in their path when walking.

Some children may crave movement and pressure finding it difficult to stay still in a chair. Children with propioceptive dysfunction may crave hugs and generally invade personal space.

If you have persistent concerns about a child/young person’s difficulties

Educational professionals should discuss concerns with parents/carers and vice versa

Interventions to support child/young person should be initiated without delay.

Advice/ support should be sought from health professional s within schools e.g. school nurse, occupational therapists if available.

Evidence to support a formal referral to a family doctor/GP or Paediatrician may include relevant screening forms e.g.strengths and difficulties questionnaire/ SDQs-freely downloadable from internet (http://www.sdqinfo.com).

Include any relevant useful current/past school reports, school observations and educational psychologist assessments (if available).

ABSENCE SEIZURES (PREVIOUSLY CALLED PETIT MAL SEIZURES)

Children and young people with this type of seizure would have grown out of it by adulthood. This seizure can be commonly confused with ADD or ADHD as children appear frequently inattentive. When experiencing absence seizures, individuals lose consciousness for only a few seconds staring into space sometimes accompanied by fluttering of eyelids. Children may also be unresponsive when their name is called. It is highly likely that seizures may go unnoticed as these last for a short time. The child may carry on as usual after the attack. Children who are not identified may struggle with keeping up with lessons particularly if they are having frequent seizures in class.

If you have persistent concerns about a child/young person’s difficulties

Educational professionals should discuss concerns with parents/carers and vice versa.

Interventions to support child/young person should be initiated without delay.

Advice/ support should be sought from health professional s within schools e.g. school nurse if available.

Evidence to support a formal referral to a family doctor/GP or Paediatrician may include relevant screening forms e.g.strengths and difficulties questionnaire/ SDQs-freely downloadable from internet (http://www.sdqinfo.com).

Include any relevant useful current/past school reports, school observations and educational psychologist assessments (if available).

PATHOLOGICAL DEMAND AVOIDANCE SYNDROME (PDA)

This is a neurodevelopmental disorder characterised by obsessive avoidance of everyday demands of life. PDA can easily be confused with Autism Spectrum Disorder (ASD).  It is now increasingly being recognized as part of ASD.

Children and young people with PDA have better social interaction compared with individuals with ASD although there is a tendency for PDA individuals to dominate relationships in line with their desire to be in control.

If you have persistent concerns about a child/young person’s difficulties

Educational professionals should discuss concerns with parents/carers and vice versa.

Interventions to support child/young person should be initiated without delay.

Advice/ support should be sought from health professional s within schools e.g. school nurse if available.

Evidence to support a formal referral to a family doctor/GP or Paediatrician may include relevant screening forms e.g.strengths and difficulties questionnaire/ SDQs-freely downloadable from internet (http://www.sdqinfo.com).

Include any relevant useful current/past school reports, school observations and educational psychologist assessments (if available).

OPPOSITIONAL DEFIANCE DISORDER (ODD)

Children and young people with this type of disorder display persistent uncooperative, hostile, aggressive and annoying behaviours towards peers and authority figures. These behaviours may have a significant negative impact on learning, social interaction and self esteem. ODD is commonly associated with ADHD. Children with ODD can go on and develop conduct disorder if unsupported.

If you have persistent concerns about a child/young person’s difficulties

Educational professionals should discuss concerns with parents/carers and vice versa.

Interventions to support child/young person should be initiated without delay.

Advice/ support should be sought from health professionals within schools e.g. school nurse, mental health and family support workers if available.

Evidence to support a formal referral to a family doctor/GP or Paediatrician may include relevant screening forms e.g. strengths and difficulties questionnaire/ SDQs-freely downloadable from internet (http://www.sdqinfo.com).

Include any relevant useful current/past school reports, school observations and educational psychologist assessments (if available).

CONDUCT DISORDER

Individuals with this disorder may exhibit aggressiveness, cruelty to animals and people, vindictiveness, fire setting and general antisocial behaviours. They may be involved in school refusal and truancy, persistent lying, shoplifting and severe disobedience.

If you have persistent concerns about a child/young person’s difficulties

Educational professionals should discuss concerns with parents/carers and vice versa.

Interventions to support child/young person should be initiated without delay.

Advice/ support should be sought from health professionals within schools e.g. school nurse, mental health and family support workers if available.

Evidence to support a formal referral to a family doctor/GP or Paediatrician may include relevant screening forms e.g. strengths and difficulties questionnaire/ SDQs-freely downloadable from internet (http://www.sdqinfo.com).

Include any relevant useful current/past school reports, school observations and educational psychologist assessments (if available).

POOR SLEEP PATTERN

Sleep is essential for physical, emotional and mental well being in both children and adults. Sleep problems in childhood are common and can have an impact on the whole family and also affect a child’s ability to function properly during the day. Sleep problems are even more common in children with developmental and mental health disorders.

Changing lifestyle trends linked to advances in modern technology has led to more exposure to electronic media such as computers, televisions and electronic games leading to later bedtimes. Poor sleep can impair daytime functioning leading to poor academic performance.

It is very important to encourage children and young people to switch off electronic devices at least an hour before bedtime. Light emanating from the screens can affect the brain’s natural sleep hormone resulting in difficulties falling asleep.

If you have persistent concerns that a child/young person is not getting enough sleep

Educational professionals should discuss concerns with parents/carers and vice versa.

Interventions to support child/young person should be initiated without delay.

Advice/ support should be sought from health professional within school e.g. a school nurse or a family support worker.

Evidence to support a formal referral to a family doctor or Paediatrician may include relevant screening forms e.g. strengths and difficulties questionnaire/ SDQs-freely downloadable from internet http://www.sdqinfo.com

It may be helpful to include any relevant useful current/past school reports/observations and educational psychologists assessments (if available).

A well completed 2-3 week sleep diary is useful.

HYPERMOBILE JOINTS

Hypermobile joints are generally more flexible and can move in excess of normal range of motion. Individuals who experience symptoms as a result of their hypermobility may have a condition known as benign joint hypermobility syndrome.

Children/young people may complain of pain during and after sports. They may also experience achy joints when writing and may avoid writing altogether. Associated features are clicky hips and poor coordination. Complications of this condition include joint dislocations, sprains and back pain.

If you have persistent concerns about a child/young person’s difficulties

Educational professionals should discuss concerns with parents/carers and vice versa.

Interventions to support child/young person should be initiated without delay.

Advice/ support should be sought from health professionals within schools e.g. school nurse, occupational/physiotherapists.

Evidence to support a formal referral to a family doctor/GP or Paediatrician may include relevant screening forms e.g.strengths and difficulties questionnaire/ SDQs-freely downloadable from internet (http://www.sdqinfo.com).

Include any relevant useful current/past school reports, school observations and educational psychologist assessments (if available).

PE and handwriting assessment reports may be useful.

MENTAL HEALTH ISSUES

Mental Health disorders in children and adolescents should be everyone’s business. Mental health issues can be difficult to detect in children and young people. Disorders can manifest as anxiety, challenging behaviours, low mood, mood swings, inattention and general lack of motivation. Individuals may gradually appear withdrawn and socially isolated.

Mental health disorder may coexist with learning and developmental disorders. Young people may have visible signs of self harm on body.

If you have persistent concerns about a child/young person’s mental health

Educational professionals should discuss concerns with parents/carers and vice versa.

Interventions to support child/young person should be initiated without delay.

Advice/support should be sought from health professionals within schools e.g. school nurse, family support/mental health workers if available.

Evidence to support a formal referral to a family doctor/GP or Paediatrician may include relevant screening forms e.g. strengths and difficulties questionnaire/SDQs-freely downloadable from internet (http://www.sdqinfo.com).

Include any relevant useful current/past school reports, school observations and educational psychologist assessments (if available).

FOETAL ALCOHOL SPECTRUM DISORDER (FASD)

FASD is one of the commonest causes of learning disability however it remains underdiagnosed in many children. FASD is caused by alcohol exposure during maternal pregnancy . Alcohol is a teratogen( toxin) and can cause damage to several cells/ organs in the fetus which could result in the child having physical, neurological, cognitive and behavioural difficulties. The neurological and cognitive impact of FASD is due to alcohol impact on the brain.

Children with FASD may have normal IQ scores however they may still struggle with several aspects of learning and functioning independently. Children with FASD may have significant sensory difficulties which can impact their home, school and social life. They may struggle with their attention and concentration and also have significant memory difficulties. Children with FASD find it difficult to socialise. They can appear very sociable but lack understanding of expected social behaviours.

When should FASD be suspected?

• Children with striking facial features of FAS ( smooth philtrum, thin upper lip and small eye openings)
• Children who have difficulty with their behaviour and learning with maternal history of alcohol consumption in pregnancy.
• Children with poor growth and failure to thrive with a history of maternal alcohol consumption during pregnancy.

What treatments / services are available for children with FASD?

Having the right diagnosis opens up doors to the right treatment strategies for the child with FASD. These strategies are sometimes different to those used in other neurodevelopmental conditions. Practical strategies to address the child’s behavioural difficulties, learning, memory and sensory difficulties are tailored for each child.

Children with FASD learn differently. Having a diagnosis helps the child access these strategies and the curriculum at school. Applying the right strategies also helps the child’s functioning at home and the community.

What to do when you suspect FASD

Parents/Carers should contact the GP if they suspect the child may have FASD.

Schools should discuss the child’s learning and behaviour concerns with Parents/Carers.

GP should make referrals to a multidisciplinary team (Paediatrician, Psychologist, Speech and Language Therapist and Occupational Therapist) for an FASD assessment.