A number of key personnel can advise, assess and treat your child, as well as give them the best possible chances to realise their potential.
SEN professionals – why they matter
A multi-disciplinary team is a consultative team made up of a combination of professionals, eg occupational therapist, physiotherapist, educational psychologist, speech and language therapist and medical practitioners, and there may be occasions when all experts will meet together. However, more often a child will need to see just one specialist.
If you have concerns, speak to your health visitor or your child's school, or seek a referral from your GP to your local child development centre or paediatric service.
Early assessment from a paediatrician, occupational therapist, speech and language therapist or educational psychologist is important; the sooner the correct support is put in place, the more chance it has to make a difference. Unfortunately, long waiting lists and limited therapy times are not uncommon. If this is the case, it may be worth considering contacting a private therapist who can work with your child and the school over a longer period.
Who does what?
Educational psychology is the study of how we learn. An Educational Psychologist will assess a child for learning difficulties, by observing and assessing their development, cognition and behaviour.
In addition to knowledge of specific difficulties that affect learning, for example dyslexia or autism, they will recommend adjustments in environment and instruction that are effective boosts to learning.
A good educational psychologist will spend time getting to know your child, both by observing them in a variety of settings, and taking time to put a child at ease before beginning the formal assessment process. They will conduct interviews with carers and teachers and carry out a variety of formal tests to pinpoint areas of difficulty. They draw conclusions explain their findings and recommend strategies that will help.
Some EPs run private practices others are employed by the LA. They work in collaboration with teachers, parents, carers and other agencies to promote a child’s welfare, both by inclusion in schools and to developing strategies. In addition to individual casework, EPs may visit schools to talk with teachers about ways of meeting the needs of individuals or groups of children. Many schools now need to buy in the help of a local authority Educational Psychologist, and when money is tight, they may be reluctant to do so. You may be quicker organising an EP assessment privately if you can manage it, but beware EPs are in great demand, so book early.
If a child is to have a consultation with the EP the child should, wherever possible, be prepared for this. There is no right way but it is usually best to be as truthful as possible, explaining in a way that the child will understand and will not frighten or intimidate.
Don't be afraid of taking your child to an EP: a treatment plan makes it much easier for everyone - you, the school, and above all the child ('thank goodness, I thought I was stupid') - to deal with the problem. An EP report has a lifetime of two years, after which it will need to be reviewed, to be useful.
Communication is central to the learning process - it is the main tool for teaching, learning and building relationships. Difficulty with communication can impact on a child’s learning and academic progress; it can also adversely affect their social situation and confidence. There is evidence that young children with language difficulty continue to have confidence issues right up to secondary school, even when the original language problem has resolved.
Who can benefit from seeing a SaLT?
An estimated 1 in 10 children experience a communication difficulty. The type of difficulty can be very different, for example:
- Difficulty with speech sounds. It might be hard to work out what a child is trying to say if they have problems with specific sounds - for example, a 4-year-old who says 'tat' instead of 'cat'.
- Problems with spoken language. Some children use less vocabulary than their peers or their utterances are jumbled or incorrect. They may also have problems understanding spoken language eg following instructions.
- Social communication difficulties. For some children the problem lies with the pragmatic aspects of communication, for example using and interpreting language, for instance they may take things over literally. Using language in interacting with friends, facial expression and making eye contact are also aspects of social communication.
- Stammering: children who get 'stuck' when talking. They might repeat part of a word or a whole word or struggle to start off a sentence.
- Attention and Listening difficulties affect how well a child learns language and responds to communicative situations.
- Voice – some young children may develop vocal problems, like vocal nodules.
- Psycho-social difficulties like selective mutism.
- Some children have a specific communication difficulty in just one area and generally good development otherwise. Therapists also see children whose speech and language difficulties are part of an additional learning, physical or medical condition.
- Specialist knowledge of speech and oral anatomy enables therapists to work with babies and children who have difficulty in eating, drinking or swallowing. A child who is inclined to choke easily on lumpy food, for example, may be referred to a SaLT, whose role will be to assess and provide advice. This may involve liaison with other professionals such as a dietitian or paediatrician.
What will happen?
Initially the therapist will want to gather as much information as possible about your child's skills and difficulties. They need to know about their general development eg when your child started to talk medical needs and hearing. It helps the therapist to know about your child's strengths as well as the things they find hard - what sort of toys and games they enjoy, what they quickly tire of, how they manage at school and in other settings.
The therapist may ask to talk to other professionals involved with your child, such as teaching staff. This is important as it helps them gain a better understanding of your child and how they communicate in different situations.
Throughout the session the therapist will be assessing your child's communication skills. With a young child this may be through play and observation, while older children may complete a more formal assessment. Some tests provide standardised scores, which help the therapist decide whether a child's skills are appropriate for their age. You and the therapist will then discuss together whether your child will benefit from therapy and what form this should take.
How will the therapist work with my child?
Therapy is not like medicine, which may cure a problem by medication or a prescribed treatment. It means working together and speech and language therapists work with clients in a variety of ways. This may mean one-to-one sessions or group sessions with the child, whichever is beneficial for your child’s needs.
Or it might take the form of home or school activities and advice to parents and teachers - therapists also provide formal training and workshops for parents and professionals. It makes sense for all the key adults in your child's life to know how best to support your child's skills.
Some schools have regular visits from therapists, or even resident therapists. Work with your child in the classroom can be of considerable benefit because it supports the child’s learning in targeted and functional ways.
A physiotherapist (‘Physio’) helps with movement, to restore movement when a child is affected by injury, illness or disability and to reduce the risk of injury in the future. The impairment may be in the bones, joints or soft tissue, in the nervous system and brain, the heart and circulation or in the lungs and breathing.
Problems with neuromuscular development include developmental co-ordination disorder and dyspraxia. These children have more difficulty adapting their behaviour appropriately and thus may have difficulties with academic learning. Fortunately the brain has the capacity to re-route connections through physiotherapy. Children with pervasive developmental conditions such as cerebral palsy may need a physiotherapist to support themselves in sitting, standing or walking.
Treatment by a physio
Treatment depends on what each child may need and might involve advice and a programme to follow at home, or weekly treatment plus home programme, or perhaps an intensive course of treatment. Physiotherapists also work in a consultative way with schools and teachers, providing advice on reducing risk in daily activities, e.g. lifting a child from a wheelchair. Children can be seen individually or in small groups and may be seen in clinics, at home or in school. The length of time children will need to attend for physiotherapy depends on the age of the child, need, and rate of progress the child makes.
Referral to a physiotherapist
All NHS hospitals have a paediatric physiotherapy department, which can be accessed via referral through GPs or medical consultants. Private physiotherapists can be accessed directly by parents.
An occupational therapist works with children to improve their ability to do daily activities. They can provide specialist equipment to help your child manage or improve specific tasks eg equipment to help with handwriting, or teeth brushing or managing a child’s sensory sensitivity to day to day functioning. The aim is to maximise a child’s potential ability and increase independence.
Problems which an occupational therapist can help with include:
- Fine motor skills such as tying shoelaces, cutting and handwriting.
- Hand-eye co-ordination, such as when children have problems with copying from a blackboard or ball games.
- Daily living skills such as doing up buttons, using utensils, washing, eating and drinking.
- Sensory integration, when children find it difficult to process message from the senses into motor responses.
- Spatial awareness and proprioception, knowing where your body and limbs are in space, and where objects are in relation to that, organising and interpreting sensory stimuli.
- Visual discrimination – children with visual processing difficulty may not see the difference between a triangle and a square, or may mix up similar letters such as p and q. They have trouble reading maps or finding specific items on a page, colouring or writing within lines or margins, and identifying an object when parts of it are hidden.
The therapist will give you a programme to work on at home, which may work on strength and dexterity, or on sensory/visual processing. Therapists can also give you tips and recommend equipment which needn’t be costly but may make a big difference – a rubber mat beneath a dinner plate to stop it slipping and specialised cutlery can greatly improve messy eating, while washing socks with conditioner will make them stretchier and easier to put on for those with co-ordination difficulties.
NHS therapists work in hospitals or in a community setting, advising families in their own homes, or schools. They also make recommendations for adjusting housing arrangements for a child with disabilities or particular needs. Private occupational therapists can also be commissioned to visit schools and liaise with teachers to improve a child’s learning.