A number of key personnel may advise, assess and treat your child, to help give them the best possible chances to realise their potential.
In an ideal world, a multi-disciplinary team made up of an occupational therapist, physiotherapist, educational psychologist, speech and language therapist and paediatrician would be available to help every child who needs it.
Each discipline can add an important part to the jigsaw of assessment and treatment. Unfortunately, lack of funding for staff, or staff shortages (a national problem), means this situation is rarely found. Even those who have therapies identified on their statement are not guaranteed delivery of provision.
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 diagnosis from a paediatrician, occupational therapist, speech and language therapist or educational psychologist is important; the sooner the correct support is put in place, the better. Unfortunately, long waiting lists and limited therapy time 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 art of diagnosing the reasons for a child's behaviour or learning difficulties.
In addition to knowledge of specific difficulties that affect learning, for example dyslexia or autism, they can help by suggesting effective teaching and learning approaches.
A good educational psychologist will spend time getting to know your child, either by observing them in a variety of settings, or taking time to put a child at ease before beginning the formal assessment process. They will conduct a variety of tests and sub-tests to pinpoint areas of difficulty, explain their findings and recommend strategies that will help.
Some EPs run private practices others are employed by the LA to work in collaboration with teachers, parents, carers and other agencies to promote inclusion in schools and to develop strategies aimed at enhancing a child's learning and development. 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. There can be a long wait to see a local authority EP, so you may be best organising this privately if you can manage it.
When an EP is asked to become involved with an individual child, the first step is for the school to arrange a consultation meeting that involves those who know the child well, usually parents or carers, teachers, the SENCo and the EP. The purpose of this initial meeting is to examine concerns and agree a plan of action to improve the child’s progress. This may involve the EP working with the child's teachers or with the child directly.
EPs often begin by observing the child in class as it helps to see the child in their regular environment. 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 diagnosis 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. In case of doubt, and if you can afford the fee, get a second opinion.
Speech and language therapist (SaLT)
Communication is central to the learning process - it is the main tool for teaching, learning and building relationships. So a child who is experiencing any sort of difficulty in this area, perhaps having trouble in making themselves understood, embarrassment over a speech impediment, or difficulty understanding the meaning of what people are saying to them, is likely to find not only lessons, but social interaction a struggle.
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 and immature. They may also have problems understanding spoken language.
- Social communication difficulties. For some children the problem lies with the pragmatic aspects of communication, for example using and interpreting facial expression and eye contact. They may tend to take things too literally.
- 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.
- 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 additional learning, physical or medical difficulties.
- 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 an SaLT, whose role will be to assess and provide advice. This may involve liaison with other professionals such as a dietitian.
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 and hearing skills as well as, for instance, when your child said their first words. 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. Sessions can then be geared to the most effective way of reaching and helping your child in a way that they enjoy and respond to.
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?
Speech therapists work with children in a variety of ways. This may mean one-to-one sessions or group sessions. Parents sometimes worry that a group will amount to 'watered down' therapy. In fact, group sessions can be very effective, provided the group meets your child's specific needs.
As well as working directly with a child, therapists work indirectly. This 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 is desirable to establish good communication everywhere.
Most children with SEN and associated physiotherapy needs will have some problem with the way the network of 'wires' in their brain connects up. Ideally, this network becomes increasingly more efficient as the child problem-solves its way through developmental challenges. But if a child's brain is not as successful at reinforcing the most successful neural pathways, messages will travel along extended routes, increasing the time for processing, or information may not reach the required destination or may go to the wrong destination. Problems with this sort of 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, and physiotherapy (like occupational therapy) can help this in various ways.
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. 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 practical considerations such as who else the child is seeing. The average length of therapy with a 6-year-old who has developmental co-ordination disorder would be two to three terms.
From the child's perspective, therapy involves playing games, which they often enjoy..
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, and most children with SEN will need a physiotherapist with neuro-developmental experience.
An occupational therapist can provide therapy and specialist equipment to help your child manage or improve specific difficulties. This can range from exercises to help with handwriting, through to teaching basic tasks such as teeth brushing to children with developmental delay. 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, where 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 and can result in clumsiness
- 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 best occupational therapy is provided where the therapists are embedded in the school curriculum and residential accommodation. Sadly NHS occupational therapy for children is almost non-existent, so if your child is in mainstream schooling you may have to seek private help.
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 much stretchier and easier to put on for those with co-ordination difficulties.
'Coloured lenses - cure or craze?'
Orthoptists are specially trained in how the eyes work as a pair, how the eyes are controlled and how vision is used. A large proportion of orthoptic work is concerned with squints and the visual development of young children. Orthoptists have a detailed knowledge of the eye and the muscle system which controls the eyes and can often help children with learning difficulties, particularly dyslexia and dyspraxia.
How an orthoptist can help
An orthoptist will test for a variety of possible causes for vision problems. Difficulties with binocular vision are common with dyslexics and some other conditions, and so they will measure how well the eyes are held straight, how well and quickly they adjust their focusing and the eyes' fusion.
Fusion is the 'glue' which allows the two eyes to work in unison for prolonged periods. Measuring this and comparing it to normal ranges shows the amount of drifting of the eyes.
One treatment that you may already associate with orthoptics is a temporary eye patch. This occlusion therapy (as it is more formally known) was traditionally followed when a test called the Dunlop test showed unstable fixation (the inability of the eye to look steadily at something) or lack of eye dominance.
An orthoptist will also check eye movements and tracking ability (ie following a line of writing). The developmental eye movement test compares a person's ability to read vertical numbers with horizontal numbers and also gives an indication of automaticity (the ability to see and say out loud).
Some problems an orthoptist deals with are to do with automatic muscle control and co-ordination, while others relate to how our brain reacts to what it sees. MIS (Meares-Irlen syndrome) is caused by a heightened sensitivity to pattern. This can be treated firstly by using coloured overlays, and subsequently by using precision coloured lenses. The colour required for an overlay may be different from that in lenses and a special assessment is needed to find the correct colour for spectacles.
Most orthoptists working in the NHS can assess patients for MIS using overlays. Some have access to a colorimeter, but others will know of an optometrist or orthoptist in your area who can provide tinted lenses if they are required. An increase in reading speed or tracking is used to determine that the correct colour has been selected and that this is a useful treatment for you.