Autism spectrum disorder (ASD) is a lifelong developmental condition characterised by struggles with social communication and interaction as well as repetitive behaviours and restricted interests. The social elements of autism relate to difficulties with social-emotional reciprocity, non-verbal communicative behaviours, and understanding the nature of social relationships. On the other hand, the non-social domains of autism entail repetitive motor movements, the obsessive desire for sameness, highly restricted interests, and hyper- or hypo-reactivity to sensory input.
Signs of autism in young children include:
- Not responding to their name.
- Avoiding eye contact.
- Not smiling when you smile at them.
- Getting very upset if they do not like a certain taste, smell or sound.
- Repetitive movements, such as flapping their hands, flicking their fingers or rocking their body.
- Not talking as much as other children.
- Repeating the same phrases.
Gilliam Autism Rating Scale – Second Edition (GARS-2).
Communication and Symbolic Behavior Scales (CSBS).
Parents’ Evaluation of Developmental Status (PEDS).
Screening Tool for Autism in Toddlers and Young Children (STAT).
Kenny, L. (2018). Understanding executive function in young autistic people: moving from the lab to everyday (Doctoral Thesis). Retrieved from UCL Explore.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington: American Psychiatric Association.
Biro, S. & Russell, J. (2001). The execution of arbitrary procedures by children with autism. Development and Psychopathology, 13(1), 97-110.
A specific learning difficulty that is characterised by difficulties with phonological awareness, a weakness in working memory, and struggles with rapid naming, which mainly affect reading and spelling.
There are several types of dyslexia:
- Phonological Dyslexia.
- Surface Dyslexia.
- Rapid Naming Deficit.
- Double Deficit Dyslexia.
- Visual Dyslexia.
- Poor phonological awareness (difficulty manipulating unit sounds of language).
- Lack of awareness of rhyme and rhythm.
- Inability to listen to stories.
- Poor memory.
- Difficulty repeating nonsense words.
- Inability to produce clear sounds.
- Difficulty coordinating/balancing between skills.
- Slight difficulty in activities such as: categorisation, naming, ordering, and sequencing.
- Common actions may include: omitting, adding, reversing, repeating, and substituting sounds or words while reading printed texts.
RTI (Response to Intervention): Prevents academic struggle through early intervention and frequent progress measurement. Early intervention may include noting some of the risk factors associated with Dyslexia.
Phonological Assessment: can be administered by a teacher through observing a child's reading pattern. Phonological Assessment Battery (PHAB), the Comprehensive test of Phonological Processing (CTOPP).
Reid, G. (2011). Dyslexia / Gavin Reid (3rd ed., SEN series). London: Continuum.
Difficulties with spelling/writing, poor handwriting, and trouble putting thoughts on paper.
Motor dysgraphia: Lack of fine-motor coordination and visual perception. Illegible and slow handwriting, poor drawing and tracing skills, and slow finger-tapping.
Spatial dysgraphia: Problems of spatial perception, which affects letter spacing and drawing ability. Struggle with handwriting and drawing.
Linguistic dysgraphia: Impacts the language processing skills required in the writing process. It most strongly affects spontaneously written text
- Tight, awkward pencil grip and body position.
- Messy handwriting (incorrect spacing of letters, difficulty writing in a straight line, struggle with forming letters).
- Quickly tiring when writing and avoiding writing, difficulties organising thoughts on paper.
- Unfinished words in sentences.
Mechanics of Writing Tests: Test of Written Language - 4th Edition (TOWL-4). The spelling and writing sections in the Woodcock-Johnson IV Test of Achievement and Wechsler Individual Achievement Test-Third Edition.
Fine Motor Skills Tests: Grooved Pegboard (ages 5-18), Purdue Pegboard, NEPSY-II Visuomotor Precision subtests
National Centre for Learning Disabilities. Found on: http://www.ldonline.org/article/12770/#:~:text=Dysgraphia%20is%20a%20learning%20disability,has%20dysgraphia%20is%20not%20sufficient.
Chung, P. J., Patel, D. R., & Nizami, I. (2020). Disorder of written expression and dysgraphia: definition, diagnosis, and management. Translational pediatrics, 9(Suppl 1), S46–S54. https://doi.org/10.21037/tp.2019.11.01
Döhla, D., & Heim, S. (2016). Developmental Dyslexia and Dysgraphia: What can We Learn from the One About the Other?. Frontiers in psychology, 6, 2045. https://doi.org/10.3389/fpsyg.2015.02045
An acquired difficulty in math processing, concepts, and calculations. Dyscalculia appears in multiple forms and is identified by various characteristics.
- Difficulty with number processing like producing or reading numbers and comprehending order and value of numbers.
- Inability to perform the correct arithmetic operation (e.g. adding instead of multiplying).
- Producing multiple arithmetic errors in simple calculations.
NPC: a battery of number processing and calculation.
CAB-DC: Online neuropsychological assessment for dyscalculia that allows for a complete cognitive screening and assessment of the risk index of having this math-based learning disorder.
Cipolotti, L, & Van Harskamp, N. (2005). Dyscalculia. Advances in Clinical Neuroscience and Rehabilitation , 5 (4) Pp. 14-16. (2005), Advances in Clinical Neuroscience and Rehabilitation , 5 (4) pp. 14-16. (2005).
Struggles with planning and processing motor tasks, movement/coordination, and perception.
Very early childhood: take longer than usual to learn how to crawl, sit, stand, speak, be potty-trained, build vocabulary.
Early childhood: struggles with subtles movements (tying shoelaces, using cutlery, handwriting), getting dressed, maintaining concentration, performing playground movements (jumping, catching/kicking a ball, skipping), performing classroom movements (using scissors, colouring), going up/down stairs. Higher tendency to fall over or bump into things.
Movement Assessment Battery for Children (Movement-ABC – Movement-ABC 2).
Peabody Developmental Motor Scales- Second Edition (PDMS-2).
Test of Gross Motor Development, Second Edition (TGMD-2).
Bruininks-Oseretsky Test of Motor Proficiency (BOTMP-BOT-2).
Rosenblum S (2013). "Handwriting measures as reflectors of executive functions among adults with Developmental Coordination Disorders (DCD)". Frontiers in Psychology. 4: 357. doi:10.3389/fpsyg.2013.00357. PMC 3693067. PMID 23805113
Kotsopoulos, S. (2013). "Neurodevelopmental Disorders". Diagnostic and Statistical Manual of Mental Disorders. Journal of Psychiatry and Neuroscience. DSM Library. 26. American Psychiatric Association. p. 257. doi:10.1176/appi.books.9780890425596.dsm01. ISBN 978-0890425558. PMC 1408294
Attention Deficit Hyperactivity Disorder is a neurodevelopmental disorder characterised by inattention, impulsivity, and hyperactivity. It is usually first diagnosed in childhood and often lasts into adulthood. Children with ADHD may have trouble paying attention, controlling impulsive behaviors (may act without thinking about what the result will be), or be overly active. The cause(s) and risk factors for ADHD are unknown, but current research shows that genetics plays an important role.
- Fails to give close attention to details or makes careless mistakes in schoolwork, at work, or with other activities.
- Has trouble holding attention on tasks or play activities.
- Does not seem to listen when spoken to directly.
- Does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (e.g., loses focus, side-tracked).
- Has trouble organising tasks and activities.
- Loses things necessary for tasks and activities.
- Is often easily distracted.
- Is often forgetful in daily activities.
- Often fidgets with or taps hands or feet, or squirms in seat.
- Leaves seat in situations when remaining seated is expected.
- Often unable to play or take part in leisure activities quietly.
- Often talks excessively.
- Often blurts out an answer before a question has been completed.
- Often has trouble waiting their turn.
- Often interrupts or intrudes on others.
Barkley Adult ADHD Rating Scale-IV (BAARS-IV)
Behavior Assessment System for Children (BASC-3)
Brown Attention/Executive Function Scales
Behavior Rating Inventory of Executive Function 2 (BRIEF-2)
Conners Adult ADHD Rating Scales (Conners-3, CAARS*)
Child Behavior Checklist (CBCL)
Connors Comprehensive Behavior Scale (CBRS)
Comprehensive Executive Function Inventory (CEFI)
Caused when abnormal cell division results in an extra full or partial copy of chromosome 21. It varies in severity among individuals, causing lifelong intellectual disability and developmental delays:
- Trisomy 21: There is an extra copy of chromosome 21 in every cell. This is the most common form of Down Syndrome.
- Mosaicism: Chromosome in some but not all cells. Tend to have fewer symptoms than those with trisomy 21.
- Translocation: Only have an extra part of chromosome 21.
It is a genetic condition so it is apparent from birth. However, some common physical features of Down Syndrome include:
- A flattened face, especially the bridge of the nose.
- Almond-shaped eyes.
- Shorter height/neck, smaller ears/hands/feet, and a longer than usual tongue.
- Tiny white spots on the iris (coloured part) of the eye.
- A single line across the palm of the hand (palmar crease).
- Poor muscle tone or loose joints.
Chorionic villus sampling (CVS)—examines material from the placenta.
Amniocentesis—examines the amniotic fluid (the fluid from the sac surrounding the baby).
Percutaneous umbilical blood sampling (PUBS)—examines blood from the umbilical cord.
Preschool Language Assessment Instrument-2 (PLAI-2)
Clinical Evaluation of Language Fundamentals-Preschool 2 (CELF-P2).
Receptive One-Word Picture Vocabulary Test-4 (ROWPVT)
Expressive One-Word Picture Vocabulary Test-4 (EOWPVT)
Test of Auditory Processing Skills-3 (TAPS-3)
Narrative Assessment Protocol (NAP)
Mai CT, Isenburg JL, Canfield MA, Meyer RE, Correa A, Alverson CJ, Lupo PJ, Riehle‐Colarusso T, Cho SJ, Aggarwal D, Kirby RS (2014). National population‐based estimates for major birth defects, 2010–2014. Birth Defects Research. 2019; 111(18): 1420-1435.
Ghosh S, Feingold E, Dey SK (2009). Etiology of Down syndrome: Evidence for consistent association among altered meiotic recombination, nondisjunction, and maternal age across populations. Am J Med Genet A. 2009 Jul;149A(7):1415-20.
A motor disability that impacts an individual's ability to move as well as maintain balance and posture. It is caused by abnormal brain development or damage to the brain, which affects an individual's muscle control. There are a number of kinds of CP and there can be cases where an individual has a mix of CP forms.
Spastic CP: the most common type of CP that is characterised by increased muscle tone and stiffness, thus resulting in awkward movement.
Dyskinetic CP: characterised by issues with movement control leading to very rapid or slow movements and/or a hard time swallowing/chewing/talking.
Ataxic CP: leads to issues with balance and coordination regarding walking, writing, and other movements.
The signs of CP vary greatly due to there being many types and levels of disability. However, the most critical sign is a delay in achieving motor milestones such as sitting, standing, rolling over, or walking.
In a baby younger than 6 months old, risk factors could include stiff or floppy muscle movement, overextension of back or neck when cradled in arms, and head lagging when being picked up from lying on back.
For a baby older than 6 months old, early signs could include not rolling over in either direction, the inability to bring hands together, and a difficulty bringing hands to mouth.
Developmental screening should be adminstered to test if a child has specific developmental delays. There are a number of CP assessmens that can be done but some of them include:
2D Gait Analysis: visually assesses a child's walking style to identify any issues with walking.
Gross Motor Function Measure (GMFM): evaluates change over time in the gross motor function of children with CP (lying & rolling, sitting, crawling & kneeling, standing, walking, jumping, and running).
Range of Motion (ROM) Assessment: A ROM assessment is most commonly used to measure movement of the ankles, knees, hips, shoulders, elbows, wrists and fingers. Measures are taken on consecutive occasions to assess any change over time. They are used to determine whether an individual’s ROM is within the expected range.
Honeycutt A, Dunlap L, Chen H, Homsi G (2004). Economic costs associated with mental retardation, cerebral palsy, hearing loss, and vision impairment: United States, 2003. MMWR Morb mital Wkly Rep. 53(3): 57-59. American Association on Intellectual and Developmental Disabilities https://aaidd.org/
Pellegrino, L. (2007). Cerebral Palsy, in Batshaw ML, Pellegrino L, Roizen NJ (eds.), Children with Disabilities, 6th Edition, Baltimore, MD, Paul H Brookes Publishing Company, 2007, pp 387-408
Students with physical impairments may have difficulties with mobility, manual dexterity and speech. Some would use a wheelchair all or some of the time. They might need support with personal care.
With vision impairment, this can be classified into several groups:
- Loss of Central Vision: creates a blur or blindspot, but side (peripheral) vision remains intact. This makes it difficult to read, recognise faces and distinguish most details in the distance.
- Loss of Peripheral (Side) Vision: an inability to distinguish anything to one side or both sides or anything directly above and/or below eye level. Central vision remains, however, making it possible to see directly ahead. Typically, loss of peripheral vision may affect mobility and if severe, can slow reading speed as a result of seeing only a few words at a time. This is sometimes referred to as "tunnel vision."
- Blurred Vision: causes both near and far to appear to be out of focus, even with the best conventional spectacle correction possible.
- Generalised Haze: causes the sensation of a film or glare that may extend over the entire viewing field.
- Extreme Light Sensitivity: exists when standard levels of illumination overwhelm the visual system, producing a washed out image and/or glare disability. People with extreme light sensitivity may actually suffer pain or discomfort from relatively normal levels of illumination.
With hearing impairment, a person who is not able to hear as well as someone with normal hearing – hearing thresholds of 25 dB or better in both ears – is said to have hearing loss. Hearing loss may be mild, moderate, severe, or profound. It can affect one ear or both ears, and leads to difficulty in hearing conversational speech or loud sounds.
Can be identifiable through physical traits at birth.
For mobility impairments, this can be identified through:
Deformity in neck, hand, finger, waist, legs.
Difficulty in sitting, standing, walking.
Difficulty in lifting, holding, keeping things on floor.
Difficulty in moving or using any part of the body.
Difficulty in holding pen.
Using a stick to walk.
Jerks in walking.
Lack bodily coordination.
Epileptic behaviour/have tremors.
Any part of the body is amputated.
For hearing impairments, this can be identified through:
Malformation of the ear.
Discharge from ear.
Pain in ear.
Irritation in ear.
Trying to listen from a closer distance.
Ask for the instructions repeatedly.
Not able to write properly.
Trying to listen to the echo reflection rather than from the speaker.
Make errors while copying from black board.
Frequently ask a colleague to show his workbook.
Problems in paying attention in the class.
Favour one ear for listening purposes.
For visual impairments, this can be identified through:
Watering of eyes.
Inappropriate stumbling over objects or bump into other people.
Tilting of the head or closure of one eye.
Headache while doing fine work.
Difficulty in counting the fingers of an outstretched hand at a distance of one meter.
Moving head side to side while reading.
Isernhagen Work System Functional Capacity Evaluation: performance-based measure that can be used to assess function at multiple parts of the body.
Functional Gait Assessment
Work Disability Functional Assessment Battery (WD-FAB).
Landolt's C Chart for vision impairment or blindness
Fricke, TR, Tahhan N, Resnikoff S, Papas E, Burnett A, Suit MH, Naduvilath T, Naidoo K. (2018). Global Prevalence of Presbyopia and Vision Impairment from Uncorrected Presbyopia: Systematic Review, Meta-analysis, and Modelling, Ophthalmology.
International Classification of Impairments, Disabilities, and Handicaps (1980). Geneva, Switzerland: World Health Organization.
A consistent failure to speak in specific social situations where speaking is expected, despite being able to speak in other situations. Can affect social and emotional development and can persist into adolescence.
- Fear of talking to people outside of one's comfort zone. More like a phobia.
- Can fill the child with increased panic, nausea, body tension, and shortage of breath.
- Social isolation.
- Clinging to caregivers.
Comprehensive standardised testing for speech & language, gather relevant case history.
The Selective Mutism Questionnaire (SMQ) is the only available instrument developed to measure a child's frequency of non-speaking behavior across situations in which children are expected to speak. This parent-report measure consists of 17 items that allow the clinician to quantify the degree of mutism in various social and interpersonal contexts, and to assess the severity and interference associated with the child's non-speaking behavior.
Presence of repetitive tics (movements and unwanted sounds) that cannot be controlled. Though largely attributed to genetic dispositions, Tourette's is commonly activated by a combination of genetic and environmental factors.
Persistent motor and vocal tics that vary in frequency and severity over a long period of time. Tics appears during childhood and may take the form of: shrugging, jumping, eye rolling, touching objects and people.
Common Vocal Tics may include: throat clearing, swearing, whistling, tongue clicking, saying random words/phrases, and repeating random sounds/words/phrases.
PUTS: The Premonitory Urge for Tics Scale
MRI: Used to rule out conditions for Tourette's.
Martino, D., & Leckman, J. F. (Eds.). (2013). Tourette syndrome. Oxford University Press.
Specific language impairment (SLI) is a communication disorder that interferes with the development of language skills in children who have no hearing loss or intellectual disabilities. SLI can affect a child's speaking, listening, reading, and writing. SLI can exist in the form of delay or deviance. "Delay" or slower than average development of language from the point of emergence to the point of mastery is more common than deviance. "Deviance" is having out of the ordinary language errors. Common errors affect expressive vocabulary, comprehension, and grammatical constructions. SLI is also called developmental language disorder, language delay, or developmental dysphasia. It is one of the most common developmental disorders, affecting approximately 7 to 8 percent of children in kindergarten. The impact of SLI usually persists into adulthood.
Preschool-aged children with SLI may:
- Be late to put words together into sentences.
- Struggle to learn new words and make conversation.
- Have difficulty following directions, not because they are stubborn, but because they do not fully understand the words spoken to them.
- Make frequent grammatical errors when speaking.
Symptoms common in older children and adults with SLI include:
- Limited use of complex sentences.
- Difficulty finding the right words.
- Difficulty understanding figurative language.
- Reading problems.
- Disorganised storytelling and writing.
- Frequent grammatical and spelling errors.
CELF: Clinical Evaluation of Language Fundamentals; a common Test Battery for SLI.
GAPS: The Grammar and Phonology Screening; a ten minute test that be administered by professionals and non-professionals for children between ages 3.4 and 6.8.
CCC-2: The Childrens' Commmunication Checklist; a language skills assessment tool used by parents for school-aged children.
Gardner, Hilary, Froud, Karen, McClelland, Alastair, & Van der Lely, Heather K. J. (2006). Development of the Grammar and Phonology Screening (GAPS) test to assess key markers of specific language and literacy difficulties in young children. International Journal of Language & Communication Disorders, 41(5), 513-540.
Leonard, L. (2014). Children with specific language impairment / Laurence B. Leonard. (Second ed., Language, speech, and communication).
A developmental delay refers to a child who has not gained the developmental skills expected of him or her, compared to others of the same age. Delays may occur in the areas of motor function, speech and language, cognitive, play, and social skills. Global developmental delay means a young child has significant delays in two or more of these areas of development. There is not one cause for delays in development. Factors that may contribute can occur before a child is born, during the birth process, and after birth. These could include:
- Genetic or hereditary conditions like Down Syndrome.
- Metabolic disorders like phenylketonuria (PKU).
- Trauma to the brain, such as shaken baby syndrome.
- Severe psychosocial trauma, such as post-traumatic stress disorder.
- Exposure to certain toxic substances like prenatal alcohol exposure or lead poisoning.
- Some very serious infections.
- Deprivation of food or environment.
There are many different signs and symptoms of delay that can exist in children and often vary depending upon specific characteristics. Sometimes you may see signs in infancy, but in other cases they may not be noticeable until the child reaches school age. Some of the most common symptoms can include:
- Learning and developing more slowly than other children same age
- Rolling over, sitting up, crawling, or walking much later than developmentally appropriate
- Difficulty communicating or socialising with others
- Lower than average scores on IQ tests
- Difficulties talking or talking late
- Having problems remembering things
- Inability to connect actions with consequences
- Difficulty with problem-solving or logical thinking
- Trouble learning in school
- Inability to do everyday tasks like getting dressed or using the restroom without help
Assessment for developmental delay in primary care settings should include a general and systemic examination, including plotting growth centiles, hearing and vision assessment, baseline blood tests if deemed necessary, referral to a developmental paediatrician, and counselling the parents. It is important to follow up with the parents at the earliest opportunity to ensure that the referral has been activated. For children with mild developmental delays, in the absence of any red flags for development and no abnormal findings on clinical examination, advice on appropriate stimulation activities can be provided and a review conducted in three months’ time.