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Attention and Listening

  

Where attention and listening are the primary concerns, the assessment will evaluate:

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  • Ability to selectively attend

  • Ability to switch attention from one task to another

  • Ability to inhibit verbal and motor responses

  • Ability to divide attention between two tasks

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  • Word discrimination (discerning phonological differences and similarities within word pairs)

  • Phonological segmentation

  • Phonological blending

  • Auditory memory

  • Auditory comprehension and reasoning

  • Auditory figure ground

  • The ability to discriminate between sounds

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  • Impulsivity

  • Following multi-step instructions

  • The ability to process, interpret and integrate sensory information (vestibular, proprioceptive, auditory, visual, touch)

  • Modulation (e.g. over or under arousal)

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It is important to be aware of any hearing and vision difficulties before this assessment, therefore prior testing by a suitably qualified professional (e.g. audiologist and optometrist) is recommended.

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Where assessment indicates that a child/young person may meet the DSM-5 criteria for Attention Deficit Hyperactivity Disorder (ADHD), this will be explicitly stated and explained in the assessment report, which can be used to support a formal diagnosis by a doctor.

 

Red flags:

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  • Under-achieving with reading, writing and other academic activity

  • Often does not respond when spoken to; tunes out

  • Difficulty following instructions especially when there is more than one step

  • Difficulty attending/listening for long enough to learn

  • Flitting from one activity to another without being able to complete any

  • Difficulty sitting still during whole-class teaching or to complete homework

  • Difficulty with on-task behaviour e.g. completing a meal or a game when playing

  • Relies on peers and copies their actions

  • Does not ask for clarification

  • Repeats himself

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In addition your child may experience difficulty with:

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  • Organising his thoughts (especially to put them down on paper)

  • Difficulty planning/organising daily life activities such as getting ready for school

  • Difficulty adhering to home and school routines

  • Correctly pronouncing words, poor articulation (speech is difficult to understand)

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The following difficulties, in addition to those listed above, may be indicative of a diagnosis of ADHD:

  • Significant difficulties in curbing immediate reactions (impulsivity)

  • Interrupting others and blurting out answers before questions have been completed

  • Difficulty in keeping quiet or waiting her turn

  • Poor safety and danger awareness; does not think about the consequences of his actions

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What can be done to help?

Advice for home and school: Assessment is a valuable opportunity to gain recommendations and advice for school and home in terms of management and self-regulatory strategies. Home/school programmes may also be given to maximise opportunity for progress. In some cases, this is sufficient and direct intervention isn’t required/recommended, however review sessions are usually recommended so that advice can be updated.

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Direct intervention: For those who would benefit from direct intervention, therapy is based on the premise (supported by neuroscience) that attention, listening, working memory and auditory processing capacities are not fixed and can be improved, particularly in children (whose brains have an amazing neuroplasticity, enabling significant changes to be elicited reasonably quickly.)

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Intervention plans may include:

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  • Auditory and visual attention work

  • Working memory, visual and auditory memory 'training'

  • Sensory Integration based methods to elicit a well regulated/modulated state (calm yet alert- ready for learning!) prior to working on functional tasks such as writing or reading or prior to working on underlying cognitive weaknesses

  • Teaching cognitive self-regulation strategies to the young person and the adults in their lives

  • Therapeutic Listening programme

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Please see the Intervention page for more information on these approaches/methods.

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Attention and listening therapeutic work is often merged with work on specific functional concerns.

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Many children with Attention Deficit Hyperactivity Disorder and Autism Spectrum conditions have an underlying sensory processing weakness (research currently suggests about 40% for ADHD/ADD and about 80% for ASD) which impact greatly on their attention and listening abilities and, when addressed, can open up windows for more specific learning to occur (such as reading or writing).

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Also, many seemingly ‘typically’ developing children who do not meet criteria for any DSM-V diagnosis may have a sensory processing weakness (please see sensory processing page), memory or auditory processing weakness which affects their attention and listening abilities, and in turn their learning/functioning.

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The overall aim of intervention is to calm or alert the neurological system (depending on the child's individual physiological make-up) and to improve awareness of the body in space so that the child is prepared for learning by feeling more ‘grounded’. With engagement in specific activities on a regular basis the child becomes more regulated. Other functions such as sleep and toiletting often improve. Once the child is in the ‘just right’ state of arousal (alertness), she is open to attending, listening and learning. Most importantly, therapy also offers the child options for self-management of escalating emotions and behaviours. 

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At Sunshine Coast Kids Therapy, the Sensory Integration approach is often coupled with specific cognitive programmes to help the child learn to self-assess his arousal levels and to learn to choose self-regulating activities. This is ultimately aimed at empowering the family and the child to learn to manage difficulties themselves in the long term.

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Why is intervention important?

Attention and listening are the most basic precursors to social interaction (e.g. turn taking in conversation), engagement (e.g. in play), movement (in the first days of life a baby will synchronise its movements with the rhythms in mum's speech patterns) and all school-led learning such as reading and writing.

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Listening is a more active process than simply hearing. In order to listen, we need to pay attention and in order to pay attention we need to maintain an optimum level of alertness (not too high and not too low). Therefore, listening is a sensory integrative experience, as we are choosing and modulating specific bits of auditory information, integrating them with information from other senses and extracting meaning from them.

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Attention and listening are closely connected to arousal and task-oriented behaviour as well as helping us to modulate (react appropriately to) and integrate sensation. In fact, attention and listening skills underlie all functions of daily life.

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Why might my child have attention and listening challenges?

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  • Disordered auditory processing (difficulty processing what they are hearing)

  • A cognitive weakness or more pervasive intellectual/cognitive delay

  • An over-sensitivity to sounds, noise or movement/vestibular information (certain sensory stimuli are difficult to process or tolerate, resulting in behaviour which is disengaged and distracted in the classroom)

  • An under-sensitivity to sounds, noise or movement/vestibular sensory information (she constantly seeks out sensory stimulation such as movement (through the vestibular sense), touch (e.g. constantly fiddling with objects, hair, toys) and deep pressure (through the proprioceptive sense which enhances the awareness of body positioning in space e.g. through crashing around, bumping into things and others), at the expense of focusing on what she is being asked to focus on

  • Inability to filter out unimportant ‘background’ stimuli. The child tries to attend to everything at the same time, as if all the stimuli in the environment are new and equally important ALL the time (e.g. he can’t attend to what the teacher is saying as he is also attending to the rustling paper from the child behind him, the projector humming, the rain outside and the voices in the corridor) resulting in a constant ‘high alert/high arousal’ state.

  • A delay in receptive and/or expressive language or a specific speech and language impairment

  • Early hearing issues such as glue ear (often not identified at the time but may have had a lasting effect on how the brain processes sound)

  • Hereditary factors are likely to play a part in some instances

  • The attention and listening challenges are often part of a wider neuro-diversity such as Autism Spectrum Disorder, Developmental Coordination Disorder (Dyspraxia), Dyslexia, ADHD/ADD or genetic condition/developmental delay.

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Kid Rowing

Dyspraxia and Motor Skills

Where motor skills and coordination are a concern, assessment will evaluate:

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  • Motor planning/praxis (having an idea of what to do, planning out the motor action/the movements, carrying out the movements in a fluid and well sequenced way)

  • Gross motor skills (e.g. postural motor control, muscle tone, inhibition of primitive childhood reflexes which may still be present, coordination of both sides of the body)

  • Balance (static and dynamic)

  • Fine motor skills (speed, dexterity, precision, manipulation, grasp)

  • Perceptual-motor integration skills (the integration of how the brain processes what he/she sees with an effective motor action)

  • Fluidity and automaticity of movement (processing of movement)

  • Ocular-motor coordination (eye-hand coordination and ocular-motor skills such as fixation, scanning, tracking, visually crossing the midline, convergence)

  • Visual perception (how the brain is processing and interpreting what the eyes are seeing)

  • Sensory processing and integration (how the child is processing, interpreting and integrating sensory information (vestibular, proprioceptive, auditory, visual, touch)

  • Specific functional skills that are of concern to the child/school/parent (e.g. ball skills, handwriting, dressing, planning and organisation)


Where assessment indicates that a child/young person meets the DSM-5 criteria for Developmental Coordination Disorder (commonly known as Dyspraxia), this will be explicitly stated and explained in the assessment report.

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Red flags:

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  • Lagging behind peers in basic motor skills (e.g. catching, throwing, kicking a ball, running in a coordinated way, jumping with two feet together, hopping, climbing, cutting with scissors, colouring within the lines and other motor patterns typically used in childhood play)

  • Poor balance, clumsiness, dropping or bumping into things, falling over frequently

  • Poor handwriting which is significantly below the child’s achievement in other areas

  • Marked delays in achieving developmental motor milestones (e.g. walking, crawling, sitting)

  • Delays in functional milestones such as learning to dress, do up buttons, use cutlery, shoelaces

  • Early acquisition of milestones may have been 'normal' but difficulty with more complex motor learning later on, such as playground activities, learning to ride a bike, playing sports

  • Difficulty organising themselves and their thoughts e.g. haphazard approach when getting dressed (always looks dishevelled) or retelling a story

  • Difficulty reflecting what they know and what they have learned on paper

  • Uncoordinated and messy feeding/eating



What can be done to help?

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Advice for home and school: Assessment provides a valuable opportunity to receive individualised detailed recommendations for school and home. The assessment will identify the specific mechanisms which are contributing to the child’s motor difficulties, as these can vary markedly from child to child. The assessment identifies percentiles (to form a baseline of where the child/young person is at so that future progress can be measured and to get a feel for where the child’s abilities ‘fit’ in comparison to their peers), strengths/weakness.

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Home/school programmes are recommended to be provided to maximise opportunity for positive change. In many cases, this is the most appropriate pathway to enable participation in play, learning and other childhood/young adult occupations in everyday ‘real’ life and further therapy sessions with the OT may not be required/recommended.

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Periodic review visits are usually recommended, following which programmes may be updated.

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Direct intervention: In some cases, a block of clinic based therapy sessions may be recommended. Research suggests that a top-down cognitive approach (where the child actively problem solves and is encouraged to come up with strategies to overcome a specific motor difficulty) and a bottom-up sensory integrative approach (improving the integrated functioning of various brain parts) should be used in combination when addressing Dyspraxia/DCD.

This is reflected in intervention sessions which commonly use a combination of the Cognitive Orientation to Daily Occupational Performance (an approach which teaches children to solve problems through guided discovery), Sensory Integration work and the Astronaut programme (a sound activated vestibular-visual protocol) -all these approaches are embedded in neuro-science research.


Sessions always address specific functional concerns such as gross motor skills e.g. ball skills or fine motor skills e.g. handwriting, as well as the neuro-motor mechanisms which we rely on for effective motor coordination.


Why are assessment and intervention important?

Developmental Co-ordination Disorder (DCD)/Dyspraxia involve a marked impairment in the development of motor (movement) skill and coordination, so much so that it interferes with the learning of most tasks. This has a significant knock-on effect on play, academic learning, the ability to perform every day activities independently, social functioning, pre-vocational and vocational activities and leisure.


Typically, practice and repetition using the same approaches that would be used with any other child and without an understanding of the underlying impaired mechanisms yields little improvement.


Many children with motor coordination challenges learn to mask their difficulties (e.g. by avoiding things they find hard) or to ‘get by’ without the skills that their peers may have mastered. Although the child may eventually learn some of the above mentioned motor skills, learning new skills can be a laborious and slow process. The effort required can come at the expense of learning other higher level or more age appropriate skills.


Motor performance difficulties of children with DCD are often viewed as ‘‘mild” and as such they are not seen as priority for statutory services when compared to the needs of children with more severe physical impairments.

However, research has shown that children with DCD and Dyspraxia tend to be more introverted, judge themselves as physically and socially less able than their peers and have greater levels of anxiety. Children start to compare their abilities with peers at around the age of 5. The experience of not being good at group games, play activities and classroom activities impacts on self-esteem and can lead to a lack of motivation and avoidance.


Academic outcomes are usually lower, despite average or above average intelligence. Children do not ‘grow out of’ DCD/Dyspraxia and symptoms usually persist into adulthood (although they may be easier to mask in adulthood). This is why strategies should be incorporated into the child’s daily life at school and at home on a long term basis.


Why might my child have motor coordination challenges?

Children at greater risk:

  • perinatal complication such as jaundice

  • children with other neurodevelopmental diagnoses such as Attention Deficit Hyperactivity Disorder/Attention Deficit Disorder, Autism Spectrum Disorders (50%-80% co-morbidity reported by research studies) and learning differences such as Dyslexia

  • a family history of the condition or other specific learning differences

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Social Communication, Interaction and Engagement

Where social communication/interaction and engagement are a concern, the assessment will evaluate:


  • Social communication/ interpersonal abilities such as the ability to initiate and sustain interactions and conversations, reading social cues in play, use of and understanding of non-verbal communication, social and conversational turn-taking, joint attention and pragmatic use of language, understanding how others might feel, solving social problems.

  • Imagination and flexibility of thought e.g. adherence to home and school routines, pretend and other play skills, ability to accept changes in plans and to transition from one activity to another

  • Self-regulation: does he have difficulty modulating (balancing) his activity levels, arousal and energy levels? Is she under-aroused (appears uninterested, withdrawn, passive, tired most of the time; is compliant in class but does not seem to be learning or ‘taking it in’) or over-aroused (too excitable and unfocused to sustain attention for long enough to learn or to complete a task) for the majority of the time? Or maybe she fluctuates wildly between the two?

  • Intrinsic motivation to engage: is she reluctant to engage in daily activities which are not inherently stimulating from a sensory standpoint (e.g. daily routine tasks such as writing, getting dressed, grooming and personal hygiene, sitting in class, focusing and listening)

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Where assessment indicates that a child/young person is likely to meet the DSM-5 criteria for Autism Spectrum Disorder, this will be explicitly stated and explained in the assessment report, which can be used to support a formal diagnosis by a Paediatrician.

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Red flags:

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  • Delayed speech and language skills

  • Gets upset by minor changes and unexpected events

  • Obsessive interests or very narrow range of interests; repetitive play- does the same thing over and over; poor pretend play; engrossed in an activity/topic/interest at the expense of all others

  • Rarely shares interests with others or initiates interaction; frequently only interacts to achieve a desired goal

  • Has flat or inappropriate facial expressions; has a restricted range of facial expressions; does not use gestures often (e.g. waving)

  • Does not understand personal space boundaries

  • Struggles to engage in any one activity on offer at preschool or at unstructured times at school (e.g. at playtime, choosing time, golden time) but wonders around seemingly aimlessly instead

  • Uncoordinated, weak gross motor skills, poor spatial awareness and usually weak fine motor skills as well (e.g. handwriting and dexterity); movements lack fluidity (may have previously been diagnosed with DCD/Dyspraxia)

  • Toe walking, hand flapping, finger flicking, rocking, spinning (unusual movements), particularly in sensory-intense environments such as supermarket or party

  • Excessively rough play, hitting, biting, pinching

  • Rigid and repetitive behaviours e.g. the furniture in the room needs to be always arranged in a certain way and if this is changed the child becomes distressed

  • Meltdowns at bath time and dressing time; rigidity about what clothes he will and won’t wear to the point of being distressed; dislikes sand or other specific textures


What can be done to help?

OT intervention for children with social communication/interaction and engagement difficulties typically addresses:

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  • Self-regulation of behaviour and controlling emotional responses: reducing meltdowns, increasing frustration tolerance, promoting calm and organised behaviour, reducing over activity (where a child is hard to engage and often appears ‘all over the place’), increasing under activity (where a child is hard to engage and often appears ‘switched off’), managing transitions

  • Increasing the range of affective expression, engagement and interaction, auditory discrimination in complex environments, emotional expression and connection with others, social turn taking and turn taking in speech (timing and sequencing) 

  • Ideational praxis: coming up with new play ideas, new ways of using a toy, new ways of thinking and doing things; reducing rigidity and repetitiveness

  • Sensory sensitivities/defensiveness e.g. high frequency sound sensitivities (speech), low frequency sound sensitivities (vacuum, blender, lawn mower), movement sensitivities

  • Motor planning and motor abilities (gross and fine motor skills/coordination ) through developing body scheme and perceptual maps; auditory-motor integration


Advice for home and school:

All children who are assessed receive detailed recommendations for school and home in the assessment report.

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Direct intervention:

Many children with social communication/interaction and engagement difficulties benefit from a block of therapy sessions. A limited number such as 6 sessions may be recommended or longer term intervention may be appropriate, depending on the presenting difficulties. These sessions typically combine ‘traditional’ sensory integration work with sound based intervention (see Therapeutic Listening information) and other vestibular-visual-auditory programmes (see Astronaut Training information) which all work to open up channels for social communication, interaction and engagement.

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This is because effective social communication/interaction and engagement rely on:

  1. Good sensory processing/ integration

The child’s sensory organs (e.g. eyes, ears, touch receptors) may be working perfectly but the processing system is amiss. For example, the child may be hyposensitive (under sensitive) in that he is not receiving enough of the sensory signal to make sense of its message or hypersensitive (over sensitive) in that even a little of the sensory stimuli is uncomfortable or overwhelming.

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2. Good spatio-temporal orientation

Spatial awareness and a feeling for time and timing is necessary for social engagement, the back and forth rhythm of social engagement and speech, and for keeping us behaviourally organised so we can maintain the interaction for extended periods of time.


Good spatio-temporal orientation requires:

  • Adequate processing of vestibular information which informs us about gravity, motion and positioning

  • Good processing of auditory information which informs us about the characteristics of the space and time around us

  • Effective integration of the two


So, by working through the vestibular and auditory systems, we can make significant changes in many pre-requisites for social engagement and functional activity.

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Why is intervention important?

'Studies by the SPD Foundation suggest that more than three-quarters of children with autistic spectrum disorders have significant symptoms of Sensory Processing Disorder' (Sensory Processing Disorder Foundation).


Such difficulties typically result in behavioural volatility, flight or fight survival responses such as hitting out or withdrawal/disengagement and/or signs of distress, anxiety, rigidity/inflexibility or meltdowns.


This inhibits learning and the ability of the child to cope with daily challenges.

Also, when a child is frequently in ‘survival mode’ or ‘too high’ or ‘too low’ in arousal, she will not be open to learning, making friends and engaging.


With early intervention most children will improve and many make excellent progress. Older children/teens benefit greatly from advice and home programmes which they can incorporate into their daily lives on a long term basis.

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Handwriting

Where handwriting is a concern the assessment will evaluate:


  • Letter formation: has a motor memory been formed for correct writing of all letters?

  • Speed of handwriting: is he slower than age norms suggest he should be?

  • Free writing/composition ability: can she generate ideas to consistently write for an age appropriate block of time?

  • Dictation: Does the quality of handwriting suffer when she is not copying?

  • Fine motor skills: has he developed hand arches, motoric separation of the two sides of the hand, true dominance, range of movement and strength of intrinsic hand muscles required to hold the pencil with an effective grasp, isolated finger movements?

  • Postural control and upper limb control: are primitive reflexes integrated? Are muscle tone, shoulder stability, trunk rotation and stability all at optimum levels?

  • Bilateral integration skills: can he integrate the workings of both sides of the body?

  • Motor planning/praxis: does she have a good mental plan of how to carry out the movements for letter formation?

  • Sensory processing and sensory integration: does he have the body awareness needed for the subtle postural adjustments during writing?


Where a child/young person meets the DSM-5 criteria for ‘Specific Learning Disorder- Impairment in Written Expression’ (also known as Dysgraphia) this will be explicitly stated and explained in the assessment report.

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Red flags:

  • Poorly formed letters (overlapping letters, collisions, distortions, lack of letter closure)

  • Makes lots of mistakes when copying from board to paper

  • Does not leave appropriate spaces between words

  • Too much pressure being put on the paper (leading to fatigue/achy hand after only a short time writing, holes in paper, smudges)

  • Too little pressure put on paper (leading to faint jerky writing which is difficult to read)

  • Slow, laboured writing and poor endurance

  • Reversals (back to front) and transposition errors (two letters or numbers switch places)

  • Poor organisation and spacing of writing on the page e.g. cannot stay on the line, doesn’t start at margin


What can be done to help?

Research shows that children who struggle with reading and handwriting through primary school, on the whole, do not ‘catch up’ without intervention. They continue to struggle through secondary school where the curriculum makes new and complex demands.

Simple repetition or more practice alone is often ineffective for these children. Instead, a targeted approach is needed (targeting the underlying weaknesses) coupled with cognitive strategies and explicit instruction.


Intervention programmes are designed by the therapist to address specific weaknesses. They may, for example, focus on perceptual-motor skills, teach cognitive self-strategies to improve writing, improvement of neuro-muscular components, sensori-motor training or tackling specific issues such as reversals, letter formation or spacing.


Specific evidence-based and well-recognised therapeutic handwriting programmes are often used in therapy and recommended if it is what the child needs. 


Interventions are designed to complement teaching strategies and approaches used in the classroom. 


In some instances, an assessment and recommendations that are to be implemented at home and/or school are all that is needed.


Why are assessment and intervention important?

Learning to write is a major occupation of childhood and essential skill in adulthood. Handwriting is a complex process which requires the temporal and spatial coordination of movement and the integration of many other processing skills.


A child who struggles to write legibly and with adequate speed, usually also struggles to:

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  • Write the amount (the volume) that is expected, particularly at secondary school level 

  • Produce notes from which he/she can later deduce content

  • Solve maths problems correctly

  • Concentrate on higher order processes such as text content, grammar and syntax (as underlying processes e.g. producing the movements, require conscious thought and effort rather than being automatic)

  • Record instructions correctly (resulting in not knowing what to do)


Why might my child have writing challenges?

Handwriting challenges are frequently present in children with:

  • Specific Learning Disorder- Impairment in Written Expression (Dysgraphia)

  • Developmental Coordination Disorder (Dyspraxia)

  • Autism Spectrum Conditions

  • Specific Learning Disorder- Impairment in Reading (Dyslexia)

  • Sensory Integrative/Sensory Processing dysfunctions

  • Global Developmental Delay or Intellectual Disability (overall learning difficulties)

  • A history of low quality or infrequent instruction

  • A history of instruction which did not suit their preferred learning ‘style’

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Reading

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Where reading is a concern, the assessment will evaluate:

  • Word discrimination (discerning phonological differences and similarities within word pairs)

  • Phonological segmentation

  • Phonological blending

  • Auditory memory

  • Auditory figure ground (e.g. identifying a spoken word in a background of people talking)

  • The ability to discriminate between similar sounds

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  • Current reading and spelling ability compared to age norms

  • Reading comprehension: can she absorb/make sense of what she is reading whilst reading it?

  • Listening comprehension

  • Oral expression and fluency

  • Written expression

  • Sentence composition

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  • Visual-spatial relationships: can she determine one single form or a part of a single form which is going in a different direction from the other forms?

  • Visual discrimination: can he match or determine exact characteristics of two forms when one of the forms is among similar forms?

  • Visual figure ground discrimination: can she find a form hidden in a ‘messy’ background?

  • Visual memory: can he remember, after 4 or 5 seconds, the characteristics of a given form and distinguish this form from a number of similar forms?

  • Visual closure: can she determine from an incomplete form, the form which would match it if the incomplete form was to be completed?


  • Ocular-motor control: fixation, scanning, tracking, visually crossing the midline, convergence

  • Vestibular processing


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Where a child/young person meets the DSM-5 criteria for Specific Learning Disability-With Impairment in Reading, also known as Dyslexia, this will be explicitly stated and explained in the assessment report.

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What are the red flags?

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  • Struggles to understand what he is reading (can’t repeat the storyline back to you) but may understand a story when read to him

  • Short attention span when reading and writing

  • Turning head when reading across a page rather than tracking with her eyes

  • Easily loses place, needs a finger or marker to keep track

  • Rereads or skips words

  • Doesn’t maintain eyes on text when reading

  • Often guesses the word when reading

  • Relies heavily on the pictures for contextual cues

  • Difficulty with rhyming, blending sounds, learning the alphabet, linking letters with sounds

  • Slower than peers when reading

  • Great difficulty with words in lists, nonsense words and words not in his listening vocabulary

  • Tendency to mispronounce common words when speaking (floormat for format)

  • Difficulty using or comprehending more complex grammatical structures

  • Weak vocabulary knowledge and use

  • Difficulty perceiving similarities in the initial or final sounds of words

  • Difficulty perceiving the similarities in words e.g. ‘fat’ and ‘pat’

  • Poor discrimination of short sound vowels such as ‘tin’, ‘ten’, ‘ton’

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  • Great difficulty reading and spelling sight words (‘little’ words you can’t create a visual picture for or that cannot be “sounded out” like ‘on’, 'of', 'said'

  • Difficulty learning rules for spelling–spells words the way they sound (e.g., lik for like)

  • Uses the letter name to code a sound (lafunt for elephant)

  • Very poor spelling–miscodes sounds, leaves out sounds, adds or leaves out letters or whole syllables

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What can be done to help?

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Research shows that children who struggle with reading and/or spelling through primary school, on the whole, do not ‘catch up’ without intervention. They continue to struggle through secondary school where the curriculum makes new and complex demands.


Simple repetition or more practice alone is often ineffective for these children. Instead, a targeted approach is needed (targeting the underlying weaknesses) coupled with cognitive strategies and explicit instruction using highly structured phonics based multi-sensory programmes.


Reading and spelling intervention programmes combine a focus on:

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  • Enhancing visual processing, auditory processing, vestibular or ocular-motor skills

  • Explicit instruction using widely used evidence based programmes which emphasise guided practice, explicit explanations, modelling, teaching decoding methods used in phonics

  • Teaching study skills relevant to reading and spelling


Interventions are designed to complement teaching strategies and approaches used in the classroom. 

In some instances, an assessment and recommendations that are to be implemented at home and/or school are all that is needed.

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Why are assessment and intervention important?

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Learning to read and spell are a major occupation of childhood and essential skill in adulthood. Reading and spelling are complex processes which require precise temporal and spatial coordination of eye movement, visual processing skills and visual memory and the integration of many other cognitive and language processing skills such as phonological awareness, phonic knowledge and knowledge of morphemic principles.


A child who struggles to read and spell accurately and with adequate speed and fluency, usually also struggles to:

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  • Convey ideas and understanding of what he/she has learned 

  • Achieve in exams and tests

  • Read instructions correctly (resulting in not knowing what to do)

  • Concentrate on higher order processes such as text content, grammar and syntax as so much effort is being put into decoding and spelling the words

  • Develop a wide vocabulary to express themselves both verbally and in writing which has consequences for not only academic and subsequent socio-economic outcomes but social connectedness as well

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Why might my child have reading and/or spelling challenges?

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Reading and spelling challenges are frequently present in children with:


  • Specific Learning Disability-With Impairment in Reading (Dyslexia)

  • Specific Language Difficulty- With Impairment in Writing

  • Speech and Language Delay

  • Auditory Processing difficulties

  • A history of low quality or infrequent instruction

  • A history of instruction which did not suit their learning ‘style’ or learning difference

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Sensory Processing Disorder

Where sensory processing is a concern, the assessment will evaluate:


  • The specific sensory profile of the child

  • Sensory behaviours e.g. seeking, avoiding, distracted, emotional reactivity

  • Aversive responses to sensory information such as sound, movement, touch, what is seen

  • Arousal thresholds/levels and ability to self-regulate

  • Registration thresholds

  • Functioning in multi-sensory environments

  • Ocular-motor functions

  • Equilibrium reactions

  • Gravitational security

  • Integration of primitive reflexes

  • Postural extension and flexion patterns; core postural control

  • Various aspects of praxis: ideation, planning, sequencing

  • Bilateral coordination and visual-motor integration


Red flags:

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Sensory Processing Disorder can be classified under three symptom clusters that may occur independently but usually occur in combination with each other:

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  1. Sensory Modulation Disorder


The child is either under-aroused or over-aroused for the majority of the time or fluctuates wildly between the two. Some of the following signs may be present:

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  • Has difficulty with attention and listening

  • Appears uninterested, withdrawn, passive, tired most of the time; is compliant in class but does not seem to be learning or ‘taking it in’.

  • Conversely, he may be too excitable and unfocused to sustain attention for long enough to learn or to complete a task

  • Is very reluctant to engage in daily activities which are not inherently stimulating (e.g. writing, getting dressed)

  • Has decreased or heightened awareness of pain or temperature

  • Avoids getting messy with glue, sand, finger paints; avoids walking bear footed; toe walks or overly seeks out tactile input (constantly touching something)

  • Needs to be physically active to be able to attend and engage (always out of his seat in class, always fidgeting with objects or mouthing them)

  • Has difficulty controlling emotional and behavioural responses (e.g. frequent tantrums and meltdowns; low frustration tolerance)

  • Is unable to block out irrelevant stimuli (tries to attend to everything at the same time resulting in agitated and distracted behaviour or ‘switches off’, resulting in withdrawn and disengaged behaviour)

  • Is impulsive, appears to have little awareness of safety risks, seems to always be seeking out the next ‘thrill’ (sensation seeking behaviour), always ‘on the go’

  • Behaviour disintegrates or the child becomes distressed in multi-sensory environments (a classroom which is ‘stimulating’ in a positive way to most children may be over stimulating and difficult to cope with for the child with SPD); shopping centres, swimming pools, kids parties, the playground

  • Over sensitive to (over reacts or becomes distressed by) noise, certain sounds, visually busy environments, movement, the feel of clothes, smells


2.   Sensory-Based Motor Disorder (Dyspraxia and Postural Disorder)

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  • Gross motor, praxis (motor planning) and body awareness difficulties (appears awkward when moving around, bumps into things and trips over things)

  • Requires excessive amounts of time to generate ideas

  • Difficulty with planning and sequencing the steps required or body movements required to achieve a task e.g. to tie shoe laces, open a food packet, open unfamiliar doors

  • Delays in learning new motor skills, needs much more repetition than the next child (e.g. putting socks and shoes on, getting dressed, using cutlery, drawing and handwriting, keyboard skills, bike riding, swimming)

  • Difficulty generalising  motor skills which have been learned to another context or a similar activity

  • Repetitive or limited play skills and play interests; needs to be shown how to play

 
3.   Sensory Discrimination Disorder

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The child has difficulty identifying the temporal and spatial qualities of stimuli. The following signs may be present:

  • Over-manipulates toys and constantly touches or hangs on to people

  • Mouths toys and clothes, chews fingers

  • Not driven to interact with the environment or to play with toys

  • Overly relies on vision when using hands for play or to manipulate tools such as a pencil for writing and struggles when he/she has to rely on the tactile sense and sense of body scheme (e.g. copying writing from board, getting dressed)

  • Delayed fine motor skills e.g. tends to use whole handed movements rather than isolated finger movements

  • Oral motor problems (e.g. very slow feeding, keeps food in mouth for long periods of time without chewing or swallowing it, loads mouth with too much food, appears not to notice he/she is dribbling)

  • Gross motor, praxis (motor planning) and body awareness difficulties (appears awkward when moving around, bumps into things and trips over things, slumps in chair, often plays in lying down position)

  • Has decreased awareness of pain or temperature

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What can be done to help?

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Advice for home and school: For many children, being assessed and receiving individual advice on strategies to help them cope with their SPD symptoms is invaluable.

These might be strategies or advice on how to deal with challenging scenarios in your child’s life such as how to get through the school day, dealing with transitions and change, suggestions on how to extend the child’s play repertoire (young children learn through play so this is crucial), how to deal with sensitivities in the context of the school day such as tolerating putting on their school uniform in the morning, the school bell, sitting still in assembly, eating in a busy lunch hall, how to engage a low arousal child in learning tasks in school and at home etc.


Many parents find that once they have gained an in-depth understanding of their child’s SPD through the assessment process and the tools to help manage it, they can help to manage their child's SPD without ongoing therapy input.


Direct Intervention: Many parents opt for a period of individual therapy to help make more significant changes on a neural-physiological level.  Using a sensory integration based approach can be extremely beneficial.

Such intervention works best when there is an intensive period of one to one intervention coupled with a home programme.

Opportunities are provided (through active engagement in very specific play activities) for varied sensory experiences which include tactile, vestibular and proprioceptive, with the aim of improving underlying impairments. Postural (core stability, flexion and extension patterns), ocular, vestibular, oral and /or bilateral motor mechanisms are challenged. The child is assisted to attain and maintain appropriate levels of alertness through an emphasis on proprioception and deep pressure input which parents are also taught and encouraged to use at home.

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Why are assessment and intervention important?

Sensory Processing Disorder (SPD) occurs when the child has difficulty processing information coming through one or more sensory systems, to the point that a child's daily routines, learning and development are disrupted.  The senses commonly affected are the auditory sense, the vestibular sense (e.g. processing of movement and balance), the tactile sense (e.g. processing touch, certain materials and textures) and the visual sense. Usually, more than one sense is affected.


'At least one in twenty people in the general population may be affected by SPD.'

Sensory Processing Foundation (US)


Assessment and intervention are important because untreated SPD puts children at high risk of:

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  • Psychological-emotional difficulties such as poor self-esteem, anxiety, depression

  • Being mislabelled as uncooperative, disruptive, disengaged, aggressive or a child with ‘behavioural issues’

  • Academic underachievement

  • Social difficulties such as making friends or being a part of a group

  • Not being able to engage in the full range of ‘childhood occupations’ such as parties, participation in family routines such as going to the supermarket or shopping centre, swimming, playground play

  • Rigid behavioural patterns (which are a response to the challenging sensory processing experiences) becoming engrained and habitual, such as inflexibility, difficulty coping with changes in plans, the need to be the one in control, extreme reluctance to try new thing

  • Difficulties persisting into adulthood and affecting work, relationships and quality or life


Why might my child have sensory processing challenges?

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Children at greater risk of sensory processing difficulties:

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  • Fed via nasal-gastric tube at some point in the child’s life

  • Prolonged hospital stays in the early years

  • Relatives or siblings with SPD (inherited link)

  • Diagnosed Autism Spectrum Disorder, Asperger Syndrome

  • Fragile X Syndrome, Down Syndrome, ADD/ADHD and other developmental delays and neurological disorders

  • Children with speech and language difficulties

  • ‘Gifted’ children

  • Exposure to drugs or alcohol during foetal development


With many children with SPD there is no identifiable cause and it is almost certainly nothing that the parent/caregiver has done.

Plastic Utensils

Activities of daily living: feeding/eating, dressing, toileting

Where independence skills are a concern, the assessment will evaluate:

  1. Current functional level 

  2. Underlying mechanisms which are likely to be contributing to the delay or difficulty, primarily: ​

  • motor (e.g. balance, spatial awareness functions, core and distal stability, muscle tone, midline crossing, bilateral motor coordination, segmentation of movement)

  • sensory (e.g. tactile registration and discrimination)

  • cognitive (e.g. attention, memory, sequencing, ideation, planning)

  • perceptual (e.g. figure-ground, form constancy)

  • social-emotional functions (e.g. motivation to engage, anxiety)

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Red flags:

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  • the child's abilities are significantly below that of his peers (he needs lots of assistance or verbal prompts)

  • educational setting has suggested there is a delay when compared to peers

  • he seems unmotivated and disinterested to try; seems to lack initiation; avoids 

  • restricted food repertoire; gagging at food smells or food in mouth, refusing to eat whole food groups particularly certain textures e.g. soft mushy foods or lumpy foods, very rigid about which cup he will drink from or which plate he will use

  • unaware of food on mouth/chin or runny nose; over stuffs mouth

  • holds food in mouth or spits it out

  • limited tolerance of some textures such as sand or grass 

  • insistence on wearing specific and limited range of clothes

  • dislike of messy play

  • poor body awareness and coordination (seems 'clumsy', bumps into things, seems not to know how to arrange body parts to get them to do what he wants to do e.g. crawl, drink from a cup, climb)

  • poor chewing skills, drooling, poor articulation of speech

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What can be done to help?

Therapy sessions provide a fun and engaging environment in which to practice functional skills. Learning is achieved through play, opportunity to explore problem solving strategies, guided discovery and explicit coaching. Generalisation and transfer of skills to other contexts is promoted.

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The clinic has a range of paediatric oral-motor (eating/feeding) and dressing intervention resources at its disposal and provides advice to caregivers for toileting and sleeping issues.

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Many children require therapy sessions, others just an assessment followed by advice (via a report) in order to achieve their goals.

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Why are assessment and intervention important?

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Independence and self-care skills are important for social integration, feelings of self worth and mastery, access to community, recreational and educational opportunities.


Families who attend the clinic learn a wide range of management strategies to assist their child's learning in self care and independence skills. They are better able to recognise and capitalise on their child's strengths, and are able to carry on the work at home and into the future based on the additional understanding and 'treasure chest' of techniques they gain in therapy. They are better able to provide opportunities for success, thus reducing anxieties and increasing self confidence and esteem.

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Why might my child have independence skills challenges?

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Common reasons are:

  • intellectual disability

  • developmental delay

  • sensory processing difficulties

  • Dyspraxia/ Developmental Coordination Disorder

  • a genetic disorder or syndrome

  • a neuro-muscular disorder or cerebral palsy

  • a social communication/interaction difficulty (e.g. Autism Spectrum Conditions) affecting initiation and motivation to engage in daily living tasks

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