Routines help family members know who should do what, when, in what order and how often.

Family routines help children feel safe and secure.

For children with disability, autism or other additional needs, routines can also be a way to develop new skills.

Good routines are ones that suit your family.

It’s also good if routines can be flexible when circumstances change.

Routines are how families organise themselves to get things done, spend time together and have fun. Routines help family members know who should do what, when, in what order and how often.

Some routines might be for things you do every day – for example, getting ready for bed.

These routines might involve things like having a bath, putting on pyjamas, brushing teeth, going to the toilet, reading a story and going to sleep.

You do these in the same order each day.

Other routines can be weekly or occasional ones.

Examples might be going to the park a few times a week, going to playgroup on Tuesdays, or doing the shopping on Wednesdays.

There’s no rule about how many or what kind of routines you should have.

What works well for one family might be too strict and structured for another.

An organised and predictable home environment helps children feel safe and secure, including children with disability, autism or other additional needs.

Routines can be especially helpful when things are stressful or when children are going through difficult stages or experiences.

They can free up time for you to think about other things and help you feel more organised.

You can also use routines to introduce fun family activities like games nights or reading books together.

Activities like these are good for relaxed family bonding and togetherness.

Just like typically developing children, some children with disability, autism or other additional needs like and need routine more than others.

So the best routines will be the ones that suit you and your child, and that make your daily family life easier.

Effective routines also generally share 3 key features:

• Well planned – good routines are clear, and everyone in the family understands their role and knows what they need to do.
• Regular – good routines become part of everyday family life.
• Predictable – in a good routine, things happen in the same order each time.

You might need to adjust your routine if your situation changes.

What works well for you or your child at one point in time might not be the best at other times.

Or you might need to be flexible if your child isn’t well or hasn’t slept well or you go on holiday.

Or you might find after a break that you need to bring your routines back in gradually.

Self-regulation is a person’s ability to adjust and control their energy level, emotions, behaviours and attention. Appropriate self regulation suggests that this adjustment and control is conducted in ways that are socially acceptable.

Self-regulation development occurs in the following manner:

• 12-18 months is when children become aware of social demands and develop the ability to change their behaviour when a parent asks. In most cases, this early step in self-control requires an adult to be nearby and directing behaviour.
• By 2 years of age, this ability improves to the point where children start to develop self-control, or the ability to follow others behaviour guidelines more often even when mum and dad aren’t around.
• Then by 3 years old, most children can generalise self regulation strategies used from previous experiences. In other words, children will act in ways that reflect how they think mum or dad would want them to act in different situations.

The processes involved in self-regulation can be divided into three broad areas: sensory regulation, emotional regulation and cognitive regulation.

• Sensory Regulation: Allows children to maintain an appropriate level of alertness in order to respond appropriately across environments to the sensory stimuli present.
• Emotional Regulation: Allows children to respond to social rules with a range of emotions through initiating, inhibiting, or modulating their behavior in a given situation to ensure social acceptance.
• Cognitive Regulation: Allows children to use cognitive (mental) processes necessary for problem solving and related abilities in order to demonstrate attention and persistence to tasks.

Self-regulation skills are linked to how well children manage many tasks during early childhood.

With these skills, children are more able to manage difficult and stressful events that occur as part of life, such as the loss of a pet, death of a family member or family separation.

This helps to decrease the ongoing impact of stress that can contribute to mental health difficulties.

As a child learns to self-regulate, skills such as concentrating, sharing and taking turns also develop.

This enables a child to move from depending on others to beginning to manage by themselves.

Most children at some stage will struggle to manage their feelings and behaviours, particularly when they are tired, hungry or facing new experiences.

When this happens, they might become upset, sulky or angry.

This is all part of being a young child and is not necessarily cause for concern.

If however this is problematic on a regular basis and there are seemingly little reasons for a child to be displaying such behaviours it is likely to be problematic in that it will impact upon academic performance.

• Behaviour: The actions of a person, usually in relation to their environment.
• Sensory processing: Accurate processing of sensory stimulation in the environment as well as in one’s own body.
• Emotional Development/regulation: Involving the ability to perceive emotion, integrate emotion to facilitate thought, understand emotions and to regulate emotions.
• Attention and Concentration: Sustained effort, doing activities without distraction and being able to hold that effort long enough to get the task done.
  Executive Function: Higher order reasoning and thinking skills (e.g. what would mum want me to do in this situation?).
• Planning and sequencing: The sequential multi-step task or activity performance to achieve a well-defined result.
• Receptive Language: Comprehension of spoken language.
• Social skills: Are determined by the ability to engage in reciprocal interaction with others (either verbally or non-verbally), to compromise with others, and be able to recognize and follow social norms.
• Working memory: The ability to temporarily retain and manipulate information involved in language comprehension, reasoning, and learning new information.

If a child has difficulties with self regulation they might:

• Be under-reactive to certain sensations (e.g. not noticing name being called, being touched, high pain threshold).
• Appear lethargic/disinterested; appearing to mostly be in their ‘own world’.
• Have difficulty regulating their own behavioural and emotional responses; increased tantrums, emotional reactive, need for control, impulsive behaviours, easily frustrated or overly compliant.
• Have tantrums that last for longer than typical
• The number of tantrums or behavioural episodes per day is more than typical
• Is difficult to discipline
• Typical behavioural strategies are ineffective.
• Is easily distracted, shows poor attention and concentration.
• Has poor sleep patterns.
• Loves movement. Seeks out intense pressure (e.g. constant spinning, running around, jumping, crashing in objects/people).
• Has delayed communication and social skills, is hard to engage in two-way interactions.
• Prefers to play on their own or has difficulty in knowing how to play with other children.
• Has difficulty accepting changes in routine or transitioning between tasks.
• Has difficulty engaging with peers and sustaining friendships.

When a child has self regulation difficulties, they might also have difficulties with:

• Heightened reactivity to sound, touch or movement.
• Being under-reactive to certain sensations (e.g. not noticing name being called, being touched, high pain threshold).
• Appearing lethargic/disinterested; appearing to mostly be in their ‘own world’.
• Being easily distracted, showing poor attention and concentration.
• Have poor motor skills; appearing clumsy, have immature coordination, balance and motor planning skills, and/or poor handwriting skills.
• Have poor sleep patterns
• Have restricted eating habits or be a picky eater.
• Become distressed during self-care tasks (e.g. hair-brushing, hair-washing, nail cutting, dressing, tying shoe laces, self-feeding).
• Love movement so they seeks out intense pressure (e.g. constant spinning, running around, jumping, crashing into objects/people). or
• Avoid movement such as avoiding movement based play equipment (e.g. swings, slides etc).
• Appear floppy or have ‘low muscle tone’, tire easily and shows a slumped posture.
• Perform tasks with too much force, have big movements, move too fast, write too light or too hard.
• Have delayed communication and social skills, is hard to engage in two-way interactions.
• Prefer to play on their own or have difficulty in knowing how to play with other children.
• Have difficulty accepting changes in routine or transitioning between tasks.
• Have difficulty engaging with peers and sustaining friendships.
• Display risky behaviours in play.
• Flits between play activities, instead of sticking with one long enough to actually engage in it.
• Seem less ‘mature’ than other of the same age.
• Being emotionally labile (showing rapidly fluctuating emotion levels in a short time).

• Trialing Management strategies: Trialing and refining the variety of management strategies as not all management strategies work with all children.
• Sensory Processing: Enhancing the child’s efficient and appropriate response to sensory stimulation through therapeutic intervention.
• Social stories: Visually depicted stories which are used to teach children specific social skills that they may find confusing or difficult to understand. The goal of the story is to increase the child’s understanding by describing in detail a specific situation and suggesting an appropriate social response.
• Role playing: As a means of addressing possible scenarios to teach appropriate ways to act and interact.
• Improve language and communication to improve the ability to cognitively regulate better.
• Alert (Engine) program to promote self-regulation through sensory and cognitive strategies.
• M.O.R.E program implementation using motor components, oral organization, respiratory demands, and eye contact to assist with sensory regulation.
• The Wilbarger Protocol (Deep Pressure Proprioceptive Technique sometimes known as the “Brushing” program) is a therapy program designed to reduce sensory or tactile defensiveness and assist with sensory regulation.

• Sensory diet to provide sensory feedback to the body which enables better sensory regulation.These activities might include:
  Wheelbarrow walking
  Animal walks
  Trampolining
  Cycling
  Swings (forward and back, side to side, rotary)
  Rough and tumble play / squishing or sandwiching with pillows or balls.
  Wearing a heavy backpack
  Weighted items (wheat bag on lap while sitting or heavy blanket for sleep).
  Chewy toys
• Discrete skills: Activities that have a defined start and end point such as puzzles, construction tasks, mazes, and dot to dots.
• Narrowly focused tasks: Sorting, organising and categorising activities (e.g. card games such as Uno, Snap or Blink).
• Visual schedules enable a child to see and understand what is going to happen next. Schedules also help people to organise themselves and to plan ahead.
• Timers help with transitions as they tell the child how long and when they are going to have to do an activity.Timers also allow us to pre-warn the child when a favoured activity is coming to an end.
• Talking/question counters for the over-talkers: For small discrete periods of time where the child is engaged in an activity, provide a series (maybe 5) of talking or question counters. Each time the child talks or asks a question one counter is removed.
• When the child has no more counters, adults do not respond and the child learns to hold onto questions and when to ask them.

When children have difficulties with self regulation difficulties, they might also have difficulties with:

• Anxiety and stress in a variety of situations leading to difficulty reaching their academic potential.
• Appropraite behaviour, contributing to extreme fatigue as they may have an inability to settle themselves to sleep.
• Challenges working in small groups/with others for play or group learning tasks.
• Making and keeping friends.
• Families of a child experiencing self regulation difficulties are also likely to be negatively impacted through stress and the inability to participate in day-to-day activities due to their child’s difficulty coping with change.

**Please note that the diagnostic criteria has changed as of May, 2013. Autism Spectrum Disorder now is a single category that encompasses Autistic Disorder, Asperger’s Disorder and PDD-NOS. The label of Asperger’s Syndrome is no longer a diagnostic label.

Asperger’s Syndrome is one of several Autism Spectrum Disorders (ASD) characterised by difficulties in social interaction and by restricted, stereotyped patterns of behaviour, interests and activities.

It is distinguished from the other ASDs in having no general language delay, language disorder or delay in cognitive development.

Although not mentioned in standard diagnostic criteria, motor clumsiness and atypical use of language are frequently reported.

As a pervasive developmental disorder, Asperger’s Syndrome is distinguished by a pattern of symptoms rather than a single symptom.

• Impairment in social interaction
• Stereotyped and restricted patterns of behaviour, activities and interests.
• No significant delay in cognitive development or general delay in language.
• Intense preoccupation with a narrow subject.
• One-sided verbosity, restricted rhythm, stress and intonation in speech and motor clumsiness are typical of the condition, but are not required for diagnosis.

• Poor understanding of the conventions of social interaction.
• Poor imaginative play.
• Being resistant to change.
• Preference for solitary play.
• Being very literal in what they say and how they understand what others say. For example, if told to ‘get lost’ (meaning ‘go away’), a child with Asperger’s Syndrome may leave the place and try to become lost.
• Poor conversational skills and may talk too much or too little.
• Poor ‘listening’ skills, despite intact hearing.
• Interrupting others and taking over a conversation to talk about their own area of personal interest, failing to notice that other people are not interested in what they are saying.
• Fail to notice that other people are not interested in what they are saying
• Find it difficult to understand the non-verbal language of others (such as facial expressions, gestures and body movements) or the rules of social behaviour.
• They often appear rude or uncaring because they interrupt, have trouble taking turns, move too close to other people or make limited eye contact.
• May be extremely sensitive to criticism and need continual reassurance.
• May have an exaggerated sense of what is right or fair, especially in relation to how other people should treat them.
• May be unable to predict what other people will do in response to their actions.
• May become quite angry and aggressive when things do not happen as they want or expect. They may have prolonged tantrums.
• Have narrow areas of interest and may learn all there is to know about one special thing (such as cars, trains, computers, astronomy, insects, etc).

• Routine/planned and structured events.
• A good knowledge of the child strengths and weakness, and areas of extreme interest.
• Extra time/support to transition to school.
• 1:1 support at school, if available.
• The use of social stories to train appropriate responses in social situations.

• Expanding abilities: Actively working on broadening their range of skill areas and interests.
• School/preschool transition: Providing additional support in the transition into school or preschool and liaising with teachers as required.
• Pre-warning: Giving advance notice of change to routine and instructing parents and teachers of appropriate strategies to implement in other environments.
• Visual cues can be used at home and preschool/school to reduce anxiety regarding expectations of tasks, to support routine and to introduce new, or a change in, tasks.
• Social stories: Developing social stories to help a child understand routines and how to respond in certain situations. This will improve a child’s ability of knowing when to talk and what sort of conversation conventions may be appropriate.
• Physical skills: Developing strength and coordination to enable a child to participate in a multitude of co-curricula activities which will be a good vehicle for social interaction.
• Sensory processing: Improving sensory processing of the child so they are able to demonstrate their skills across a wider variety of environments.
• Behaviour management: Teaching families to use a consistent approach to manage behaviour (e.g. if the child finds that every time they are given a direction, the same response is expected, or that every time they react in a certain way, the same consequence follows, they will learn the appropriate behaviour far more quickly).
•  Daily activities: Helping the child to understand the environment, routines and language.
• Developing language: Helping the child to understand and use richer language and to use their skills more spontaneously.
• Conversation skills: Developing conversation skills (e.g. back and forth exchange, turn taking).
• Concept skills: Developing concept skills, especially abstract concepts such as time (e.g. yesterday, before, after).
• Visuals can be used to help with understanding and a child’s ability to express their needs, wants, thoughts and ideas.
• Social skills: Development of social skills (i.e. knowing when, how to use language in social situations).
• Enhancing verbal and non-verbal communication including natural gestures, speech, signs, pictures and written words.
• Visual strategies: Using visual information to help understand, organise and plan daily routines.
• Social stories to help a child understand routines and how to respond in certain situations.

• Following instructions within the home, preschool or school environment.
• Understanding jokes and figurative language during interactions with others, and when watching TV shows and movies and reading books.
• Managing a full school day due to poor strength and endurance.
• Participating in sporting activities leading to an inactive lifestyle, increasing the risks of other health related issues such as obesity, diabetes, cardiovascular disease or similar conditions.
• Self esteem and confidence when they realise their skills do not match their peers.
• Bullying when others become more aware of the child’s difficulties.
• Fine motor skills (e.g. writing, drawing and cutting) due to poor core stability, meaning they do not have a strong base to support the use of their arms and hands.
• Completing self-care tasks (e.g. doing up shoelaces, buttons, zips, using cutlery).
• Self regulation and behaviour, as the child is unable to regulate themselves appropriately to settle and attend to a task for extended periods of time.
• Accessing the curriculum because they are unable to attend to tasks long enough to complete assessment criteria.
• Sleep habits, impacting upon skill development due to fatigue.
• Anxiety and stress in a variety of situations leading to difficulty reaching their academic potential.
• Reading/understanding social situations and being perceived as ‘rude’ by others.
• Social communication, such as eye contact, appropriate distance when talking to someone, turn-taking within a conversation.
• Academic performance: Developing literacy skills such as reading and writing and coping in the academic environment.
• Academic assessment: Completing tests, exams and academic tasks in higher education.

Executive functioning is a process of higher brain functioning that is involved in goal directed activities.

It is the part of the brain that enables people to make decisions and direct attention to a range areas in order to be successful in in a more wholsitic goal.

It is similar to an executive of a company who plans out how the resources of the company will be used, decides what the priorities are, decides what direction things will take in the long term and decides what to do when there is conflicting information.

This is a process of understanding the concept that all actions cause a response or have a consequence.

For most people executive functioning occurs without conscious thought and we improve as we mature.

For some, however, they require explicit guiding to develop appropriate strategies to overcome their lack of innate functioning.

Executive functioning deficits are not a diagnosis in themselves, but they make any other diagnosis that much more difficult to address.

The skills involved in executive functioning allow us do the following:

• Initiate: Beginning a task or activity.
• Impact of difficulty: May have trouble getting started on homework or independent tasks.
• Inhibit: Not acting on an impulse or stopping one’s own inappropriate activity at the proper time.
• Impact of difficulty: May have trouble stopping negative behavior or acts without thinking.
• Shift: The ability to move from one situation, activity, or aspect of a problem to another as the situation demands.
• Impact of difficulty: Can get stuck on a topic or tends to perseverate on ideas or actions.
• Plan: Anticipating future events, setting goals, and developing appropriate steps ahead of time to carry out an activity.
• Impact of difficulty: May start assignments at the last minute; does not think ahead about possible problems.
• Organise: Establishing or maintaining order in an activity or place; carrying out a task in a systematic manner.
• Impact of difficulty: Often has a scattered or disorganised approach to solving a problem; is easily overwhelmed by large tasks or assignments and unsure where to begin.
• Self-monitor: Checking on one’s own actions during, or shortly after finishing, the task or activity to ensure appropriate attainment of goal.
• Impact of difficulty: Unlikely to check work for mistakes; is unaware of own behavior and its impact on others.
• Working memory: Holding information in the mind for the purpose of completing a specific and related task.
• Impact of difficulty: Trouble remembering things, even for a few minutes; when sent to get something, forgets what he or she is supposed to get.
• Emotional control: Modulating/controlling one’s own emotional response appropriate to the situation or stressor.
• Impact of difficulty: Is easily upset, explosive; small events trigger a big emotional response.

Executive functioning is in fact the underlying skill for many other areas of development and as such there are no other building blocks relevant.

There are, however, important key concepts that help develop executive functioning skills that all parents and carers should be aware of.

If a child has executive functioning difficulties they might:

• Have difficulty with goal setting
• Show little awareness of the process involved in how things happen.
• Have difficulty getting started on a task.
• Live in the current moment and not think for the future or about consequences.
• Be unable to reflect on past experiences to plan for the future, resulting in discipline measures producing little change.
• Use the same strategy to solve a repeated problem, even if proven ineffective.
• Change from impulsive to rigid rapidly, often when there is an increase in anxiety.
• Have difficulty adapting to change.
• Rarely match a strategy to a problem.
• Have low self esteem and is unrealistic about their abilities.
• Have difficulty overriding an emotion in order to behave appropriately.
• Locate the source of their troubles outside their control.
• Have a low tolerance for failure.
• Skip steps in a procedure and is baffled when the outcome is not reached.
• Have difficulty putting a sequence of steps in order or realising there are sub goals in a task.
• Have difficulty shifting perspectives.
• Need prompting to consider the feelings of others.
• Fail to see the ‘big picture’ of a task or situation.

• Behaviour: The child’s actions, usually in relation to their environment or task demands.
• Self regulation: The ability to obtain, maintain and change one’s emotion, behaviour, attention and activity level appropriate for a task or situation in a socially acceptable manner.
• Social skills: Determined by the ability to engage in reciprocal interaction with others (either verbally or non-verbally), to compromise with others, and be able to recognize and follow social norms.
• Academic performance: The ease with which a student is able to complete academic tasks.
• Attention and concentration: Sustained effort, doing activities without distraction and being able to hold that effort long enough to get the task done.

• Rationale: When a child learns new skills, provide the rationale behind them or things like planning for the task might feel like a waste of time.
• Outline steps: Support the child by defining the steps involved in tasks ahead of time to make a task less daunting and more achievable.
• Use aids: Use tools like time organisers, computers, ipads, or watches with alarms.
• Visuals: Prepare visual schedules and review them several times a day.
• Provide 2 types of information: Provide the child with written (or visual) instructions as well as oral instructions.
• Create checklists and “to do” lists, estimating how long tasks will take. Use checklists for getting through assignments. For example, a student’s checklist could include items such as: get out pencil and paper; put name on paper; put due date on paper; read directions.
• Use calendars to keep track of long-term assignments, due dates, chores, and activities.
  Improve working environment: Assist the child to organise their work space and minimise clutter.
• Teacher meetings: Meet with a teacher or supervisor on a regular basis to review work and troubleshoot problems.
• Establish routines to try to consolidate skills and memory of what needs to be done.

• Cut and paste projects requiring multiple steps in which they must complete tasks in a sequential manner.
• Mind mapping to assist the child to get ideas down on paper strategically.
• Games: Planning and problem solving games such as puzzles or games like ‘Go Getter’ (River & Road game).
• Lotus diagrams: Use lotus diagrams with the child to help with structuring thoughts on paper whilst creating clear expectations as to how much to write.
• Block building: Get the child to copy block designs from a picture or a 3D model.
• Drawing: Draw a picture as a model. Then draw an incomplete version of the same picture and ask the child to finish the picture to make it look like the model.
• Practice goal setting with the child (e.g. Help the child to set attainable goals that are well-defined).
• Break goals down into smaller steps and talk about alternative approaches with the child.
• Recall games that require the child to recall information such as Memory: “I went to the shops and bought a…”.
• Multi-tasking: Practice doing a number of activities at once (it may be helpful to number the activities) to encourage the child to learn to shift from one activity to another.

• Making friends and poor self-esteem.
• Inability to cope with the demands of school or life.
• Poor work and organisational habits.
• Frequently loosing track of personal items.
• Poor academic results.
• Not completing school work or daily chores in a timely manner.
• Having grandiose ideas of what they wish to achieve but not being able to achieve it pragmatically.

Developmental delay is the term used when a young child is slower to reach milestones than other children.

Delay may occur in the way a child moves, communicates, thinks, learns or behaves with others.

The features noted will vary according to the area(s) of delay, but can include:

• Difficulties producing controlled speech (e.g. making speech and/or sequencing sounds and words).
• Difficulty controlling breathing and phonation.
  Slow language development resulting in a language delay.
• Difficulties combining physical movements into a controlled sequence, learning basic movement patterns and/or remembering the next movement in a sequence.
• Difficulties establishing the correct pencil grip and age appropriate speed of writing.
• Poor balance (sometimes even falling over in mid-step).
• Problems with spatial awareness (e.g. fitting objects into appropriate sized spaces such as puzzles, and knowing left from right).
• Trouble picking up and holding onto simple objects due to poor muscle tone.
• Trouble with body awareness, such as applying more force than intended, determining the distance between themselves and objects and invading other people’s personal space without recognising this.
• Difficulties achieving and maintaining continence (of bladder, bowel or both).
• Bed-wetting (nocturnal enuresis) is common.

• A lack of hand-eye coordination, which causes problems with basic skills such as throwing and catching.
• Heavy reliance on seeing how things are done to learn movements (verbal input is often insufficient).
• Uncoordinated physical movements, awkward postures and running styles.
• Inadequate whole body (gross motor) control skills (e.g. they may find it difficult to stand on one leg or handle equipment like a bat or racquet).
• Requiring more than typical time and effort to master a new physical skill.
• May not retain the skill if practice ceases (e.g. swimming lessons that cease over the school holidays can see these children needing to relearn the skills gained before the holidays).
• Unable to anticipate what might happen next (e.g. in sport cannot ‘read the play’ to realise that the ball may be sent their way).
• Failure to respond quickly to their surroundings (e.g. may stand still when a ball is kicked to them).
• Has a lower level of athletic abilities compared to other children of the same age.
• Shows evidence of hand dexterity (fine motor) control problems, such as untidy writing.
• Understanding of the conventions of social interaction.

• Encouragement to persist and attempt tasks.
• Liaison between health professionals and educational staff to provide information to be incorporated into an education plan and/or implementing ideas/suggestions/activities to help improve the child’s speech skills and ability to access to the curriculum.
• Provide extra time to complete tasks.
• Recognise and reinforce the child’s strengths.
• Opportunities to succeed
• Visuals such as signs or pictures can be used to facilitate and support a child’s understanding.
• Visual aids (e.g. pictures, gestures, body language, facial expression) can be used to assist the child’s comprehension and recall of the instruction.
• Using simple language whilst playing with your child.

• Underlying skills: Developing the underlying skills necessary to support whole body (gross motor) and hand dexterity (fine motor) skills.
• Confidence: Building confidence to enable a child to willingly participate in activities.
• Task complexity: Mastering a skill first and then gradually increasing the demands of it (much more slowly than with more typical learners).
• ‘Just right’ tasks: Presenting the activities at the ‘just right challenge’ level (that is not too hard for the child) or lower than this to build self confidence and encourage task engagement (it is common for these children to shut down when they perceive a task to be too hard).
• Simplifying tasks to the smallest possible components.
• Use specific language: Use of simple and concise language.
• Brief instructions where the child is not required to remember a long list of things to do.
• Non-verbal cues: Use physical and visual models or instructions (wherever possible) not just verbal.
• ‘Backwards chaining’: Mastering the last step of the activity first and then the second to last.
• Chunking information: Learning to perform or associate multiple steps together once the individual steps are mastered separately.
• Developing attention: Complete activities to support attention.

• Vocabulary whereby a child cannot clearly get their message across due to limited word knowledge.
• Learning to talk, speech intelligibility and clarity.
• Managing a full school day due to poor strength and endurance.
• Participating in sporting activities leading to an inactive lifestyle, increasing the risks of other health related issues such as obesity, diabetes, cardiovascular disease or similar conditions.
• Self esteem and confidence when they realise their skills do not match their peers.
• Fine motor skills (e.g. writing, drawing and cutting) due to poor core stability, meaning they do not have a strong base to support the use of their arms and hands.
• Completing self-care tasks (e.g. doing up shoelaces, buttons, zips, using cutlery).
• Self regulation and behaviour, as the child is unable to regulate themselves appropriately to settle and attend to a task for extended periods of time.
• Accessing the curriculum because they are unable to attend to tasks long enough to complete assessment criteria.
• Social communication, such as eye contact, appropriate distance when talking to someone, turn-taking within a conversation.
• Social isolation because they are unable to cope in group situations or busy environments, impacting on their ability to form and maintain friendships.
• Academic performance: Developing literacy skills such as reading and writing and coping in the academic environment.
• Academic assessment: Completing tests, exams and academic tasks in higher education.

Dyspraxia is a neurological condition that affects a child’s ability to perform motor tasks.

Children with dyspraxia are often overly clumsy and they are more likely than others to have ADHD.

If your child struggles with persistent clumsiness, gross motor movement, and physical coordination, you might consider pursuing an evaluation for dyspraxia, a condition with significant ADHD overlap.

Dyspraxia is a neurological disorder that affects a child’s ability to plan and process motor tasks.

Children with dyspraxia appear awkward when moving their whole body, or use too much or too little force.

When a child has dyspraxia, he can’t imitate others, often mixes up the steps in a sequence, and can’t come up with new ideas during play.

Dyspraxia is sometimes called “clumsy child syndrome” and is often considered ubiquitous with Developmental Coordination Disorder (DCD), a unique but very similar diagnosis also associated with poor eye-hand coordination, posture, and balance.

Dyspraxia-related coordination difficulties affect all aspects of daily life — for example, brushing teeth, getting dressed, and doing laundry.

Though dyspraxia research is growing, the condition is often misunderstood or diagnosed improperly.

Well-intentioned professionals dismiss symptoms of dyspraxia by saying, “Oh, he’s just an active boy” or “She will come around eventually.”

But an overdue diagnosis of dyspraxia can greatly affect the self-confidence and achievement of a child, even if he or she has an average or above-average IQ.

• Delayed early motor development
• Delayed language development
• Repetitive behaviors and frequent motor activity
• Highly emotional
• Feeding difficulties
• Sleeping difficulties
• Toilet training may be delayed

• Can’t stay in one place for longer than 5 minutes, constantly tapping feet or hands
• Speaks too loud, easily distressed
• No sense of danger
• Clumsy, constantly bumping into things
• Associated mirror movements (hands flap when running or jumping)
• Trouble with fine motor skills — when handwriting, using scissors and eating utensils, tying shoes, buttoning clothes
• Limited response to verbal instructions
• Sensitive to sensory stimulation
• Difficulty with speech, concentration and memory

Many of the signs listed above are similar to ADHD symptoms, and they persist through a child’s development.

Additionally, a child with dyspraxia may learn well in a one-on-one setting, but struggle in a class with other children around.

He or she may also avoid physical sports and particularly struggle with math and writing homework.

• Occupational Therapy: An occupational therapist helps children with dyspraxia develop skills specific to the daily tasks that challenge them most.
• Speech and Language Therapy: A pathologist will administer a speech assessment used to develop a treatment plan to help your child communicate more effectively.
• Perceptual Motor Training focuses on language, visual, auditory, and movement skills. Children with dyspraxia are given a set of tasks that gradually become more advanced, challenging the child but not so much that become stressed.
• Active Play: Anything that involves physical activity, inside or outside the home, helps improve motor play.

Break complicated tasks into smaller steps. Master one before moving on to the next one.

For example, when teaching shoe tying, make sure your child can independently complete the first step of making the knot.

Use pictures or video modeling to illustrate the sequence of steps in doing a difficult task.

Use multi-sensory teaching. Add songs, movements, scents, and textures to learning a new task.

Use a song or rhyme when learning to tie shoes.

When learning how to form letters, trace a letter onto sandpaper, paint it, or form it with scented dough.

Create an obstacle course in or outside your home.

Have your child try to complete the course without shoes to stimulate sensory receptors in the feet.

Add beanbags, soft mats, swings, and cut pool noodles in half to make balance beams.

Purchase a scooter board.

The obstacle course builds motor skills in a fun way.

Let your child plan the course and give her different commands, such as, “Now crawl like a puppy.”

Imitating animals is fun and builds creativity and muscle strength.

Allow children to use pencil grips, scissors with self-opening handles, and other therapeutic tools that hone fine motor skills.

Begin with verbal and physical cues, then ask your child to name the next step.

Look into Cognitive Orientation to daily Occupational Performance (CO-OP), an active treatment approach that uses mutual goal-setting, analysis of a child’s performance, and high-level cognitive (thinking) strategies to improve motor-based skills.

Auditory processing disorder (APD) is a hearing problem characterized by deficits in how the brain processes auditory input.

Children with APD struggle to make sense of what they hear — a symptom that is easily mistaken for other conditions and learning disabilities.

Auditory processing disorder (APD) throws a child’s ears and brain out of sync.

This misalignment can cause a range of challenges – struggles with auditory discrimination, with listening in noisy environments, with remembering what you’ve heard, and with recalling the sequence of words spoken – that may resemble (and co-occur with) other conditions.

APD may interfere with learning, however it is not correlated with intelligence.

It may cause communication difficulties, but it does not show up in traditional auditory tests for hearing loss.

It is a misunderstood and largely overlooked condition that may appear in 3% to 5% of all children.

Normal auditory processing occurs when the brain receives auditory input and processes the information into something meaningful at an acceptable speed.

Auditory processing disorder may cause deficits at any point in this process.

• Auditory discrimination: noticing and differentiating similar but unique sounds
• Auditory memory: remembering what was heard
• Auditory sequencing: recalling words and directions in the correct order
• Auditory figure ground: discerning and processing a single audio input amid competing stimuli (e.g., background noise)
• Auditory cohesion difficulty, or problems processing when undertaking higher-level listening tasks (e.g., difficulty drawing inferences from conversation, picking up on tone and inflection, understanding riddles.)

The signs of auditory processing disorder often include the following daily challenges and manifestations:

• Trouble following verbal directions (“Huh? What did you say?”)
• A blank stare when spoken to; may appear distracted or unfocused
• Trouble following conversations with multiple speakers or background noise, no matter how minimal (“It’s too noise in here!”)
• Difficulty distinguishing similar-sounding words, like “coat” and “boat”
• Trouble following multi-step directions in the correct order
• Noticeable delay in responding to conversational questions

In addition to these communication difficulties, APD may trigger the following additional challenges for students:

• Behavior problems: Auditory processing issues can cause children to feel embarrassed and frustrated. They may react by becoming defensive, or cover by acting disinterested. Teachers sometimes assume that students with undiagnosed APD are ignoring instructions and displaying defiance.
• Poor social skills: Difficulty keeping up with conversations, especially in loud, active environments (like the playground, school auditorium, and classroom), can cause children to miss out on friendships and other connections. They might withdraw from social settings or compensate by acting as the class clown, or by pretending they don’t care.
• Anxiety: When children can’t trust that what they’ve heard is accurate, they may feel flustered and stressed, which could contribute to anxiety, which further impairs auditory processing.
• Academic challenges: Poor auditory processing abilities could put children at a greater risk for learning difficulties,3 and research suggests that many children with APD also have comorbid language or reading impairment.4 APD affects a child’s ability to interpret information (a problem when so much of it is delivered verbally in the classroom), which is fundamental for learning.

Though APD can occur independently or alongside other conditions, it is often overlooked altogether. These missed diagnoses often happen because APD’s challenges overlap with those of other conditions.

Though APD and attention deficit hyperactivity disorder (ADHD or ADD) share similar signs, the why behind the manifestations differ significantly. (If ADHD is also present, that only complicates the picture.) In children with APD, the following may be true:

• Inattention may be due to an overwhelming number of concurrent auditory directions, or because the child needs time to process information.
• Hyperactivity may be due to sensory overload, especially in noisy environments.
• Fidgeting may help a child focus and process information.
• Challenges with behavior, social skills, and academic achievement may all be traced back to problems processing auditory input.

Remediation, Skill-Building, and Accommodations

These activities and accommodations, broken down by the auditory processing components they address, can help improve communication skills and the overall learning experience.

Auditory Discrimination: Exercises

• Ask your child to identify whether a sound is “loud” or “soft.” Give examples in advance.
• In everyday life, stop to identify the source of a sound – Is it a car? An animal? A fellow student?
• Listen to and repeat a sound pattern.

Auditory Discrimination: Accommodations

• Speak clearly, but at a normal volume, so that students can discern individual words; consider a sound amplification system.
• Repeat instructions often, especially if they contain similar-sounding words.
• If you’re wearing a facemask, use a clear film so students can lip-read.
• Allow the student additional time to process verbal information and offer a response.
• Allow students to use response cards to convey information (instead of verbal answers).

Auditory Figure Ground: Exercises

• Ask students to close their eyes and point to the physical source of a sound.
• Record a conversation and ask students to listen and reflect on what they learned.
• Experiment with music; have your child or student repeat lyrics from different songs. (Take note of what type of music is most challenging in this exercise.)

Auditory Figure Ground: Accommodations

• Sit students with APD close to the board and to your voice.
• Minimize distracting noises in the classroom.
• Allow students to wear headphones to block out background sounds while working.
• Consider providing environmental accommodations by improving the classroom carpeting and acoustics.
• Important: Teach students to be alert to safety issues and instructions (like fire alarms and protocols).

Auditory Memory: Exercises

• Give simple auditory directions and gradually add on to them (e.g. play the “I went to the market” game).
• Rehearse poems.
• Teach word associations (word webs) and mnemonics.
• Use visuals (like graphic organizers) and multi-sensory approaches to support auditory information. Redundancy builds fluency.

Auditory Memory: Accommodations

• Use cues like “this is important” and “be sure to write this down” when delivering information verbally. Look out for “Swiss cheese notes,” which are incomplete due to hurried writing to keep up with the teacher’s key points, and trying to record what the teacher says while the teacher continues to talk.
• Repeat instructions and important information.
• Provide written class notes prior to the lesson (to allow students to review prior to and after class) or use a note taker.
• Allow students to use voice-to-text software and other assistive technologies.

Auditory Sequencing Exercise

• Dictate simple directions, out of order, and have the student write them down. Make sure to use vocabulary the student understands.
• Ask the student to arrange the directions in order.
• Provide them with clues as needed. Optional: Have them draw a picture of each direction and rearrange the visuals in order.
• Have the student dictate the directions they arranged and complete each direction.

If a student struggles with written expression, skip the written portion of this activity. Have the student use visuals and other methods to convey sequence.

Auditory Sequencing: Accommodations

• Delivery simple instructions one at a time, and repeat as necessary.
• Provide visual cues showing procedure.
• Provide written instructions or cue cards.

Auditory Cohesion: Exercises

• Dictate a statement and ask the student what they can infer from it (e.g., reading between the lines, picking up on emotion, mood). Reword your statements if necessary. You can also use scenes and snippets from movies, TV shows, and audiobooks for this exercise.
• Explain your emotion when addressing a student. (“I’m happy you applied lots of effort in class.”)
• Rehearse challenging social situations.

It’s important to teach children with APD (and any other learning difficulty) compensatory skills to help boost their self-esteem and motivation.

• Talk to your child or student about their strengths, and about their challenges. Always lead with their gifts and assets, especially when they are learning a new skill.
• Always point out a student’s successes with affirming statements: “I noticed you were really paying attention in class today. Well done.”
• Attribute their successes to their purposeful effort.
• Teach children and students how to speak up and advocate for themselves – a useful skill for later in life, too. They should know to clearly state their needs (“Multi-step directions are difficult for me to follow due to auditory processing disorder. Can you repeat them or write them down?”
• Remind your child or student that you will always support them, and that they should use supports without shame or embarrassment.

Dysgraphia is a neurological disorder of written expression that impairs writing ability and fine motor skills.

It is a learning disability that affects children and adults, and interferes with practically all aspects of the writing process, including spelling, legibility, word spacing and sizing, and expression.

Dysgraphia is typically identified as a child learns to write.

However a disorder of written expression may remain unrecognized through the early school years as a child’s writing ability continues to develop; dysgraphia may remain undiagnosed until adulthood.

Symptoms of dysgraphia include:

• Trouble forming letters shapes
• Tight, awkward, or painful grip on a pencil
• Difficulty following a line or staying within margins
• Trouble with sentence structure or following rules of grammar when writing, but not when speaking
• Difficulty organizing or articulating thoughts on paper
• Pronounced difference between spoken and written understanding of a topic

Dysgraphia symptoms typically change over time.

Children with dysgraphia generally have trouble with the mechanics of writing and exhibit other fine-motor impairments, while dysgraphia in adolescents and adults manifests as difficulties with grammar, syntax, comprehension, and generally putting thoughts on paper.

Dysgraphia is associated with writing difficulties, whereas dyslexia is associated with reading difficulties.

Both learning disorders share some symptoms, like difficulty with spelling, that may complicate a diagnosis.

It is possible for an individual to have both dysgraphia and dyslexia.

Hearing impairments can range from mild to profound.

People who are hard of hearing may use a range of strategies and equipment including speech, lip-reading, writing notes, hearing aids or sign language interpreters.

• Children with hearing loss have hearing difficulties.
• These difficulties can range from muffled hearing to profound deafness.
• Early diagnosis of hearing loss is important, because it leads to early intervention.
• Early intervention might include therapies, supports and listening devices that help children learn to communicate.
• Children with hearing loss might use spoken language, sign language or a combination to communicate.

If your child is deaf or has hearing loss, it means that your child’s ears can’t do all or any of the things they should be able to do. For example, your child might:

• have muffled hearing
• not be able to hear sounds coming from some directions
• have trouble hearing certain frequencies or sounds.
• Hearing loss can be mild, moderate, severe or profound. It can affect one or both ears.

Deafness or hearing loss can be:

• congenital – this is deafness or hearing loss from birth or soon after birth
• acquired – this is deafness or hearing loss that happens later in life.

There are two main types of deafness or hearing loss – conductive and sensorineural.

Conductive hearing loss is when sounds from outside your child’s ear have trouble getting through the outer or middle ear. Conductive hearing loss is usually caused by middle ear fluid from middle ear infections, and is usually temporary.

Sensorineural hearing loss is when the inner ear or the auditory nerve doesn’t work properly. Sensorineural hearing loss usually lasts for life and can get worse over time.

Mixed hearing loss is when a child has both conductive and sensorineural hearing loss.

The earlier you find out your child has a hearing loss, the sooner your child can begin early intervention and develop language to communicate with.

If your baby is deaf or has hearing loss, they won’t hear people speaking.

This means that your baby might not respond to your voice and other noises in the way you’d expect.

As your baby gets older, you might notice that their speech and language aren’t developing like other children’s.

As a guide, here’s what you’d expect in a typically developing baby.

If your child isn’t doing these things, it might be a good idea to talk to your doctor.

• At 0-4 months, your baby should startle at a loud noise, turn their head or move their eyes to locate the source of the sound. If your baby is upset by the noise, they should calm down when they hear your voice.
• At 4-8 months, your baby should notice sounds nearby, smile when spoken to, babble and understand simple words like ‘bye-bye’.
• At 8-14 months, your baby should respond to their name, say simple words like ‘mama’ and ‘dada’, copy simple sounds and use their voice to get attention from people nearby.
• At 14-24 months, your child will start to develop vocabulary, understand and follow simple instructions, and put 2 words together.

Even if everything seems OK but you still feel worried, you should see your doctor.

The most important thing for your child’s development, and for your relationship with your child, is being able to communicate.

If your child is deaf or hard of hearing, they might use spoken language, sign language or a combination of sign and spoken language to communicate.

Many families choose to teach their child to both speak and sign, regardless of whether the child can use spoken language.

If this is your family’s choice, you and the rest of your family need to learn sign language too.

There are devices that can help your child hear spoken language.

And when your child can hear spoken language, they can start learning to use language.

The right type of device for your child will depend on the type of hearing loss they have and how severe it is.

These devices, called amplification devices or assistive listening devices, include:

• hearing aids
• bone conduction implants
• cochlear implants
• personal frequency modulation (FM) systems.

Your child might use one device, or a combination of devices.

Using a combination might give your child more opportunities to hear sounds because each device does a slightly different job.

Your child might also use these devices in combination with spoken language and sign language.

Many children with hearing loss use assistive listening devices on both ears.

Your child’s audiologist can help you tell whether the devices are helping your child.

Although it’s easy to get caught up in looking after your child, it’s important to look after your own wellbeing too.

If you take care of yourself, you’ll be better able to care for your child.

Talking to other parents can be a great way to get support.

You can connect with other parents in similar situations by joining a face-to-face or an online support group.

If you have other children, they might have a range of feelings about having a sibling with disability.

They need to feel that they’re just as important to you as your child with disability – that you care about them and what they’re going through.

It’s important to talk with your other children, spend time with them, and find the right sibling support for them.

There are various ways of describing people with hearing loss:

• ‘Hard of hearing’ usually describes people who have hearing loss ranging from mild to severe.
• People who are ‘deaf’ (with a small d) usually have profound hearing loss. They might have little or no hearing.
• ‘Deaf’ (with a capital D) usually describes people who use sign language to communicate and who identify as members of the signing Deaf community.