Children struggling with dressing skills may have an underlying difficulty with motor co-ordination, particularly if they are significantly behind their peers. An Occupational Therapy assessment would be recommended for these children. They can be supported to develop skills through a backward chaining approach where the adult starts off the dressing and then the child finishes it off (e.g. adult helps child step feet into trousers and child pulls them up).

Children struggling with scissor skills can be prompted to always place their thumbs on top of both hands, and to point their scissors forward when cutting. Children often need prompts to adjust the position of their supporting hand in order to make it easier to cut a shape. Adapted scissors can be recommended by an Occupational Therapist.

Children struggling with handwriting should be prompted to use a dynamic tripod grasp (where they move their fingers). This can be encouraged with a ‘cross guard ultra grip’ or ‘large ultra grip’ (available from Task Master online). Some children may also need a writing slope to support their wrist position. Children struggling with the positioning of their letters on the line can be encouraged to use ‘sky, grass, soil paper’. Occupational Therapy assessment and intervention can provide recommendations for specific input to help children develop their handwriting and assessment of underlying causes of difficulties.

You should always consult an Occupational Therapist to ensure that you are providing the right type of sensory input for the child. The following are some general suggestions for children with sensory needs. Equipment such as a ‘junior move ‘n’ sit cushion’ is recommended for children who struggle to sit still at their desks. This should be partially inflated so that it is a wedge shape, this will help to promote a good sitting position as well as reduce fidgeting. A gym ball which is a similar height to the child’s knee can be used for children to sit at their desks (with close supervision) in order that they can move while sitting (they should be sitting in a posture with their knees and feet at a 90 degree angle). Theraputty is excellent for children to fidget with while they are listening- a 454g pot is a recommended size as a general guide, young children would need yellow (soft) putty), infants would need red (medium-soft) putty and juniors and above would need green (medium) putty. Please note that Theraputty also develops hand strength and cannot be substituted for Play Doh. Other fidgets include items such as ‘Tangle Junior’ and stretchy men.

Children who struggle to sit still in class may have difficulties with their sense of body awareness or proprioception. Proprioception is our sense of where our body is in space, proprioceptors in our joints send signals to our brain about the position of our body. Regular proprioceptive activities that allow a child to experience pressure through their joints helps to improve their body awareness and therefore reduce fidgeting. Proprioception is also a sensory regulator and therefore will help with general attention and concentration. Activity ideas include walking like an animal (e.g. like a bear or a crab with hands and feet on the floor and bottom in the air) pushing the wall and counting to ten (making sure feet are on the floor, body straight and elbows bent), posture preparation (e.g. pushing hands together and counting to ten, pulling hands apart and counting to ten, giving self a big hug and counting to ten). Some children may need the use of a fidget toy to help them reach the level of sensory input they need in order to be able to attend and concentrate, children should be allowed to use these when teachers are giving the input.

Children typically have an attention span matching their age in years. A child’s attention skills also develop over time and younger children may present with single-channeled attention, in which they are able to attend to only one thing at a time – either looking at their task or listening to instructions. Being aware of which level of attention a child is at can help us tailor activities to match their needs. Some useful strategies for children who struggle with maintenance of attention include: the use of visual timetables to outline their tasks; using now-next boards; using a ‘working for’ token chart. An Occupational Therapist may also recommend regular movement breaks between tasks to help a child regulate their energy and processing levels.

Some children may present with a lack of joint attention skills (in which the child is able to pay attention to something you point out, or something you are showing them). This is a key foundational skill for language learning and is usually targeted first in therapy. For a child who lacks joint attention skills, it is usually recommended to use high-motivation or high-interest toys (like spinners, toys that light up or make sounds) and objects (like food) to engage with the child.

As with all parts of development, children move through stages in their play development as well. Very young babies tend to be able to participate in exploratory and people play, in which they are learning about the world around them and enjoy games with their carers, like ‘peek-a-boo’ and tickles. Young toddlers enjoy cause-and-effect play, like pressing a toy to make it emit a sound. Children around two years of age begin to develop the ability to play with more than one item at once, and use an object based on its function – for example, pretending to drink out of a toy cup. Further on, children develop better imaginative play sequences and are able to play elaborate imaginative games and re-enactments.

To support a child in developing their play skills, adults and carers should play alongside the child and model different ways of playing with a toy at the child’s developmental level – for example, for a young child, people games like peek-a-boo, jumping, and tickles, give opportunities for the child to request ‘more’ and develop interaction skills. For older children, modelling pretend play sequences like pretend-eating toy food, pretend-cooking toy food, or combining different food items to make a sandwich, or feeding and dressing a baby doll, can be helpful.

Comprehension of language is usually referred to as ‘Receptive Language’ by Speech and Language Therapists. Receptive language involves the ability to listen, understand, and carry out instructions and commands, and participate in interactions or conversations.

For a child who has receptive language difficulties, strategies such as slow and staged presentation of information is recommended, in a visual, pictured format wherever possible. For example, writing down a child’s timetable or list of tasks can be helpful. Printing out lesson slides for an older child, or using mind maps/thinking maps to organise information, can also be helpful. Adults should also be aware that children with receptive language difficulties tend to need extra processing time (count to at least five seconds in your head after asking a question or giving an instruction – it’s longer than we think!). Classroom strategies such as SLANT (sit up, listen, ask questions, nod, track the teacher), tracking, and visualisation are also useful strategies to support a child who has receptive language difficulties.

Expressive language is often referred to as a child’s ‘speech’, however, in Speech and Language Therapy terms, ‘expressive language’ refers to the ability to use language to interact and convey meaning clearly through sentences or narratives. It also involves choosing the appropriate vocabulary, and using grammatical forms appropriately.

A child who has expressive language difficulties will usually find tasks like telling a story or formulating sentences using different words or connectives difficult. They may appear to use ‘general all purpose’ words like ‘this’ and ‘that thing’, use the wrong word in a sentence, or be unable to name things that they should be familiar with.

To support a child with expressive language difficulties, it is generally recommended that adults use strategies such as ‘recasting’, in which you repeat the child’s erroneous sentence with corrected grammar or vocabulary, emphasising the correct words. (e.g. Child says ‘The mouses running’, adult says ‘yes, the mice are running’) Semantic cues such as describing the function, appearance, or location of a word the child cannot name can also be helpful in supporting vocabulary development. To increase utterance length for a child who does not produce full sentences, repeating what they have said as a question is also a useful prompt (e.g. Child says ‘boy run’, adult says ‘The boy is running…?’ to prompt for additional information like ‘fast’ or ‘in the park’).

Speech or articulation refers to a child’s ability to produce all the sounds in a language clearly and correctly, especially in connected speech. This may also be referred to as ‘pronunciation’. Speech and Language Therapists assess a child’s ability to produce the sounds they are expected to have developed at their age, and also their general intelligibility (how much of their speech can be understood) in conversation.

Children develop speech sounds over a period of time from birth to around the age of 6, after which most speech sounds in English should be fully developed. Babies as young as 4-6 months begin to develop motor speech patterns through babbling, and children usually gain their first word by 12 months. Children at around 2 years should have gained simple sounds like ‘p’, ‘b’, ‘m’, ‘n’, ‘t’, ‘d’, and their speech sounds continue to develop up to age 6, by which time children should have gained the later developing sounds like ‘th’ and ‘r’. Children may present with developmental speech sound errors between the ages of 2-4, such as ‘fronting’ (‘key’ sounds like ‘tea’, for example), or cluster reduction (‘star’ may become ‘tar’). If you are concerned about a child’s speech sounds, it is best to consult a Speech and Language Therapist.

General strategies that can be helpful in support a child’s speech sound development is to model the correct speech sounds without expectation of copying, e.g. if a child says ‘I see wabbit’, you can say ‘yes, that’s a rabbit’.

Social communication skills refers to a child’s ability to utilise skills such as expressing and understanding body language; forming friendships; initiating, responding to, and participating in interactions or conversations; manage their emotions; and respond to situations assertively. Social communication skills are usually targeted in a small group setting, and schools often find it useful to set up lunchtime or breaktime clubs to support children who struggle with making friends or with other aspects of social communication.

There are many good resources for working on different aspects of social communication skills. Your Speech and Language Therapist may recommend programs such as LEGO Therapy, the Talkabout Social Skills programs by Alex Kelly, or the Superflex program by Michelle Garcia Winner. It is best to work on social communication skills with guidance from a Speech and Language Therapist.

Time taken: 4 hours

The assessment involves:

• General Development Assessment (1 hour – conducted by a developmental paediatrician)
• Autism Diagnostic Interview (1 hour– conducted by a developmental paediatrician)
• Autism Diagnostic Observations Schedule-2 (ADOS-2) (1 hour- conducted by 2 therapists)
• Parent Feedback (1 hour – conducted by the developmental paediatrician)
• Following assessment, there is a comprehensive report written up detailing the results of the assessments.

The assessment is conducted by our Consultant Paediatrician and ADOS-trained therapists.

Time taken: 3 hours

This assessment takes approximately up to 3 hours including a break and is conducted by an Educational Psychologist. We also have a Dyslexia Specialist Assessor who assesses specifically for dyslexia only, for children between the ages of 7-13.

Time taken: 3 hours (including a break)

Our Educational Psychologists can assess and provide advice for the following areas:

• IQ, developmental, and/or academic learning
• Learning difficulties
• Specific learning difficulties (including dyslexia)
• Language and Communication
• Autistic Spectrum Disorders and related social communication disorders
• Neurodevelopmental disorders such as ADHD
• Asperger’s Syndrome
• Education, Health, and Care Plan applications
• Behaviour
• Medico-legal work, including tribunals

Time taken: 1 hour

Assessments Used:

• General Developmental Assessment forms

This assessment is conducted by our Consultant Paediatricians and Occupational Therapists.

Time taken: 90 minutes

Assessments Used:

• Movement ABC
• Detailed Assessment of Speed of Handwriting (DASH)
• Beery VMI
• Informal Assessment and Observations
• General Developmental Assessment

This assessment is conducted by our Consultant Paediatricians and Occupational Therapists.

Please note that the standardised assessments used for the Occupational Therapy assessment will be dependent on the age of the child and the type of referral provided by parents/ teachers etc.

Our Speech and Language Therapists assess the following skills:

• attention and listening,
• play skills
• following instructions,
• vocabulary and word-finding difficulties
• receptive (understanding) and expressive (use of) language,
• auditory processing,
• social communication skills, including: interaction with peers, taking turns, conversational sills,
• speech sounds and sound awareness skills
• stuttering/stammering

Time taken: 1.5 hours

Assessments used:

• Clinical Evaluation of Language Fundamentals (CELF-4)
• Renfrew Action Picture Test (RAPT)
• ACE (6-11)
• CLEAR Phonology Screen Assessment
• Diagnostic Evaluation of Articulation and Phonology (DEAP)
• Informal Assessment and Observation

Please note that the standardised assessments used will be dependent on the age of the child and the type of referral provided by parents/ teachers etc.

Our Occupational Therapists assess the following skills:

• gross and fine motor skills,
• sensory processing,
• attention and focus,
• coordination,
• independent living skills, such as dressing, handwriting, postural control and movement

Time taken: 2 hours

Assessments Used:

• Movement ABC
• Beery VMI
• DASH
• Sensory Profile Questionnaire (this is a parent questionnaire)
• Robert Hedderly Sentence Completion Test
• Informal Assessment and Observation

Please note that the standardised assessments used will be dependent on the age of the child and the type of referral provided by parents/ teachers etc.

Time taken: 1 hour

This assessment aims to help identify potential causes of feeding difficulties in children who are ‘picky eaters’ or who have a restricted diet intake. Our therapists can then provide advice and strategies for home and suggest therapeutic approaches to managing feeding difficulties.

The assessment is carried out either by a Speech and Language Therapist who specialises in feeding difficulties, or an Occupational Therapist, or both.

Our assessments and reports can be tailored for the purpose of Education, Health, and Care Plan (EHCP) applications. We are typically asked to provide the following assessments for EHCP applications:

• Speech and Language Therapy
• Occupational Therapy
• Educational Psychology
• Dyslexia

If you are unsure as to the type of assessment your child needs, your child’s school will generally be able to provide some recommendations. Otherwise, give us a call at +44 (0) 207 467 9520 or email us at wimpolest@londonchildrenspractice.com

Our experienced Speech and Language Therapists and Educational Psychologists are also able to provide in-depth assessment of your child’s needs for legal purposes, or for tribunals.

These assessments generally include the following:

• Classroom observation
• Direct Assessment
• Parent Consultation
• Extensive and Detailed Report

Therapist attendance at tribunals may also be possible.

For more information, contact us at +44 (0) 207 467 9520 or email assessments@londonchildrenspractice.com.