DCD/Dyspraxia in a day 2011 by amanda kirby

A day in the life of the child Developmental Coordination Disorder Supporting the school and home. Professor Amanda Kirby

Sam,9 years of age • • • •

walked at 19 months talked indistinctly at 2 ½ years of age very fidgety and hyperactive at 4 years of age. he usually tells his mother he can’t remember what he has done in school He has an older brother who is in the football team locally and his father coaches. Sam doesn’t want to play. He has one friend in his class, and does not get asked to parties very often. His writing looks like this: Dyscovery Centre copyright 2011 Amanda Kirby. Please do not copy without permission of the author

Prevalence The ALSPAC UK based large population study more recently has shown a prevalence of 1.7% with a further 3.2% of children considered as having "probable developmental coordination disorder" by using broader cut-offs for coordination testing and activities of daily living (Lingham et al,2009). â&#x20AC;˘ 3:1 boys to girls Dyscovery Centre copyright 2011 Amanda Kirby. Please do not copy without permission of the author

Definitions and confusions

Diagnostic criteria for Developmental Coordination Disorder (APA, 2000) A.

Performance in daily activities that require motor coordination is substantially below that expected given the personâ&#x20AC;&#x2122;s chronological age and measured intelligence. This may be manifested by marked delays in achieving motor milestones (e.g., walking, crawling, and sitting), dropping things, â&#x20AC;&#x153;clumsinessâ&#x20AC;?, poor performance in sports, or poor handwriting. The disturbance in Criterion A significantly interferes with academic achievement or activities of daily living. The disturbance is not due to a general medical condition (e.g., cerebral palsy, hemiplegia, or muscular dystrophy) and does not meet criteria for a Pervasive Developmental Disorder. If Mental Retardation is present, the motor difficulties are in excess of those usually associated with it. ICD10 (WHO)- Specific Developmental Disorder of Motor Function is also used- similar but some differences Dyscovery Centre copyright 2011 Amanda Kirby. Please do not copy without permission of the author

Dyspraxia Developmental dyspraxia is an impairment or immaturity of the organisation of movement. It is an immaturity in the way that the brain processes information, which results in messages not being properly or fully transmitted. The term dyspraxia comes from the word praxis, which means 'doing, acting'. Dyspraxia affects the planning of what to do and how to do it. It is associated with problems of perception, language and thought. Dyspraxia Foundation Some children despite adequate teaching, a stimulating environment and with a generally normal intellect, have difficulty with movement and specific aspects of learning. Dyspraxia is a difficulty with thinking out, planning and carrying out sensory / motor tasks. Dyspraxia Association of Ireland

DCD has also been called... 

 

     

“Awkward” - “in the wrong way” derived from “awke” or wrong -from an Old Norse term “öfugr” meaning backward 1949-MBD 1963-“minimal cerebral palsy”; “minimal cerebral dysfunction” (Bax & MacKeith) 1965- perceptual-motor dysfunction (Ayres) 1967-visuo-motor disability in school children ( Brenner) 1968/70 -Clumsy child syndrome ( Illingworth) 1970s –Motor Morons 1975- Developmental apraxia ( Gubbay) 1982- Developmental dyspraxia ( Denckla) Dyscovery Centre copyright 2011 Amanda Kirby. Please do not copy without permission of the author

What is DCD/Dyspraxia?

A day in the life • Take any age • Go through what happens in a day from getting up to going to bed • List the activities that are non motor! The fact is that hardly anything happens without the involvement of the motor system!

So DCD is: 



  

A movement disorder affecting children in more than one setting-pervasive Enduring Developmental Has multiple causes Has more than a motor impact Dyscovery Centre copyright 2011 Amanda Kirby. Please do not copy without permission of the author

ADHD

13 5

3 19

ASD

DYSLEXIA

What do we know about causes?

Shared environment

Shared genetics

ENVIRONMENTAL

BEHAVIOURAL

NEURAL

GENETIC

Turvey,2006

Genetic and biochemical level Genes involved in dopamine regulation (DRD4 and DAT1) receptor genes have been highlighted in ADHD- and may control attention and EFâ&#x20AC;Ś DAT1 and spatial attention have been associated (Bellgrove and Mattingly,2008)

Overlap may be linked to shared genes e.g. in

ADHD and DCD 1285 twin pairs aged 5 and 16 years from the volunteer Australian Twin Registry (ATR). The DCD-fine motor and ADHDInattentive were most strongly linked using the DSM-IV based scale. (Martin ,Piek and Hay, 2006) Dyscovery Centre copyright 2011 Amanda Kirby. Please do not copy without permission of the author

Klinefelters (XXY)

NF1

NF1 and cognitive deficits • Deficits in: – visuospatial ability, – executive function, – expressive and receptive language – attentional skills • Abnormal MRI and Nf1= fine motor deficits •

Feldmann R, Denecke J, Grenzebach M, Schuierer G, Weglage J. Neurology. 2003 23;61(12):1725-8. Neurofibromatosis type 1: motor and cognitive function and T2-weighted MRI hyperintensities.

•

Hyman SL, Shores A, North KN.,Neurology. 2005 Oct 11;65(7):1037-44.The nature and frequency of cognitive deficits in children with neurofibromatosis type 1. Dyscovery Centre copyright 2011 Amanda Kirby. Please do not copy without permission of the author

Structural or mechanical Cerebral palsy  Epilepsy and BECTS- post rolandic epilepsy  Agenesis of the corpus callosum  Cerebellar dysfunction 

CP and DCD

BECCTS Benign Epilepsy of Childhood with Centrotemporal Spikes

BECCTS – Commonest childhood epilepsy – Motor cortex – Abnormal EEG pattern – Night time seizures… thought to not be as significant but may have an impact on learning – Preservation of consciousness – Pooling of saliva – Speech arrest – 75% at night One study from Italy( Scabar,2005) Dyscovery Centre copyright 2011 Amanda Kirby. Please do not copy without permission of the author

6 out of 8 with MABC <1% had BECTS

Other reasons for co-ordination difficulties 

   

Degrees of freedom- Joint Hypermobility Syndrome Visual/visual perceptual Language –not understanding what to do Inattention- less practice,less focus Executive functioning- can’t plan what to do Dyscovery Centre copyright 2011 Amanda Kirby. Please do not copy without permission of the author

Joint hypermobility syndrome (JHS)

Reported to affect around 11% of the population (Seckin et al, 2004) â&#x20AC;˘ F: M = 2.5:1( Didia, Dapper and Boboye(2002)

Impact of difficulties

Environmental factors

Changing lives

Linear approach

environment

Genes

symptoms

diagnosis

Dynamic systems model Low self worth

Fail exams

Traumatic experiences

Child with additional learning needs

Low self worth

Poor co-ordination Poor reader

Parent with poor literacy Hereditary factors

Poor nutrition

Poor fitness levels overweight

BUTâ&#x20AC;Śitâ&#x20AC;&#x2122;s not just motor!

DCD overlaps with: • • • • • • •

Dyslexia- 35% ADHD- 35-50% Autism Spectrum Disorders (ASD) Tourette’s Syndrome Specific Language impairments Anxiety and depression Joint hypermobility syndrome Dyscovery Centre copyright 2011 Amanda Kirby. Please do not copy without permission of the author

Impact of DCD • Self esteem- Piek et al • Anxiety and depression- Myihara

Self esteem and DCD • Miyihara and Piek ,2006 showed that in studies reviewed (7) there was a medium effect size on self esteem and DCD(greater than in children with CP (6 studies) • Skinner and Piek ,2001- 8-10 yr olds had worse self perception and self worth • Increased in 12-14 years

Anxiety and depression • 3.5-5 year olds - +ve correlation between motor difficulties ( MAND) and anxious /depressed scale ( using CBCL) ( Piek, Bradbury,Elsley, Tate, 2008) • 8-10 and 12-14 years olds had increased state/trait anxiety cf td kids- Skinner and Piek, 2001 • Depressive symptoms in children (8-10 yrs) with DCD were significantly worse than td children ( Francis and Piek,2001) – Perceived athletic competency predicted depressive symptomatology Dyscovery Centre copyright 2011 Amanda Kirby. Please do not copy without permission of the author

Cognitive functioning and DCD • Wallin (1916) +ve correlation between motor and cognitive development ( Wassenburh et al,2005) • Dyck,Piek et al, 2009 have shown an age differential with linkage – 3-5 years motor and cognition linked – 6-8 yrs motor and emotion recognition linked – 9-11 years motor linked to perceptual organisation, receptive language and emotion recognition – 12-14 years.. Not signifcant links Dyscovery Centre copyright 2011 Amanda Kirby. Please do not copy without permission of the author

Executive Functioning and DCD • Roebers et al, 2009 – EF and Motor linked in 7 year olds

• Murray et al, 2006 – Early standing- better working memory at 33-35 years of age!

• Piek, Dawson, Smith and Gasson (2008) – Gross motor scores at 4 yrs 4 months predicted working memory and processing speeds at school age EF- DCD and ADHD ( in 6-14 yr olds cf TD) – DCD worse than all groups on working memory – Showed an overall timing deficit – Poorer visuospatial ability Dyscovery Centre copyright 2011 Amanda Kirby. Please do not copy without permission of the author

Motor Development and Learning Resources of the Child

Outcomes

Environment in which Activity occurs

Manner of presentation

Presentation at different ages

Key features of DCD.. Difficulty with: •Self care tasks •Writing – quality and speed •Tool usage •Riding a bike and balance tasks •Dual tasking •Learning new tasks •Team games Dyscovery Centre copyright 2011 Amanda Kirby. Please do not copy without permission of the author

DCD: In childhood

John is 9 years old • John is slow getting dressed in the morning, he still needs help with his top button and his shoe laces. Mum cleans his teeth for him. He is a messy eater and often spills things • In school his writing is poor and he writes short stories despite telling you great stories orally. He is often on his own in the playground as he finds playing ball hard to do and the others laugh at him. • He keeps losing his possessions and gets in trouble for it. • He has an older brother who is in the local football team and his dad is the coach . • His mother is a musician and she wants him to play the piano.

Fig. 1: Concerns typically noted by parents of children with developmental coordination disorder at different ages

Core symptoms and signs of DCD 3-7 year old

• • • •

Riding a tricycle/bicycle Painting/jigsaws/ colouring/ cutting/drawing Hopping/ jumping/ball skills/balance Self care: Untidy eater/ spills drinks/dressing/ undressing/bottom wiping/teeth cleaning

7-11 year olds • Riding a bike • Poor handwriting • Poor tool usage -scissor skills, rulers etc • Posture at the desk • Ball skills- team games • Self care tasks

• Low self esteem • Increased social isolation/difficulties making friends • Poor organisational skills Dyscovery Centre copyright 2011 Amanda Kirby. Please do not copy without permission of the author

Secondary school

Senior school child • • • • • •

Slower learning new skills Handwriting remains poor Ball skills and team games Dressing / undressing slow Social skills / few friends Organisation / time management /planning

• Lowered self esteem • Social isolation

Persistence of motor difficulties

• 73%15-17 years continued to have difficulties (small sample- n=15)

– (Losse et al (1991) 10 year follow up study)

• 65% Finnish 17 year olds remained having some difficulties especially in visual motor integration – (Cantell et al' study,1998)

• 50%17 year olds still had difficulties – ( Van Dellen and Gueuze,1988)

• Cousins & Smyth (2003) showed a variable pattern of presentation in the index adults Dyscovery studiedCentre (average 38 years) but did not exclude copyright 2011 Amanda Kirby. Please do not copy ADHD. without permission of the author

Social outcome Cantellet al (1994) showed that those with the most severe motor difficulties as a young child seem to be the ones whose difficulties persist most and have fewer hobbies

Overlap may predict poorer outcome • Rasmussen et al (2000) followed children diagnosed at 7 years of age with DCD and ADHD . • At 22 years of age, the research participants were more likely than their matched controls to be unemployed, to have had problems with breaking the law, to be alcohol or drug misusers and to have mental health difficulties. • ADHD + DCD (not taking medication) had worse prognosis than ADHD alone respect of academic success and employment

Interaction

Parental support

Peer interaction

0 years

10 years

18 years

Dyscovery Centre copyrightDCD 2011 Typically developing Amanda Kirby. Please do not copy Individual without permission of the author

20 years

Outcome of DCD in adulthood: is dependent on : a) Severity of motor difficulties b) Level of comorbidity c) Intervention in childhood d) Family factors- FH of DDs as well!

So what changes and what stays the same?

Parent concerns change over time

15 Child Adult

ca re

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Study of 16-25 year olds with DCD in FE and HE

50 TD %

40 DCD %

Favourite Leisure Choices Leisure choices 80 70 60 50 % of students 40 choosing 30 20 10 0

Movement difficulties TDA

Bar

Reading Films/TV Club** *

Sport*** Other**

Approaching significance at 0.06 level Dyscovery Centreat copyright **Amanda Significant 0.05 2011 level Kirby. Please do not copy ***without Significant level permissionat of 0.01 the author

G et t in or g u p g pa anis bed ck i in ng b g a fo sui g ld t in ca s g clo e or pe ga t rfo nis h es rm e in roo pl g 2 m an t ni h in ge ng gs lo tti ng fol ss ah re low of a e a a d in d g tten y to ins ti pl le an ar ra tru on av ni c ng ng in co e th tion g s to m e d o roo ple ho so m a tin u se g m t et nd w ask hi or ng ork s g a pl an t a a re as or an ise s ga nin d et ti to ni g se s o me le is d c fo u re ia l ra ac ise cla tiv ss itie /m s ee t in g

40 TD %

30 DCD %

Handwriting • . “keeping handwriting tidy at the same time as writing quickly”. • “Remembering stuff, writing lecture notes whilst listening, reading to understand - have to read a difficult page 8 times”.

Independent living skills Parent comments

• “anything that involves sequencing, like making a cup of tea or a sandwich.” However she describes how “He can make a very simple meal, taking something out of the fridge and putting it into the microwave, or toast or a sandwich”. • “Impulsive, lacks stability for daily living skills e.g. difficulty in pouring drink in a controlled way”. • personal hygiene was still poor • Dental hygiene is poor Dyscovery Centre copyright 2011 Amanda Kirby. Please do not copy without permission of the author

Psychological • “I’m just useless, I’m not very good, I’m not very bright”.

• “He is often depressed and withdrawn” and “OCD means he spends a lot of time checking/rechecking switches, doors, taps etc”.

The importance of driving • An important rite of passage. • Parental perspective → one of the last times teaching their child a new skill. • “fleeing the nest”.

Driving: Required skills • Accurate perception of the traffic environment. • Ability to react to a given situation and act accordingly. • Co-ordination of several separately related motor tasks simultaneously (e.g. looking in the mirror while continuing to steer the car) or in a sequence (e.g. mirror, gears, making a manoeuvre). • Additionally difficult for young people in the UK:- learning in a manual car.

Have you learnt/ are you learning to drive? 90 80

70 60

DCD (38)

Control (77)

30 20 10 0 Yes

A chi-square test for significance indicated that this difference was significant (Ď&#x2021;Â˛=9.72, N=115, df =1, p<0.002). Dyscovery Centreas copyright 2011 Both groups cited lack of finances a reason for not driving Amanda Kirby. Please do not copy without permission of the author

Reasons for not learning to drive: The DCD group “Do not see things like others do. Poor sense of danger and speed. Do not feel confident enough to learn to drive” “After 10 lessons driving instructor did not think it [was] worth me continuing - I had only been driving on trading estate” “I would like to learn but am unsure I could do it safely” Dyscovery Centre copyright 2011 Amanda Kirby. Please do not copy without permission of the author

Reasons for not learning to drive: The DCD group “Lack of direction ” “*I+ Don't think I would have the ability (nervous)”

“Worried about the lessons and my Dyspraxia, will try when I leave college”

Number of times taken Practical test

3 2.5 2 1.5 1 0.5 0 Mean

DCD

Control

Miles driven per week 150 100 DCD (15) Control (54)

0 Mean***

â&#x20AC;˘An independent samples t-test indicated that the control group reported driving significantly more miles in an average week than DCD group (t(67)=2.75, p<0.008). Dyscovery Centre copyright 2011

Amanda Kirby. Please do not copy â&#x20AC;˘This may be related to social behaviour with the control group going out more.

without permission of the author

Day- to- day driving behaviours DCD

Control

Driving without a valid license

9.5%

License revoked/suspended

3.1%

Involved in an accident

40%

48.4%

Struck a pedestrian/cyclist

1.6%

Reported for reckless driving

4.8%

Reported for driving intoxicated

Difficulties parking***

44.4%

11.1%

Distance estimation difficulties *

63.2%

16%

DCD adults were significantly more likely to report having difficulties with distance estimation (χ²=10.38, N= 44, df=1, p<0.001) and parking (χ²=3.86, N= 27, df=1, p<0.05) than the control group Dyscovery Centre copyright 2011 Amanda Kirby. Please do not copy without permission of the author

Approach to support

M.A.T.C.H. the activity to the child Modify the task Alter your expectations Teach strategies Change the environment Help by understanding M.A.T.C.H. strategies available from CanChild website http://www.canchild.ca/ Dyscovery Centre copyright 2011 Amanda Kirby. Please do not copy without permission of the author

M.A.T.C.H.- Organisational difficulties Messy/disorganised desk or tray Ensure time between activities to put things away Provide visual clues/labelling to help with effective use of space (e.g. for pencils or notebooks) Use colour coded workbooks Timetable weekly desk/tray cleaning time Teach child how to organise desk/tray Minimise what children keep in their desk/tray

Towards success CARE • Develop Competence • Provide opportunity for Autonomy • Promote positive adult peer Relationships • Maximise Enjoyment and minimise anxiety

Develop competence • Optimally challenging activities – Match the activity to the child – Modify the equipment and rules – Frame simple goals

• Create mastery motivational climate – – – –

Provide appropriate praise, encouragement and instruction â&#x20AC;&#x201C; Participation and effort â&#x20AC;&#x201C; Mastery attempts and achieving goals

Opportunity for autonomy Provide opportunity for a variety of activities – Menu of structured and unstructured – In and outside – Allow for activity choices – Help children help themselves- self regulation strategies e.g. think aloud

Promote positive relationships • Feel connected with peers/adults • Structured after school programmes • Promote social relationships • Parents acting as role models • Maximise enjoyment Dyscovery Centre copyright 2011 Amanda Kirby. Please do not copy without permission of the author

Intervention approaches • • • • •

Practicing what you can’t do Doing what you want to do Doing what you need to do Avoiding what is difficult and is likely to persist Seeking out strengths

Approaches to support How much time have you got What is important for now What is important for the future Listen to the child Practise enough and appropriately

Practical strategies for home and school

Getting up in the morning Challenges

Responses • Putting out clothes the night before • Alternative fasteningsvelcro etc • Timer for teeth cleaning • Wet wipes and practice- be explicit • Adapted cutlery/stable position • Verbal prompts Dyscovery Centre copyright 2011 Amanda Kirby. Please do not copy without permission of the author

Teeth cleaning

Shoe lace tying

Dressing

pants T-shirts

Organisation at home

Recordable speech bubbles

Preparing for school Response

Challenges • Packing bag • Remembering what to take • Leaving on time • Catching a bus

• List of what to do • Night before by the front door • List in bag/kitchen etc • Timer with an alarm • Practice new journeys • Practice sorting.. To do lists

Preparing for school • • • • •

Lunch box List of items – for the day Labelled clothes Right and left shoes Preparing for periods

Arriving at junior school Around the school Challenge

• • • •

Cloakroom Toilets Getting to class Remembering possessions

Response • Signposting around school • Hook on the end of the row • Practicing processespecially when changing schools • Practicing dressing in the holidays • Buddy system around school • Naming clothes Dyscovery Centre copyright 2011 Amanda Kirby. Please do not copy without permission of the author

Map of the School Using colours, key features, reference points

At play time Challenge

Response

• Being on own • Can’t /won’t join in with play • Bullied

• Circle time • Friendship bench • Small clubs and planned activities • Quiet place • Bullying policy- explicit • SEAL

Friendships • ‘Circle of Friends’ • Peer mentor • Social groups and opportunities • Friendship bench or stick

Social currency Family

Friends

Teachers

Strangers

Teaching Social skills

Social rules Creating Social networks

Making friends â&#x20AC;˘ Topics of conversation â&#x20AC;˘ One to one before bigger parties

www.blacksheeppress.co.uk

Learn the “NON” rules “ COOL” “WICKED”

Ensure social currency

Lunch and break times • Encourage lunch time clubs where there are “ formalised” opportunities for socialising • Peer mentor schemes • Play ‘what if’ • Play’ canteen chaos game’ • Get weekly menu from school

Toilets

In the canteen • • • • •

Queuing and choosing Paying Using cutlery Spills Where to sit

In class Challenge • • • • • • • • •

Recording from the board Listening Planning out tasks Using tools- scissors /rulers Maths Posture Position Task Motivation

Response • Facing the front • Angle board • Adapted tools • ICT • Minimise writing

Handwriting • • • • • •

Observe pupil writing Pencil grip, sitting position, letter formation Look at handwriting Letter size, spacing, on the line Discuss with pupil Do they want writing to be different, does their hand ache? Dyscovery Centre copyright 2011 Amanda Kirby. Please do not copy without permission of the author

Working on core stability

Position

Posture- in seating

Angle boards

Pencil case

Book holder

Pencil grips

Writing tools

Working environment

Time reminders

Handwriting practice â&#x20AC;˘ Sand tray shapes â&#x20AC;˘ Shaving foam and stick

Finger puppets

Finger painting

Hand strength

Minimise or avoid

Mind mapping -www.ikon.com

Use alternatives

Lower case keyboard

Dana Neo

Typing programmes

First Keys

Literacy software Clicker

http://www.readwritethink.org/files/resources/i nteractives/essaymap/

Co Writer

Text-to-speech

Speech-to-text

Other software

Changing colour background

Screenruler

Mathematics – – – – –

Language of maths Visualisation of maths Learning times tables Recording in class Using tools

Jonny went down the street and had ÂŁ3.20, He had to buy six apples at 20p each and 4 pears at 10p. What change did he have?

Making maths real Cookery

Weights and measures Shape- geometry Half and quarters Language Planning Motor skills

Difficulties can impact on different lessons Science- weights, measures, recording, using tools Sport- sequences of instructions, direction, timing, understanding the plan/teams Geography- map reading, recording, orientation, graphs

History- time lines

CDT- measuring, tool usage, planning, language

Tool usage

Rulers

Scissors

Inattention/fiddling

Movement breaks

• • • • •

Running on the spot Shoulder shrugs Hand presses Playing the piano Stretch and walk

www.shelterpub.com

Homework- school approaches • • • • • •

Print on labels ‘My Space’ Write up at start of class School Intranet Buddy system Differentiate-Reduce volume- same level of work but less • Or- easier Dyscovery Centre copyright 2011 Amanda Kirby. Please do not copy without permission of the author

Literacy based difficulties Suitable reading materials

Rising Stars

Barrington Stoke

In PE/Games Challenge • Understanding instructions • Following sequences of instructions • Carrying out movements • Working together in a group of different ability

Response • Break down tasks • Small group work • Stronger and weaker pairing • Model- alongside, practice and practice-video

Going home Challenge

• • • • •

Homework Tired Friendships Parties Hobbies

Response • Regular processes – Time out- walk dog, chill,play a game

• Place to study – same each time • Eat together • Friends around- semiplanned activities • Not rely on sibs for friendship circle Dyscovery Centre copyright 2011 Amanda Kirby. Please do not copy without permission of the author

Food

Emotional/social

• • • • • •

Lonely Frustrated Flare ups Sib stuff Parent stuff Sex stuff

• • • • • • •

Time out Dedicated time Planning time Reflecting time Time aware Social opportunities Seeking strengths

Homework at home • • • • • • •

Same place Same time All equipment ready Home- school diary Create a plan Use an essay planner Parent buddy Dyscovery Centre copyright 2011 Amanda Kirby. Please do not copy without permission of the author

Organisational strategies â&#x20AC;˘ www.mycorkboard.com â&#x20AC;˘ Post-it note and alarm

Bedtime- routine

Managing change and family dynamics • Holidays- home and away • Other sibs friends around • Family occasions • Times of transition

Holidays at home • Create a time table • Provide a framework to the week • Opportunity for practicing skills – dressing, cutlery

Holidays away • • • •

Calendar Travel time Smells, tastes Climate

Siblings and their roles • • • •

As a parent/carer As a source of friends Disclosing Separate time for every one

Family/Social occasions • • • • •

Too loud Too long Too many people Too higher expectations Highlights differences between your own child and others and raises your own anxieties... Pass these onto your children Dyscovery Centre copyright 2011 Amanda Kirby. Please do not copy without permission of the author

Survival guide.... • Don’t expect more than usual- expect less • Allow time out/alone time to prevent explosions

CAPACITY THEORY

Moving schools- junior to secondary school Challenge • New school • New teachers • Bigger environment • New friends • Older children • More subjects • No lockers/desks • Puberty

Response

www.move627.org

Create a time table

„To do‟ list

MATCH- IT

What if?

Guidance on each scenario

Moving on to adolescence Challenge • Social isolation • Increased weight gain • Continuing writing difficulties • Organisation and planning difficulties • Anxiety

Response • Topics of interest • Movement – walking, climbing • Brief therapy/cognitive behaviour

Seek out hobbies for success

• • • • • • • • • • • • • •

Swimming Horse riding Trampolining Canoeing Photography Cookery Rambling Badminton Fencing Archery Golf Gym work Orienteering Wall climbing Dyscovery Centre copyright 2011 Amanda Kirby. Please do not copy without permission of the author

Mapping SEN routes to identification

Mapping SEN

www.boxofideas.org

www.spldtransitions.co.uk

www.move627.org

amanda.kirby@newport.ac.uk www.dyscovery.org