1.

Learning Disabilities

1.1.What are learning disabilities?

Learning and attention issues cover a wide range of challenges children face in school and at home,
affecting how they learn. These neurological difficulties affect a child’s reading, writing, learning
mathematics and social and motor skills. A child with a learning disability may also have problems in
focusing, organisation and listening comprehension. These skills are essential for success at school,
at the workplace, and coping with life in general.

In India, the Rehabilitation Council of India (RCI) defines learning disabilities as – “a disorder in one
or more of the basic psychological processes involved in understanding or in using language, spoken
or written, which may manifest itself in an imperfect ability to listen, speak, read, spell or do
mathematical calculations. The term includes such conditions as perceptual handicaps, brain injury,
minimal brain dysfunction, dyslexia and developmental aphasia. However, the term does not include
children who have learning problems which are primarily the result of visual, hearing or motor
handicaps, or mental retardation, emotional disturbance or environmental, cultural or economic
disadvantages.”

Learning disabilities (LD) usually fall into four broad categories:

• Reading and language processing skills

• Fine-motor and handwriting skills

• Number and arithmetic skills

• Reasoning, organisation and integration of ideas and thoughts.

The most commonly known learning disabilities are dyslexia, dyscalculia and dysgraphia, among
others.

Learning disabilities can vary significantly from person to person, even within the same type of
learning disability. For example, there are two children with dyslexia; one child may struggle
considerably with reading while another child may only have problems reading aloud.

ADHD and dyspraxia are not learning disabilities but are neurological disorders that impact the
brain's parts that help children plan, focus on, and execute tasks.

Generally, children with learning disabilities learn and understand differently; there appears to be a
gap in their potential and actual achievement. Learning disabilities are also sometimes referred to as
“hidden disabilities” as the disability is not visible. A child may look “normal” but cannot perform at
a level expected from someone of their age.

As parents, you might worry about your child’s future if you think your child has a learning disability.
Remember, a learning disability is a lifelong challenge; there is no cure or fix for them. However,
with appropriate support and intervention, learning disabilities can be managed significantly, giving
children a chance to succeed in school, at home, at work, in relationships, and society.

1.2.Common myths about learning disabilities

(Image – Myths/Facts)

Learning disabilities are common – one to 19 per cent of school-going children in India have a
learning disability – but are usually misunderstood. As a result, parents tend to be clueless about the
correct diagnosis around learning disabilities and create a wrong assessment about the ever-
changing patterns of their child’s behaviour. Below we list common myths around learning
disabilities that need to be identified before any further engagement begins.

Children are just lazy or unintelligent

Learning disabilities are not outcomes of just “kids being lazy.” Having these issues does not mean a
child is not intelligent. Children with learning and attention issues may be just as bright and work
harder than their peers, but the results might not show. With proper intervention, accommodations
and support, children with learning disabilities can succeed in life.

Learning disabilities are a cause of low vision or hearing

Sometimes people mix up learning disabilities with other conditions, e.g. people attribute learning
disabilities to low vision or hearing. Some learning disabilities and co-morbidities like ADHD may
indeed result from how the brain processes sights and sounds, but this is not the same as having
poor eyesight or hearing, which corrective aids may improve.

A child must be sufficiently literate to get a diagnosis

It is also a common myth that for diagnosis of learning disabilities, a child must be fully literate, i.e.
after a child has experienced years of academic underachievement. Instead, a child starts showing
signs of learning disabilities as early as age three. Identifying a learning challenge as soon as possible
is crucial because early educational and other interventions are much more likely to yield long-term
gains than those implemented at higher grades or in adulthood.

Children can outgrow their learning disabilities

Another prevalent myth is that children with learning disabilities will outgrow them in adulthood.
Learning disabilities are not curable; instead, some adults adopt coping mechanisms and strategies
to reduce the impact of their learning disabilities, while some continue to struggle through their
adulthood.

Children with learning disabilities have low IQ

Children with learning disabilities or ADHD generally have average or above-average IQ, but they can
impact the way children receive and process information. As a result, it affects their ability to learn
necessary skills like reading, writing, maths and social skills.

Children with learning disabilities cannot have successful careers

Children with learning disabilities and ADHD generally have average or above intelligence. However,
with appropriate support and intervention, they can significantly manage their learning disabilities
and succeed in school, home, and work. Abhishek Bachchan, Hrithik Roshan, Richard Branson, Keira
Knightley, Jay Leno, and Albert Einstein are just a few examples of successful adults with learning
disabilities.

Lack of parental involvement causes learning disabilities

While the specific reason for learning disabilities is not entirely known, it is a neurological disorder
that affects a child’s ability to receive, store and process information. Learning disabilities and
Attention Deficit Hyperactive Disorder (ADHD) are not a result of where or how a child grows up.
They are also not caused due to watching too much TV or eating a poor diet. Receiving childhood
vaccines or lack of early parent or teacher involvement also do not cause learning disabilities.

1.3.Understanding essential terms and definitions

The field of learning disability and attention issues is full of acronyms and specialized words. It can
sometimes be confusing and overwhelming for parents and educators who are new to this field. This
section has tried to provide several terms frequently used across the website and while working with
children with learning disabilities. This glossary will help parents and educators understand the
meanings of such terms.

Access

Access means being able to make use of or make meaning of the learning material. Making
learning material accessible would mean that all learners can use, understand and engage
with the material. Access may look different for different learners as per their abilities. Some
may need additional supports or varied formats of the same material to access it. For
instance, a student who struggles with reading may not be able to fluently read text from
their grade level book, which makes it inaccessible for them. However, providing the written
text with an audio version may make it more accessible.

Accommodation

A change in classroom techniques, materials or environment made for an affected student.

Accommodations help students work around their challenges. This is generally contrasted
with modifications.
Advocacy

Speaking or acting on behalf of a person or group in order to promote their rights or need.

Aptitude test

A test designed to assess a person's level of competency to perform a specific type of task.

Assessment

Is the collection and analysis of information and data to determine what is causing a
child’s issues. It may involve tests, interviews, and observations conducted by doctors,
specialists, and educators.

Assistive Technology

Any item, piece of equipment or software that enhances the ability of students and
employees to be more efficient and successful.

Attention-Deficit / Hyperactivity Disorder (ADHD)

ADHD stands for Attention-Deficit Hyperactivity Disorder. It is a neurodevelopmental

disorder that can cause attention issues, impulsivity, distractibility, and hyperactivity. A child
can be either predominantly be inattentive or predominantly hyperactive-impulsive or a
combination of these two.

Audiologist

Health care professionals who identify, assess and manage disorders of hearing, balance and
other neural systems.

Auditory Memory

The process of remembering what is heard.

Auditory Processing

The way one understands the information they hear. Learning disabilities affecting this
process can affect the accuracy of what is heard, the memory of what is heard, organisation
of what is heard, or figure-ground discrimination of sounds.

Behavioural Modifications

Behavioural modification is the process of changing patterns of human behaviour over the
long term using various motivational techniques. The ultimate goal is to swap objectionable,
problematic, or disagreeable behaviours with more positive, desirable behaviours.
C
Children with Disabilities

Children who have long-term physical, mental, intellectual, or sensory impairments which, in
interaction with various barriers, may hinder their full and effective participation in society
on an equal basis with others (based on Article 1 of UNCRPD)

Cognitive Ability

A person’s ability to think and reason fluidly.

Developmental delay

When a child does not reach a developmental milestone by the age expected, it is called a
developmental delay. The milestones can be language, thinking and social skills milestones.

Decoding

The ability to translate a word from print to speech, usually by employing knowledge of
sound-symbol correspondences. It is also the act of deciphering a new word by sounding it
out.

Developmental Aphasia

A severe language disorder presumed to be due to brain injury rather than a developmental
delay in the normal acquisition of language.

Disability

Disability is an evolving concept and … [it] results from the interaction between persons with
impairments and attitudinal and environmental barriers that hinder their full and effective
participation in society on an equal basis with others (based on the UNCRPD preamble)

Dyscalculia

A learning disability involving maths. People have severe difficulty understanding and using
arithmetic symbols or functions, including recognising numbers and symbols, memorising
basic number facts, aligning numbers, and understanding abstract concepts like time, place
value, and fractions.

Dysgraphia

A learning disability that affects writing abilities, vocabulary, grammar, hand movement, and
memory. Dysgraphia may result from problems in either of these areas, and it can manifest
itself as difficulties with spelling, poor handwriting and trouble putting thoughts on paper.

Dyslexia
 A language-based disability that affects both oral and written language. It is commonly
misunderstood to be a condition that causes letters to appear backwards or upside down,
but it is much more complicated in reality. The bottom line of dyslexia is now thought to be
a problem with the sounds in words (phonological awareness).

Dyspraxia

A severe difficulty in performing drawing, writing, buttoning, and other tasks requiring fine
motor skill, or in sequencing the necessary movements.
E

Encoding

The ability to translate ideas into words or symbols.

Executive Function

The ability to organise cognitive processes. These include skills that are needed to plan
ahead, manage, organise, prioritise, stop and start activities, shift from one activity to
another in everyday life as well as school and work.

Fine-motor Skills

Fine motor skills refer to the ability to use small muscles to do small things – threading a
needle, holding a pen etc.

Formal Assessment

The process of assessing a condition by providing standardised tests or instruments in

conjunction with specific administration and interpretation procedures.
G

Graphic Organisers

Text, diagram or other pictorial devices that summarises and illustrates interrelationships
among concepts in a text. Graphic organisers are often known as maps, webs, graphs,
charts, frames, or clusters.

Gross Motor Skills

Gross-motor skills refer to the ability to use large muscle for activities like dancing or
jumping.

Impulsivity
 Impulsivity is the tendency to act without thinking or considering the consequences of the
performed actions.

Inclusive education

A fundamental human right, a principle that values the well-being of all students, respects
their inherent dignity and autonomy and acknowledges individuals’ requirements and their
ability to effectively be included in and contribute to society. It is also a means of realising
other human rights and a result of a process of continuing and proactive commitment to
eliminating barriers impeding the right to education (based on General Comment 4 on
Article 24: Right to inclusive education, by the Committee on the Rights of Persons with
Disabilities, 2016).

Individualised Education Program (IEP)

A blueprint or plan outlining a student’s special education needs and related services. It is
specifically designed to meet the unique educational needs of a student with a disability.

Intelligence Quotient (IQ)

A measure of someone's intelligence as indicated by an intelligence test, where an average

score is 100. An IQ score is the ratio of a person's mental age to his chronological age
multiplied by 100.
L

Learning Disability (LD)

It is a neurological disorder that affects how the brain works with information. It can
impact the ability to receive, process, store, respond and communicate and manifests
itself in the inability to learn at the same pace as peers. It affects people's ability to
interpret what they see and hear. It is sometimes referred to as a learning disorder or a
learning difference.

Mainstream

Mainstream, in the learning disability context, is the classroom that follows the general
education system.

Mainstreaming

The practice of placing students with special education services in a general education
classroom during

Memory (Long-Term)

Memory that stores information for later use. For example, the phone number of your best
friend or a family member that you have memorised is stored in your long-term memory.

Memory (Short-Term)
 Memory that holds information briefly while you use it. For example, when you read a
phone number and then dial it, the number is held in your short-term memory.

Memory (Working)

Memory that holds an idea while you are using it – for example, your working memory holds
a formula when you are working on a math problem.

Modifications

Are changes made in what or how much a student is taught. While accommodations are for
the same grade-level content, modifications may include making changes in the content in
terms of complexity, amount, and pace, e.g. shorter assignments, less complex assignments
etc.

Motor Planning

The ability to remember and perform certain steps to complete an action. For e.g. knowing
what actions to take and in what order to complete a particular task.

Multisensory Teaching

Teaching that uses more than one sense (visual/auditory, kinesthetic-tactile) and pathways
in the brain simultaneously in order to enhance memory and learning.

Nonverbal Learning Disability

A neurological disorder that affects all learning not related to language, causing
problems with visual-spatial, intuitive, organisational, evaluative, and holistic
processing functions like social skills and physical coordination. Also called NLDs or
NVLDs.

Occupational Therapy (OT)

A rehabilitative service that helps improve the skills needed for everyday tasks
like writing, gripping etc. These include exercises for improving hand-eye
coordination, strength, and fine motor skills like pencil grip.

Organisational Problems

Organisational problems can include problems with managing time, organising tasks, and
organising space.

Orton-Gillingham Method
 A multisensory approach, created by Dr Samuel Orton and Anna Gillingham, to remediating
dyslexia.
P

Person with disability

Any person with long term physical, mental, intellectual or sensory impairment that hinders
their full and effective participation in society equally with others.

A person with a benchmark disability

A person with not less than forty per cent of a specified disability as certified by the
certifying authority.

A person with a disability having high support needs

A person with benchmark disability who needs high support.

Phoneme

The smallest unit of speech that serves to distinguish one utterance from another in a
language.

Phonemic Awareness/ Phonological Awareness

The ability to recognise the distinct sounds in words, which is required for further language
and reading development.

Phonics

Phonics is a method for teaching the relationships between the letters of a written language
and the sounds of the spoken language and shows how this information can be used to read
or decode words.

Physical Therapy (PT)

A form of instructional support and treatment that helps improve the gross motor skills
needed for walking, reaching, and standing. It also helps with balance and muscle control.

Processing Speed

Processing speed refers to how quickly or slowly a person is able to use, take in, or bring out
information. It is not related to cognitive ability – just to speed and fluency.

Psychiatrist

A medical practitioner specialising in the diagnosis and treatment of mental illness.

Remedial programs
 Remedial programs are the various programs that try to help kids catch up in reading,
writing, math and other subjects.

The Rehabilitation Council of India (RCI)

RCI is a statutory body established by the government of India to regulate and monitor
services given to persons with disabilities, standardise syllabi, and maintain a Central
Rehabilitation Register of all qualified professionals and personnel working in the field of
rehabilitation and special education. The Act also prescribes punitive action against
unqualified persons delivering services to persons with disabilities.

Right to Information (RTI)

The term derives from the Right to Information Act, passed by Parliament, and means that
citizens can request information from state or central government departments and offices.
Such requests are processed and responded to in a timely way as mandated by the RTI Act.

Right to Education (RTE)

The term derives from the Right to Education Act which describes the modalities of the right
to free and compulsory education for children between the age of six to 14 years in India.

RPWD Act, 2016

The RPWD Act is a social welfare legislation passed by the Indian Parliament to fulfil its
obligation to the United Nations Convention on the Rights of Persons with Disabilities, which
India ratified in 2007.

Speech Therapy (ST)

A form of treatment that helps improve speech and language issues.

Screening

A preliminary way to identify whether a child needs an in-depth evaluation or the child's
needs can be fulfilled by providing additional learning aids.

Scaffolding

A method of teaching in which the teacher breaks up the learning into chunks while
providing a tool, or structure, with each chunk to support learning. Tools come in many
forms like modelling, prompting, direct explanations or targeted questions.

Self-advocacy

The ability to develop specific skills and understandings to communicate one’s specific needs
and disabilities to others. Self-advocacy gives a person the confidence to cope positively with
the attitudes of others like peers, parents, teachers, and employers.
Special Education (SPED)

Special education refers to a range of educational and social services provided to children
with disabilities.

Specific Learning Disability (SLD)

A specific learning disability refers to difficulty in specific areas of learning, like the ability to
listen, think, speak, write, spell, or do mathematical calculations rather than in all areas of
learning.

Social perception

Social perception refers to the ability to identify and interpret various social situations like
the tone of voice, body language, ‘reading’ facial expressions etc. Individuals who suffer
from difficulties with social skills have trouble using social perceptions to guide their
behaviour.

Social Skills

The skills we use on a daily basis to communicate and interact with others to get along
socially. Individuals with learning disabilities generally have difficulties in learning social
skills, which may cause social struggles like loneliness, conflict, awkwardness, etc.

Universal Design For Learning (UDL)

UDL is an approach to teaching and learning that provides a framework for creating flexible
goals, methods, materials, and assessments to accommodate learners with differences.
V

Visual-Motor Integration

The ability to use sensory feedback to guide physical movements – what is loosely referred
to as “coordination”. A deficit in this area can make it difficult to coordinate large or small
movements – catching a ball while running, waving goodbye, to more complex tasks like
brushing teeth or copying seatwork from the blackboard. Also known as dyspraxia.

Visual Processing

The brain's ability to use and interpret visual information. Individuals with visual processing
disorders have an effect on the accuracy of what they see, the memory of what is seen, and
have difficulty in understanding what is seen.

Visual Tracking

The way we follow a line of text on a page.

W
Working Memory

The limited amount of brain’s ability to store and manage information in one's mind for a
short period of time. The average adult can hold up to seven numbers in their working
memory. Working memory is sometimes called short-term memory.

1.4.Developmental milestones

Learning disabilities look quite different from one child to another. One child may struggle with
reading and spelling, while another may love books but not understand maths. Yet, another child
may have difficulty understanding what others are saying or communicating out loud. The problems
are quite different, but they are all learning disorders.

It is not always easy to identify learning disabilities, and before we describe and learn ways to
identify learning disabilities, let us understand what normative developmental milestones are.
Remember that children who do not have learning disabilities may still experience some of these
difficulties at various times. The time for concern comes when there is a consistent unevenness in
your child’s ability to master specific skills.

Developmental milestones or developmental indicators are a set of behavioural or functional skills

thresholds that map the course of your child’s development. These behaviours are categorised into
five domains – physical and motor, social and emotional, cognitive, adaptive and communication
and language. These emerge over specific timeframes in a child’s intellectual progress, forming the
building blocks for growth and continued learning.

Communication and Language Skills

Communication and language skills include both the expressive and receptive abilities of a child. It
gives a child the ability to recognise words, read, speak, and write. Children also learn to
communicate and express opinions as they age. Parents must keep in mind that India has great
linguistic diversity, and children may have to be taught the same words in different languages.

Physical and Motor Coordination Skills

As the name suggests, this set of skills pertain to the child’s physicality and largely involve body
muscles to accomplish a pre-determined task. Motor skills allow a child to perform physical tasks
according to the directions sent by the brain and feel the accomplishment of these tasks. Motor
skills can be further divided into gross motor and fine motor skills. Gross motor skills, like walking,
involve the large muscle groups, and fine motor skills, like writing, incorporate small muscles. Gross
motor skills are related to balance and coordination, whereas children use fine motor skills to make
small movements. Fine motor skills, built upon gross motor skills, involve the brain and muscles'
coordinated efforts.

Social and Emotional Interaction Skills

Social and emotional skills start developing from birth, like smiling and crying. As the child grows,
these skills become more complex, like playing with others, self-awareness, the ability to express
emotions, etc.

Adaptive Skills

Adaptive skills are self-help skills, such as eating, drinking, and dressing. It is also the skill that
teaches a child to be aware of their environment and their safety.

Cognitive Skills

Cognitive development refers to a child’s development in terms of thinking, reasoning, problem-

solving, understanding and processing information which help them think about and understand the
world around them.

1.4.1. Developmental milestones by age one

Developmental milestones or developmental indicators are a set of behavioural or functional skills

thresholds that map the course of your child’s development. These behaviours are categorised into
five domains – communication and language, physical and motor, social and emotional, adaptive
and cognitive. Parents must keep in mind that India has great linguistic diversity, and children may
have to be taught the same words in different languages. However, by age one, a child normally
attains the following skills in each domain.

Language Milestones

o Recognises own name

o Says 2-3 words besides “mama” and “papa.”
o Imitates familiar words
o Understands simple instructions
o Recognises words as symbols for objects

Box

Do these activities to support your child’s language

o Respond to their babbling, coos and gurgles

o Talk to your child throughout the day
o Read colourful books to them
o Sing songs and nursery rhymes to them
o Teach your child the names of familiar people and everyday items
o Expose your child to new places and situations
o Play simple games like “peek-a-boo” with your child

Motor Coordination Skills Milestones

Gross Motor Milestones

o Can sit without support

 o Starts crawling
o Is able to pull self to a standing position
o Stands unaided
o Starts walking with aid
o Rolls a ball in imitation of adults

Fine Motor Milestones

o Reaches for toys, grasps, or put objects in the mouth

o Is able to pick things with a pincer grasp (thumb and one finger)
o Can transfer objects from one hand to the other
o Drops and picks up a toy

Social Interaction Skills Milestones

o Has a spontaneous smile

o Has different responses for familiar people and strangers
o Pays attention to own name
o Responds to “no”
o Copies simple actions of others

Adaptive Skills Milestones

o Eats figure food on their own

o Starts holding a cup
o Drinks from cup or glass with help
o Keeps arms and legs out while being dressed

Cognitive Skills Milestones

o Follows moving object with eyes

o Recognises differences between familiar people and strangers
o Imitates and responds to facial expressions of others
o Follows very simple directions
o Imitates gestures and actions
o Puts small objects in and out of a container with the intention

1.4.2. Developmental milestones between age one and two

Developmental milestones or developmental indicators are a set of behavioural or functional skills

thresholds that map the course of your child’s development. These behaviours are categorised into
five domains – communication and language, physical and motor, social and emotional, adaptive
and cognitive. Parents must keep in mind that India has great linguistic diversity, and children may
have to be taught the same words in different languages. By age two, a child normally attains the
following skills in each domain.

Language Skills Milestones

 o Starts understanding “no”
o Is able to use around 10-15 words, including names
o Can combine two different words such as “mama” and “bye-bye.”
o Waves good-bye
o Makes familiar sounds like that of animals
o Gives an object when asked
o Make wants known by using words such as “more”
o Points to toes, eyes, and nose, toys and things in books when prompted
o Is able to bring objects when asked
o Repeats words overheard in conversation

Box

Do these activities to support your child’s language

o Encourage and reward your child’s early attempts at saying new words
o Talk to your child about activities that you’re doing with them
o Talk in simple and clear language
o Talk about any new situations that your child will face before they happen
o Look at your child while talking to them
o Describe to them what they are doing, hearing or feeling
o Let them listen to records and tapes in a child’s voice
o Praise your child’s efforts to communicate

Motor Skills Milestones

Gross Motor

o Walks alone
o Walks backwards
o Is able to pick up toys from the floor without letting them fall
o Plays with pull and push toys
o Is able to seat self in a child-size chair
o Can walk up and down the stairs with assistance
o Moves to music

Fine Motor

o Is able to build a small tower, say of three blocks

o Puts rings on a stick
o Is able to place pegs in a pegboard
o Turns pages of books, two or three at a time
o Is able to scribble and turn knobs
o Can throw a small ball
o Makes painting strokes with whole arm movement, is able to shifts hands

Social Skills Milestones

 o Recognises self in mirror or picture
o Refers to self by name
o Plays by self; initiates own play
o Imitates adult behaviours in play
o Helps put things away

Adaptive Skills Milestones

o Uses spoon, spilling little

o Drinks from cup with one hand, unassisted
o Chews food
o Unzips large zipper
o Indicates toilet needs
o Removes shoes, socks, pants, sweater

Cognitive Skills Milestones

o Imitates actions and words of adults

o Understands and follows simple, familiar directions
o Responds to words or commands with the appropriate action
o Can match two similar objects
o Begins to sort shapes and colours
o Names or points familiar objects on request while reading a storybook with pictures
o Recognises difference between you and me
o Has minimal attention span
o Accomplishes primary learning through own exploration
o Find things when hidden under two or three covers

1.4.3. Developmental milestones between age two and three

Developmental milestones or developmental indicators are a set of behavioural or functional skills

thresholds that map the course of your child’s development. These behaviours are categorised into
five domains – communication and language, physical and motor, social and emotional, adaptive
and cognitive. Parents must keep in mind that India has great linguistic diversity, and children may
have to be taught the same words in different languages. By age three, a child normally attains the
following skills in each domain.

Language Milestones

o Is able to identify various body parts

o Has ‘conversation’ with self or toys like dolls
o Starts asking, “what is that?” or “where is my?”
o Uses two-word phrases such as “no want”.
o Is able to form plurals by adding “s”; e.g. book, books
 o Has a 450-word vocabulary
o Gives the first name, holds up fingers to tell the age
o Is able to combine nouns and verbs, e.g. “papa go”
o Starts understanding simple time concepts like “last night”, “tomorrow”
o Refers to self as “me” or “I” rather than by name
o Likes to get adult attention, say words like “watch me”
o Likes repetitions, hears the same story every day
o Sometimes say “no” when they mean to say “yes”
o Tries to talk to other children or adults
o Develops problem-solving capacity by talking instead of hitting or crying
o Answers “where” questions
o Is able to name familiar pictures and things
o Starts using short sentences like “I want more” or “me want milk”
o Matches three to four colours, knows the difference between big and small

Box

Do these activities to encourage your child’s language

o Repetition, say new words over and over

o Play games with instructions: “pick up the ball,” “Touch your nose”
o Take a trip and talk about what you see on the trip
o Ask simple questions and encourage them to think and answer
o Read bedtime stories as a routine
o Listen without distraction when your child speaks to you
o Describe the things that you are doing
o Make them deliver simple messages on your behalf , “Mommy needs you, sister”
o Have regular conversations with them
o Let them realise that you understand they are saying by nodding your head, answering or by
smiling
o Complete their sentences. For e.g. If they say, “more juice,” you say, “Adi wants more juice.”

Motor Skills Milestones

Gross Motor

o Is able to run forward fairly well

o Starts jumping with two feet together
o Stands on one foot with assistance
o Tries to walk in a tiptoe position
o Is able to kick a ball forward

Fine Motor

o Is able to strings large beads

 o Turn a single page in a book
o Snips with the use of a scissor
o Grips start correcting, is able to hold a crayon with thumb and fingers (not fist)
o Uses one hand consistently in most activities
o Imitates circular, vertical, horizontal strokes
o Paints with some wrist action; make dots, lines, circular strokes
o Rolls, pounds, squeezes and pulls the clay

Social Skills Milestones

o Is not afraid to play near other children

o Watches other children; sometimes joins them briefly
o Defends own possessions
o Begins to play the game of “house”
o Symbolically uses objects, self in play
o Participates in a simple group activity
o Knows gender identity
o Shows a wide range of emotions
o Shows empathy or some type of concern of someone in distress

Adaptive Skills Milestones

o Uses spoon with little spilling

o Is able to open a door by turning the handle
o Takes off coat
o Puts on a coat with assistance
o Washes and dries hands with assistance

Cognitive Skills Milestones

o Responds to simple directions

o Selects and looks at picture books, names pictured objects, and identifies several items
within one picture
o Matches and uses associated objects meaningfully
o Stacks rings on a peg in order of size
o Plays make-believe with dolls, animals and people
o Recognises self in the mirror
o Says own name
o Can talk briefly about the activity they are doing
o Tries to imitate adult actions
o Has limited attention span; learning is through exploration and adult direction
o Is beginning to understand functional concepts of familiar objects and part/whole concepts

1.4.4. Developmental milestones between age three and four

Developmental milestones or developmental indicators are a set of behavioural or functional skills

thresholds that map the course of your child’s development. These behaviours are categorised into
five domains – communication and language, physical and motor, social and emotional, adaptive
and cognitive. Parents must keep in mind that India has great linguistic diversity, and children may
have to be taught the same words in different languages. By age four, a child normally attains the
following skills in each domain.

Language Milestones

o Is able to tell a small story

o Has a sentence length of four to five words
o Has a vocabulary of nearly 1000 words
o Names at least one colour
o Understands concepts like, "lunchtime", "little-big" "summer", "tonight",
o Begins to obey requests like "put the glass for washing "
o Knows their last name, name of the street on which they live
o Know several nursery rhymes

Box

Do these activities to encourage your child's language

o Talk about how objects are either the same or different

o Encourage them to tell stories using books and pictures
o Encourage them to play with other children, set playdates at home or park
o Start reading longer stories to them
o Pay attention to your child when they are talking
o Talk about places you have been or would like to go Motor Skills Milestones

Gross Motor

o Is able to run around obstacles and walk on a line

o Can balance on one foot for a couple of seconds
o Hops on one foot
o Pushes and pulls, steers wheeled toys
o Rides tricycle
o Uses slide independently
o Jumps over a six-inch-high object and lands on both feet together
o Throws ball overhead
o Catches a bounced ball

Fine Motor

o Builds a tower of nine small blocks

o Drives nails and pegs
o Copies circle
o Imitates cross
o Manipulates clay material (rolls balls, snakes, cookies)
Social Skills Milestones

o Interacts and joins in play with other children

o Shares toys; takes turns with assistance
o Begins dramatic play, acting out whole scenes

Adaptive Skills Milestones

o Pours well from a small pitcher

o Spreads soft butter with a knife
o Buttons and unbuttons large buttons
o Washes hands independently
o Blows nose when reminded
o Uses toilet independently

Cognitive Skills Milestones

o Recognises and matches six colours

o Stacks blocks or rings in order of size
o Draws a somewhat recognisable picture that is meaningful to a child if not to adult; names
and briefly explains the picture
o Starts asking questions: why and how questions requiring simple answers
o Knows own age and name
o Has short attention span; learns through observing and imitating adults and by adult
instruction and explanation; is very easily distracted
o Has increased understanding of concepts of the functions and grouping of objects and
part/whole
o Begins to be aware of past and present

1.4.5. Developmental milestones between age four and five

Developmental milestones or developmental indicators are a set of behavioural or functional skills

thresholds that map the course of your child’s development. These behaviours are categorised into
five domains – communication and language, physical and motor, social and emotional, adaptive
and cognitive. Parents must keep in mind that India has great linguistic diversity, and children may
have to be taught the same words in different languages. By age five, a child normally attains the
following skills in each domain.

Language Milestones

o Has a sentence length of four to five words

o Uses past tense correctly
o Has a vocabulary of nearly 1500 words
o Points to colours red, blue, yellow and green
 o Identifies triangles, circles and squares
o Understands "In the morning", "next", "noontime"
o Can speak of imaginary conditions such as “I hope”
o Asks many questions, asks “who?” And “why?”

Box

Activities to encourage your child’s language

o Do activities that require sorting objects and things

o Make phone calls to extended family and let them talk
o Let your child help you plan activities such as the dinner menu
o Continue talking with them about their interests
o Read longer stories to them
o Let them tell and make up stories for you
o Show your pleasure when they come to talk with you

Motor Skills Milestones

Gross Motor

o Walks backwards toe-heel

o Jumps forward ten times without falling
o Walks up and down stairs independently, alternating feet
o Turns somersault

Fine Motor

o Cuts along the line continuously

o Copies cross
o Copies square
o Prints some capital letters

Social Skills Milestones

o Plays and interacts with other children

o Dramatic play is closer to reality, with attention paid to detail, time, and space
o Plays dress-up
o Shows interest in exploring sex differences

Adaptive Skills Milestones

o Cuts easy foods with a knife

o Laces shoes
o Dresses self completely
o Ties bow
o Brushes teeth independently
o Crosses streets safely
Cognitive Skills Milestones

o Plays with words: creates own rhyming words, says or makes up words having similar sounds
o Points and names four to six colours
o Matches pictures of familiar objects
o Draws a person with two to six recognisable parts, such as head, arms, and legs; can name or
match illustrated parts to own body
o Draws, names, and describes recognisable pictures
o Rote counts to five, imitating adult
o Knows own street and town
o Has more extended attention span; learns through observing and listening to adults, as well
as through exploration; is easily distracted
o Has increased understanding of concepts of time, part/whole relationships; function or use
of objects
o Time concepts are expanding; can talk about yesterday or last week, about today, and about
what will happen tomorrow

1.4.6. Developmental milestones between age five and six

Developmental milestones or developmental indicators are a set of behavioural or functional skills

thresholds that map the course of your child’s development. These behaviours are categorised into
five domains – communication and language, physical and motor, social and emotional, adaptive
and cognitive. Parents must keep in mind that India has great linguistic diversity, and children may
have to be taught the same words in different languages. By age six, a child normally attains the
following skills in each domain.

Language Milestones

o Has a sentence length of 5-6 words

o Has a vocabulary of around 2,000 words
o Defines objects by their use (you eat with a fork) and can tell what these objects are made of
o Knows spatial relations like "on top", "behind", "far" and "near"
o Knows her address
o Identifies a penny, nickel and dime
o Knows common opposites like “big/little”
o Understands “same” and “different”
o Counts ten objects
o Asks questions for information
o Distinguished left and right hand in herself
o Uses all types of sentences, for example, “let’s go to the store after we eat”
Box

Activities to encourage your child’s language

o Praise your child when she talks about her feelings, thoughts, hopes and fears
o Comment on what you did or how you think your child feels
o Sing songs, rhymes with your child
o Continue to read longer stories
o Talk with him as you would an adult
o Look at family photos and talk to him about your family history
o Listen to her when she talks to you

Motor Skills Milestones

Gross Motor

o Runs lightly on toes

o Walks on a balance beam
o Can cover 2 meters hopping
o Skips on alternate feet
o Jumps rope
o Skates

Fine Motor

o Cuts out simple shapes

o Copies triangle
o Traces diamond
o Copies first name
o Prints numerals 1 to 5
o Colours within lines
o Has an adult grasp of pencil
o Has handedness well established
o Pastes and glues appropriately

Social Skills Milestones

o Chooses own friends

o Plays simple table games
o Plays competitive games
o Engages in cooperative play with other children involving group decisions, role assignments,
fair play

Cognitive Skills Milestones

o Retells a story from the picture book with reasonable accuracy

o Names some letters and numerals
o Rote counts to ten
o Sorts objects by single characteristics
 o Begins to use time concepts of tomorrow and yesterday accurately
o Uses classroom tools meaningfully and purposefully
o Begins to relate clock time to a daily schedule
o Attention span increases noticeably; learn through adult instruction; when interested, can
ignore distractions
o Concepts of function increase, growth in understanding of why things happen;
o Time concepts are expanding into an understanding of the future in terms of major events

1.4.7. Developmental milestones between age seven and nine

Developmental milestones or developmental indicators are a set of behavioural or functional skills

thresholds that map the course of your child’s development. These behaviours are categorised into
five domains – communication and language, physical and motor, social and emotional, adaptive
and cognitive. Parents must keep in mind that India has great linguistic diversity, and children may
have to be taught the same words in different languages. By age nine, a child normally attains the
following skills in each domain.

Language Milestones

o Understand what they read and begin to move from “learning to read” to “reading to learn”
o Learn vocabulary through reading
o Use words to talk through problems, both socially and academically
o Start playing with words to make puns; understand jokes and riddles
o Test out “bad” words for shock value
o Use all letter sounds correct; don’t substitute w for r anymore when speaking
o Use writing to express feelings, tell stories, and summarise information

Box

Activities to encourage your child’s language

o Incorporate a “question of the day” to start conversing with your child. E.g. What was the
best/worst thing that happened in school today?
o Role-play various conversations that your child is generally nervous about, like talking to
teachers or asking other kids to involve her in play.
o Read with your child every day, even if it is the same book.

Motor Skills Milestones

Gross Motor

o Can run farther and for longer

o Ride a bike without training wheels
o Gain strength in both big and small muscles
o Co-ordinate movements like dribbling, martial arts or dance
Fine Motor

o Forms letters correctly

o Cuts complex designs
o Start typing on a keyboard
o Ties shoes, buttons, and undo zippers

Social Skills Milestones

o Have moments of extreme insecurity and need a lot of encouragement from their family
o Change often between being helpful and upbeat to being unhelpful and grouchy
o Enjoy being part of a team, group, or club
o Spend more time with and are easily influenced by peers
o Experience periods of dramatic emotion and impatience (feeling that everyone is against
them) and then bounce right back to everything being just fine
o Start seeing things from other points of view and incorporate that into everyday life
o Be somewhat aware of others’ perceptions of them
o Want to behave well but aren’t yet very attentive to directions
o Share secrets and jokes with friends

Cognitive Skills Milestones

o Look for the reasons behind things and ask questions for more information
o Understand cause and effect and make more in-depth connections (for example, know that
if 6 + 2 = 8, then 8 ‒ 6 = 2)
o Use those connections to do more complex math like multiplication and division
o Start planning ahead (for example, create a drawing of something to build or a plan for an
experiment)
o Can sit and pay attention to something that interests them for at least 30–45 minutes
o Start collecting things
o May try out different types of writing, like narratives and opinion papers (“Why I liked this
book”)
o Use complex sentences and different types of sentences to express ideas clearly
o Recognise and know the value of coins
o Learn how to do addition and subtraction with regrouping

1.4.8. Developmental milestones between ages 10 and 13

Developmental milestones or developmental indicators are a set of behavioural or functional skills

thresholds that map the course of your child’s development. These behaviours are categorised into
five domains – communication and language, physical and motor, social and emotional, adaptive
and cognitive. Parents must keep in mind that India has great linguistic diversity, and children may
have to be taught the same words in different languages. By age 13, a child normally attains the
following skills in each domain.
Language Milestones

o Use metaphors, slang, text-speak, and other ways of talking

o Has discussions, debates, and arguments (sometimes just for the sake of it)
o Start to “get” and pay more attention to body language, tone of voice, and other nonverbal
language cues
o Go through “what if” scenarios and talk through different ways of problem-solving
o Continue to build grammar knowledge and vocabulary
o Start to use writing to describe personal experiences

Box

Activities to encourage your child’s language

o Encourage your child to describe her day in as much detail as possible.

o Recount events of your day as well. This will promote a connection between you and your
child too.
o Model one of the most crucial conversation skills: Listening to and expanding upon what
someone else says. After your child has told you something, repeat back part of what your
child said, and then follow up with a question.

Physical Milestones

o They generally do not experience any additional improvement in their motor skills unless
they are specifically training for a sport or hobby which requires these skills.
o They become a little less co-ordinated as height and weight change quickly
o Start showing uneven development in skills like agility, balance, strength, and flexibility (For
example, they may be able to run fast, but not gracefully.)
o Need more rest since so much energy is being used for growing
o Has a difference between the body and brain growth; maybe more mature physically than
cognitively or emotionally

Social Skills Milestones

o Are uncertain about puberty and changes to their bodies

o Are insecure or have mood swings and struggle with self-esteem (This tends to be more
pronounced in girls.)
o Test limits and push boundaries (For example, they may try to figure out which rules are
negotiable and which are not.)
o Are increasingly independent of family, withdraw more from family activities, and need
privacy
o Form stronger and more complex friendships
o May face intense peer pressure and find it hard to resist if they struggle with self-esteem
(Learn how to give praise that boosts your child’s self-esteem.)
o Have a deeper understanding of how relationships with others can include more than just
shared interests
o Bow to peer pressures
o Have a first crush or pretend to have a crush to fit in with peers
 o Value friends’ opinions; share secrets and inside jokes
o Are kind, silly, and curious, but also can be self-involved, moody, and disrespectful
o May test out new attitudes, clothing styles, and mannerisms while figuring out where/how
to fit in

Cognitive Skills Milestones

o Realise that thoughts are private and that people see others differently than they see
themselves
o Start predicting the consequences of an action and plan accordingly
o Can argue more than just one side of an issue
o Begin to rely on friends, the news, and social media to get information and form opinions
o Develop a better sense of responsibility and help out around the house (For example, kids
may look out for younger siblings.)
o Start understanding how things are connected (For example, kids may be able to understand
the effects of climate change or how the mood of one person in the house can impact
everyone else.)
o Start to understand concepts like power and influence
o Question things and don’t take everything at face value
o Think about how current actions affect the future and may worry about things like climate
change and war
o Memorise information more easily
o Use flexible thinking, like checking work and changing approaches as needed
o Begin developing a worldview and a basic set of values
o Want to contribute and make their own money

1.4.9. Developmental milestones between ages 13 and 16

Developmental milestones or developmental indicators are a set of behavioural or functional skills

thresholds that map the course of your child’s development. These behaviours are categorised into
five domains – communication and language, physical and motor, social and emotional, adaptive
and cognitive. Parents must keep in mind that India has great linguistic diversity, and children may
have to be taught the same words in different languages. By age 16, a child normally attains the
following skills in each domain.

Cognitive skills Milestones

o Memorise information more easily

o Use flexible thinking, like checking work and changing approaches as needed
o Begin developing a worldview and a basic set of values
o Want to contribute to the household

Physical Milestones
 o The difference in growth between boys and girls is very noticeable at this age.
o Many high-schoolers have a big appetite
o Need more sleep and maybe sleepy in school if it starts early
o Have the required visual-spatial coordination to help judge distance and speed and react
quickly when learning to drive
o Are more agile and coordinated, making it easier to do things like type on a keyboard or
build complex projects.

Social Skills Milestones

14 – years old 15 – years old 16-18 years old

Can recognise personal Don’t want to talk as much; Start relating to family better;
strengths and challenges are argumentative begin to see parents as real
people
Are embarrassed by family and May appreciate siblings more Develop a better sense of who
parents and may seem self- than parents they are and what positive
centred, impulsive and moody things they can contribute to
friendships and other
relationships
Strive to be independent Narrow down to a few close Spend a lot of time with
friends and may start dating friends
Are eager to be accepted by Analyse their feelings and try Can voice emotions (both
peers and to have friends to find the cause of them negative and positive) and try
to find solutions to conflicts
chooses own friends

Cognitive Skills Milestones

o Show an increasing ability to reason, make educated guesses, and sort fact from fiction
o Start thinking more abstractly, comparing what is to what could be
o Think about and come up with ways to deal with hypothetical situations
o Begin to set their own goals for the future; take other opinions into account but make their
own decisions
o Understand the consequences of actions, not just today, but also in far-reaching ways (For
example, understanding that failing English isn’t just a bummer—it can mean summer
school, too.)
o Develop a strong sense of right and wrong and make decisions based on following their
conscience
o Write with complexity about a variety of content areas (science, social studies, literature)
o Use strategies to search for, use, and compare information from multiple sources
o Use numbers in real-life situations (like calculating tax or a tip)
 1.5.Types of Challenges

1.5.1. ADHD

Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder defined by

impairing levels of inattention, disorganization, and/or hyperactivity-impulsivity. ADHD reflects a
child’s inborn, neurology-based temperament. It affects the brain's parts that help children plan,
focus on, and execute tasks. Children with ADHD show some positive traits, like spontaneity,
creativity, the ability to lock on to and hyper-focus, while some other characteristics present
potential problems, including hyperactivity, selective attention, distractibility and impulsivity.
Depending on how they are perceived and shaped, the combination of these traits can work to a
child’s advantage or disadvantage.

The exact cause of ADHD is not fully understood, although it is considered genetic and runs within
the family in most cases. Some research also shows a difference in brain function and structure in
children with ADHD compared to their peers. Certain studies suggest that an imbalance in the brain's
level of neurotransmitters may be the cause of ADHD. However, it is a common myth that having a
learning disability causes ADHD. The fact is that some learning differences, like dyslexia, dysgraphia
and dyscalculia, frequently co-occur with ADHD.

1.5.1.1. ADHD - Signs to look out for

Children with ADHD are a heterogeneous group, manifesting symptoms in varying combinations and
degrees. The symptoms of ADHD include inattention, hyperactivity, a lack of focus, poor time
management, weak impulse control, exaggerated emotions, hyperfocus, and executive dysfunction.
To qualify for a diagnosis, the child must exhibit one or more of these symptoms before age 12. You
will observe that the signs are present in more than one setting, like at school or home or in the
company of friends. Moreover, the intensity and frequency of symptoms must interfere with the
child’s functioning in school, work, or other social situations for them to be considered for
evaluation. For a diagnosis of ADHD, these symptoms should not occur due to mood or anxiety
disorders and must be noticeable for at least six months consistently.

It can be hard to know if what you are seeing is a sign of ADHD or not. Explore this list of common
symptoms to get an idea.

BOX

Adi, a nine-year-old child, has an excellent memory for things that interest him, like names of all the
dinosaurs that ever existed or types and functions of machines used in construction. Still, he is unable
to memorise his multiplication tables. In the classroom, Adi seems to hear the teacher's first
instruction, and by the time he was able to bring his textbook to the instructed page, he would miss
the following two instructions. He has trouble getting started on his homework at home and will
often abandon it long before completing the homework to sharpen a pencil or start something else.
Adi’s parents could not understand his inability to attend to an assigned task for any reasonable
length of time as they had observed time and again how he could play for hours with his building
blocks or video games.

Children with ADHD will exhibit a “persistent” pattern of

o inattention
o hyperactivity-impulsivity.

A diagnosis is generally made after the child turns seven when a persistent pattern of the symptoms
is noticed. However, children may start exhibiting signs early on too. In addition, these signs may
occur in more than one setting, such as at home and school.

Inattention

While showing signs of inattention, the child

• Gives less attention to detail and makes careless mistakes in schoolwork or with other
activities.
• Has difficulty in holding attention on tasks or play activities.
• Gives the impression of not listening when spoken to directly.
• Fails to follow through on instructions and is unable to finish assigned schoolwork or chores
(e.g., loses focus, side-tracked).
• Faces trouble organising tasks and activities.
• Dislikes and avoid tasks that require mental effort over a long period.
• Tends to lose things required for completing tasks or activities (e.g. school materials, pencils,
books, tools etc.)
• Is often easily distracted
• Is often forgetful in daily activities, like doing chores.

While showing signs of hyperactivity and impulsivity, the child

• Is fidgety, taps hands or feet or often squirms while seated.

• Usually stands up when the situation demands to seat.
• Inappropriate running or climbing (adolescents or adults may be limited to feeling restless)
• Usually avoids taking part or play in quite leisurely activities.
• Is generally “on the go”. Feels as if “driven by a motor”.
• Often talks non-stop or speaks out of turn.
• Often blurts out an answer before listening to a question completely.
• Has trouble waiting their turn.
• Often interrupts a conversation or intrudes while playing games

1.5.1.2. You suspect ADHD; what next?

There is a lot of conversation about how ADHD is not a real thing, and it is all about hyperactivity, or
it is just a “boy thing”. It becomes difficult for parents to recognise the signs and ask for help, but the
fact is that ADHD is a biological condition and affects children in many different ways. If you are
worried about your child and suspect that they might have ADHD, you should first talk to the school
counsellor, paediatrician, or school teacher. The paediatrician cannot formally diagnose your child,
but they can refer you to a professional, such as a child psychologist or psychiatrist if they feel that
your concerns are valid.

When you see the professional, they may ask you:

• about your family history

• about any recent prominent event in the family, for example, a death in the family or
something equally impactful

• about any recent accident your child had, for example, a head injury

• about any other significant health conditions, you or your child may have

• to explain what your worries about your child are

• when and where did you start seeing the symptoms?

• if the symptoms you observe are affecting your child's day-to-day life, for example, if they
have difficulty in following instructions or are unable to socialise

The professionals may then further ask you to observe your child for a few weeks. They may ask you
to look out for certain signs and ask you to keep notes. It is a good practice to keep an eye out for
repeated behaviours to convey your concerns appropriately.

As a second step, it would be good to connect to the child’s teacher, who can shed light on what’s
going on at school and share similar concerns, especially for the repeated behaviours you have
noticed. It will give you an overall picture of what your child is undergoing and help you explain it to
the professional once you decide to visit them. Finally, the school might recommend you to talk to
the school counsellor, and it is a good idea to speak to them about your concerns as they have a
better understanding and knowledge.

After you go through both these steps and feel that the child’s behaviour affects their day-to-day
functioning, the professional can recommend a formal assessment for your child. A formal
evaluation can sometimes take up to six months or more to complete; in the meantime, you should
learn some strategies that you can do at home to help your child cope with the situation.

1.5.1.3. Recommended therapies for ADHD

If your child is formally diagnosed with ADHD, it is best to learn everything about the disorder that
you can. Talk to experts, fellow parents and your doctor. Ask as many questions as you can to
understand what your child is going through. Understanding will help provide your child with the
support they need, along with the recommended treatment plan.

Many recommended treatments, like medication and behavioural and social skills therapy, can help
children with ADHD relieve various symptoms, like reducing hyperactivity and frustration, improving
their ability to pay attention and control impulsive behaviour. It is essential to talk to the child’s
doctor and understand the various medication and therapy options. Apart from this, nutritious
meals, play and exercise, parent and educational support at school are all part of a balanced
treatment plan for the child.

1.5.1.3.1. Medication for ADHD

Every child is different, and so are their levels of symptom severity and impairment. Medical
treatment should thus be tailored to the child’s needs and be in combination with non-
pharmacological therapies. The therapist will do a baseline assessment of your child’s height
and weight in accordance with the age before prescribing any medication. An evaluation of
your child’s sleep pattern, diet and exercise routine is also done to get a clearer picture.

The professional must explain the effect of the medications on the symptoms, i.e., which
symptoms will improve with medicines and which will not improve with medications.
Parents should also be aware of the available options and possible side effects of different
medicines. Parents should research and discuss with their doctor about all the available
options, the overall impact and side effects, and then judge whether the prescribed
medication will benefit their child.

Starting ADHD medication does not mean that your child has to take them forever. If you
think that the drug is not working for your child, talk to the doctor and plan for slowly
tapering off the medication.

ADHD medications are available in two main categories – stimulant and non-stimulant.

 Stimulant Medications

Stimulant medications are generally the most researched, prescribed and effective
drug for ADHD. Around 70-80% of children with ADHD take one or the other form of
stimulant medications worldwide. Stimulant medications are available in various
formulations like immediate-release (IR), short-acting, sustained/extended-release,
intermediate-acting, and osmotic-controlled release oral delivery system (OROS),
which is long-acting.

 Non-Stimulant Medications

Non-stimulant medicines do not work as quickly as stimulant medicines but are

long-lasting, and their effect can last up to 24 hrs. In addition, some parents prefer
non-stimulant medications because they are given only once a day, unlike stimulant
medications which are given at least twice a day and sometimes even thrice a day.

If you choose to put your child on the medication, you have to closely monitor your child for
side effects and keep tabs on the medicines' effectiveness to adjust the prescription
accordingly.
Monitor the effect of medication by noticing these signs:

- Your child will have a sustained focus for more extended periods and will pay attention
to details.
- Your child will show a decrease in impulsive behaviour, will interrupt less and rarely
jump around.
- You will notice an improvement in their general mood. For example, your child will seem
less stressed and is more productive than usual.
- They will have fewer social challenges
- Some children will have a night of better sleep, and some will see an improvement in
their memory.

Most often, ADHD medication has some side effects. Report any such instances as loss of
appetite, irritability, sleep problems, weight loss, and increased anxiety to the child’s doctor.

Observe and note when your child takes the medication; the medication starts working and
the time when the drug starts wearing off. Keep a daily log for the hours of sleep your child
gets, their mood while the medicine is working and their attitude when it starts wearing off.
Practice taking the record for the first couple of months to understand whether the
medication is working for your child or not.

It is advisable to see the doctor once a week and later once a month to gauge improvement
vis-à-vis side effects during the initial phase. Most of these side effects tend to be
temporary, and adjusting the dose or changing the timing can help control them. In addition,
the professional will measure your child’s weight on every visit and discuss their sleep
pattern and food intake. They will also take feedback on the medication's impact from the
parents, teachers and the child. For example, some elder children may complain that they
do not feel like themselves while taking medicine. The professional addresses such concerns
immediately as they can affect the continuance of the medication.

Box
 Feeling “revved up”
or“slowed down”

Little improvement
in ADHD symptoms
Experiencing side
or diminishing
effects
symptom control
over time

Three signs
your dosage
or medication
needs
adjustment

Doctors recommend that it is crucial to take drug holidays, i.e. planned breaks in taking the
medication, especially during school breaks/vacations. Drug holidays improve the child’s
appetite and let them catch up on growth, as one of the most common side effects of these
medications is a loss of appetite, leading to a somewhat slower physical growth rate. Longer
drug holidays also give parents and the doctor time to review the need for ongoing
medications and adjust the dose accordingly. It is not essential to take ADHD drugs forever.
Review the need for continuance of medicine periodically and, if necessary, discontinue
them in a phased manner.

Medications, whether stimulants or non-stimulants, help manage ADHD symptoms but are
not a “cure”. Medication is most effective when used in combination with exercise and
behavioural and social skills therapy.

1.5.1.3.2. Behavioural and social skills therapy for ADHD

Behavioural therapy can be used as an alternative and supplementary treatment with medication for
ADHD. Research shows that this kind of treatment can be beneficial for children who have poor
familial relationships or issues with aggression or suffer from anxiety or depression along with
ADHD. Parents play a huge role in the success of behaviour therapy because it involves them
working together. Behavioural therapy coaches parents to interact differently with children, to
discourage and replace the negative behaviours, like nagging and yelling, with desirable ones.
Therefore, behaviour therapy demands active participation from you, your child and the therapist.

Behaviour therapy focuses on replacing negative behavioural actions and habits of the affected child
with positive ones by using a reward-and-consequence system that targets specific behavioural
traits. This therapy is action-oriented, where the therapist creates plans to change behaviour
patterns, and it does not focus as much on thoughts and emotions. These plans address those
behavioural patterns that are particularly troublesome for both the parent and the child. To execute
the plan effectively, parents need to communicate clearly with the child about the actions that need
improvement. Parents need to keep a log, observe and report the effectiveness of the therapy
regularly. As suggested by the therapist, they need to set specific rules and enforce them
consistently with both positive and negative consequences in balance.

Reinforce good behaviour

Prepare a chart that lists various activities and rules that the child needs to follow in simple language
or pictures. Make a reward system and let the chart depict how successfully implementing each
activity or rule will lead the child closer to a reward. It must be done in noticeably clear and concrete
terms so that the child knows your expectations from them. Accompany the reward for expected
behaviour with verbal recognition or praise to reinforce good behaviour and boost their faith in
themselves. Sometimes, however, you might also have to use negative consequences if the positive
approach is unsuccessful, especially when the targeted behaviour is aggression. Generally, praise
your child at least three to five times as often as you criticise undesirable behaviour. Parents should
start with small, achievable goals and gradually increase their expectations.

Adapt and change

One important thing to remember is adapting and changing specific measures as your child grows;
what worked for your young child may not work with tweens and teenagers. For older children, it is
always helpful to involve your child in the process of setting up goals and rewards for good
behaviour. For this, you can schedule weekly appointments with the therapist to discuss the child’s
progress, and once a month, the child accompanies you to these sessions.

Involve the school

It is also essential to talk to your child’s teacher and set up a similar system at school to encourage
good behaviour. Make the teacher understand the need for putting extra effort in dealing with the
affected child, especially if they are not trained in dealing with students with learning disabilities and
ADHD. For example, you can request them to regularly use positive words of encouragement for
small achievements that your child accomplishes at school.

Social Factor

Another aspect of behavioural training is improving your child’s social skills; for some children, ADHD
can make it challenging to socialise and read social situations and other’s reactions. Children may
speak non-stop or speak out of turn, or have trouble controlling their emotions or thinking before
speaking. These can cause severe problems in your child’s relationship with their peers, and that
may lead to lower self-esteem and isolation. Find a good social-skills group that teaches and practice
skills that are important when interacting with others. These groups are run by professionals who
demonstrate appropriate behaviours and then lets the children practise repeating them. They also
teach children about social cues expressed through body language, tone, or words and behave
accordingly. Since children with ADHD are often prone to bullying at school, you can request the
school counsellor to have a group session for developing your child’s social skills needed for
classroom decorum and management. A special educator or counsellor in the school may help the
child acquire the necessary social skills to make friends in school.

Provide feedback

Parents can provide guidance and feedback to their children about inappropriate behaviour at home
and give tips on how to improve them. Role-playing with your child is also an effective way to teach
your child about situations that they may encounter. Give your child simple goals that are achievable
and specific. For example, teach them to say hi to a friend you meet at the movie hall and explain
how this is socially appropriate behaviour. You can schedule play dates with a couple of your child’s
classmates at your house to have your child participate in pre-planned activities with them. Since the
activities will be pre-planned and of interest to your child, chances of your child behaving
appropriately are higher than unplanned playdates.

1.5.1.3.3. How parents can support children with ADHD

As a parent, your child requires your understanding and support, which you must try to provide as
best as you can. Keep in mind the following aspects while dealing with your child with learning
disabilities:

Communicate effectively

Before considering any other strategies to help your child at home, first, you must know how to
communicate effectively with them. Children with ADHD are sensitive and tend to take things
personally. So, instead of saying “everyone one gets distracted sometimes”, you can say “everyone
has things they struggle with”, or in place of “if you can focus on things that you find fun, you can
focus on work, too”, you can say “you need to do your work even if it is hard to focus on”. Never tell
your child that “having ADHD is not an excuse”, for it may not be an excuse, but it is an explanation
as kids with ADHD often cannot control their actions due to struggles with self-control and emotion-
management. What you can say to them instead is, “Can you explain what happened?” or “What do
you think you could have done differently?” allowing them a chance at reflection instead of
dismissing their problem. Also, do not ask your child to hide their condition as it may hinder people
from trying to help them and make the child think of their situation as something wrong or
something to be ashamed of.

Help them Focus

Children with ADHD tend to lose focus quickly and are distracted by minor things. As a parent, you
will need to help your child focus. While they are working on a school project or something related
to extra-curricular activities, you can help them

 practice mindfulness
 get started on projects right away
 break projects into chunks

Limit Directions
You must limit instructions to one or two at a time to not confuse or overload your child. Set a timer
for your child to work before they can take a break. Learn how long it takes your child to complete
specific tasks to avoid putting pressure on them, as ADHD can make it hard for kids to keep track of
time.

Be open to new ideas

Ask your child what works for them and be open to ideas, like listening to music while working or
wanting to work in a noisy environment. Then, come up with a signal to direct focus back to the task
when the child starts to get distracted, like a gesture or a particular word.

Collaborate with your child

Talk about what they want to work on and how long it would take them and set goals based on that.
Then, give warnings to your child according to the stopping points agreed upon by both of you.

Get Organised

You may also help them get organised better by making colour-coded charts to show everyday tasks
or school-related work priorities. Older children can use apps to keep themselves organised and
track assignments and tasks. Having a timetable and specific time allotted for completing homework
and assignments will also help your child stay organised.

Check risky behaviours

Children with ADHD are impulsive and can engage in risky behaviours at times. You may have to
monitor your child’s activities to prevent them from engaging in risky behaviour without spying on
them. Monitor them by doing regular inspections, checking up on where they are, and keeping
computers and other electronic devices in a common area.

Self-control

For helping with self-control, you can create a quiet place at home where your child can calm down,
a special place they can go to when things become too difficult to handle, provide rewards and
positive reinforcements for practising self-control. Acknowledge their efforts out loud by saying
things like, “I appreciated that you waited patiently”. It takes time for children to learn to develop
self-control, so you, too, might have to be patient and practice simple changes in how you talk to
them when they behave “out-of-line”.

Boost confidence

Take steps to boost your child’s confidence, starting with having a special one-on-one time with your
child during the day. Praise your child for small accomplishments and tell them that you love and
support them unconditionally.

Build on strengths

Find out your child’s strength. Children with ADHD tend to have specific strengths that are not
apparent, but over time, you will recognise their strengths. For example, your child might have a
great memory or is physically strong, or they might be good at computers. Find those strengths and
build on them so that your child has a sense of accomplishment.

Self-care of parents

While you are taking care of your child's needs, it is equally important to set out time for yourself.
Engage in activities or hobbies that are of your interest. Rejuvenate yourself.

1.5.1.3.4. Educational support for children with ADHD

School administration and teachers can also help students with ADHD manage their symptoms at
school and provide support in many ways. There are numerous classroom accommodations to help
children with ADHD. Below is a list of some of these accommodations:

 extending time on tests

 allowing the permission to get up and move during class
 being seated away from doors or windows that may be distracting and offer seating
position near the teacher
 coming up with a signal to get back their attention if they have drifted

Teachers can also help the affected child by

 giving clear, brief instructions

 breaking down tasks into smaller, manageable pieces.
 praise positive behaviours, such as staying seated, not calling out, taking turns, etc.
to boost self-confidence
 notify parents about important due dates

A strategy that almost always works is pairing the student with ADHD with a buddy to help them
take out the right books, materials, and other important stuff before class starts. In addition, parents
may need to collaborate with the school to let them know the kind of strategies you use at home
and ask them to apply the same in school if possible. Besides, keeping track of your child’s
performance and behaviour at school, involving teachers and helping them understand the problems
precisely the child faces or struggles with, both in and outside the classroom, will allow the overall
approach and treatment to be more comprehensive.
 1.5.2. Dyslexia

Dyslexia is a learning disorder characterized by problems with accurate or fluent word recognition,
poor decoding, and inadequate spelling abilities. It also involves difficulty in reading due to problems
with identifying speech sounds. Children with dyslexia may have average or above-average
intelligence. However, they exhibit learning gaps. In reading and other language-related areas, the
functional level of a child with dyslexia is usually below the grade level of their peers. Dyslexia
manifests itself in many ways:

 Children have difficulty in learning how to match letters with their sounds, a process called
decoding. This difficulty with making association influences a child’s reading abilities, ability
to express themselves through words clearly, and fully understand what others mean when
they speak.
 They struggle to learn phonics, i.e. difficulty in recognising and breaking down letters or
segmenting words into smaller syllables. e.g. reads the word “doctor” as “do-ctor,” instead
of “doc-tor,”
 They face difficulties in rhyming words and struggle to recognise simple sight words like “it”,
“and”, “the”, etc.
 Processing and remembering information they see and hear can affect learning and the
acquisition of literary skills.
 Reading, writing, spelling and word recognition; hence it is a language-based disability.

Dyslexia affects the way a child’s brain processes language-based information. Dyslexia may also
influence areas such as coordination and organisation, making everyday tasks difficult. These
difficulties that the child faces significantly interfere with their academic achievement and activities
of daily life. As with all other learning disabilities, it is vital that before diagnosing a child with
dyslexia, it is significant to rule out that the academic gap is not due to other factors, such as vision
or hearing impairment, developmental delays, etc. Early identification, assessment and intervention
is the key to positively manage dyslexia.

Causes of dyslexia

What causes a person to have dyslexia is still not completely clear. Causes of dyslexia are said to lie
in both genetic and neurological factors. Dyslexia may run in families where parents of children with
dyslexia also have dyslexia. Individual differences in the functioning of the brain are also some
factors associated with dyslexia. Research shows that dyslexia happens because of the way the brain
processes information. Brain scans show that people with dyslexia use different parts of their brain
than those without it.

Many children with dyslexia have other learning and thinking differences, as well. It is common for
children to have both dyslexia and ADHD, for instance. Anywhere from 20 to 40 per cent of children
with ADHD also have dyslexia. Dyslexia is a lifelong problem that presents daily challenges. Still,
treatment and support can significantly improve a child’s reading and writing skills, giving them a
chance to succeed in their personal life and school or work.
 1.5.2.1. Dyslexia – Signs to look out for

The signs of dyslexia are not the same among all age groups; neither are they experienced in the
same way by everyone. Instead, how the symptoms and signs of dyslexia manifest themselves may
vary from person to person. Given below are some of the signs that may signify the presence of
dyslexia in a child. To formally diagnose a child with dyslexia, parents need to get an assessment
done by a professional.

Signs of dyslexia in pre-Schoolers

The signs may be difficult to recognise before the child starts school. However, some early signs may
indicate that a child may have difficulty:

• Difficulty in learning simple nursery rhymes or playing rhyming games

• Difficulty in telling left from right

• A history of slow/delayed speech development often mispronouncing familiar and simple

words like “cat”, “the”, etc.

• Finding it hard to carry out more than two instructions at one time, but carrying out tasks
individually

• Has difficulty in understanding what they have read

• Often have the feeling that the words in the book are blurred or are dancing or jumping

• Forgets names of friends, family members, colours, etc

Signs of dyslexia in school years

• A significant gap between the child’s performance and their grade of instruction

• Exhibits difficulty to read, write and spell

• While reading often omits or repeats words, the level of comprehension is low

• Continues writing letters backwards, primarily similar-looking letters like “b” and “d.”

• Often spells the same word differently, confuses upper- and lower-case letters, difficulty
with grammar
• Has difficulty taking notes in class due to the slow writing speed; hence finds difficulty
finishing tasks on time.
• Oral ability is better than written work as handwriting is poor, therefore may score better in
the verbal test than written
• Confuses direction - left/right
• Is disorganised, forgetful and clumsy
• Has difficulty making friends as reading body language is difficult
 • Needs more concentration and effort to complete a given task hence appears excessively
tired compared to his peers
• Finds it difficult to find the right word or form answers to questions

Signs of dyslexia in teens and later years

• Inaccurate reading with limited comprehension, therefore, may avoid reading aloud in the
class

• Writing slowly with unclear handwriting

• Finding it hard to concentrate if there are distractions

• Feeling sensations of mental overload and ‘switching off’

• Has difficulty in telling left from right

• Has difficulty in the organisation of – thoughts, time, priorities, etc

• Difficulty in remembering rules of games and reading clocks

• Difficulty summarising

• Trouble in understanding expressions, idioms and jokes

• Trouble in learning a foreign language

• Difficulties in understanding mathematics problems

• Has low self-esteem, mostly if dyslexia remains undiagnosed

• Struggling to meet deadlines and finish tests on time, struggles to remember names,
numbers and dates

1.5.2.2. You suspect dyslexia; what next?

As a parent, if you suspect that your child may have dyslexia, you need to meet with a qualified
professional (such as a child psychologist, school counsellor, or special educator) to discuss the next
steps. If you are a teacher, you can discuss the child’s difficulties with the school counsellor and the
parents. Often, if a child shows significant signs of having dyslexia, schedule a formal assessment for
them. Other factors like vision or hearing impairment, delay in development, or language-processing
disorders can influence a child’s language difficulties. All these factors are investigated in a formal
assessment, starting with a parent’s observations, family history, and the child's developmental
history both in house and school. The professional will need information on the child's symptoms
and the age when you first noticed the signs. They will want to know about the child’s performance
in school; hence, it helps to obtain information on development in reading, counting, spelling, and
other school subjects from teachers. The professional establishes the writing skills with the help of
writing samples of the child’s (e.g. stories, freewriting, dictation), possibly from several different
school years.
The professional might want to observe your child in their learning environment, and they will also
ask your child to take part in a series of tests. These tests examine your child’s reading, writing and
language abilities. They may administer tests for logical reasoning and memory too. They might also
test your child’s speed to process visual and auditory (sound) information along with their
organisational skills.

After completing the assessment, you will receive a formal report outlining whether your child has
dyslexia. It will also outline your child’s strengths and weaknesses. The professional will also provide
you with recommendations for improving areas in which your child is facing difficulties. For example,
finding out what lies behind your child’s reading difficulties and challenges can help find a better
treatment to help your child progress and secure their future.

1.5.2.3. Recommended therapies for dyslexia

Dyslexia is a lifelong difficulty, with no definitive medical treatment available, but early intervention
involving specialist educational interventions and emotional support can help children with their
reading, writing and general well-being.

Early intervention and diagnosis is the key to helping children with dyslexia. A two-step approach is
taken in managing dyslexia in children – educational interventions at school and interventions at
home.

Emotional support extended by a counsellor is also a significant part of managing children with
dyslexia. Counselling provides the child with an opportunity to talk about their feelings and the
difficulties that they are facing at school, social gatherings and home. The counsellor must work in
tandem with the school teacher/counsellor and with the parents so that the child gets the maximum
help that they need. We need to understand that the frustrations of children with dyslexia often
centre around their inability to meet the expectations of other people. Compound that with the
frustration that is created due to their inability to achieve the said goals. Systematic counselling
helps them in overcoming these feelings of frustration, loneliness, anger and other issues.

1.5.2.3.1. Educational techniques to help children with dyslexia

Specialist educational interventions and emotional support at school can help children with their
reading, writing and general well-being. A school can help children with dyslexia by providing them
with certain classroom accommodations and adapting some educational techniques in the
curriculum.

Classroom accommodations

Children with dyslexia need explicit and direct instructions in reading and writing that are specific,
cumulative, thorough, and focused on language structure. Teachers can accommodate students who
struggle with reading, spelling, and writing in the following ways.

a) If possible, provide one-step direction at a time, read aloud or provide a visual presentation
of the instructions.
 b) Provide them with summaries of the lessons to be taught in the class ahead of time. It will
give them time to prepare beforehand and give them more confidence while in class.
c) Break assignments into smaller steps and highlight keywords and ideas on worksheets
d) Encourage them to use sticky notes to sort and arrange essential concepts in the text.
e) Provide extra time for reading and writing, especially during exams.
f) Permit verbal responses or let them circle correct answers to test questions instead of
writing them down.
g) Let them complete tests or exams in a separate room away from distractions to allow
greater focus.
h) Grade the students on the content and not on spelling or reading fluency.
i) Allow using computers or tablets for taking notes to avoid fatigue while writing or allowing a
scribe as an alternative.
j) If possible, provide students with an audio-visual presentation or typed notes of the
instructional materials taught in the classroom.

Educational Techniques

Along with classroom accommodations, teachers can use some particular educational techniques for
interventions to improve learning. Most interventions may use several senses like hearing, vision
and touch. These techniques focus on phonics, identifying and processing word sounds, combining
letters to create words, and practising reading words accurately to help them read more quickly.

 Multi-Sensory Language Education

Multisensory teaching is an essential aspect of instruction for dyslexic students used by
trained teachers or special educators. Multisensory learning involves the use of visual (what
we see), auditory (what we hear), and kinaesthetic-tactile (language symbols that we feel)
pathways at the same time to improve memory and learning of written language.
It applies the principle of combining movement with speech and reading at different
language learning levels in the following ways:

a) Hand gestures to help the children memorise the definition of a noun.

b) Use word cards to create sentences or classify the words in sentences by physically
moving them into categories. Later on, the children can move these sentences
around to make paragraphs.
c) Storytelling with the help of three-dimensional, tactile aids

 Orton-Gillingham Approach

Orton–Gillingham, a teaching approach, is specifically designed to help struggling readers.

The method teaches the students connections between letters and sounds and focuses on
why we spell words in a specific way. Children may explore why the letter ‘s’ sounds a
certain way in the word ‘sun’ and in a different way in the word ‘lies’. Once these rules and
patterns are clear to the child, decoding words becomes more effortless. Children taught
with the Orton-Gillingham approach learn to read a word by breaking them into syllables
and phonemes.
 1.5.2.3.2. How parents can support children with dyslexia

Dyslexia can be a particularly challenging condition for children and their parents. Children
require a significant amount of support from their parents. Parents need to thoroughly
understand their child’s condition by reading and researching from trusted sources and
addressing the problem early, as early intervention can improve success. Familiarise the child
with their condition, too, so that they feel comfortable talking about their situation with you.

o Reading to your child consistently and out loud, even if you must re-read their favourite
book, helps significantly. It is better to start at a noticeably young age so that it becomes
a habit.

o As your child grows older, encourage them to read more complex and engaging material
like graphic novels. For children in high school who are still reluctant to read, try to slip
in reading wherever possible — engage them in reading magazine articles of topics that
interest them or encourage them to read the newspaper.

o Listen to audiobooks together and ask questions like, “What do you think will happen
now?” to keep them engaged.

o Help your child by providing checklists and setting regular routines. Help them prepare
for school by offering subtle help in getting ready.

o Parents may colour-code their timetable to make it easier for them to understand and
find lessons immediately.

o Work closely with your child’s school to ensure adequate support and classroom
accommodations are provided to your child, as suggested by the child’s therapist, to
facilitate learning. The earlier you start, the better it will be for your child.

o For older children, technology can come to your rescue. Learning becomes better with
visual presentation and is a suitable method of learning and working. Also, word
processing programmes are useful because of the spellchecker and autocorrect facility.
These can highlight mistakes in your child’s writing and help them correct them on the
spot.

o Text-to-speech and speech recognition software is useful as verbal skills are often better
than writing skills in children with dyslexia.

o Provide positive support by praising your child when they do something right and as
desired, even if the achievements are small. Involve your child in activities they enjoy
and are good at to balance the struggles with schoolwork.

Your support is not only essential but irreplaceable for your child. Help them understand that their
issue is not their fault and that everybody struggles with something, and they are not alone.
 1.5.3. Dyscalculia

Dyscalculia, a learning disability, is characterized by problems in processing numerical information,

learning arithmetic facts, and performing accurate or fluent calculations. Children with dyscalculia
have difficulty in understanding mathematical concepts and tasks that involve maths. Sometimes
referred to as “math dyslexia” or “number dyslexia”, a very misleading statement. Dyslexia is a
language-based learning disability, while dyscalculia is mainly a challenge with math. Children often
dislike math or have problems in the subject, or may have limited exposure to the subject, but
dyscalculia goes beyond having merely a hard time understanding math.

It involves a lot more than making mistakes in concepts like addition or reversing the digits while
writing something down. It affects a person at multiple levels, where they do not understand simple
mathematical concepts, like how one amount is greater than another or simple subtraction and
addition problems. Therefore, learning more abstract concepts like algebra is almost impossible,
making school hard for a child. It leads a child to perform below the expectations for his or her age.
Dyscalculia also makes carrying out everyday tasks equally harder because cooking, shopping, being
on time, and playing with friends all involve some necessary math skills.

Unfortunately, dyscalculia is not as well known or understood as dyslexia. Nevertheless, it is just as

commonplace. The exact causes of dyscalculia are unknown; however, the prevalent theory is that
dyscalculia is a neurological disorder. It involves differences in how one’s brain functions in terms of
perceiving, processing and responding to math-related issues. Dyscalculia may run in families where
genetics may play a part in its occurrence. Dyscalculia most often occurs along with a co-morbidity
like attention deficit hyperactivity disorder (ADHD). Up to 60 per cent of people who have ADHD also
have some form of a learning disorder, like dyscalculia.

1.5.3.1. Dyscalculia - Signs to look out for

The signs of dyscalculia vary from person to person and with age, whereby some children may show
symptoms as early as pre-school and others may display difficulty with maths at the middle-school
level. Even then, dyscalculia may be harder to spot as all children have a problem with maths from
time to time. Still, the thing to remember with dyscalculia is that the acquired mathematical skills
will be much lower than the child's age. Any math-based task or activity can frustrate children with
dyscalculia and cause them to feel extreme discomfort.

Signs of dyscalculia among pre-schoolers

• Difficulty in sorting objects by shape, size or colour

• Problem in connecting numbers to groups or things, like associating the number four with
groups of things that may be in fours such as four balloons, four kids, or four apples. Trouble
recognising patterns like greatest to smallest, or shortest to tallest
• Forgetting essential facts due to poor memory when it comes to numbers
• Not understanding what to do when tasks that involve numbers present themselves like “get
the third jar from the left” or “bring the plate with five biscuits on it.”

Signs of dyscalculia among primary school children

• Still trying to understand a basic concept while the class has moved on to one a little more
complex
• May act up or irrationally behave when it is time for math class in school or math homework
at home
• Troubling learning and remembering mathematical facts, like 2 + 3, is the same as 3+2.
• Not being able to understand that the number “5” is the same as the word five and that
both mean the same thing
• Difficulty in understanding different symbols such as +.
• Trouble with counting and mental math
• Using fingers for counting or demonstrating a number with fingers rather than saying what it
is
• Difficulty in comprehending word problems.
• Trouble with linking “clue words” to math operations whereby the child isn’t able to solve
word problems
• May avoid games that require maths such as Monopoly

Symptoms among dyscalculia in teens and adults

• Difficulty understanding graphs and charts (visual-spatial concepts)

• Struggling to understand word math-problems
• Difficulty in remembering timetables
• Trouble with remembering numbers, or their visual representations
• Struggling with time-telling and trouble reading clocks
• Trouble with making comparisons even if the differences seem glaringly obvious
• Avoiding games that involve math skills or strategies, e.g. card and board games
• Trouble with making phone calls
• Struggling with directions and moving about in new places and unwillingness to explore new
places on their own
• Unwillingness to wear a watch despite a requirement
• May use a calculator to answer fundamental math problems
• Getting anxious or freezing with questions that are related to doing math
• Struggles sticking to a budget as they cannot apply basic maths concepts to money
• Frequently running late and missing important events due to difficulty sticking to a schedule
• Have trouble in judging speed and distance, like running too fast in the first lap but
completely feeling exhausted by the second
• Losing track of time very often
• Trouble in understanding the logic behind math and finding different approaches to the
same maths problem
• Struggling with counting money

1.5.3.2. You suspect dyscalculia; what next?

If you suspect that your child might have dyscalculia, start noting down the difficulties they
experience at home as well as with their schoolwork when it comes to math. Gather as much
information about dyscalculia and how it varies among children as you can. You must understand
that most children, at one point or another, may have difficulty with maths and feel anxious about it,
but dyscalculia is not math anxiety. Children with dyscalculia often get intensely emotional with
mathematical concepts and ideas, which can cause them anxiety. They may get upset or frustrated,
even while playing if the game involves doing math in any manner. It is also important to remember
that dyscalculia does not take the same form in every child and that its manifestations may be
unique.

Talk to your child’s mathematics teacher to understand where they are having trouble and
understand the exact situation. Try talking to other teachers as well to find out if they have seen
your child struggle with numbers. Talk to the special educator or counsellor at school to understand
and pinpoint the exact issues your child is facing.

If the special educator or counsellor also share your concern, you should seek help from a
professional to assess dyscalculia. The professional will ask you questions about your child’s medical
and family history, their general health, the mother's experiences during the gestation period, and
any complications regarding the child’s birth. The answers to these questions rule out the possibility
of any other factor causing the issue in your child.

After the clinical interview, the professional will administer a series of tests to confirm whether your
child has dyscalculia, as it is challenging to identify dyscalculia via a single diagnostic test. The test
usually measures the child’s performance based on the following four skills:

o Computational Skills (ability to perform arithmetical operations)

o Mathematical Fluency (how easily does the child recall basic mathematical facts)
o Mental Computation (mental-maths abilities)
o Quantitative reasoning (ability to solve word-based math problems)

The test will determine your child’s ability to;

• Do necessary math skills like counting, addition, subtraction, multiplication and division to
know when to add, subtract, multiply, divide depending on the problem
• Organise objects in a logical way
• Measure-telling time, using money
• Estimate number quantities
• Self-check finished work
• Find alternate ways to solve problems

After a detailed assessment, the professional prepares a report that addresses the requirements of
your child. It is essential to understand your child's specific needs as all children with dyscalculia do
not have the same problems.

1.5.3.3. Recommended therapies for dyscalculia

Dyscalculia is not something that people grow out of, and there are no medical treatments available.
But there are certain ways in which we can help children with dyscalculia flourish. The two most
necessary ways are – providing classroom accommodations to support children and parental support
outside the school environment. Apart from that, children with dyscalculia can learn math concepts
by working with a special educator regularly.

A special educator uses a multisensory approach to teach concepts. The educator will also slow
down the learning pace and review the concepts often as they encounter new material. Help outside
the classroom lets your child and their educator focus specifically on the difficulties that they are
having, taking pressure off moving to new topics too quickly. Repeated reinforcement and specific
practise of straightforward ideas can make understanding easier. Hence, a preliminary treatment
plan for dyscalculia, according to learning specialists and psychologists, would involve specially
designed strategies for teaching, math-based learning games, and practising math skills consistently
and more frequently than their peers.

1.5.3.3.1. Classroom accommodations to support children with dyscalculia

The school plays an important part in managing children with learning disabilities. The
school and teachers can take the following measures to help out struggling children:

 Permitting extra time on tests may help the child as they will not feel rushed or
under too much pressure to perform in too little time, and benefit students for
whom time restrictions may be a roadblock to learning.
 Frequent checks of classwork will decrease a child’s frustration and provide constant
feedback to learn from their mistakes and develop a sense that they can improve.
 Assigning partners or do one on one testing
 Schools can provide a special educator who can work along with the child, breaking
and listing the steps involved in solving an equation or problem.
 Provision of recorded lectures to students in need may also be beneficial.
 Providing sample problems and extra examples for reference while ensuring that the
assigned problems are not too many or too burdening for the child can help better
the student’s understanding and make assessment easier.
 If possible, the use of a calculator should be allowed. CBSE has permitted the use of
a calculator for students with dyscalculia in board exams.
 Multisensory learning, i.e. using senses like touch, vision, and audio to teach math
concepts, helps children struggling with dyscalculia a lot. Successful use of these
sensibilities may help them understand the nuances of mathematics and improve
their confidence in the subject.
 To avoid students shutting down or getting overwhelmed due to anxiety, they can
provide them with plenty of opportunities to maximise engagement. Creatively
demonstrate concepts that let them physically (hear, touch) experience concepts.
 Teaching maths like a foreign language – focus on vocabulary and its reinforcement
 Specific devices and tools, like the abacus, can effectively improve number sense.
 Providing feedback to the student about where they went wrong and addressing
that can turn out to be helpful.
 1.5.3.3.2. How parents can support children with dyscalculia

There are many ways that a child can be helped at home, allowing them to better cope with
dyscalculia. For this, you must have the essential information. You must know what the child
particularly struggles with and what their problems exactly are, as the kind of difficulty one
experiences in dyscalculia may not be the same or even similar for all children.

Since it is a disability that affects different areas of daily life and not just academia, there are
many activities at home that your child can learn through.

 Positive encouragement always works. You should praise the work they do and the
effort they put in and not focus on the result. Do not get frustrated if your child
cannot understand basic concepts, like addition and subtraction. Instead, patiently
guide them towards the solution.
 Use examples of mathematical significance from daily life and the experience of the
child to teach simple concepts. Whenever possible, point out the utility of maths in
everyday life, building a sense of number application in daily life. E.g. while paying
for ice cream or candy, ask how much change they will get back or while grocery
shopping let them calculate the number of biscuits required for a week.
 During playtime with your child, try to play games that involve numbers and
calculations to make them understand that maths can also be fun, e.g. Monopoly,
candy land, Jodogyan etc.
 Talk to your child and make them understand that the issues they are facing are not
their fault but are due to their condition. Encourage them to identify their areas of
strength. Explain to them that everyone has unique strengths and areas that need
improvement. It will help boost their confidence and shed any negative beliefs they
might have.
 Use rhythm and music to teach steps, draw pictures of mathematical word-problems
and facts, use coins or blocks to do simple maths problems.
 Ensure they have the right tools and devices, like sufficient stationery, erasers, and a
calculator, which is easy to use to help them with their homework.
 Let them use their fingers to count if they are unable to do mental maths
 Use visual representation like charts and time table to help them manage time.
 Teach them self-advocacy; it will help them be independent in school, they will be
able to ask for help from teachers when they get stuck or are unable to understand
the concept

Also, make sure that you are in constant touch with your child’s teachers to be aware of their
progress and overall performance and, therefore, their changing needs.

Children who struggle with learning disabilities are often under-confident, suffer from self-esteem
issues, and may feel ashamed of their problems. So, help your child develop a growth mindset
whereby they start believing that their skills can improve and help them understand that they do not
have anything to be ashamed of or be embarrassed.

1.5.4. Dysgraphia

Dysgraphia is a learning disability that impairs the fine motor skills needed for writing. It is a
neurological disorder impacting all writing skills like handwriting, the spacing between words and
sizing, legibility, and spelling. This set of skills are known as transcription skills. Trouble expressing
oneself in writing is not particularly a part of dysgraphia. However, where transcription requires an
enormous amount of effort, one may forget what they wanted to say in the first place. Hence, it
impacts a child’s ability to express themselves through the written word while making the process of
writing laboriously slow, resulting in a dislike for or extreme resistance towards writing. This
frustration with the act of writing among those who suffer from dysgraphia is often misunderstood
as laziness on the child’s part when, in fact, the underlying factors for this behaviour are something
entirely different. Children with dysgraphia have difficulties with handwriting and tasks involving fine
motor skills like buttoning and cutting with scissors.

The causes of dysgraphia are not definitively known. Although genetics and family history are often
cited as risk-factors, sometimes brain damage at a later stage in life may also result in dysgraphia-
like symptoms in adults (agraphia). Children with dysgraphia process words and letters in a way that
makes it difficult for them to move their hands and fingers to write. Their working memory finds it
challenging to remember written words permanently. Dysgraphia generally coexists in children who
have ADHD or other learning disabilities.

1.5.4.1. Dysgraphia – Signs to look out for

Dysgraphia and dyslexia, both may affect a child’s ability to spell, but the two are very distinct
conditions. Dyslexia makes it more difficult for a child to learn to read, whereas, by itself, dysgraphia
does not affect a child’s ability to read. Dysgraphia has more to do with writing, “messy handwriting”
is one of the most common signs of dysgraphia.

Commonly found symptoms of dysgraphia among children and adults

• Pre-schoolers have difficulty in colouring between lines and are unable to use the scissors
• School going children have difficulty in forming and copying letters or words
o Have trouble with spelling and capitalization and mixes cursive and print letters;
hence the handwriting looks clumsy or untidy
o Trouble with consistency in spacing and difficulty staying within the margins
o A significant difference in the spoken and written understanding of things
o Omission of letters from sentences when writing but not when speaking
o Struggling to visualise words and letters before writing them
 o Trouble with following sentence structure and rules of grammar when writing but
not when speaking
o Since the whole process is complicated and slow, children have a habit of saying
what they are writing out loud in order not to lose their train of thought
o Trouble focusing on other things while writing due to which they have extreme
difficulty during notetaking
o Usually have difficulty maintaining a grip on a pencil or have a painful grip, resulting
in hand-cramps.
o They also have a habit of watching their hand while writing and have unusual hand
and body position when writing. Sometimes the placement of the paper or
notebook the child is writing on is also unique.
o They also sometimes mix upper and lower case letters while writing.

• Teenagers will avoid using complicated sentences and write in simple sentences, yet their
writing will have more grammatical errors than their peers.

1.5.4.2. You suspect your child has dysgraphia; what next?

If you have consistently noticed the signs and symptoms of dysgraphia in your child, the first step
would be to talk to the child’s teachers and see if they share your concerns. While talking to the
teachers, ask them specifically how the child struggles. Next, gather as much information as you can
on dysgraphia to understand other behavioural changes that might have occurred due to struggles
with writing—issues like self-esteem, anxiety with writing-related tasks, or getting upset or
frustrated when articulating. Try and be more sensitive to changes in behaviour or “mood” of the
child. Keep a close record of what you observe. Once you have enough information, speak to a
professional. They may recommend your child to undergo an evaluation to determine whether your
child has dysgraphia.

The professional may ask you a few questions before diagnosing the child to rule out the possibility
of any other condition or disease that might be causing the issue. The questions will be about the
child’s medical history, developmental history, and the signs you have observed. After completing
this process of exclusion, the professional will test your child dysgraphia.

Evaluation tests usually have two components – test for writing and fine motor skills and motor
planning skills. First, the professional will ask your child to copy a few sentences and write answers
to a few questions on their own. Through these tests, the professional will assess the child’s ability
to put their thoughts into words and fine motor skills by looking at their writing process, pencil grip,
posture while writing, hand and body position, and finished work. For testing your child’s fine motor
skills, the professional may ask your child to randomly put pegs in holes as quickly as possible or use
the tweezer to pick up small objects. The fine motor skill test is to understand your child’s ability to
manipulate small muscles and measure hand-eye coordination. The professional may also include an
IQ test and also examine the child’s academic records.
 1.5.4.3. Recommended therapies for dysgraphia

Dysgraphia is a life-long condition – there is no cure or medication. That does not mean, though,
that people with dysgraphia cannot succeed at writing and do other language-based
activities. Management of dysgraphia involves providing support at school, occupational therapy
outside of school, and things done at home to help the child.

1.5.4.3.1. Occupational Therapy for dysgraphia

Struggle with handwriting and formation of letters in children with dysgraphia is primarily addressed
by occupational therapy. This kind of treatment can prove highly beneficial for the improvement of
handwriting skills. It includes several writing programs and activities to help children and adults form
letters and sentences on paper. Therapeutic activities include doing connect-the-dots puzzles,
working with modelling clay, drawing lines within mazes, and tracing letters in cream on a desk. An
occupational therapist also works with children to improve their fine motor skills and motor planning
to make writing easier. These may include wrist and hand muscle exercises or learning to hold a
pencil in ways that make writing less strenuous.

The aim here is to gradually make the physical act of writing, the most commonly challenging thing
in dysgraphia, less daunting to a child, where the idea of expressing themselves on paper does not
cause physical or emotional strain.

1.5.4.3.2. How to support children with dysgraphia at school

It is crucial to involve the school administration and teachers to provide accommodations that help
the child cope with struggles associated with dysgraphia. Parents may approach the school to
request the needed services and support if the child is formally diagnosed with dysgraphia. Since
children with dysgraphia have a neurological condition, asking them to “practice harder” and
“increasing concentration on what they want to say” by writing often does not help them. They
require the proper kind of support that suits their needs and addresses the actual issue, which has
nothing to do with laziness or intelligence. With the appropriate letter-formation techniques, using
specific handwriting-specific training programs, and fixing incorrect grips, schoolteachers can help
children with dysgraphia. Besides, assistive technology and other devices, like dictation software,
can also prove beneficial.

Schools can help children with dysgraphia in the following ways:

• Accommodations: Schools can provide alternatives to written expression

o Oral exams and assignments, wherever possible, in place of written ones
o Allowing the use of a computer to type instead of having to hand-write
o Shorter writing tasks, or audio or visual assignments instead of written ones
• Modifications: Schools can adjust expectations from the child or minimize given tasks
o Providing copies of the class notes to reduce the work of writing or a designated
note-taker in the classroom
o Extra time on tests and assignments with a modified syllabus
 o Provision of lecture notes in digital form or as printouts
o Providing writing implements with a special grip that make the task of writing easier
• Remediation: Special educator can provide instruction for improving handwriting and writing
skills
o For guiding children, provide them with paper with raised lines
o Practice writing letters in the air for motor memory
o Teaching proper grip, posture for writing
o Break assignments into small parts or create a step-by-step instruction sheet

1.5.4.3.3. How parents can support children with dysgraphia

There are many ways that a child can be helped at home to better cope with dysgraphia.
First, understand the areas in which your child particularly struggles and provide help
accordingly.

• Encourage your child to speak things out first, and record themselves while expressing
their ideas, talking about their thoughts on a subject, or telling a story. Then, play the
recording when they sit to write. Playing the recording will give them the confidence to
write as they are already familiar with the topic.
• Use clay to practice forming letters with your child. It will help with the child’s fine
motor skills and reinforce the textures of letters in their mind. You can also ask your
child to etch letters into clay with a pencil. Working with clay is a sensory technique that
provides better information to the brain about how letters are made and make them
easy to remember.
• Allowing your child to focus on feeling and not seeing how letters are formed can also
prove beneficial. For example, you can trace letters on the child’s back and palm and see
if they can replicate the same on paper or your back or palm.
• Watch videos on how trying different pencil grips might help the child.
• Try writing aids for comfort.
• Teach your child to relieve stress before writing by shaking or rubbing their hands
together very fast. Squeeze stress balls
• Teach your child typing skills early and see if it proves to be more comfortable than
writing with one’s hand.
• Writing big can help with remembering and make letter-formation more memorable.
For example, to enhance sensory input, you can let your child use shaving cream or
spray paint to write letters or write letters in the foam of cream or damp sand.
• Using wide-ruled paper or paper with raised lines aids in aligning letters and words while
writing with hand.
• For improving hand-muscle strength and coordination, allow your child to squeeze
things, like a stress ball or sponge.
• Practice organized or structured storytelling with your child. Ask them about their day
and have them start with an introduction like what day was it, and then move on to
what they did in the morning, the afternoon and the evening, or allow them to move in
 progression towards what they did at different points of the morning, or during play.
Then, let them end by describing how the day or the event went overall.
• Praise the effort and not the work by offering positive reinforcement and not criticizing
“sloppy work” because children with learning disabilities often feel less than competent.
• Acknowledge your child’s condition, talk to them about it. Help them understand what
their condition is and how it is not their fault.

Show your child that you are there to help and that you understand. Help them build self-esteem by
practising self-advocacy and offering the right kind of praise where the child does not feel
patronized. Help them stay motivated to improve by showing examples of others who had the same
struggle and letting them know that they can excel at writing.
 1.5.5. Dyspraxia

Dyspraxia, also called developmental coordination disorder (DCD) or specific developmental disorder
of motor function (SDDMF), is a neurodevelopmental disorder that primarily affects physical
coordination – the ability to plan and process motor tasks. People with developmental dyspraxia
struggle with organization or controlling of movement, and therefore, may appear to move clumsily.
The ‘clumsiness’ stems from their brain processing information in a way that causes the transmission
of nerve impulses to be incomplete or improper. As a result, it impacts the planning and execution of
a child’s daily life tasks so that they do not exactly match up to the level appropriate for their age.
However, people with dyspraxia may demonstrate several strengths, such as determination,
motivation, creativity, and strategic thinking.

It is not clear exactly which genes cause dyspraxia, but some research suggests that it may have
something to do with neurons' development. The brain does not process information in a way that
allows for the full transmission of neural messages. Other than that, some frequently cited reasons
for dyspraxia in children are risk factors of environment, exposure to nicotine or alcohol in the pre-
natal stage, low birth weight, premature birth, etc. However, the exact cause for it is still unknown.
Dyspraxia usually runs in the family and is three to four more times common in boys than girls.

1.5.5.1. Dyspraxia – Signs to look out for

Dyspraxia is the least studied learning disability and often goes undiagnosed or unrecognised as
children experiencing it are deemed clumsy or ‘out of sync’. Even as it is associated with language,
perception, and thought problems, trouble with motor skills is the most common indicator of
possible dyspraxia. For example, an infant with dyspraxia may never go through the crawling stage
and have difficulty seating. However, how the disorder symptoms manifest themselves with age and
level of expected maturity varies.

Symptoms of dyspraxia in pre-schoolers

• Trouble learning to ride a bicycle or tricycle even with training wheels

• Difficulty eating food with cutlery
• Have trouble in being potty-trained
• Trouble throwing a ball and being afraid to play games involving co-ordination such as
stacking
• Trouble in sitting still or shows unusual body postures
• Difficulty with making gestures and motions that involve hand-movements like “Head,
Shoulders, Knees, and Toes,” where they experience a problem in pointing towards these
body parts
• Frequently bumping into others by accident
• Jagged-play or roughhousing

Dyspraxia symptoms commonly found in kindergarteners and younger children

 • Undeveloped or underdeveloped left- or right- hand dominance exhibited in using one hand
for most activities
• Awkward and slow movements, avoid physical education classes in school
• Fumbling with objects like scissors and struggling to cut out shapes
• Frequently dropping things and experiencing problems while holding things like pencils and
cups
• Avoids participating in playground activities like jumping, hopping and skipping due to lack
of coordination and fear of falling
• Struggling with building blocks and puzzles
• Struggling with getting dressed, doing buttons, tying laces and trouble with using zippers
• Bumping into people and things way too often and difficulty in walking up and downstairs
• Difficulty with the formation of letters correctly or spacing them appropriately between the
lines
• Problems brushing teeth and other self-care routines

Dyspraxia symptoms commonly found in middle-schoolers

• Poor understanding of spacing between letters and words

• Movement-imitation problems in sports or other extracurricular activities like dance
• Struggling with visually and spatially demanding tasks like moving pieces on a game-board
• Trouble with following basic routines like packing one’s bag or getting dressed for school
• Slow to pick up new skills; they need repeated instructions to learn new things
• Trouble in forming letters with a pencil because of difficulty experienced in holding a grip
• Difficulty in cutting foods or making morsels
• Improper lining of columns while doing math-problems

Dyspraxia symptoms commonly found in teens and tweens

• Poor organizing skills and trouble in getting things done

• Poor hand-eye coordination resulting in trouble with sports
• Difficulty with visual-spatial aspects of math, like geometry
• Struggling with latches to open doors or lockers, or using a lock with a combination-code
• Avoiding and having problems with typing or texting
• Unable to prepare simple foods, like sandwiches, despite knowing how
• Bumping into people or pushing people by accident way more often than other teens
• Might have behaviour problems, mainly because of frustrations stemming from their
symptoms
• Difficulty in making friends as they avoid taking part in team events or other activities at
school
• Have low self-esteem

1.5.5.2. You suspect your child has dyspraxia; what next?

Understanding where to begin and what one can do as a parent can be challenging. Getting basic
information is preliminary to start the process of helping your child. As a parent, one must first
understand and accept that a child cannot outgrow dyspraxia, but there are ways to manage
their problems. One can start by learning all they can about dyspraxia and note the specific signs
that their child shows while taking in the input from the child’s teacher at school. Observe the
child’s muscle strength, grip, balance, flexibility, manner of walking, skipping ability, and other
skills and patterns having to do with movement. Pay attention to their visual and spatial skills,
hand gestures, and similar areas of development. If you suspect the presence of dyspraxia in
your child, talk to a general physician or speak to a nurse, doctor or school counsellor. If
necessary, they may refer you to a professional to understand your child's needs.

The professional will require certain specific information from you as a parent. They will need
your child's entire, detailed medical history, including questions about their birth; general
developmental milestones like when the child first started walking or crawling. They will also ask
about your child’s overall health and your concerns regarding what you’ve observed.

It is imperative to get a diagnosis to understand the child’s problem better, and a successful
diagnosis allows one to get the appropriate treatment and support for their child. Besides, with
a correct diagnosis, stress due to uncertainty is also reduced. Even though you may suspect
dyspraxia as early as in the pre-school years, a definite diagnosis is usually only made after a
child is four or five years of age. In collaboration with an occupational therapist, a professional
usually diagnoses dyspraxia by the exclusion process (ruling out other possibilities causing
coordination difficulties). Motor ABC is commonly used for assessment, which tests a child’s fine
(drawing, writing within the lines, etc.) and gross motor skills (jumping, moving around,
balancing, etc.). The professional will assess your child’s performance by comparing their
resultant score with the average scores for that age group. Then, they will prepare a full-fledged
report on your child’s condition and specify the areas they require help in. It can be done only by
professionals after thoroughly examining the child’s issues. Once formally diagnosed, it is
essential to get started with the treatment as soon as possible.

1.5.5.3. Recommended therapies for dyspraxia

It is important to remember that in dyspraxia, the child’s mental ability is within the normal
range for their age group. There are no medications or cures for dyspraxia, but specific therapies
can make it easier for your child to manage and cope with their problems.

Occupational and physical therapy are commonly used management techniques for children
with dyspraxia.

To improve language and communication skills, speech and language therapy and sensory
integration therapy, which involves exposure to senses like sound and touch in a controlled
environment, have also proven effective for treatment.

Since dyspraxia rarely occurs alone, other healthcare professionals specialising in issues that co-
occur with DCD are also involved in fostering a holistic treatment. Besides, involving the school
 to build special support mechanisms for the child again proves beneficial for them. As a parent,
with the essential information, you can also develop simple activities, and fun ways to help your
child at home whilst other treatments continue.

1.5.5.3.1. Occupational therapy for dyspraxia

This therapy, focussing on enhancing coordination, remains the primary treatment for dyspraxia.
Occupational therapists often start by evaluating the areas where the child struggles or displays
weakness. The therapist then comes up with a suitable set of techniques and activities that would
address these issues particularly. The fundamental aim is to get the child to do the necessary tasks
needed for school and daily life as independently as possible by improving their motor skills. Tasks
like writing, texting, drawing, tying one’s shoes, getting dressed are worked upon. You can also ask
your occupational therapist how you can help your child build these skills.

For a more comprehensive motor control, the occupational therapist addresses the multiple aspects
of motor development, including fine motor planning, fine motor skills and gross motor skills. In
other words, how the child plans to do things and the physical manner, they do it, respectively.
Gross motor skills involve the movement of large body parts or muscles like the arms, torso, feet,
and legs exhibited in actions like sitting, swimming, running, jumping, etc. Fine motor skills are those
skills that involve the movement of hands, wrists, toes, fingers, and feet for actions such as writing,
drawing, buttoning and unbuttoning, using scissors, etc.

Read here for further information on occupational therapy.

1.5.5.3.2. Physical therapy for dyspraxia

It primarily centres around strengthening muscles through exercises of various kinds that are proper
and doable, according to the child’s requirements. It helps improve the functioning of muscles
needed for motor skills, again, to help the kid achieve better balance and coordination in everyday
school and home tasks.

A physiotherapist starts by establishing the child’s baseline motor skills through assessment, from
where the specific developmental, physiotherapeutic intervention begins. The child’s programme
may include exercises for:

o Improving Strength
o Improving Body Awareness (like playing in obstacle courses)
o Improving Balance (such as standing on one foot)
o Improving task-specific skills (like riding a bicycle)

1.5.5.3.3. Accommodations the school could provide for children with

dyspraxia
It is essential to work with your child’s teacher and school to provide them with the necessary
accommodations in school. Be in constant touch with your child’s teacher and maintain a good
relationship with the teacher.

o A student buddy to help in the class to take notes or let the child use a computer to
take notes. Teachers can also provide the child with printouts of notes.
o A relaxed corner, away from doors and windows, to sit in class or to sit closer to the
teacher and board may help
o Provide special pencil grips, special raised-line paper and other writing tools to
reduce pressure
o Allow students to submit typed assignments and homework instead of hand-written
or providing worksheets of the assignments
o Allow the student to stand or give small breaks during class to improve
concentration
o Give extra time for tests and written assignments or take an oral test
o Break assignments into smaller tasks, provide bullet points

1.5.5.3.4. Equine therapy for dyspraxia

Equine therapy uses the physical motion of riding a horse to stimulate and improve cognition,
concentration, balance and motor skills in children with dyspraxia. Thirty minutes of horse-riding
sessions twice a week can help children with dyspraxia enhance their physical ability. Remember to
hire a trained coach for this activity, as it is a specialised sport which can cause grievous physical
injury if not done correctly.

1.5.5.3.5. Treatment for co-occurring issues with dyspraxia

Children with dyspraxia have a unique set of difficulties, and all these different issues may get
treated simultaneously with it. Learning about these other issues that co-occur commonly with
dyspraxia like dyscalculia, dyslexia, dysgraphia and ADHD, and depression and anxiety is also
important. Hence, one must also be sensitive to signs that may point towards such issues. These
problems may require different kinds of treatment under the supervision of various specialists in
healthcare. For example, ADHD may require medication and behavioural therapy, while depression
or anxiety may need clinical treatment.

Teaching child self-advocacy skills is also crucial as having dyspraxia can impact self-esteem and
result in related issues. One must learn to build and maintain confidence to ensure that the child
does not lose faith in themselves, which requires active parental involvement.