Webchat with Professor Amanda Kirby
This is an edited transcript of our live webchat with Professor Amanda Kirby on 12 November 2008. She's an expert in child development, with over 25 years' specialist experience under her belt. She's written a number of books, both as a parent and professional, and her team at the Dyscovery Centre Wales has an international reputation for nutritional and behavioural research. She has also recently written the Haliborange Play and Learn Guide.
The Dyscovery Centre is internationally recognised for its work in Developmental Coordination Disorder (DCD or dyspraxia) and related specific learning difficulties. Amanda has both a professional and personal interest in DCD as her middle child has coordination difficulties - and trying to address his difficulties first sparked her interest in the area. She's currently based at the University of Wales.
Developmental milestones | Nutritional supplements | Poor visual perception | Poor muscle tone | Hypermobility | Autism and gross motor skills | Poor concentration | Dyspraxia | Fussy eating and behavioural issues | Developmental delay | Diagnosis process | Asperger's and sport
cammelia: I just had a quick skim through your Haliborange Guide and was particularly interested in your milestones for the different ages. What have you based these on?
Prof Amanda Kirby: The developmental milestones are based on normative data. But it is always useful to remember that development can vary from child to child. For most developmental tasks, there is no average but a range of milestone times.
Hathor: The Haliborange Play and Learn guide seems to be full of useful suggestions. But, when you get to the section on age six-to-eight nutrition, you state categorically: 'Ensure they are given a daily dose of Haliborange Omega-3.' I prefer to give my family whole nutrition from food, as I believe it is bound to be safer, more natural and prevents the 'medicalisation' of a normal diet. What dietary sources of omega-3 are equivalent to the supplement you suggest? Is there any research into the effect on behaviour/learning of improving diet with regards to omega-3?
Prof Amanda Kirby: Hi Hathor. thanks for your question. We would recommend, as a first line, healthy balanced eating with fish in the diet a couple of times a week. If your child is a 'fussy' eater ,then you may consider a supplement to make sure they are getting what they need.
We are about to publish a study where we have considered your questions and will be able to tell you more about this early next year.
The jury is out at the moment but it looks like attention and concentration levels may be linked with fatty acid levels.
zoots: I've got a question for Prof Kirby: how conclusive is the research on omega-3s and how much fish would you have to eat to avoid taking supplements? We eat a ton of salmon - well, twice a week! Is that enough? Also what foods/additives should you avoid if you're trying to help your child concentrate?
Prof Amanda Kirby: You probably need oily fish at least twice a week. Some children may need more than this in order to have sufficient levels. We will know more when we have our full results from the study we have been doing - it should be published next year.
I would advise you to avoid additives and colouring where you can. There has been some evidence of a link between benzoates and attention and concentration in young children.
Wrinklytum: My daughter has lissencephaly, cortical band heterotopia. She is progressing very well given her diagnosis. What role have nutritional supplements got to play in helping the child with a neurological malformation, if any? She has hypotonia, and some hyperextensible joints.
Prof Amanda Kirby: I'm afraid we do not have any research at the moment to help us know if fatty acids or supplementation can help specific groups of children like your daughter. More work needs to be done in this area, I think.
PeachyFizzesLikeADampSquibb: Hi, I have four boys. The oldest has dyslexia and Asperger's which we struggle with, as he is very aggressive. Our third son has delays and issues which we have been told place him on the spectrum - quite where we should find out shortly, but he is severe enough that independence isn't likely. We have just been told our second son has either severe dyslexia or dyspraxia but we are awaiting further assessment. Our fourth son is seven months old. We have breastfed him and he is on a gluten and casein free diet (like two of our sons and myself, he is casein intolerant, anwyay). I just wondered what else would be worth a shot to help him develop as well as he can do in light of our family history? I beleive the Dyscovery centre is quite local to us, and I have heard positive feedback.
Prof Amanda Kirby: Thanks for the nice comment about the centre. There is little research at the moment in terms of using supplementation to prevent developmental disorders but a balanced diet, including avoiding artificial colourants, is important, I would say. Encouraging language is also important: give him plenty of face-to-face contact so he can hear and then, as he gets older, mimic sounds and facial expressions. Let him also have different sensory stimuli: place him on a mat and let him feel different textures. He is young, so it is 'normal' exposure to his world that is important at this stage.
Poor visual perception
anonandlikeit: My son was born at 28 wks and has a diagnosis of mild cerebral palsy, ASD and learning difficulties. Most of the additional learning support and material available is aimed at very visual learners but my son is a very auditory learner (I think this is associated with very poor visual perception). What would you recommend to help him learn the basics of letters, reading and even drawing, as his visual perception and co-ordination are so very out of synch?
Prof Amanda Kirby: Play rhyming games, so your child can hear how words link together by sound. And try using textures to reinforce the letter shapes - such as making words out of sandpaper.
Poor muscle tone
southeastastra: A couple of years ago my son, who's seven, was referred to occuptional therapy (OT). The OT said he has low muscle tone and flexible joints. We were then signed off the service and I thought that would be the end of it and he'd just catch up naturally. But he really is struggling with maths at school and they want to get him assessed by an educational psychologist and maybe get him a statement. I know it's probably not alot to go on but do you think his problems with maths could be related to his muscle tone problems? Noone seems to be able to pinpoint exactly what the trouble is, or if anything can be done to help him.
Prof Amanda Kirby: Some children have difficulties with maths if they cannot see the 'shapes' in their mind's eye (this is visual perception). Some children with hypermobility problems sometimes have problems 'controlling' their eyes. Your child could also have difficulties with the 'language' of maths and so this may need to be reinforced. An educational psychologist may actually be able to tease some of this apart. It may perhaps also be useful to have his eyes checked, as well.
lulumama: Do you know if there's any connection between hypermobility and any other issues? My son is dyslexic and has a degree of hypermobility. He is nine, and was diagnosed a year or so ago. My daughter is three, and we've no idea yet whether she has the same issues but she is very bendy! My son has been discharged from the OT, though. Any thoughts?
Prof Amanda Kirby: Hypermobility and motor difficulties have been linked together. This may be because of poor stability, making tasks, such as playing ball games, harder. Some children get pain on writing and may need to have their hands supported when writing. This may also be associated with visual perceptual difficulties (or control of the eyes). Minimising writing will help. Go to the hypermobility syndrome association site for more information, as well as www.parent-plus.org
Autism and gross motor skills
coppertop: My eight-year-old has a diagnosis of autism. He gets help with his fine motor skills difficulties but not so much with his gross motor skills and general coordination. He is often described as 'floppy' and 'bendy' and has to use a wedge-shaped cushion to stop him from sliding off chairs. He also tires easily. What can we do at home to help him?
Prof Amanda Kirby: Hi coppertop. There are some suggestions for gross motor skills activities on parent-plus.org. I recommend trampolining and swimming or working with large balls (he could be placed on his front with a rolled-up cushion or towel and encouraged to roll the ball to you if he can). Horse riding for the disabled is also excellent as that can work on his ' core stability'. Restrict these sessions to five or ten minutes, though, as he will need time to recover.
TinySocks: My son is almost four years old. He was born with a brain atrophy which has caused developmental delay in all areas. He is doing extremely well and has exceeded doctor’s expectations. He is communicating well with us but II am concerned about his concentration. I am aware that poor concentration is common for children with neurological problems but how likely is it to impove with time? I am not sure how my son will learn at school if he is unable to sit still and pay attention. He needs to be highly motivated to stay focused on one task for some minutes. What are the strategies that schools are encouraged to use in cases like his (if any)?
Prof Amanda Kirby: Your child may be communicating but he may still have some difficulty understanding. This can also lead to poor attention skills. Use visual reinforcement, such as photos of what you want him to do. You could make some pictures of things you use regularly: laminate them and back them with Velcro so you can stick them on a board. You could then show him the sequence of activities he needs to do. I think www.do2learn.com has good some visual icons that are free to download. Make sure you break down tasks into short sessions - he may not be able to concentrate for more than five minutes at a time. Use a timer with him that rings when his task is finished - and then praise him.
expatinscotland: My five-year-old daughter has DCD. It's moderate/severe and she has been retained at stage in a nursery with an ASN unit. Her attention span and impulse control issues give cause for concern. Is there any precedence for asking her paediatrican if medical treatment (such as Ritalin) will help.
Prof Amanda Kirby: Yes, talk to your paediatrician and get her assessed for her attention and concentration. Some children have benefited by using Ritalin and have seen an improvement in writing quality, as well attention and concentration spans.
Pollyanna: My son, aged nine, has a diagnosis of dyspraxia. At the moment, the issues that are causing us the most concern are his behaviour and his handwriting. He can't control his emotions and this causes problems when he gets angry as he is violent. His school are very concerned and we desperately need help teaching him to control his anger (he can't control any other emotions either - fear, humour etc are all very exaggerated). And his handwriting is absolutely appalling. He has had various sessions of OT over the years and has done the Write from the Start programme, too, but this has made no difference. Apart from typing (and what would be a good programme, please?) what else can we do to help him? He has lots more problems - eating, organisation, social skills - and we are just starting to realise how much help he needs as his differences with his peer group become more apparent.
Prof Amanda Kirby: As children with dyspraxia get older, they become more aware of their difficulties. Your son will be doing more writing and he will be able to see his difficulties and this will make him feel more frustrated. Write for him when you can and teach him typing - good free programmes include www.tuxtype.sourceforge.net and bbc.co.uk/typing. There are more suggestions on www.parent-plus.org - and we have some skills packs that may be useful for making visual timetables and improving organisation, as well as helping with writing. With regards to his eating problem, I think Caring Cutlery is helpful as it places your fingers in the right position - we stock this. Make sure, too, that your child has his feet on the floor when he eats, so he is balanced.
nolongeraworriedmummyfied: My daughter has dyspraxia. How do I help her learn to skip and pedal a bike as all the other little girls at school do. Also, what effect does dyspraxia have on everyday learning? Could that be why my daughter is bright and brilliant at most things academically but still has no number recognition?
Prof Amanda Kirby: Dyspraxia affects most aspects of movement in all areas of your life, such as cleaning your teeth, dressing, using cutlery, playing ball. Start by teaching your child to jump over a rope. This is the first stage. Once she has done that, then swing the rope back and forth and get her to jump over that. Break it down into stages. On the www.parent-plus.org site, there is a factsheet and guidance on learning to ride a bike (in the activities at home section).
RTKangaMummy: My son is 13 years old and had a diagnosis of dyspraxia and hypermobility about four years ago. He was born extremely prematurely (27 weeks) and was on oxygen for three months in neonatal intensive care. Do you think being so premature has any influence on dyspraxia and hypermobility? He still can't ride a bike. He did have OT and physio when they first diagnosed him but he doesn't have either help now. Do you think there will be any difference with things like learning to drive a car? Will he be able to drive a manual car? Do you have any ideas for improving his posture? He has very hunched shoulders and walks looking at the floor.
Prof Amanda Kirby: Yes, I think being premature can have an influence on dyspraxia. There have been research studies from Holland showing this (google Marian Jongmanns in Holland to find out more). And, yes, driving may be a problem - using an automatic is better than a manual. Sometimes parking and distance perception is a problem as well - sensors on cars are very helpful. Some adults just need longer to learn, so a good instructor, with plenty of patience, is very important. My son took three years to learn to drive. You may want to try Alexander techniques to help with his posture. Or using a swiss ball and trampolining can be very good.
Fussy eating and behavioural issues
Mercy: Hello, my son is four years and eight months and has what I can only describe as an unsual personality (no known medical or physical issues). He has been a fussy eater since he was 18 months old, often refuses to acknowledge familiar adults and even peers, is aggressive, insists on inapproriate clothing (I could go on but I won't). I would like to know if fussy eating is an early sign of, or connected to, other behavioural/developmental issues.
Prof Amanda Kirby: Thanks for the question. Some of the signs and symptoms you are describing, including fussy eating, may be linked to developmental issues and it may be worth talking with your health visitor or GP or asking his nursery/school (if he is going to one) if they have noticed any 'unusual ' behaviours also, to see if this is consistent or only at home.
lou: Hi there, My daughter is currently being assessed by a developmental paediatrician - she will be three in December. He assessed her last Friday, and said that she had delays of 18 months in some areas, 12 months in others, and in a couple of areas was at age. Her expressive language seems to be ahead of her understanding, but she is very good with 'factual' things such as colours. How severe is this level of delay at this age? Nobody has said, and I can't find anything on the internet. She also seems to be very sensory in her behaviour. What should we be doing while we wait for our SALT, Physio & OT referrals to come through? Many thanks in advance.
Prof Amanda Kirby: Hi lou. It's difficult for me to say to rate your child without having seen her. It sounds like she has some level of delay that is impacting on her daily functioning and skills. Go to www.parent-plus.org - we have activities for preschool that may be helpful for you with your child. Take her swimming to encourage movement but with support from you. Place her on her front but supported to encourage her to reach for items in front of her - such as colourful toys. Show her pictures and toys and talk about them, but keep the language very simple (at a one or two-word level).
Buckets: I would just like to ask if you know why diagnosis for ASDs is a postcode lottery in the UK, with single health professionals making subjective judgements in some areas and whole multidisciplinary teams in others? What would be your suggestions for unifying the process up and down the country - and would a Mumsnet campaign help, do you think?
Prof Amanda Kirby: Great question. It is very true that there's huge variability across the UK. Parent power is really important. Try to catalogue together some of your journeys through the health/education system: evidence is essential to 'prove' this is a problem. Gather this information and go to the politicians with it. We need common baseline assessments so that children are seen 'holistically' and not in bits, which sadly is what happens in some areas of the UK.
Watchtheworldcomealivetonight: My daughter (nearly six) seems to be reaching milestones very, very late but no one seems concerned. She walked and sat up very late, She was a selective mute until four and a half, although she is now talking at school. She wouldnt even go near other children till age four and had no idea what to do when they were near her, despite attending playgrounps. Her social skills are very poor. She still cannot pedal a trike or skip like the other little girls can. She is very clumsy and falls over all the time (on average, five or six times a day out of school, and comes home daily with scrapes from school). She has little set things that have to be just so - for example, you can't walk in front of her; you have to walk behind her - if you do walk in front, she gets very distressed. She still has very little number recognition, although she is an excellent reader. She seems to be doing things now that she should have done at two or three. I have always had this niggling that something isnt quite right but have been ignored. We have autism, Aspergers and dyspraxia in our family history.
Prof Amanda Kirby: I think there is some concern from what you have documented here. Perhaps take this information and go to your GP and ask for a referral to a paediatrician. Also ask the school what they have noticed so you can tell the doctor this, as well.
Asperger's and sport
mabanana: Hi. My son has Aspergers and quite bad dyspraxia with low muscle tone. He is clever, though: in the top set for maths and literacy. He is seven and has only just learned to use a scooter (one of the easy, two wheels at the front type that three year olds use). I would like him to learn to swim and I wondered if learning the piano would help him - he would love to learn to play, he tells me. I know he wouldn't cope in a swimming class with kids his own age or really in any group setting. Do you think one-to-one lessons would be a good idea at this age or should I wait? And as for the piano, do you think this is a good idea, and how can I find a suitable teacher?
Prof Amanda Kirby: I think swimming lessons would be great. Some children with motor difficulties sometimes find swimming under the water easier than on top of it - you could try a snorkel and flippers even, as this sometimes makes it easier. A patient teacher is important. Learning to play the piano can be difficult. I have seen some successes but learning to play the drums may be easier - I have seen more success with this.
PeachyFizzesLikeADampSquibb: mabana, I hope you don't mind me butting in but my son has AS/HFA and low muscle tone, especially in his wrists, and violin has helped loads. It's really showing with regards to his art (he got through to the finals of a contest recently) and handwriting. It also boosts his confidence loads and gives him something to be proud of.