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Hearing loss
Identification and early help for hearing loss.
Identification of hearing loss can happen just after birth when newborns receive a screening (hearing test); this occurs days after birth. If hearing loss is not identified then, it may be picked up at the regular assessments for the healthy child programme. These occur at around 8-12 months, 24 months and before the begin school at aged 4.
If an issue is identified by a parent or family member, they may visit the GP for advice and a referral for a hearing test. The NHS offer the following tests:
Visual reinforcement audiometry
Visual reinforcement audiometry (VRA) is usually used to test hearing in children from approximately 6 months of age up to 2.5 years old.
During the test, your child will sit on your lap or a chair while sounds are presented. Your baby will be taught to link the sound to a visual reward such as a toy or computer screen lighting up.
Once your child is able to associate the sound and the visual reward the volume and pitch of the sound will be varied to determine the quietest sounds your child is able to hear.
Play audiometry
Play audiometry
Young children between 1.5 and 5 years old may have a play audiometry test.
During the test, sounds will be played through headphones or speakers and the child will be asked to perform a simple task when they hear the sound. This may vary from putting a ball in a bucket to completing a puzzle.
As with VRA, the volume and pitch of the sound will be varied to determine the quietest sounds the child is able to hear.
Pure tone audiometry
Pure tone audiometry
Older children may have a test called pure tone audiometry. This is the test often used to screen a child's hearing before they start school, when it is sometimes referred to as the "sweep test". It's similar to a hearing test an adult might have.
During pure tone audiometry, a machine generates sounds at different volumes and frequencies. The sounds are played through headphones and the child is asked to respond when they hear them by pressing a button.
By changing the level of the sound, the tester can work out the quietest sounds the child can hear.
Bone conduction test
Bone conduction test
In addition to using speakers or headphones, most of the tests above can also be carried out using a small vibrating device placed behind the ear.
This device passes sound directly to the inner ear through the bones in the head, which can help identify which part of the ear is not working properly if the child is having hearing problems.
(NHS online, 2022).
Signs of a possible hearing problem can include:
inattentiveness or poor concentration
not responding when their name is called
talking loudly and listening to the television at a high volume
difficulty pinpointing where a sound is coming from
mispronouncing words
a change in their progress at school or nursery
Cerebral palsy
Identification and early help for cerebral palsy may occur at birth, if the signs are severe. However, symptoms of cerebral palsy are not usually obvious just after birth. They normally become noticeable during the first 2 or 3 years of a child's life. The parent may identify differences about their child's development, however, if the signs are not obvious, and if a parent is a first time parent, they may not realise their child is developing differently. The symptoms can include:
delays in reaching development milestones – for example, not sitting by 8 months or not walking by 18 months
seeming too stiff or too floppy
weak arms or legs
fidgety, jerky or clumsy movements
random, uncontrolled movements
walking on tiptoes
a range of other problems – such as swallowing difficulties, speaking problems, vision problems and learning disabilities
The severity of symptoms can vary significantly. Some people only have minor problems, while others may be severely disabled (NHS online, 2022).
Examination and checks to confirm cerebral palsy.
Examination and checks to confirm cerebral palsy.
First a specialist may:
ask about your child's medical history and development
check for any symptoms of cerebral palsy
ask about any problems during your pregnancy, during the birth or soon afterwards
An assessment of the child's movements and learning abilities may also be carried out.
Brain scans
Brain scans
A brain scan may be used to look for signs of cerebral palsy.
One or more of the following scans may be recommended:
a cranial ultrasound scan – a small handheld device that sends out sound waves is moved over the top of the child's head to create an image of their brain
an MRI scan – a scanner that uses magnetic fields and radio waves to produce a more detailed image of the brain
a CT scan – a scanner that takes several X-ray pictures to create a detailed image of the brain
Other tests
Other tests
Other tests that may be used to help confirm cerebral palsy and rule out other conditions include:
an electroencephalogram (EEG) – where small pads are placed on the scalp to monitor brain activity and check for signs of epilepsy
an electromyogram (EMG) – where tiny needles are gently inserted into the muscles and nerves to check how well they're working
blood tests to check for problems that can cause similar symptoms to cerebral palsy (NHS online, 2022).
Autism
Identification and early help for autism.
Autism is usually identified through the observation of a child's behaviour. This may be at a formal observation such as a 2-year check or a baseline assessment when starting nursery, or could be informally observed by a parent or relative.
Examples of Autism Spectrum Behaviours:
Examples of Autism Spectrum Behaviours:
Communication
Communication
Echoing words/phrases without context
Taking an adult to the biscuit tin rather than asking or pointing
Taking language too literally
Social Interactions
Social Interactions
Preference to play alone
Difficulty relating to other people
Not understanding other’s thoughts and emotions
Repetitive behaviours
Repetitive behaviours
Hand flapping
Toe walking
Spinning wheels
Lining up cars
Restrictive behaviour
Restrictive behaviour
Eating only yellow food
Insisting on walking the same route
Only watching Thomas the Tank Engine
Other Characteristics of Autism
Other Characteristics of Autism
People with autism may or may not have the following:
Exceptional attention to detail
Sensory differences, this is most noticeable when children are over-sensitive to stimuli e.g. distress at loud noises
Trouble with co-ordination
Unusual eating behaviour such as only eating certain foods
Additional learning disabilities
A very small percentage have unusual abilities for example with music or memory (Baird, G et al, 2006).
To receive a formal diagnosis of autism, the child will need to have formal observations from a medical professional.
The assessment team may:
ask about the child's development, such as when they started talking
watch how you and the child interact, and how the child plays
read any reports sent by the GP and the nursery or school
A member of the team may also visit the child's setting or school to observe them.
Speech and language delay
Identification and early help for speech and language delays
The Department for Education reported in 2019 that 22% of SEN pupils, Speech, language and communication needs (SLCN) is now the most common primary type of need reported in schools. However, it’s most likely not a rise in numbers of children and young people with SLCN, but an increase in identification (iCan, 2022).
Some methids used in early years settings to identify SLCN include:
Wellcomm https://www.gl-assessment.co.uk/assessments/products/wellcomm/
ECAT (Every Child a Talker) https://resources.leicestershire.gov.uk/education-and-children/early-years/childcare-practice/teaching-learning-and-assessment/every-child-a-talker-ecat/child-monitoring-tool-and-action-plan
Teddy Talk Test https://www.teddytalktest.co.uk/
Most local authorty will have their own toolkit available for their registered providers.
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