Initial Assessment

When a referral has been made and accepted, I send out my information to you, including charges, for your consideration. Once you have read my information and would like to proceed with an appointment then we arrange a time and date to meet. I expect you to confirm the appointment by email or text message.

You may well want to explain to your child what sort of person you are taking them to see. I suggest you say that you are taking them to see a doctor to see if there is a medical reason for their problems. The doctor will ask them some questions but it is not a test or exam. There will not be any operation or injection. They will return home afterwards.

I usually start by seeing child and parents together because this enables me to get a list of problems from all concerned (there is often more than one problem or at least more than one aspect of it). Meeting all of you helps me understand what interventions would be best. It also enables me to observe the child or young person without embarrassing them. Although it is not essential, I prefer to also meet brothers and sisters, unless this is very inconvenient, especially if they are part of the problem in question.

The first meeting or assessment is a general one regardless of what the referred or stated problem is and includes screening for all sorts of medical, developmental and other problems which are relevant. This is because I have a duty to ensure that nothing important is missed with regard to my patients’ mental or physical health. Sometimes there are  issues which have to be addressed alongside the main presenting problem and I would advise about this.

Following this appointment I write a summary letter to your GP or other referrer and copy this to you. If you prefer, I will send a draft to you beforehand, to check if there is anything that I have misunderstood. Sometimes a separate letter or report for school is required but I do not write to or contact anyone there without your consent.

If you have any professional reports from other specialists or school reports, please bring them with you. I will not contact your child’s school without your permission.

After the first assessment, you may just have some advice and a report or there may be treatment that is required. You may choose to proceed with a treatment option either with me or with someone else.

If you are claiming against health insurance bring any authorisation number and the relevant claim forms with you.

If you are coming by car, use the car parks in Cavendish Square or the so-called Harley Street Car Park (actually in Chandos Street, off Cavendish Square). Otherwise remember to familiarise yourself with credit card parking or bring some coins for parking meters though they mostly have a maximum of two hours which is only just enough for a first appointment as you may not be able to park directly outside 104 Harley Street. If you are coming by Tube, the nearest stations are Regent’s Park, Oxford Circus and Bond Street; allow 10 minutes to walk. At the door ring the bell marked ‘Reception’. Let us know if you need help with a wheelchair, there is a lift.

A failed appointment means that we have lost an opportunity to offer somebody on the waiting list an earlier appointment, so we make a charge for failed appointments when insufficient notice is given (less than 2 full working days). If you cannot keep an appointment, please let me know as soon as possible.

Please address post to 104 Harley Street, London W1G 7JD. I cannot normally answer telephone calls myself immediately as my daily schedule is tightly packed. Please leave a telephone message. I will try and return your call as soon as possible and within 3 working days. E-mails are easier to respond to, but again, please allow 3 working days for my response. Please allow 7 working days for me to receive and look at letters and other correspondence.

Attention Deficit and Hyperactivity Disorder

The symptoms of attention deficit hyperactivity disorder (ADHD) can be categorised into three types of behavioural problems:

• inattentiveness
• impulsiveness
• hyperactivity

Most people with ADHD have problems that fall into all 3 categories.

Some youngsters with the condition may have problems with inattentiveness, but not with hyperactivity or impulsiveness. This form of ADHD is also known as attention deficit disorder (ADD). ADD is more common in girls and can sometimes go unnoticed because the symptoms may be less obvious.

The symptoms of ADHD are usually noticeable before the age of six. They occur in more than one situation, such as at home and at school.

The main signs of each behavioural problem are detailed below.

Inattentiveness

The main signs of inattentiveness are:

• having a short attention span and being easily distracted
• making careless mistakes – for example, in schoolwork
• appearing forgetful or losing things
• being unable to stick at tasks that are tedious or time-consuming
• appearing to be unable to listen to or carry out instructions
• constantly changing activity or task
• having difficulty organising tasks

Hyperactivity and impulsiveness

The main signs of hyperactivity and impulsiveness are:

• being unable to sit still, especially in calm or quiet surroundings
• constantly fidgeting
• being unable to concentrate on tasks
• excessive physical movement
• excessive talking
• being unable to wait their turn
• acting without thinking
• interrupting conversations
• little or no sense of danger

These symptoms can cause significant problems in a child’s life, such as underachievement at school, poor social interaction with other children and adults, and problems with discipline.

The main treatment is behavioural management and may or may not include medication. Specific behavioural management includes strategies and exercises to extend attention span and to reduce impulsivity and  hyperactivity. Occasionally family approaches are useful.

Treatment with me consists of 4 to 6 sessions about a fortnight or a month apart. This can include titrating of medication to the lowest effective  optimum dose in addition to behavioural and family approaches.

In cases where medication is required I also offer follow up longer term 3 or 6 monthly for physical monitoring and dose adjustment for as long as the patient remains on medication. These appointments can include “refreshers” and checking in with you on behavioural strategies. If all is straightforward these are usually 30 minute appointments.

Some General Practitioners  work with me offering a shared care package where they prescribe and I offer physical monitoring and advise on  dosage of medication and progress.

Talking treatments in ADHD

Different therapies can be useful in treating ADHD in children, teenagers and adults. Therapy is also effective in treating additional problems, such as conduct or anxiety disorders, that may appear with ADHD.

Some of the therapies that may be used are outlined below.

Psychoeducation

Psychoeducation means that you or your child will be encouraged to discuss ADHD and how it affects you. It can help children, teenagers and adults make sense of being diagnosed with ADHD, and can help you to cope and live with the condition.

Behaviour therapy

Behaviour therapy provides support for carers of children with ADHD, and may involve teachers as well as parents. Behaviour therapy usually involves behaviour management, which uses a system of rewards to encourage your child to try to control their ADHD.

If your child has ADHD, you can identify types of behaviour you want to encourage, such as sitting at the table to eat. Your child is then given some sort of small reward for good behaviour, and removal of a privilege for poor behaviour.

For teachers, behaviour management involves learning how to plan and structure activities, and to praise and encourage children for even very small amounts of progress.

Parent training and education programmes

If your child has ADHD, specially tailored parent training and education programmes can help you learn specific ways of talking to your child, and playing and working with them to improve their attention and behaviour. Parent training can be helpful before your child is formally diagnosed with ADHD. Its aim is to teach parents and carers about behaviour management (see above), while increasing confidence in your ability to help your child and improve your relationship.

When there are sufficient numbers of interested parents I also offer 6 meetings in a Parent Group  for parents of youngsters with ADHD. This is for an hour monthly between September and June.

Social skills training

Social skills training involves your child taking part in role play situations, and aims to teach them how to behave in social situations by learning how their behaviour affects others.

Cognitive behavioural therapy (CBT)

Cognitive behavioural therapy (CBT) is a talking therapy that can help your child manage their problems by changing the way they think and behave. A CBT therapy would try to change how your child feels about a situation, which would in turn potentially change their behaviour.

Other possible treatments

There are other ways of treating ADHD that some people with the condition find helpful, such as cutting out certain foods and taking supplements. However, there’s no strong evidence these work.

Medication for ADHD

There are four types of medication licensed for the treatment of ADHD:

• methylphenidate
• lisdexamfetamine
• atomoxetine
• guanfacine

These medications aren’t a permanent cure for ADHD, but may help someone with the condition concentrate better, be less impulsive, feel calmer, and learn and practise new skills.

Some medications need to be taken every day, but some can be taken just on school days. Treatment breaks are occasionally recommended, to assess whether the medication is still needed.

In the UK, all of these medications are licensed for use in children and teenagers. Atomoxetine is also licensed for use in adults who had symptoms of ADHD as children.

Methylphenidate

Methylphenidate is the most commonly used medication for ADHD. It belongs to a group of medicines called stimulants that work by increasing activity in the brain, particularly in areas that play a part in controlling attention and behaviour.

Methylphenidate can be used by teenagers and children with ADHD over the age of six. Although methylphenidate isn’t licensed for use in adults, it may be taken under close supervision from your GP and specialist.

The medication can be taken as either immediate-release tablets (small doses taken two to three times a day), or as modified-release tablets (taken once a day in the morning, and they release the dose throughout the day).

Common side effects of methylphenidate include:

• a small increase in blood pressure and heart rate
• loss of appetite, which can lead to weight loss or poor weight gain
• trouble sleeping
• headaches
• stomach aches
• mood swings

Lisdexamfetamine

Lisdexamfetamine is a similar medication to dexamfetamine, and works in the same way.

It can be used by children with ADHD over the age of six if treatment with methylphenidate hasn’t helped. You may continue to take it into adulthood if your doctor thinks you’re benefitting from treatment.

Lisdexamfetamine comes in capsule form, which you or your child usually take once a day.

Common side effects of lisdexamfetamine include:

• decreased appetite, which can lead to weight loss or poor weight gain
• aggression
• drowsiness
• dizziness
• headaches
• diarrhoea
• nausea and vomiting

Atomoxetine

Atomoxetine works differently to other ADHD medications.

It’s known as a selective noradrenaline reuptake inhibitor (SNRI), which means it increases the amount of a chemical in the brain called noradrenaline. This chemical passes messages between brain cells, and increasing the amount can aid concentration and help control impulses.

Atomoxetine can be used by teenagers and children over the age of six. It’s also licensed for use in adults if symptoms of ADHD are confirmed.

Atomoxetine comes in capsule form, which you or your child usually take once or twice a day.

Common side effects of atomoxetine include:

• a small increase in blood pressure and heart rate
• nausea and vomiting
• stomach aches
• trouble sleeping
• dizziness
• headaches
• irritability

Atomoxetine has also been linked to some more serious side effects that it’s important to look out for, including suicidal thoughts and liver damage.

If either you or your child begin to feel depressed or suicidal while taking this medication, speak to your doctor.

Guanfacine

Guanfacine acts on part of the brain to improve attention and it also reduces blood pressure.

It’s used for ADHD in teenagers and children if other medicines are unsuitable or ineffective.

Guanfacine is usually taken as a tablet once a day, in the morning or evening.

Common side effects include:

• tiredness or fatigue
• headache
• abdominal pain
• dry mouth

Diet

People with ADHD should eat a healthy, balanced diet. Don’t cut out foods before seeking medical advice.

Some people may notice a link between types of food and worsening ADHD symptoms. For example, sugar, food colourings and additives, and caffeine are often blamed for aggravating hyperactivity, and some people believe they have intolerances to wheat or dairy products, which may add to their symptoms.

If this is the case, keep a diary of what you eat and drink, and what behaviour this causes. Discuss this with your GP, who may refer you to a dietitian (a healthcare professional who specialises in nutrition).

Supplements

Some studies have suggested that supplements of omega-3 and omega-6 fatty acids may be beneficial in people with ADHD, although the evidence supporting this is very limited.

Depression and low mood

Children and teenagers may undergo emotional and behavioral changes when depressed. Emotional changes may include:

• feelings of sadness, hopelessness, or emptiness
• irritability
• moodiness
• loss of interest or pleasure in activities once enjoyed
• low self-esteem
• feelings of guilt
• exaggerated self-blame or self-criticism
• trouble thinking, concentrating, making decisions, and remembering things
• frequent thoughts of death, dying, or suicide

Behavioral changes may include:

• restlessness
• tiredness
• frequent crying
• withdrawal from friends and family
• angry outbursts
• acting-out
• changes in sleep
• changes in appetite
• alcohol or drug use

Treatments vary depending on presentation, environmental factors and severity of problems. There are talking treatments which can include cognitive-behavioral and interpersonal therapies. Treatment plans should consider individual, family, school, and medical issues. Depression in teens often is related to problems at home. Family therapy work and enhancing parenting skills is often an important part of treatment.

Depression in adolescents may result in academic delays.  An educational assessment may be helpful.

Depression and low mood can cause significant problems in a child’s life, such as underachievement at school, poor social interaction with other children and adults, and problems with discipline.

The main treatment is one to one talking treatment and the type of treatment depends on your child, their age and presentation. This talking treatment can happen with me or with someone else, depending on your preference (and on how busy I am). I do not generally offer long term treatments and 4 to 6 sessions is average. I tend to review the need for any further meetings at every session. Treatment may or may not include medication. If medication is considered or used, then each treatment session with me also serves as review with regard to medication. Generally the younger the child the less likely it is that medication will be helpful. I involve my patients and their parents in a risk benefit analysis when considering the use of medication. There are many types of antidepressant medications available.

Occasionally, family approaches are useful and I would explain that when we meet.

In cases where medication is required the average length of treatment with medication with me is 6 months. This is reviewed during the course of treatment. Sometimes, medication is required for longer or re-introduced after a break.

Some General Practitioners  work with me offering a shared care package where they prescribe and I offer advice on  dosage of medication and progress.

When does anxiety become a mental health problem?

Anxiety (and stress) can be viewed as a solution to a problem. It is an adaptation that helps us protect ourselves from dangerous or life-threatening situations. Anxiety disorder is when the solution is no longer helpful and becomes the problem.

Because anxiety is a normal human experience, it’s sometimes hard to know when it’s becoming a problem for you – but if your feelings of anxiety are very strong, or last for a long time, it can be overwhelming.

For example:

• You might find that you’re worrying all the time, perhaps about things that are a regular part of everyday life, or about things that aren’t likely to happen – or even worrying about worrying.
• You might regularly experience unpleasant physical and psychological effects of anxiety, and maybe panic attacks.
• Depending on the kind of problems you experience, you might be given a diagnosis of a specific anxiety disorder.

If anxiety is affecting your ability to live your life the way you’d like to, it’s worth thinking about ways to help yourself, and what kind of treatments are available. 

useful resource: http://OCD action

Eating problems

These can range from faddy eating to Eating Disorders such as Bulimia Nervosa and Anorexia Nervosa. I always offer an assessment fist. There are a lot of online resources such as :

http://kidshealth.org/eating problems

http://nhs choices

Your son or daughter’s behaviour may suddenly become very different from what you’re used to: withdrawn, touchy and even rude. This can make it very difficult to talk to them at a time when communication is so important.

Get advice on how to talk to your teenager.

It can help to remember that they are likely to be defensive because their eating disorder is their way of coping, therefore they will be reluctant to let go of it.

Severe Anorexia Nervosa requires a Team approach in its treatment so I tend to refer these patients on when appropriate. I can sometimes treat patients in the recovery phase.

Tics are rapid, repetitive, involuntary contractions of a group of muscles. Although they’re rarely harmful, some tics can severely interfere with daily life.

Tics may occur as either:

• motor tics (bodily movements) – such as facial twitching or shrugging the shoulders
• phonic or vocal tics (sounds) – such as grunting, clearing the throat or sniffing

Tics can also be described as simple or complex.

Simple tics, such as blinking or coughing, tend to happen quickly and may not even be noticeable. Complex tics, such as facial grimacing or repeating a sound, tend to be slower and may appear intentional.

Read more about different types of tics. (NHS choices website)

• Usually tics occur in bouts during the day and when they last for long periods of time they can wax and wane in severity and change in nature.

• Sometimes tics are preceded by premonitory feelings or sensations but these are more commonly seen in children aged more than 10yrs old. Older children also show some ability to suppress their tics but younger children can often be unaware of their tics.

• Tics usually increase with stress, tiredness and boredom and are often prominent when watching television, there are triggers individual for each person

• Tics usually decrease with concentration, exercise and distraction. They decrease in frequency during sleep but do not go away completely

Defining tic disorders – a spectrum:

Transient tic disorder:

single or multiple motor and/or vocal tics that occur many times a day nearly every day for more than 4 months but for no longer than 12 consecutive months in children (<18 yrs old)

Chronic motor or phonic tic disorder:

single or multiple motor or vocal tics but not both which occur many times a day on most days or intermittently throughout a period of more than 1 yr during which there was never a tic-free period of more than 3 consecutive months. (<18 yrs old)

Tourette Syndrome

Tourette Syndrome (TS) is an inherited, neurological condition, the key features of which are tics, involuntary and uncontrollable sounds and movements. TS is sometimes known as Multiple Tic Disorder or Tic Spectrum Disorder.

Usually both multiple motor and one or more vocal tics have been present at some time though not necessarily concurrently and the tics occur many times a day on most days or intermittently throughout a period of more than 1 yr during which there was never a tic-free period of more than three consecutive months (<18 yrs old). Often TS is associated with other complex phenomena such as saying or doing movements gestures which are obscene or socially unacceptable (coprophenomena, echophenomena). TS is also often associated with a number of behavioural disorders such as Attention Deficit Hyperactivity Disorders or Obsessive Compulsive Behaviours/Disorders.

TS is a complex condition and covers a wide spectrum of symptoms. People may have a mild form, and they and those close to them may not even be aware that they have TS. At the other end of the scale, medical symptoms are extreme and the social, educational and economic effects can be serious. These are the examples that generate media interest and generate some of the stereotypes that exist about TS.

A good resource is http://Tourette-action.org

What causes tics:

The cause of motor tics is not fully understood, however, much research has suggested that there is a strong genetic component, and therefore run in families. Other research has also suggested that the constant movement or sound production is related to brain chemical (neurotransmitter) abnormalities (Dopamine).

Treatment for tics isn’t always necessary, although several different treatments are available.

If your tic is mild and doesn’t usually interfere with your school, work or everyday life, you may decide it doesn’t need treating. The tic may improve without treatment as you get older.

If your tic needs treatment, you can try behavioural therapy, which is often recommended as the first approach, or there are a number of medicines you can choose from. When deciding whether you need treatment, you should bear in mind that tics tend to be better or worse at different times and often improve during later teenage years or early adulthood.

The various treatments for tics are outlined below. You can also read asummary of the pros and cons of the treatments for tics, allowing you to compare your treatment options.

Self-help

There are some simple things you can do that may help to improve your tics, such as avoiding things which make them worse. This may involve reducing stress, trying not to become too tired or over-excited, or being aware that you may experience more tics at these times and being prepared for this.

Try to make time for activities that are relaxing and enjoyable.

If your child develops a tic, there are several things you can do that may help them. For example:

• don’t tell them off about their tic
• don’t try to stop them making repetitive movements or sounds, because this may cause them to become stressed, which may make the tic worse
• try to ignore the tic, because drawing attention to it may make it worse
• reassure your child that they’re well and there’s no reason for them to feel ashamed
• make a point of educating other children about tics, so they’re aware of your child’s condition; encourage them to react naturally

Most importantly, you should try to reduce the levels of stress and anxiety around you and your child.

Read more about:

• reducing stress
• tiredness and fatigue
• anxiety in children

Behavioural therapy

Behavioural therapies are often recommended as one of the first treatments for tics. Behavioural therapy is a type of psychotherapydesigned to change the pattern of your behaviour.

The most suitable type of therapy depends on the nature and severity of your tics. Several different techniques are often used together.

You may be referred to a specialist psychological treatment service, where staff can advise about an appropriate treatment plan.

One of the main types of behavioural therapy used to treat tics is called habit reversal therapy (HRT). HRT aims to:

• educate you about your condition and how it’s treated
• make you more aware of when you tic and identify the urges you feel
• teach you a new response to carry out when you feel the urge to tic – for example, if your tic usually involves shrugging your shoulders, you may be taught to stretch out your arms until the urge subsides

Behavioural therapy for tics may also include a technique called exposure and response prevention (ERP). ERP aims to help you learn to suppress the growing feeling you need to tic (premonitory urge) until this feeling subsides.

The idea is that, over time, you’ll get used to the feeling of this premonitory urge (habituation) and the need to tic in response will lessen.

Studies have shown both HRT and ERP can improve tics in around half the people using them. These techniques are more likely to be successful if practiced regularly.

Medication

If you decide to use medicines to treat your tics, the choice of medicine will initially depend on several things, including:

• the type of symptoms that are most problematic
• the severity of your symptoms
• how important treatment is to you
• the risk of possible side effects

In clinical studies, a variety of medicines have been shown to be effective in treating tics, although they can have unpleasant side effects. Some of these are described below.

Neuroleptics

Neuroleptics, also known as antipsychotic medicines, are a type of medicine used to treat psychosis. In much lower doses, they’ve also been shown to be effective at treating tics.

Neuroleptics work by altering the effects of dopamine on the brain. Dopamine is a naturally occurring chemical in the brain that helps to control and co-ordinate your body’s movements.

Examples of neuroleptics include haloperidol, pimozide and risperidone. However, haloperidol is rarely prescribed nowadays due to the potential side effects (see below).

Neuroleptics can be divided into two main groups:

• typical neuroleptics – the first generation of neuroleptics, developed in the 1950s
• atypical neuroleptics – a newer generation of neuroleptics, developed in the 1990s

The newer, atypical neuroleptics tend to have milder side effects.

Side effects of both typical and atypical neuroleptics include:

• weight gain
• blurred vision
• constipation
• a dry mouth

However, typical neuroleptics can also cause:

• drowsiness
• shaking
• trembling
• muscle twitches
• spasms

Studies have found that neuroleptics can improve tics in about seven out of every 10 people.

Alpha2-adrenergic agonists

Alpha2-adrenergic agonists, such as clonidine, have been shown to be effective in suppressing tics, as well as treating the symptoms ofattention deficit hyperactivity disorder (ADHD).

Alpha2-adrenergic agonists have relatively mild side effects, including:

• drowsiness
• constipation
• dry mouth
• feeling sick

Studies have shown that alpha2-adrenergic agonists can reduce the frequency of tics in about half the people who are prescribed them.

Benzodiazepines

Benzodiazepines, such as clonazepam, have been shown to reduce the severity of tics in some people. They work by altering the way that certain chemicals transmit messages in the brain.

Benzodiazepines aren’t as effective as neuroleptics in suppressing tics and it’s possible to become addicted to them if they’re used for a long time. However, they can be useful for the short-term treatment of tics.

Tetrabenazine

Tetrabenazine is a medicine used to treat conditions that affect movement. Some studies have found that tetrabenazine improved tics in eight out of every 10 people, and some people experienced a long-term improvement in their symptoms.

It can cause side effects, such as drowsiness, feeling sick and depression. However, it’s less likely to cause weight gain than some of the other medicines.

Autism spectrum disorder

Autism spectrum disorder (ASD) or “Social Communication Difficulties” covers a set of developmental disabilities that can cause significant social, communication, and behavioral challenges. People with ASD process information in their brain differently than other people.

ASD affects people in different ways and can range from mild to severe. People with ASD share some symptoms, such as difficulties with social interaction, but there are differences in when the symptoms start, how severe they are, how many symptoms there are, and whether other problems are present.

The signs of ASD begin before the age of 3, although some children may show hints of future problems within the first year of life.

It’s estimated that about 1 in every 100 people in the UK has ASD. More boys are diagnosed with the condition than girls.

There’s no “cure” for ASD, but speech and language therapy, occupational therapy, educational support, plus a number of other interventions are available to help children and parents.

Read about help and support available for people with ASD.

The word “autism” has its origin in the Greek word “autos,” which means “self.” Children with ASD often are self-absorbed and seem to exist in a private world where they are unable to successfully communicate and interact with others. Children with ASD may have difficulty developing language skills and understanding what others say to them. They also may have difficulty communicating nonverbally, such as through hand gestures, eye contact, and facial expressions.

Not every child with ASD will have a language problem. A child’s ability to communicate will vary, depending upon his or her intellectual and social development. Some children with ASD may be unable to speak. Others may have rich vocabularies and be able to talk about specific subjects in great detail. Most children with ASD have little or no problem pronouncing words. The majority, however, have difficulty using language effectively, especially when they talk to other people. Many have problems with the meaning and rhythm of words and sentences. They also may be unable to understand body language and the nuances of vocal tones.

Below are some patterns of language use and behaviors that are often found in children with ASD.

• Repetitive or rigid language. Often, children with ASD who can speak will say things that
  have no meaning or that seem out of context in conversations with others. For example, a child may count from one to five repeatedly. Or a child may repeat words he or she has heard over and over, a condition called echolalia. Immediate echolalia occurs when the child repeats words someone has just said. For example, the child may respond to a question by asking the same question. In delayed echolalia, the child will repeat words heard at an earlier time. The child may say “Do you want something to drink?” whenever he or she asks for a drink. Some children with ASD speak in a high-pitched or singsong voice or use robot-like speech. Other children may use stock phrases to start a conversation. For example, a child may say “My name is Tom,” even when he talks with friends or family. Still others may repeat what they hear on television programs or commercials.
• Narrow interests and exceptional abilities. Some children may be able to deliver an in-depth monologue about a topic that holds their interest, even though they may not be able to carry on a two-way conversation about the same topic. Others have musical talents or an advanced ability to count and do math calculations. Approximately 10 percent of children with ASD show “savant” skills, or extremely high abilities in specific areas, such as calendar calculation, music, or math.
• Uneven language development. Many children with ASD develop some speech and language skills, but not to a normal level of ability, and their progress is usually uneven. For example, they may develop a strong vocabulary in a particular area of interest very quickly. Many children have good memories for information just heard or seen. Some children may be able to read words before 5 years of age, but they may not comprehend what they have read. They often do not respond to the speech of others and may not respond to their own names. As a result, these children sometimes are mistakenly thought to have a hearing problem.
• Poor nonverbal conversation skills. Children with ASD often are unable to use gestures—such as pointing to an object—to give meaning to their speech. They often avoid eye contact, which can make them seem rude, uninterested, or inattentive. Without meaningful gestures or the language to communicate, many children with ASD become frustrated in their attempts to make their feelings and needs known. They may act out their frustrations through vocal outbursts or other inappropriate behaviors.

Useful resources:

National Autistic Society

NIH website

NHS choices

Screening : http://www.childbrain.com/pddassess.html

website: Centre for Parent Information and Resources

Talk to frank (website)

Post-traumatic stress disorder (PTSD)

If you develop strong feelings of anxiety after experiencing or witnessing something you found very traumatic, you might be given a diagnosis of PTSD. PTSD can cause flashbacks or nightmares which can feel like you’re re-living all the fear and anxiety you experienced during the actual event.

(See MIND pages on PSTD for more information on what PTSD is, and what treatments and support are available.)

www.oneplusone.org.uk

www.aboutKidsHealth

www.wavetrust.org/our-work/publications