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Neurodiversity

Definition, types of, symptoms (positive and challenging), accommodations, neurodiversity and children, self-regulation, sleep problems, adaptive functioning, social work practice approach, autism, ADHD, dyslexia, OCD, Tourette’s syndrome, Bipolar disorder


Four sections follow:

  1. Background Material that provides the context for the topic

  2. A suggested Practice Approach

  3. A list of Supporting Material / References

  4. An Appendix discussing neurodiversity and children

Feedback welcome!


Background Information

What is neurodiversity?

The term "neurodiverse" refers to the idea that differences in the human brain are natural and normal and, in many cases, can lead to meaningful and positive insights and abilities. The concept of neurodiversity is gaining traction as both neurodiverse and “neurotypical” people are finding that differences are not necessarily disabilities. Some differences can be real strengths (Rudy, 2022). For example people with neurodiverse brains can be creative, big-picture, out-of-the-box thinkers, while also having difficulty with some aspects of everyday living (Wiginton, 2021). In other words, there is a developing acceptance that there is no “one” type of brain. Each person has natural variances in experience, learning, and information processing. These cognitive differences aren’t deficits and aren’t inferior to neurotypical brains (Cooks-Campbell, 2022).


Broadly speaking, the neurodiversity approach defines atypical neuro-development as variation in the human experience that should be accepted and respected. Judy Singer is a pioneer of neurodiversity. In her blog, NeuroDiversity 2.0, she suggests neurodiversity is a subset of biodiversity, i.e. the total diversity of species that inhabit the planet. Just as biodiversity is essential and necessary for healthy ecosystems, so too might neurodiversity contribute to human flourishing. Neurodiversity refers specifically to the limitless variability of human cognition and the uniqueness of each human mind. Neurodiversity suggests it is important to include and support all neurotypes in order to develop a thriving human society. Neurodiversity is an umbrella term used to advocate for the common interests of various neurological minorities (some are listed below).


The neurodiversity movement grew out of the Autistic Self-Advocacy movement and has as it aims to:

  • shift mainstream perceptions of marginalized neurominorities

  • replace negative, deficit-based stereotypes of neurominorities with a more balanced valuation of their gifts and needs

  • find valued roles for neurologically marginalized people

  • show that all society benefits from the incorporation of neurominorities.

Singer points out that the meaning of neurodiversity will continue to evolve as people discuss its merits and implement change (Schuck et al., 2022; Singer, 2019).


Who is neurodiverse? Types of neurodiversity

People are described as neurodiverse when their thought patterns, behaviors, or learning styles fall outside what is considered normal, or ”neurotypical”. The neurodiverse population includes people with specific diagnoses that are considered developmental disorders (as opposed to intellectual disabilities or mental illnesses) (Rudy, 2022). Diagnoses coming under the umbrella of neurodiverse include:

  • Autism Spectrum Disorder (ASD): A developmental disorder that includes differences in social communication skills, fine and gross motor skills, speech, and more (Rudy, 2002). Those with autism pay attention to complex details, have good memories, and show certain "specialty" skills. Experts think this can be an asset in certain jobs, such as computer programming or music (Wiginton, 2021). Asperger’s syndrome falls under the autism spectrum. Many in the autistic community show exceptional levels of intelligence, pattern recognition, and cognitive abilities. Often, hyperlexia (the ability to read early and exceptionally well) is correlated with ASD (Cooks-Campbell, 2022).

  • Attention Deficit Hyperactivity Disorder (ADHD): A neurodevelopmental disorder that includes features of inattention, hyperactivity, and impulsivity (Rudy, 2022) some of the time, all of the time, or rarely (Cooks-Campbell, 2022). People with ADHD have high levels of spontaneity, courage, and empathy. They can hyper-focus on certain tasks (Wiginton, 2021). Employers may need to adjust how they communicate with people with ADHD. Adapting performance-review strategies, proactive communication, and altered workflows can help them optimize their abilities at work (Cooks-Campbell, 2022).

  • Various learning disabilities such as dyslexia (difficulty with language skills, especially reading and dyscalculia (difficulty with doing basic arithmetic) (Rudy, 2022): People with these disabilities have certain skills that can be useful in specific jobs, e.g. people with dyslexia can perceive certain kinds of visual information better than those without the condition. This skill can be useful in jobs like engineering and computer graphics (Wiginton, 2021). However, they can be written off as lazy because they struggle to process certain information (Cooks-Campbell, 2022).

Cooks-Campbell (2022) suggests the above three syndromes constitute around 70% of all diagnoses of neurodiversity. Other diagnoses include:

  • Tourette's syndrome: A tic disorder starting in childhood that involves involuntary, repetitive movements and vocalizations (Rudy, 2022).

  • Bipolar disorder / manic depression: People with bipolar disorder have extreme mood swings that range from mania to depression. These mood swings are generally not rapid with people often experiencing weeks or months of depression, punctuated by manic episodes. During manic episodes, affected individuals might feel very up, energetic, and confident. However, during depressive periods, they may feel hopeless, angry, or suicidal (Cooks-Campbell, 2022).

  • Epilepsy: Epilepsy is a cognitive disorder that results in repeated seizures, caused by sudden and short bursts of electrical activity in certain parts of your brain. Some research shows that those with epilepsy may have higher intelligence scores than those without epilepsy (Cooks-Campbell, 2022).

  • Obsessive Compulsive Disorder: People with OCD have intrusive, obsessive thoughts that trigger anxiety and discomfort. The compulsions are the repetitive, specific behaviors carried out in an attempt to relieve that anxiety. When it comes to processing information and interacting with people or objects, there’s not much difference between individuals with OCD and those without it (Cooks-Campbell, 2022).

Signs of neurodivergence

The following (from Rudy, 2022) are very generalized descriptions. Each individual is unique, and certain differences are more likely to appear in, for example, an autistic person than a person with dyscalculia, or vice versa.


Some common and challenging symptoms of neurodiversity include:

  • Social communication difficulties,

  • Speech and language challenges,

  • Learning challenges that may be related to difficulties with focus, reading, calculation, ability to follow spoken language, and/or problems with executive functioning (i.e. working memory, flexible thinking, and self-control),

  • Unusual responses to sensory input (e.g. sensitivity or unusual insensitivity to light, sound, heat, cold, pressure, crowds, and other stimuli),

  • Unusual physical behaviors (e.g. such as rocking, expressing tics, blurting, and shouting at unexpected times),

  • Inflexibility (i.e. inability to adapt or to change interests based on age or situation).

Some positive signs of neurodiversity include:

  • Ability to stay focused for long periods on a topic or activity of interest,

  • Outside-the-box thinking, which can lead to innovative solutions,

  • Strong observational skills and attention to detail,

  • Superior ability to recognize patterns, including in codes and behaviors,

  • Having strong skills in areas such as music, art, technology, and science.

Accommodating neurodivergence

People who are neurodiverse can be very different from one another, which makes it difficult to provide a single list of accommodations. However, some accommodations can be implemented and may be helpful for those without a formal diagnosis (Rudy, 2022).

  • Be aware of the potential for neurodivergence and be willing to accommodate people when specific, reasonable requests are made; requests may range from wearing noise-blocking headphones, a preference to work from home or to communicate via text rather than video conference.

  • Have a positive response where sensory challenges cause physical discomfort: These may include replacing fluorescent light bulbs with less-harsh incandescent or LED lights, reducing ambient noise, eliminating perfumes, providing noise-blocking headphones, and providing natural light.

  • Allow technological supports for managing time and schedules: These can include smartphone alarms, calendars, and other time-management software.

  • Be open to learning to communicate in a person’s preferred ways.

  • Provide options for different ways of taking in and communicating information: These may include oral vs. written reports, videos vs. lectures, typed responses vs. in-person meetings.

  • Be sensitive to social differences: Examples include taking it in stride rather than reacting negatively if someone speaks loudly, has tics, stammers, or finds it difficult to socialize in a typical manner.

  • Be prepared to repeat words or speak more slowly to improve comprehension.

  • Assign a particular job or activity based on an individual's strengths and preferences.

  • Ask people who are neurodivergent for their advice and input when designing office spaces, forming teams, and developing project management systems.

Supporting Children Who Are Neurodiverse

The following material relies on the work of McLean (2022) who has recently written a practice paper around supporting children with neurodiversity (Child Family Community Australia, Paper No. 64). The following is a relatively brief outline of this paper. A more extensive summary can be found in Appendix located after the reference list that follows the Practice Approach section of this document.


Introduction

The concept of neurodiversity is generally associated with placing value on the strengths and benefits that are associated with diversity in brain functioning; and on an accepting and inclusive approach to children who experience this diversity. Conventional counselling approaches may need to be adapted to better suit the needs of these children. Traditional approaches to behaviour management may not work as they rely on a child’s ability to self-monitor, anticipate outcomes and reliably link their actions to consequences, abilities often compromised in children with neurodiverse tendencies.


Children who are neurodiverse are likely to find it difficult with neurocognitive skills (e.g. paying attention), self-regulation, and acquiring age-appropriate daily living skills (adaptive functioning).


Neurocognitive Skills in Children

Neurocognitive skills include the ability to:

  • sustain attention to what is important and relevant, and avoid distraction,

  • evaluate, prioritise and process information from a range of sources, and to adapt behaviour and learning in response,

  • inhibit, control and monitor one’s behaviour, thoughts and emotions, and

  • organise, plan and initiate actions in order to reach an agreed goal.

Children with neurodiversity will struggle in the following situations and settings:

  • Unstructured settings

  • Transitions involving re-directing attention from one activity to another

  • Situations that involve frequent change, novelty or are unpredictable

  • Highly reflective , language-based approaches.

These difficulties can arise in all situations, e.g. at school, at home and in counselling. Strategies to manage these difficulties revolve around creating a structured environment that enables a child to experience success and simplifying adult-child interactions. For example, minimise distractions, use auditory cues to refocus, provide reinforcement for on-task behaviour, provide regular movement breaks, provide instructions one step at a time, use simple language, allow take-up time, use visual supports, manage transitions through visual and auditory warnings, finish instructions before distributing materials).


Self-regulation in Children

Self-regulation refers to a child’s ability to regulate inner sensations, behavioural or emotional states. Children who are able to self-regulate find it easier to meet social expectations, adhere to good sleep routines, engage optimally in learning and express themselves in socially appropriate ways. Children with self-regulation difficulties have reduced capacity to engage in educational, social and community activities. They can experience sensory processing difficulties and sleep difficulties.


Sensory processing difficulties include being oversensitive or under-sensitive to touch, sound or movement, becoming overwhelmed by the environment, unable to remain calm and alert, difficulty attending, and recognising bodily cues such as hunger or toileting needs. Strategies include calming activities (e.g. singing, massage), active movement, allowing doodling, and creating a visual timetable of regular tasks.


Between 44% and 89% of children with neurodiversity are more likely to experience sleep disturbances, placing significant strain on families. Addressing sleep difficulties depends on the type of difficulty: sleep onset, sleep maintenance and/or delayed sleep-wake cycle.


Sleep onset refers to difficulty falling asleep at socially appropriate times. In addressing sleep onset, it is important to manage negative parent-child interactions.

  • Keep a regular night-time routine, without screens and stimulating activities one hour before bedtime.

  • Reward the child for adherence to bedtime routine.

  • Ensure the child only uses their bed for sleep, and only goes to bed when tired.

  • Enforce a consistent wake-up time.

Sleep maintenance refers to difficulty staying asleep throughout the night, e.g. disordered sleep cycles, sleepwalking, or disability related symptoms such as sleep apnoea, bed-wetting or night-time pain. Frequent wakening can be managed by returning the child to bed, with minimal interaction, in conjunction with a planned ignoring (extinction) protocol. Slightly older children can be taught to use digital clocks to indicate what time they are allowed out of bed. Older children’s behaviour can be reinforced for time spent in bed during the night. Pharmacological support may also be indicated.


Delayed sleep-wake cycles refer to difficult waking at a socially appropriate time.

  • Expose the child to bright light first thing in the morning, coupled with the good sleep onset measures, outlined above.

  • Sleep movement disorder, parasomnias (e.g. sleep walking) and sleep apnoea should be explored.

Strengthening Adaptive Functioning in Children

Adaptive functioning refers to how well a child can communicate, engage in activities with and express thoughts to others. Children should be able to perform daily living skills (e.g. personal hygiene, self-care), and use appropriate social skills (e.g. form friendships).


Strategies to improve adaptive functioning include creating a structured and predictable environment rich in visual supports and adopting specialised teaching methods that include modelling and rehearsal of new skills, breaking down complex tasks into simple steps to be performed in order, and implementing errorless learning for children with significant cognitive and memory impairment.


Social Work Role and Neurodiversity

Research by Bishop-Fitzpatrick et al. (2019) focuses on autism spectrum disorder (ASD). They list nine broad areas where social workers can offer support. These suggestions may be relevant for people who are neurodiverse in areas other than ASD.

  1. The consequences of ASD on individuals and families

  2. The financial burden of ASD

  3. Offering support to parents of young children on the autism spectrum

  4. Screening young children for ASD

  5. Addressing racial and ethnic disparities

  6. The impact of key life course transitions

  7. Health and quality of life in middle-aged and older adults

  8. Interventions for grownups

  9. Support for multicultural parents and children with ASD.

Furthermore, in elaborating on these areas Bishop-Fitzpatrick et al. stress the areas of most importance are (i) focusing on family systems, (ii) addressing the substantial social and economic injustices and health disparities experienced by individuals and families (advocacy) and, (iii) sharing their experiences so other can learn and adapt their own practice, e.g. by engaging in both formal and informal research and sharing findings with the social work community.


In discussing dyslexia in the context of social work, Schelbe et al. (2022) suggest a social worker’s role revolves around identifying risk, referring, educating and advocating,


Kottler (2000), discussing attention deficit/hyperactivity disorder, suggests social workers play an important role in educating adults, adolescents, older children and parents about the basics of ADHD and its effect on behaviour. Highlighting the positive traits is important (e.g. high energy, optimism, creativity, and an engaging personality). With children, parents need to be involved, as much of the treatment milieu occurs at home. Parents need to understand how the whole gamut of traits associated with ADHD — restlessness, poor attention regulation, impulsivity, distractability, low frustration tolerance, emotional over reactivity, and disorganization — cause behavioral, social, and academic problems. They need support to develop alternative ways of managing and working with their child’s behaviour, e.g. setting clear rules, and tasks that are broken down into smaller and more manageable components with success rewarded immediately. With adolescents, parent-adolescent negotiation is crucial.


PHD Therapy (2018) list eight ways social workers can help those with ADHD. These include:

  • Understand the Symptoms of ADHD Symptoms may vary widely from childhood to adulthood as the symptoms change in complexity. Social workers must consider the co-morbidity of this condition alongside conditions like anxiety and depression.

  • Consider Pointing Clients Toward Many Treatment Options Possible therapy options include medication management, individual therapy, family therapy, support groups, parenting courses, and even personal coaching. Understand clients’ needs to best point them in the right direction.

  • Address the Entire Family Social workers can help to decrease some of the tension the condition can cause within families. For clients who are children, working with parents to understand behavior modification strategies is a great step. For others, finding new ways to build a strong support network is crucial. Howe (2010) suggests specific training can support parents to become more attuned and responsive as they try to help their children learn to regulate their own behaviour: study skills training, social skills training, parent skills training, group therapy and educational programs.

  • Provide a Necessary Self-Esteem Boost Many clients managing ADHD are lacking in self-esteem, often in conjunction with low social skills and problems adjusting to new situations and settings. One way to help clients cultivate a sense of self-worth is to pinpoint small, specific goals toward which they can work. For instance, a client might struggle to manage time effectively. The social worker can brainstorm goals that facilitate better time management.

Practice Approach


Social workers may come across neurodiversity as part of their everyday practice. Knowledge of neurodiversity will assist social workers to adapt their practice models (e.g. problem solving, solution-focused, task-centered, brief intervention, behavioural activation, mindfulness) so they can accommodate the various neurocognitive qualities of the person. In implementing their practice models, and in keeping with the theme of neurodiversity, social workers should accept the person as they are and focus on their strengths, not necessarily seek radical change in behaviour. Some of the following information, a synthesis of the background material above, may help inform social work practice.


1. Be aware of the accommodations that may need to be made in counselling sessions. Children in particular (but also some adults) may have difficulty with:

  • remembering what is being discussed

  • staying on topic

  • listening closely to what is being said

  • generating ideas and possible solutions

  • adapting and changing plans as needed

  • reporting back on what they are thinking and feeling

  • forming plans and timelines (McCabe, 2022).

2. Writers looking at people with ASD, ADHD or dyslexia suggest varying ways social workers can offer support and some of these would be transferable to a person presenting with neurodiverse characteristics. For example

  • Highlight the positive, the person’s strengths—boost self-esteem

  • Educate the entire family in symptoms and how to manage these

  • Point individuals and parents to treatment options

  • Identify situations that pose a risk and discuss how to manage these

  • Refer to specialists for a diagnosis

  • Advocate with schools, employers, health systems and others as appropriate.

3. Support the parents of children with neurodiverse characteristics; the article by McLean (in the References below and the Appendix that follows) has a number of strategies parents can use to manage a child’s attention difficulties, less cognitive flexibility, poor self-regulation, sleep issues, interactions with others, daily living skills and social skills. Strategies suggested:

  • Providing structure to enable success

  • Simplifying adult-child interactions

  • Adopting certain behaviours to manage the impact of the sensory world

  • Addressing sleep onset and sleep maintenance difficulties

  • Using visual supports

  • Adopting specialised teaching approaches: modelling and rehearsal, task analysis and chaining and errorless learning.

4. Advocacy – support people with neurodiverse characteristics to replace negative, deficit-based stereotypes with a more balanced evaluation of their gifts and needs (Singer, 2019); advocate with employers to find roles within an organisation to utilise the strengths of people who exhibiting neurodiverse qualities.


5. As neurodiversity is a relatively new concept in the social work field, it is important that social workers engage in both formal and informal research and share their experiences with the wider social work community.


References / Supplementary Material


Bishop-Fitzpatrick, L., Dababnah, S., Baker-Ericzen, M., Smith M., & Magana, S. (2019). Autism spectrum disorder and the science of social work: A grand challenge for social research. Social Work Mental Health, 17(1), 73-92. doi:10.1080/15332985.2018.1509411


Cooks-Campbell, A. (2022). No two brains are the same. Learn about the types of neurodiversity. https://www.betterup.com/blog/types-of-neurodiversity


Howe, D. (2010). ADHD and its comorbidity: An example of gene–environment interaction and its implications for child and family social work. Child and Family Social Work, 15, 265-275. doi:10.1111/j.1365-2206.2009.00666.x


Kottler, S. (2000).A social worker’s guide to Attention Deficit/Hyperactivity Disorder: What is it? Who has it? And what should we do about it? NASW. https://www.naswma.org/page/362


McLean, S. (2022). Supporting children with neurodiversity: CFCA Paper No. 64. Child Family Community Australia. https://aifs.gov.au/resources/policy-and-practice-papers/supporting-children-neurodiversity


PDH Therapy. (2018). 8 ways social worker can help those with ADHD. https://pdhtherapy.com/2018/03/8-ways-social-workers-can-help-those-with-adhd/


Rudy, L. (2022). The neurodivergent brain: Everything you need to know. https://www.verywellhealth.com/neurodivergent-5216749?print


Schelbe, L., Pryce, J., Petscher, Y., Fien, H., Stanley, C., Gearin B., & Gaab, N. (2022). Dyslexia in the context of social work: Screening and early intervention. Families in society: the Journal of Contemporary Social Services, 103(3), 269-280. doi: 10.1177/10443894211042323


Schuck, R., Tagavi, D., Baiden K., Dwyer, P., Williams, Z., Osuna, A., Ferguson, E., Munoz, M., Poyser, S., Johnson, J., & Vernon T. (2022). Neurodiversity and Autism Intervention: Reconciling Perspectives Through a Naturalistic Developmental Behavioral Intervention Framework. Journal of Autism and Developmental Disorders, 52, 4625-4645. https://doi.org/10.1007/s10803-021-05316-x


Sewell, A. (2022). Understanding and supporting learners with specific learning difficulties from a neurodiversity perspective: A narrative synthesis. British Journal of Special Education, 49(4), 539-559. doi: 10.1111/1467-8578.12422


Singer, J. (2019). Reflections on neurodiversity: Afterthoughts, ideas, polemics, not always serious. NeuroDiversity 2.0 [website]. https://neurodiversity2.blogspot.com/p/what.html

Wiginton, K. (2021). What Is Neurodiversity? https://www.webmd.com/add-adhd/features/what-is-neurodiversity


Appendix

Supporting Children Who Are Neurodiverse


The following material relies on the work of Sara McLean (2022) who has recently written a practice paper around supporting children with neurodiversity (Child Family Community Australia, Paper No. 64).


Key Messages

Neurodiversity is an umbrella term that refers to the diversity in brain functioning associated with a range of developmental conditions and experiences. These can include autism, intellectual disability, attention deficit hyperactivity disorder, oppositional defiant disorder, fetal alcohol spectrum disorder and early life adversity. A psychological assessment is needed to confirm a child’s neurocognitive status.


Children with neurodiversity may have more difficulty in reflective learning, and in developing behavioural and emotional control. They may need additional supports to help them develop new skills, participate in learning environments, and develop self-regulation. After exploring the literature around how to support children with neurodiversity Sewell (2022) suggests a focus on the cognitive, social and emotional strengths of learners is important. From this basis further strengths can be developed. Sewell also found neurodiverse teaching interventions can foster successful learning, but there is currently a dearth of practice-based research into these strategies. McLean suggests these strategies include:

  • Providing structure and predictability, scaffolding using visual supports, and simplified adult–child interactions,

  • Helping children understand how the sensory world affects them and appropriate behavioural strategies to manage this impact,

  • Using explicit and systematic techniques to gradually improve their independence in manageable increments.

Introduction

The concept of neurodiversity is generally associated with placing value on the strengths and benefits that are associated with diversity in brain functioning; and on an accepting and inclusive approach to children who experience this diversity. Many children with neurodiversity will present to services as experiencing difficulty with developing emotional and behavioural control. Conventional counselling approaches may need to be adapted to better suit the needs of these children. Traditional approaches to behaviour management may not work as they rely on a child’s ability to self-monitor, anticipate outcomes and reliably link their actions to consequences, abilities often compromised in children with neurodiverse tendencies.


Children who are neurodiverse are likely to find it difficult with neurocognitive skills (e.g. paying attention), self-regulation, and acquiring age-appropriate daily living skills (adaptive functioning). These three topics are developed in detail in the material that follows.


Neurocognitive Skills in Children

Neurocognitive skills support reasoning, learning, self-regulation and behaviour through the ability to:

  • seamlessly direct (or redirect) and sustain attention to what is important and relevant, and avoid distraction,

  • evaluate, prioritise and process information from a range of sources, to adapt behaviour and learning in response to change or feedback,

  • inhibit, control and monitor one’s behaviour, thoughts and emotions, and

  • torganise, plan and initiate actions in order to reach an agreed goal.

These skills provide the foundation for the collaborative and reflective processes needed in counselling and other forms of reflective learning, including at school.


Common signs of difficulty

Children with neurodiversity will struggle with the following situations and settings, due to their underlying difficulties with attentional control and cognitive flexibility:

  • Unstructured settings (e.g. recess or lunch at school) because they prefer highly structured approaches to learning and social interaction.

  • Re-directing attention from one activity to another (transitions), e.g. to a new set of behavioural expectations, which relies on cognitive flexibility. Other transitions include leaving home for school, moving from one activity to another or finishing a game when requested. Transitions can trigger behavioural issues and defiance.

  • Situations that involve frequent change, novelty or are unpredictable (i.e. situations of dynamic demand), e.g. change of work groups, and situations of rapid social interchange—they may be more successful as one-on-one learners and find group interaction difficult.

  • Highly reflective , language-based approaches (that increase cognitive demand) can be difficult leading to disengagement and/or behavioural avoidance

In a counselling / family setting children may experience difficulty with:

  • remembering what is being discussed

  • staying on topic

  • listening closely to what is being said

  • generating ideas and possible solutions

  • adapting and changing plans as needed

  • reporting back on what they are thinking and feeling

  • forming plans and timelines

In a school setting children may experience difficulty with:

  • getting started on learning activities

  • keeping track of what they are supposed to be doing

  • maintaining focus on relevant information

  • selectively attending to what is important in the learning environment

  • thinking in abstract ways

  • adapting to changing routines and transitions

  • generalising their learning from one setting to another

What supports neurocognitive functioning?

Strategies to support a child with attentional control difficulties:


Create a structured environment that enables a child to experience success

  • Minimise environmental distractions, non-essential verbal and visual input, and sensory stimulation (put away unnecessary toys and activities, declutter the room).

  • Use strategic seating away from doors, corridors or windows to avoid distractions.

  • Use physical barriers to reduce unnecessary visual distractions. Use study carousels or cover windows.

  • Use regular auditory cues to remind children where their focus should be or to ensure small periods of sustained focus. Use timers, chimes and phone alarms.

  • Provide reinforcement for on-task behaviour and effort, rather than outcomes.

  • Provide regular movement breaks and take time to re-orient children to tasks following breaks. Visual prompts and visual schedules can help a child to remember what to focus on.

Simplify adult–child interactions to support the child

  • Break activities or requests into smaller steps and give instructions for one step at a time.

  • Chunk instructions into manageable bits of information, use short sentences (5–7 words) and visual prompts to assist focus.

  • Use simple language that focuses on core concepts (e.g. ‘Close your books. Put the books back on the shelf’). Use language to structure expectations and activities (e.g. ‘First we will learn about feelings. Then we will match feelings with colours’).

  • Teach one concept at a time and allow the child time to take up an instruction (count silently to 10).

  • Simple visual supports can be used to supplement what you are saying and can help children to focus on important information. Try to avoid visuals that are busy or have bright colours.

  • Sometimes headphones or similar technology may be needed to help the child screen out background noise.

Strategies to support a child with less cognitive flexibility


Create a structured environment that enables a child to experience success

  • Predictable, structured learning environments are easier for the child to manage. Where possible, provide visual schedules to outline expectations and stick to routines. Warn the child of any unexpected changes and rehearse with the child what to do to manage this.

  • Transitions can be assisted by providing verbal, visual and auditory warnings, if feasible. Examples include sand timers, paper-chain links, abacuses, digital countdown apps, chimes and transition songs.

  • Transitional tasks and transition objects can help the child to re-orient to what you want them to achieve next (e.g. ‘Take this to your mum. She’s waiting next door’).

  • Visual prompts and mental maps can assist the child to understand how concepts are related or to unpack the steps in an activity.

  • Use tangible objects to assist the child to engage in back-and-forth turn taking in group activities or counselling (e.g. talking stick or soft ball).

Simplify adult–child interactions to support the child

  • Give clear feedback and concrete explanations about target behaviours, rather than talking about general concepts like sharing. What actions does it involve? What do you want the child to do?

  • Teach and model reflective self-talk (e.g. ‘What should I start first? What’s the first step? What’s next?’).

  • Teach and model coping self-talk (e.g. ‘I can slow down’, ‘I have lots of good ideas’, ‘I am feeling stressed’,’ I can kick the soccer ball’ or ‘I can take a shower’).

  • Prefacing activities with meta cognitive questions can help the child to understand what is expected of them (e.g. ‘I’ll read you a story. See if you can notice what Amir does to feel better’).

  • Finish any instructions before handing out materials, games or activities.

  • Use short, step-by-step instructions to tell the child what you want them to do first and then what the next steps are.

Self-regulation in Children

What is self-regulation?

Self-regulation refers to a child’s ability to regulate inner sensations, behavioural or emotional states. Children who are able to self-regulate find it easier to meet social expectations, adhere to good sleep routines, engage optimally in learning and express themselves in socially appropriate ways. Children with self-regulation difficulties have reduced capacity to engage in educational, social and community activities. They can experience sensory processing difficulties and sleep difficulties.


Sensory processing difficulties

Children with neurodiversity cannot easily screen, process and integrate competing sensory input, and are easily overwhelmed. But they can be supported to understand how the sensory world affects them and be taught to use behavioural strategies to manage this impact. This will help them to participate in learning activities and social relationships. Behavioural strategies that may be helpful include:

Screening tools are available from:

Strategies for sleep in children

Children with neurodiversity are more likely to experience sleep disturbances (i.e. between 44% and 89%) because they have difficulty in regulating hormones that affect the sleep-wake cycle. This places significant strain on families. The traditional use of behavioural approaches to address sleep difficulties may be more complicated because of co-existing medical issues that can disrupt sleep, sensory issues (sensitivity to body position, tags on clothes, textures, room temperature, etc.), difficulty in establishing new routines and adapting to change. In addition, exhausted parents can find it difficult to follow through with behavioural sleep interventions. Addressing sleep difficulties depends on the type of difficulty: sleep onset, sleep maintenance and/or delayed sleep-wake cycle.


Sleep onset difficulties

Sleep onset refers to difficulty falling asleep at socially appropriate times. In addressing sleep onset, it is important to manage negative parent-child interactions.

  • Keep a regular night-time routine. Eliminate screen and blue-light-emitting devices and stimulating activities one hour before bedtime.

  • Reward the child for adherence to bedtime routine.

  • Ensure the child only uses their bed for sleep, and only goes to bed when tired (e.g. push bedtime back by 15 minutes). Ask the child to get out of bed if they are not asleep after 15 minutes and engage in a low-stimulus activity (e.g. reading) until they are ready to return to bed.

  • Enforce a consistent wake-up time (e.g. increase natural light in the morning).

Sleep maintenance difficulties

Sleep maintenance refers to difficulty staying asleep throughout the night, e.g. disordered sleep cycles, sleepwalking, or disability related symptoms such as sleep apnoea, bedwetting or night-time pain. Addressing sleep maintenance difficulties typically involves changing reinforcement patterns and addressing problematic parent–child interactions that may be reinforcing difficulties with sleep maintenance.

  • Frequent wakening can be managed by returning the child to bed, with minimal interaction, in conjunction with a planned ignoring (extinction) protocol. For younger children, this might mean getting a hug from a parent then returning to bed. Over time, parental involvement can be systematically reduced (graduated extinction) and the child can be rewarded for successive steps towards independently returning to bed. Slightly older children can be taught to use digital clocks to indicate what time they are allowed out of bed. Older children’s behaviour can be reinforced for time spent in bed during the night (i.e. self-settling and not seeking out an adult).

  • For children who are awakened easily by background noise, white-noise screening or earplugs can be worn during sleep.

  • Pharmacological support may also be indicated, under medical supervision, where behavioural approaches have been trialled unsuccessfully or where a short-term ‘circuit breaker’ is needed (e.g. clonidine).

Delayed steep-wake cycles

Delayed sleep-wake cycles refer to difficult waking at a socially appropriate time.

  • When difficulty in morning wakening occurs in conjunction with a later than acceptable bedtime and sleep onset, this is likely to reflect an advanced sleep–wake cycle. This can be addressed by exposure to bright light first thing in the morning, coupled with good sleep onset measures, particularly the elimination of blue-light devices before bedtime, sleep restriction and an enforced set time and routine for morning wakening.

  • Difficulty in morning wakening could also reflect poor-quality sleep. Sleep movement disorder, parasomnias (e.g. sleep walking) and sleep apnoea should be explored. In this case, pharmacological support may also be indicated

More information in implementing options around sleep onset, sleep maintenance and delayed sleep-wake cycle is available from Medalie and Gozal (2018) on pp. e177 - e178 at https://pdfs.semanticscholar.org/c186/3f2f630d59a2e8d201a8f1facd2dc4ab69cd.pdf.


Strengthening Adaptive Functioning in Children

What is adaptive functioning?

Adaptive functioning refers to how well a child can communicate with others, engage in activities with others, express thoughts to others, perform daily living skills (personal hygiene, self-care), and use appropriate social skills (e.g. form friendships).


Strategies for adaptive functioning development

Create structured and predictable environments rich in visual supports

Structured environments reduce cognitive burden, minimise distractions and make it easier for children to direct their attention to relevant information. Visual supports also reduce cognitive and language burden and can be used to:

  • convey essential information to the child

  • outline the individual sequence of steps involved in completing a task and provide a road map for the child and their learning

  • support a child to understand what is expected of them in social environments and assist them to make good choices under pressure

  • build a child’s independence and self-efficacy by gradually reducing their reliance on the presence of an instructing adult

  • offer the flexibility of being able to meet a child’s current level of functioning and developmental need while being easily adapted in response to a child’s growing skill level.

Guidance on how to select and use visual supports is available at http://csefel.vanderbilt.edu/modules/module3b/handout2.pdf


Adopt specialised teaching methods to support learning

Teaching adaptive skills to children with neurodiversity involves: (i) maximising opportunities for initial success by setting tasks at an appropriate level, (ii) building task expectations and complexity in a graduated and incremental way over time, (iii) using high levels of task exposure, repetition and extended learning to help consolidate learning.


There are three broad approaches to teaching adaptive functioning:


1. Modelling and rehearsal teaches children new skills where

a. The skill is explained in simple language with a brief rationale

b. The steps are explained in the correct sequence (with appropriate visual supports)

c. The steps are modelled by the instructor

d. The child practises these steps under supervision until the skill is understood

e. The instructor monitors compliance and provides reminders / minor corrections.


2. Task analysis and chaining breaks down complex tasks into steps in a sequenced chain of events that must happen in a set order. This enables adults to plan and organise skill development and extend the child’s learning incrementally as learning happens without the risk of failure or frustration.


3. Errorless learning may be more appropriate for children with significant cognitive and memory impairment. Errorless learning closely links instructions with prompts for desired behaviour and then provides immediate positive reinforcement. It is an appropriate approach for children who don’t benefit from feedback about mistakes or respond with frustration or shame to feedback about mistakes. The child’s reliance on the instructor is gradually reduced through increasing the time delay to prompting, and systematically reducing the invasiveness of the prompts over time, but without the child experiencing constant frustration or failure.










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