Common SEND needs and specific conditions

Information and advice about common SEND and medical conditions and signposting to services

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There are lots of reasons for a child or young person to have special educational needs and/or disabilities (SEND). Here you will find information on common needs.

ADHD

Attention deficit hyperactivity disorder (ADHD) is a group of behavioural symptoms that include inattentiveness, hyperactivity and impulsiveness.
Symptoms of ADHD tend to be noticed at an early age and may become more noticeable when a child's circumstances change, such as when they start school. Most cases are diagnosed when children are 6 to 12 years old.
The symptoms of ADHD usually improve with age, but many adults who are diagnosed with the condition at a young age continue to experience problems. People with ADHD may also have additional problems, such as sleep and anxiety disorders.
You can find out more about ADHD on the NHS website.

Getting help
Many children go through phases where they're restless or inattentive. This is often completely normal and doesn't necessarily mean they have ADHD.
However, you should consider raising your concerns with your child's teacher, their school's special educational needs co-ordinator (SENDCo) or GP if you think their behaviour may be different to most children their age. It's also a good idea to speak to your GP if you're an adult and you think you may have ADHD, but you weren't diagnosed with the condition as a child.

For children with a City & Hackney GP:
For Children Over 5 and Young People Under 18
Families cannot self-refer for an ADHD assessment, a professional, such as a GP, SENCo, or social worker, must make the referral.
GPs and teachers can request an ADHD assessment from Specialist CAMHS or CAMHS Disability, depending on the child’s eligibility.
All ADHD assessment referrals come via the CAMHS SPA (Single Point of Access).

For children with a Tower Hamlets GP:
Tower Hamlets Child and Adolescent Mental Health Service (CAMHS)
Who is it for?
Anyone aged 11-18 who needs specialist mental health support.
How does it help?
CAMHS offers specialist treatments provided by mental health professionals including mental health nurses, therapists, clinical psychologists and psychiatrists. CAMHS support covers a range of mental health difficulties including depression, problems with food, bipolar disorder, self-harm, behaviour issues and schizophrenia.
How can I get support?
You can also get support through your GP. If you’re aged 11-18, you can refer yourself to CAMHS. Teachers and social workers can also refer young people they work with.
Tel: 0207 426 2375

Kooth
Who is it for?
Anyone aged 11-25 who lives or studies in City of London.
How does it help?
Kooth is a free and anonymous online community that supports each other with mental health and wellbeing. You can contribute to the community by writing stories and creative work, as well as taking part in community discussions, and you can also chat live with mental health professionals who are available 365 days a year. All your activity on Kooth is completely anonymous and monitored to make sure it’s a safe space for everyone to share their worries and get the support and assurance they need.
How can I get support?
To access the Kooth community, click “join Kooth” and follow the on-screen instructions.

Children’s Occupational Therapy and Children’s Physiotherapy Service run parents group 1-2 times a year at the Hackney Ark. The sessions explore different topics and issues for families e.g. what different services do, why we regularly assess your child using outcome measures and treatment options.

CAMHS Disability Service offer a range of parent-carer support and information sessions. CAMHS Disability are part of the CAMHS Alliance which offers a range of support to families and young people.

Or contact Tower Hamlets & City SENDIASS or City of London short breaks.

Asthma

Asthma is a common lung condition that causes occasional breathing difficulties.

It affects people of all ages and often starts in childhood, although it can also develop for the first time in adults.

There's currently no cure, but there are simple treatments that can help keep the symptoms under control so it doesn't have a big impact on your life.

The main symptoms of asthma are:

wheezing (a whistling sound when breathing)
breathlessness
a tight chest, which may feel like a band is tightening around it
coughing

The symptoms can sometimes get temporarily worse. This is known as an asthma attack.

Getting help

You should see your GP if you think you or your child may have asthma. Several conditions can cause similar symptoms, so it is important to get a proper diagnosis and correct treatment.

Your GP will usually be able to diagnose asthma by asking about symptoms and carrying out some simple tests. These can't always be done easily in young children, so your child may be given an asthma inhaler to see if it helps relieve their symptoms until they're old enough to have the tests.

Autism

Autism is a lifelong developmental condition that affects a person's social interaction, communication, interests and behaviour. It is a spectrum disorder, which means that while all people with autism share certain difficulties, the condition affects each person differently, and symptoms can range from mild to severe.
Autism is sometimes called Autism Spectrum Disorder (ASD) or Autistic Spectrum Condition (ASC).

What to do if you are worried about the way your child communicates and interacts with other people?
If your child is under age 5 you can discuss your concerns with your GP, nursery manager or children’s centre inclusion lead. You may also want to contact the:
• Speech and Language Therapy Service
• Health Visiting Service
• National Portage Association

If you child is over five and attending school you can speak to the school's special educational needs co-ordinator (SENCO) or speech and language therapist as well as your GP or the Speech and Language Service.

How do children get a diagnosis of Autism?
Autism is diagnosed by observing a child or young person’s social communications and interactions to see whether their behaviour, interests, or activities have any restricted or repetitive patterns. The assessment is carried out over time so that the child can be observed in different settings and social situations. Once the assessment has been completed, a report will be written and shared with the child's parents or carer and, if appropriate, the child's school, nursery or other setting. Parents and carers will be given more information about how the assessment will be conducted and when it will be finished at the start of the assessment.

What support is there if my child has been diagnosed with Autism?
The health professionals that made the formal diagnosis, along with your GP, should be able to refer you to specialist treatment. For more information and support for families with children with autism visit this page.

For Children Over 5 and Young People Under 18
Families cannot self-refer for an ASD assessment, a professional, such as a GP, SENCo, or social worker, must make the referral. GPs and teachers can request an ASD assessment from Specialist CAMHS or CAMHS Disability, depending on the child’s eligibility.
All ASD assessment referrals come via the CAMHS SPA (Single Point of Access).

For children with a Tower Hamlets GP:
Tower Hamlets Child and Adolescent Mental Health Service (CAMHS)
Who is it for?
Anyone aged 11-18 who needs specialist mental health support.
How does it help?
CAMHS offers specialist treatments provided by mental health professionals including mental health nurses, therapists, clinical psychologists and psychiatrists. CAMHS support covers a range of mental health difficulties including depression, problems with food, bipolar disorder, self-harm, behaviour issues and schizophrenia.
How can I get support?
You can also get support through your GP. If you’re aged 11-18, you can refer yourself to CAMHS. Teachers and social workers can also refer young people they work with.
Tel: 0207 426 2375

Kooth
Who is it for?
Anyone aged 11-25 who lives or studies in City of London.
How does it help?
Kooth is a free and anonymous online community that supports each other with mental health and wellbeing. You can contribute to the community by writing stories and creative work, as well as taking part in community discussions, and you can also chat live with mental health professionals who are available 365 days a year. All your activity on Kooth is completely anonymous and monitored to make sure it’s a safe space for everyone to share their worries and get the support and assurance they need.
How can I get support?
To access the Kooth community, click “join Kooth” and follow the on-screen instructions.

CAMHS Disability Service offer a range of parent-carer support and information sessions. CAMHS Disability are part of the CAMHS Alliance which offers a range of support to families and young people.

Self–Advocacy Toolkit for Autistic Young People - download PDF here

Contact Tower Hamlets & City SENDIASS and City of London short breaks.

Cerebral Palsy

Cerebral palsy is the name for a group of lifelong conditions that affect movement and co-ordination, caused by a problem with the brain that occurs before, during or soon after birth.
Speak to your health visitor or GP if you have any concerns about your child's health or development.
Symptoms like those of cerebral palsy can have a number of different causes and aren't necessarily a sign of anything serious.
Your child may be referred to specialists in child development who can do some checks and tests to see if there is a problem.
Useful links and resources
Scope offer independent and impartial advice, information and support via an online forum, helpline and various online resources.
• Cerebal Palsy Overview
• Information for young people
• Cerebral Palsy Online Forum
Cerebral Palsy UK - provides support by offering impartial information on a broad range of subjects that people affected by CP may find useful.
Contact UK - information and advice for parents,carers and families of children and young people with additional needs and disability, regardless of a diagnosis.
CP Teens - registered charity providing connections and friendships for young people with a range of physical disabilities as part of a monitored and supportive community.

Orthopaedic Management
There is an agreed orthopaedic pathway for referral from Hackney Ark to the Royal London Hospital. This is to monitor and prevent hip problems. Paediatricians at Hackney Ark request children’s hips be x- rayed and reviewed by orthopaedic doctors at the Royal London. Children are seen once and then a follow-up is arranged depending on the X- ray results and initial assessment.
The doctor at the Royal London will discuss the options to manage spasticity (a condition in which muscles stiffen or tighten, preventing normal fluid movement) and pain. These options may also include Botox.
Vision and Hearing
All children with Cerebral Palsy need vision and hearing checks. Children are referred for these by paediatrician at time of diagnosis. They may then need follow-up depending on initial testing.
Children’s Occupational Therapy and Children’s Physiotherapy Service run parents group 1-2 times a year at the Hackney Ark. The sessions explore different topics and issues for families e.g. what different services do, why we regularly assess your child using outcome measures and treatment options.

CAMHS Disability Service offer a range of parent-carer support and information sessions. CAMHS Disability are part of the CAMHS Alliance which offers a range of support to families and young people.

Contact Tower Hamlets & City SENDIASS and City of London short breaks.

Diabetes

Diabetes is a lifelong condition that causes a person's blood sugar level to become too high.
There are two main types of diabetes:
• type 1 diabetes - where the body's immune system attacks and destroys the cells that produce insulin
• type 2 diabetes – where the body doesn't produce enough insulin, or the body's cells don't react to insulin

Type 2 diabetes is far more common than type 1. In the UK, around 90% of all adults with diabetes have type 2.

Useful resources
• Type 2 Diabetes- Easy Read
• Diabetic Eye Screening- Easy Read
• Diabetes and your eyes- Easy Read
• Healthy Eating & Diabetes- Easy Read
• Diabetes- Information for children
• 'Make the Grade'- Schools pack
• Diabetes UK- Information in other languages

Hackney Diabetes Centre
The team provides diabetes services for inpatients and outpatients with diabetes in City and Hackney and elsewhere.
Making an appointment
Patients should be referred to the diabetes service by their GP. Appointments and referrals can be made by you or your GP via The Electronic Referral Service (e-RS). Patients may self-refer to education groups, walking group and awareness events. You can see a Diabetes Specialist Nurse and Dietitian at your G.P practice or at the Hospital, please speak to your G.P or Practice Nurse if you need to be referred.

Down's Syndrome

Down's syndrome, also known as Down syndrome or trisomy 21, is a genetic condition that typically causes some level of learning disability and certain physical characteristics.

Most babies born with Down's syndrome are diagnosed soon after birth and may have:
• floppiness (hypotonia)
• eyes that slant upwards and outwards
• a small mouth with a tongue that may stick out
• a flat back of the head
• below-average weight and length at birth
• their palm may have only one crease across it
Although children with Down's syndrome share some common physical characteristics, they don't all look the same. A child with Down's will look more like their family members than other children who have the syndrome. People with Down's syndrome will also have different personalities and abilities. Everyone born with Down's syndrome will have some degree of learning disability, but this will be different for each person.

Speech and language therapists:
Early Years Team: Speech and language therapists who work with pre-school children
School's link Speech and Language Therapist: Speech and language therapists who work with school-aged children
CAMHS Disability Service
A specialist NHS service that works with children and young people with additional disabilities, including learning disabilities, autism, and genetic disorders
Located at Hackney Ark, Downs Park Road, London, E8 2FP
Their phone number is 020 7014 7071

Special Advisory Clinic (SAC)
The SAC is a paediatric assessment appointment delivered by a community paediatrician.
The clinic sees children who are 5 years and under and who may have developmental concerns. SAC developmental assessments usually last around 30 minutes and can take place locally to where families live e.g. in a Children’s or Community Centre.
They locations are: Tyssen Children’s Centre, St Leonard’s Hospital, Anne Taylor Children’s Centre
The SAC aims to get more information about a child’s difficulties to see if further assessment is required in other more specialist clinics. It is sometimes used as a screening assessment if a referral has been made but there is not enough information with the referral to decide what next steps would be helpful.
Children maybe be seen once or twice in clinic to pull together all the information required.
If follow-up is required they are usually referred on to other more specialist clinics or services to get further clarity of the difficulties they may be experiencing.
Referrals often come through the MARS process but professionals e.g. health visitors and GPs may also refer directly to the clinic. Find out more: Multi-Agency Referrals (MARs) meetings

Enhanced Health Visiting Service
A service that contacts families during pregnancy and after the birth of their baby
You can also contact the Down's Syndrome Association for resources for children with Down's syndrome and their families.
Health visitors are nurses or midwives with specialist training in family and public health. We help parents and their families to improve health and wellbeing during pregnancy, after birth and all the way through until your child is five. We work as part of a wider health team which includes nursery nurses, GPs, midwives, paediatricians, psychologists, speech therapists, and other health professionals. We also work closely with Children’s Centre staff, family support workers, and Children’s Social Care.
You will meet us in your home or in local Well Baby Clinics, your GP’s surgery, a Children’s Centre or a Children and Family Hub, or in an Early Years setting. We offer you and your child five health and developmental appointments as part of the Department of Health's “Healthy Child Programme”. We are here to help, listen, understand your needs, and work in partnership with you to give your family the best start.
During your pregnancy after 28 weeks you will be contacted by our team:
• 10 to 14 days after the birth of your baby
• 6 to 8 weeks
• 8 to 12 months
• 27 months
• Additional contacts may be at 1 month, 3 to 4 months and 3 to 3.5 years, if required.
We provide services and support at:
• Drop-in Well Baby Clinics which you can attend without an appointment.
• scheduled appointments as agreed with you.
We can talk about any of the following issues that you and your family might need advice or support with:
• Breastfeeding
• Milk and food for babies, toddlers, and older children
• Sleep and understanding crying
• Managing childhood illnesses
• Your child’s development
• Your well-being as parents
• Understanding your child’s behaviour
• Play and stimulation
• Talking to your baby and child
Our service is for the whole family. We know that being a parent or carer can be very hard; particularly if you are feeling low, anxious, or you cannot cope. Your health visitor can give you support and provide advice on:
• you and your family’s emotional health and wellbeing
• any additional health and developmental needs your baby or child might have
• developing a relationship with your baby
• domestic abuse and drug and alcohol problems
• changes in your family life

Preparing for adulthood for children with Down syndrome - download PDF here:

Contact Tower Hamlets & City SENDIASS and City of London short breaks.

Epilepsy

Epilepsy is a common condition that affects the brain and causes frequent seizures.

Seizures are bursts of electrical activity in the brain that temporarily affect how it works. They can cause a wide range of symptoms including; uncontrollable jerking and shaking (known as a fit), becoming stiff, strange sensations, an collapsing. Sometimes you might pass out and not remember what happened. You can find out more about the symptoms of Epilepsy on the NHS site www.nhs.uk/conditions/epilepsy

Epilepsy can start at any age, but usually starts either in childhood or in people over 60. It's often lifelong, but can sometimes get slowly better over time.

You should see your GP if you think you (or your child) have had a seizure. This may not necessarily mean you have Epilepsy, as a seizure can have several causes and sometimes they are just a one- off, but you should always see a doctor to find out why it happened.

For more information on services local to you contact:
Children’s Epilepsy Service - City and Hackney
Tower Hamlets & City SENDIASS
City of London short breaks

Learning disabilities

A child or young person with a learning disability will have reduced intellectual abilities and need some more help completing everyday tasks than a person without such a disability. Children and young people with a learning disability may take longer to learn new skills and to understand complex information.

There are different types of learning disability depending on the level of need:

Children and young people with mild learning disabilities might only require help with their school work and managing difficult tasks like opening a bank account or finding a job.
Children and young people with moderate learning disabilities may require some help looking after themselves as well as managing more difficult tasks.
Children and young people with severe or profound learning disabilities may require a full-time carer and significant help with completing a range of everyday tasks.

Around 4% of school pupils have a learning disability. Having a learning disability normally means your child will receive special educational needs and/or disability (SEND) support in school.

It is important to remember that children and young people with learning disabilities are not defined by their diagnosis. With the right support, many children and young people are able to learn skills important to them and achieve fulfilling lives in the community.

For more information and support, have a look at Mencap’s website. Mencap is the biggest UK charity supporting people with a learning disability and their families.

Physical disabilities

Physical disabilities refer to a wide range of mental and physical impairments which have a long-lasting and substantial effect on a child or young person’s ability to carry out day-to-day tasks.

Children and young people can have physical disabilities for a number of reasons including birth defects, medical conditions or injury. Some children and young people with physical disabilities will have severe or complex needs requiring multi-agency support across health, social care and education services. Others will have a milder disability with significantly lower level of need.

For more information and support if you or your child have physical disabilities, you might like to visit Newlife, the charity for disabled children, or Scope UK, the charity for all disabled people.

For information on local help and services contact:
CAMHS Disability Service offer a range of parent-carer support and information sessions. CAMHS Disability are part of the CAMHS Alliance which offers a range of support to families and young people.
Tower Hamlets & City SENDIASS
City of London short breaks
Children’s Occupational Therapy and Children’s Physiotherapy Service run parents group 1 -2 times a year at the Hackney Ark. The sessions explore different topics and issues for families e.g. what different services do, why we regularly assess your child using outcome measures and treatment options.

Sensory impairments

Sensory impairment refers to loss of function in one of the senses; sight, hearing, smell, taste, touch or spatial awareness. The most common types of sensory impairment among children and young people are visual and hearing impairments.

Visual impairment

Children and young people with visual impairment will experience some degree of sight loss.

If a child or young person has partial sightedness this means that their ability to see is significantly reduced compared to their peers and cannot be corrected with glasses. People with partial sightedness are usually able to distinguish the objects around them and can benefit from adaptations such as use of high contrast colours and large print.

Children and young people with severe sight impairment will have extreme difficulty distinguishing objects around them. High contrast and use of large print will not normally benefit a person with severe sight impairment. If a child or young person is blind, this means they will be unable to tell the difference between light and dark.

There can be many different causes of visual impairment in childhood including congenital disorders, medical conditions, and injury.

Both children and young people with partial sightedness and those who are severely sight impaired or blind can normally learn and develop to the same level as their peers. However, they will often need the support of specialist professionals in visual impairment to help ensure the best outcomes.

You may want to have a look at the website for the Royal National Institute of Blind People (RNIB), which is the largest charity supporting people with visual impairment.

Hearing impairment

Hearing impairment refers to any degree of hearing loss. There are different levels of impairment, ranging from the more common mild hearing loss, to the much rarer profound deafness where there may be no functional hearing.

Causes of hearing impairment range from congenital disorders, medical conditions or injury. Sometimes hearing impairment can be due to a treatable cause such as glue ear or build-up of earwax. However, even if the actual cause is not able to be addressed, in the vast majority of cases there are still interventions that can boost hearing levels such as hearing aids and cochlear implants.

With the right support at the earliest opportunity, children and young people with hearing impairment can learn and develop at the same level as their peers.

You may like to read more information about hearing impairment on the National Deaf Children’s Charity’s website.

Sensory Impairments
The City of London does not have its own Sensory Impairment Service. If your child has visual or hearing impairment needs, your child’s school will refer to the services in their borough. For children that attend a school in the City of London, this can be commissioned from another Local Authorities services. If there are any issues with this, please contact the Education & Early Years Service at eeyservice@cityoflondon.gov.uk
Tower Hamlets & City SENDIASS
City of London short breaks

Social, emotional and mental health

Social, Emotional and Mental Health (SEMH) needs refers to difficulties children and young people may experience in one or more of the following:

failing to manage themselves socially or emotionally
having low levels of mental and emotional wellbeing
being unable to regulate themselves and their behaviours
having a mental health condition

Children and young people can have SEMH regardless of whether they have a mental health diagnosis. They may or may not mean that the child or young person has special educational needs and/or disabilities (SEND).

Needs can manifest in many ways depending on the individual and their circumstances. Signs that a child or young person may have SEMH include:

anxious behaviours
seeming distant and withdrawn
becoming frustrated, angry and violent
self-harm, drug abuse or crime
disruptive social behaviours

Around 10% of pupils aged 5-16 have a formal mental health diagnosis, and there are a further 15% who show problems which put them at risk of getting a mental health diagnosis in the future.

With the right help and support, SEMH needs are often not permanent and most children and young people with SEMH are able to go on to normal lives in the future.

For information on local help and services contact:
CAMHS Disability Service offer a range of parent-carer support and information sessions. CAMHS Disability are part of the CAMHS Alliance which offers a range of support to families and young people.
Tower Hamlets & City SENDIASS
City of London short breaks

Kooth
Who is it for?
Anyone aged 11-25 who lives or studies in City of London.
How does it help?
Kooth is a free and anonymous online community that supports each other with mental health and wellbeing. You can contribute to the community by writing stories and creative work, as well as taking part in community discussions, and you can also chat live with mental health professionals who are available 365 days a year. All your activity on Kooth is completely anonymous and monitored to make sure it’s a safe space for everyone to share their worries and get the support and assurance they need.
How can I get support?
To access the Kooth community, click “join Kooth” and follow the on-screen instructions.

Specific Learning Difficulties (including Dyslexia and Dyspraxia)

Specific Learning Difficulties (SpLD) refer to difficulties that may impact on a specific area of learning. They are different from learning disabilities where there are generally difficulties experienced across a wide range of areas. Common SpLDs include:

dyslexia (difficulties with reading)
dyscalculia (difficulties with understanding maths or numbers)
dyspraxia (difficulties with coordinating movement)
dysgraphia (difficulties with writing)
attention deficit hyperactivity disorder (ADHD)

Nationally, around 2% of school pupils have an SpLD. Having a SpLD does not indicate general level of intelligence. With the right understanding and support, children and young people with SpLD can go on to lead full and successful lives.

The City of London uses the nationally recognised British Psychological Society/Rose report definitions and guidance about Dyslexia. The Rose Report definition of dyslexia indicates that:
“Dyslexia is a learning difficulty that primarily affects the skills involved in accurate and fluent word reading and spelling. Characteristic features of dyslexia are difficulties in phonological awareness, verbal memory, and verbal processing speed. A good indication of the severity and persistence of dyslexic difficulties can be gained by examining how the individual responds or has responded to well-founded intervention.” (Rose, J. 2009)

The British Psychological Society (BPS) definition similarly indicates:
“...Dyslexia is evident when accuracy and fluent word reading and/or spelling develops very incompletely or with great difficulty.  This focus is on literacy learning at the ‘word level’ and implies that the problem is severe and persistent despite appropriate learning opportunities.  It provides the basis for a staged process of assessment through teaching.” (BPS 1999)

Dyslexia Association of London
Tel: 0208 870 1407 - available at all times, but often on answerphone.
Read more about how dyslexia is diagnosed

Support groups
As well as national dyslexia charities, such as Dyslexia Action and the British Dyslexia Association (BDA), there are several local dyslexia associations (LDAs).
These are independently registered charities that run workshops and help to provide local support and access to information. You can find your local LDA on the BDA website.
For information on local help and services contact:
Educational Psychology Service
Tower Hamlets & City SENDIASS
Children’s Occupational Therapy

Speech, Language and Communication Needs
City & Hackney Speech and Language Therapy Service
City of London short breaks

Speech, language and communication needs

Many children and young people experience difficulties communicating with others around them. This can include one or more of the following:

problems understanding what people are saying
problems making the correct speech sounds
stammering
hoarseness or loss of voice
problems with using language
problems interacting with others.

Children and young people who have one of these are said to have speech, language and communication needs (SLCN).

SLCN can occur on its own, or it can be related to another condition or disability such as autism. It is one of the most common reasons for children having special educational needs and/or disabilities (SEND). As many as 10% of school pupils may have a form of SLCN.

Some types of SLCN will be ‘persistent’, meaning they will not go away but can be improved with therapies. Other types are ’transient’ meaning that with extra support, the child or young person can be helped to reach the same level as their peers. Many primary school pupils receiving support for SLCN will no longer require it by the time they reach secondary school.