The pace of your child's development may be due to factors such as his/her personality or the home environment.

ADHD, dyslexia, autism and other developmental delays

Every child develops at a different pace. Some children learn things earlier, others need more time. The rate of your child's development may be due to factors such as his personality or the home environment.

At some point, you might ask, “How do I know if my child is developing normally?” and you may compare your child’s physical, intellectual and behavioural development to that of your relative or neighbour’s child of the same age.

What is normal development for a pre-schooler?

A pre-schooler likes to explore the world around him by jumping, running and playing. He learns to do many things on his own, like feeding and dressing himself, and may prefer to use the toilet alone. Speech-wise, he progresses from single words to complete sentences. Socially, he will be more aware of his environment and learn how to interact with people and establish relationships with family members and peers.

Awareness and early detection of developmental delays and disabilities

We know some children cannot sit still, cannot pronounce words well, do not follow instructions no matter how you phrase them, or blurt out inappropriate comments at inappropriate times. Some children who display such behaviours may have developmental delays or developmental disabilities.

You can track your child’s developmental milestones using the checklist in the sections below, and in your child's Health Booklet.

What is a developmental delay?

The term “developmental delay” is used to describe a child who is slower to reach developmental milestones than other children in the way he moves, communicates, thinks, learns and behaves. Developmental delays can be temporary or permanent.

What is a developmental disability?

Developmental disability is a term that refers to a permanent mental and/or physical impairment that occurs in the early years of life. This disability usually results in the child being affected in the way he moves, communicates, thinks, learns and behaves. Common developmental disabilities that affect children are Autism Spectrum Disorder, Attention Deficit Hyperactivity Disorder (ADHD) and Dyslexia.

It is important for parents to be aware of and detect developmental delays and developmental disabilities early, so that the child can receive help on time and maximise his potential in the long run.

Red flags for autism spectrum disorder (ASD)

Children with Autism Spectrum Disorder (ASD) have difficulties in communication, problem-solving and social skills.

Below are the red flags for ASD in the areas of social interaction, communication, behaviour and sensory experiences.

Socially, a child with ASD

• does not consistently respond to his/her name
  
• does not show interest in other children
  
• does not enjoy or engage in play with other children or caregivers.
  

In terms of communication, a child with ASD

• does not use eye contact to get someone’s attention
  
• does not point to show people things or indicate that he/she wants something
  
• does not sound like he/she is having a conversation with you when he/she babbles
• does not understand simple one-step instructions, eg. ‘Give the block to me’.
  

Behaviour-wise, a child with ASD

• focuses narrowly on objects and activities, such as turning the wheels of a toy car only
• is easily upset by change and must follow routines, for example, leaving the house must be done in the same way every time.
  

For sensory experiences, a child with ASD

• seeks sensory stimulation, for example, he/she may like to rock himself back and forth for a prolonged duration.
  

Red flags for attention deficit hyperactivity disorder (ADHD)

Children with Attention Deficit Hyperactivity Disorder (ADHD) are over-active and display impulsive and inattentive behaviour. This behaviour is generally more frequent and intense than in other children of the same age.

A child with ADHD may

• be unable to sit through games, stories, and circle time. He/she may roll around on the floor or crawl under tables
• constantly asks questions but races off before the answer is given
• be constantly on the go, stopping only to collapse from exhaustion
  
• bang into objects and people, or climb and jump off furniture
  
• have frequent injuries often requiring hospitalisation (head injuries, fractures)
  
• be seemingly unaware of preschool routines, rules and expectations, even after several months in school
• fail to meet academic and social expectations at the school
  
• has a weak memory
  
• has difficulties controlling his/her behaviour
  
• has problems understanding the instructional language used in the classroom
  
• has problems verbalising organised and focused responses to the teacher’s questions.
  

You can seek help when your child’s behaviour exhibits problems with several areas highlighted in the above checklist and 

• has been observed for six months
• occurs during independent and group activities
  
• cannot be explained by other circumstances or disabilities
• interferes with learning
  
• affects peer relationships and social development
  
• is inappropriate despite clear and consistent age-appropriate expectations
  
• appears out of the child’s control.
  

You can consider waiting and watching if your child’s behaviour

• is recent and inconsistent
• appears at a single place or time
  
• occurs primarily during group times when prolonged sitting is required
  
• may be the result of recent life events, such as the birth of a new sibling
  
• is indicative of the child picking up new skills
  
• allows him/her to interact and make friends
  
• varies in the presence of different adults
  
• appears purposeful or attention-getting.
  

Red flags for dyslexia

Dyslexia is a learning disability that occurs when the brain does not properly recognise and process certain symbols. It is not caused by vision problems. Most people with dyslexia have normal or even above-average intelligence.

A child with dyslexia may have difficulties reading, writing and counting, as these aspects use symbols to convey information. Dyslexia often runs in families. 

Below are the red flags for dyslexia.

A 3-5 year-old child with dyslexia may:

• seem uninterested in playing games with language sounds, such as repetition and rhyming
  
• have trouble learning nursery rhymes
  
• frequently mispronounce words and persist in using baby talk
  
• fail to recognise the letters in his/her name
  
• have difficulty remembering the names of shapes and colours, letters and numbers.
  

A 5-6 year-old child with dyslexia may:

• fail to recognise and write letters, use inverted spelling for his/her name and other words
  
• have trouble breaking spoken words into syllables, such as “cowboy” into “cow” and “boy”
  
• have trouble picking out or recognising words that rhyme, such as “cat” and “bat”
  
• fail to connect letters and sounds, such as “b” makes the sound “ba”
  
• have a hard time learning letter names and sounds.
  

A 6-7 year-old child with dyslexia may:

• have difficulty recognising letter names and sounds
  
• fail to read common one-syllable words, such as "mat" and "top"
  
• make reading errors that suggest a failure to connect sounds and letters
  
• fail to recognise common, irregularly spelled words, such as “two” and "to", “where” and "wear"
  
• complain about how hard reading is and refuse to do it
  
• have a tough time learning to write his/her name
  
• have problems with fine motor skills, such as colouring and writing.
  

How to seek help

You may wish to speak to your child’s caregivers and preschool teachers to check your observations against different settings.

You might want to find out about your child’s behaviour and learning during lessons, and how your child gets along with his/her classmates.

You are encouraged to bring your child to the family doctor, doctor at the polyclinic or paediatrician for a Developmental Screening Assessment.

The doctor may refer your child to one of the following for further evaluation and follow-up: 

• Department of Child Development, KKH
  
• Child Development Unit, NUH
  
• Child Guidance Clinic 
• Private paediatricians/ child psychiatrists/ psychologists.    

   
Speaking of Children II: Dr Kenneth Poon on Tips for Managing Children with Developmental Needs

If you notice some anomalies in your child’s development or behaviour and are considering seeking professional help, Dr Kenneth Poon has some useful advice for you. He shares more about the signs to look out for, when early interventions should be carried out and the positive actions you can take to support and guide your little one through.

Speaking of Children II: Dr Kenneth Poon on Self-Care for Parents of Children with Developmental & Special Needs

As you take care of your child with developmental or special needs, it’s just as important that you and your spouse find the space in your day to practise self-care too! Watch on for some self-care tips from Dr Kenneth Poon.





Contributed by:
Health Promotion Board