Our evidence base: the research behind our child therapy

A Cochrane review of grommets (ventilation tubes) for glue ear found the hearing benefit was concentrated in the first six months, by which time children who had no surgery had usually improved on their own, and found no measurable effect on speech and language development. The reviewers noted that no trial has been carried out in children who already have speech, language or developmental difficulties — so a child who is already behind is a decision for your own ENT doctor, not a statistic.

A Cochrane review of 87 studies found that cognitive behavioural therapy (CBT) — a core psychological approach to childhood anxiety — leaves far more children free of their main anxiety diagnosis than being left on a waiting list: around 49 in every 100 children after CBT, compared with around 18 in every 100 who had no treatment. The reviewers rated this moderate-quality evidence.

A Cochrane systematic review of 25 studies found that speech and language therapy is effective for children with expressive vocabulary and speech-sound (phonological) difficulties.

That same review found no significant difference between therapy given by a clinician and therapy given by trained parents, which is exactly why coaching you to support your child at home is part of every plan we make.

A Cochrane systematic review of 25 studies found that speech and language therapy is effective for children with speech-sound (phonological) difficulties — the very difficulties behind unclear speech.

The same review found no significant difference between therapy delivered by a clinician and therapy delivered by trained parents — which is why we coach you to support your child at home as part of every plan.

A Cochrane review of early intensive behavioural intervention (which is based on Applied Behaviour Analysis) for young autistic children found improvements in adaptive behaviour, in expressive and receptive language, and in measured intelligence, compared with standard care. The authors rate this as low-certainty evidence from a small number of studies.

The same review did not find evidence that the intervention reduced autism symptom severity. That is worth saying out loud: this work teaches skills and eases the specific behaviours that make daily life hard. It is not a treatment for autism itself, and we will never describe it as one.

A Cochrane review found that early intensive behavioural intervention improved children’s adaptive behaviour, learning and language compared with standard care, though the authors note more high-quality research is still needed.

A Cochrane review of task-oriented interventions for children with DCD found the trials carried out so far too few and too varied for confident conclusions, and called for better-designed research. We would rather say that than overstate it: goal-focused, task-specific practice is the best-supported approach we have, not a guarantee.

The American Academy of Pediatrics recommends standardised autism screening for every child at 18 and 24 months, alongside ongoing developmental surveillance in primary care. Its clinical report notes that autism is common, can be diagnosed as young as 18 months, and has evidence-based interventions that may improve how a child functions.

The same clinical report describes a growing evidence base for behavioural and other interventions that target a child’s specific skills and symptoms, and frames the choice between them as shared decision-making between the family and the clinicians — not one fixed programme handed to every child.

The American Academy of Pediatrics recommends routine developmental screening in early childhood, because identifying differences early and starting support sooner improves children’s communication, social and behavioural outcomes.

The American Academy of Pediatrics reports that identifying autism early and starting support sooner improves children’s communication, social and behavioural outcomes — with parents at the centre of effective programmes.

The American Speech-Language-Hearing Association states that auditory processing disorder is diagnosed by an audiologist, and that speech and language therapists contribute to identification, screening, assessment and treatment as part of an interdisciplinary team rather than making the diagnosis. It also notes that diagnosis is genuinely difficult because the symptoms overlap so heavily with language and other disorders, and recommends three strands of support together: changing the listening environment, direct training of the skill itself, and compensatory strategies that lean on a child’s stronger abilities.

ASHA treats feeding and swallowing as related but separate. Coughing or throat clearing during meals, a wet or gurgly voice, very long chewing, food left sitting in the mouth, poor weight gain and repeated chest infections are listed as signs of a swallowing difficulty — the kind that needs a medical and swallowing assessment, not mealtime strategies.

Three features are agreed to point towards childhood apraxia of speech: inconsistent errors on consonants and vowels when the same word is repeated, lengthened or broken transitions between sounds and syllables, and inappropriate stress or rhythm. ASHA describes it as a difficulty planning and sequencing the movements of speech rather than muscle weakness — reflexes are intact and muscle tone is typically normal, which is what separates apraxia from dysarthria. ASHA reports a point prevalence of roughly 1 in 1,000 children aged 4 to 8, and around 2.4% among children seen for unexplained speech delay.

Treatment is built on the principles of motor learning, which call for frequent and intensive practice of speech movements. ASHA cites research in which children producing around 100 practice attempts in 15 minutes acquired their targets more quickly than children producing 30 to 40, and notes that children treated twice a week eventually reached the same gains as children treated four times a week, but more slowly. Named approaches with published support include Dynamic Temporal and Tactile Cueing (DTTC), Rapid Syllable Transition Treatment (ReST) and PROMPT. Where speech is not yet enough on its own, augmentative and alternative communication can support and enhance spoken speech rather than replace it.

The British Dyslexia Association describes dyscalculia as a difficulty particularly in understanding and working with numbers, showing as age-related difficulty with naming, ordering and comparing quantities and numbers, with estimating, and with place value. It also draws a distinction that matters for parents: a specific learning difficulty in maths is more common than dyscalculia itself — which is why a careful assessment should come before any label.

The NHS states plainly that dyslexia — the most common specific learning difficulty — affects reading and spelling but does not affect intelligence, and advises worried parents to start by speaking to the person responsible for special educational needs at their child’s school.

The NHS lists the signs of autism in young children as speaking later than other children, using eye contact less, repetitive movements such as rocking, spinning or hand-flapping, becoming distressed at a change of routine, and reacting very strongly to lights, sounds, smells, tastes or textures. In older children it adds having few friends and taking language literally. The NHS is clear that every autistic person is different and many will not show all the signs, and that autistic girls may copy how other children behave, stay quiet in difficult situations and appear to cope socially.

National guidelines recommend offering parents of children with ADHD a group-based parent-training programme to build practical strategies, and note that this support should not wait for a formal diagnosis.

The NHS describes it as normal for children and young people to feel worried or anxious from time to time, and treats anxiety as a problem when it affects a child’s behaviour and thoughts every day, interfering with their school, home and social life. It notes that separation anxiety is common in younger children, whereas older children and teenagers tend to worry more about school or have social anxiety — and that having a close family member with anxiety may increase a child’s chance of having it too.

The same NHS guidance says it is important to talk to your child about their anxiety or worries, and to seek professional help if a child is constantly anxious and it is not getting better, or is getting worse. It names counselling, which can help a child understand what is making them anxious, and cognitive behavioural therapy (CBT) as talking therapies that help; medicines are described as something that may be offered where anxiety is severe or does not improve.

NHS guidance for parents of fussy eaters is to judge what a child eats over a week rather than over a single day, to keep offering a variety of foods because it may take many attempts before a child accepts one, and — if food is rejected — to take it away without saying anything rather than forcing the issue.

The NHS describes selective mutism as an anxiety disorder — a phobia of talking to certain people — rather than a behaviour problem or a choice, and states it affects about 1 in 140 young children. Its advice to adults is blunt: do not pressurise or bribe a child into speaking, do not make a fuss when they manage it, and do not let them avoid social situations; adjust what is expected of them instead.

Tics are fairly common in childhood and typically first appear at around five years of age. In most cases they improve over time or stop completely — sometimes lasting only a few months, though often coming and going over several years.

Tics often begin with an unpleasant sensation that builds up in the body until it is relieved by the tic, known as the urge. They can sometimes be partly suppressed, are linked to stress, anxiety, tiredness and excitement, and tend to get worse if they are talked about or focused on.

Tourette syndrome is identified when tics started before the age of 18, have been happening for a year or more, and involve both sounds and movements; a GP refers on to a neurologist or paediatrician. Swearing tics are rare, and other conditions such as OCD and ADHD often occur alongside.

NHS advice for families puts everyday adjustments before medicine: splitting tasks into 15 to 20 minute slots with a break in between, giving clear and simple instructions one at a time in a calm voice, keeping regular sleep, and using physical activity as an outlet for energy. The same guidance notes that many children under five are easily distracted, impulsive and full of energy, and that this on its own does not mean a child has ADHD.

The NHS describes cerebral palsy as a group of lifelong conditions affecting movement and co-ordination, caused by a problem with the brain that develops before, during or soon after birth, and states plainly that the original problem with the brain does not get worse over time. Its treatment list pairs physiotherapy for movement with speech therapy for speech, communication and swallowing difficulties — the two running together, not one instead of the other. (Swallowing work is a medical matter and is not something we provide.)

The NHS states that Down’s syndrome happens by chance, because of a change in the sperm or egg before a baby is born, and that it is not caused by anything anyone did before or during pregnancy. It also describes a wide range of abilities: everyone with Down’s syndrome has some level of learning disability, yet some people go on to live largely independent lives and work, while others need more support.

The NHS notes that about half of all children with Down’s syndrome are born with a heart condition, and that people with Down’s syndrome need their sight and hearing checked regularly — some needing glasses, hearing aids or specialist care for glue ear. This is why the medical side stays with your child’s doctor while we work on communication and learning.

There is no cure for auditory processing disorder, but a great deal helps: auditory training that builds listening and concentration, reducing background noise, facing your child when you speak, backing spoken words up with visual information, and — for some school children — a wireless earpiece linked to a small microphone worn by the teacher. The NHS also notes that testing for APD is not usually carried out in children under seven, and that it commonly occurs alongside dyslexia and ADHD.

Glue ear — fluid trapped behind the eardrum after colds and ear infections — is common in young children and usually clears on its own within about three months. There is no effective medicine for it, so doctors normally watch and re-test rather than treat straight away, and re-check hearing if it persists.

Developmental Language Disorder affects approximately 1 in 14 children in kindergarten — about two children in a class of thirty.

Between 50 and 70 per cent of children with DLD have at least one family member with the disorder, which is why DLD is understood as a neurodevelopmental condition rather than as something a parent did or did not do.

By the time they reach adulthood, people with DLD are six times more likely to be diagnosed with reading and spelling disabilities. That is why good support treats DLD as a learning issue as well as a talking one, and keeps an eye on literacy from the start.

The US National Institute on Deafness and Other Communication Disorders states that a hearing test is often included in the evaluation of a child’s speech and language, because a hearing problem can affect speech and language development. That is why we think about hearing on day one rather than after a term of therapy.

Researchers developing an Urdu pre-reading assessment note that bilingual children are disproportionately under-identified for oral-language and pre-reading difficulties, partly because they are assessed only in English — so a genuine reading difficulty gets mistaken for a difference in language proficiency.

The international clinical practice recommendations on DCD advise that a formal diagnosis below the age of five is made only where impairment is severe, and that a child should be assessed on at least two occasions three months or more apart. They also confirm that DCD commonly occurs alongside other neurodevelopmental conditions, ADHD most frequently of all.

A 2024 cross-sectional study of children with autism spectrum disorder, published in the journal Children, found that caregiver pressure to eat was associated with higher levels of food neophobia — fear of new foods — and with a poorer-quality diet. It is an association rather than proof of cause, but it matches what we see at the table: pushing harder rarely widens the plate.

The American Speech-Language-Hearing Association sets out what separates selective mutism from ordinary shyness: the child can talk and does talk in some places; the silence interferes with learning and friendships; it lasts more than a month, excluding the first month at a new school; and it is not better explained by autism, stammering, or still learning the language. The approaches it describes — stimulus fading, shaping and self-modelling — all build speech up in gradual, rewarded steps.

A 2025 review of early rehabilitation for global developmental delay concluded that early identification and intervention have shown substantial effects on motor skills, cognition, language and socio-emotional skills — and that therapy works best when it is multidisciplinary and family-centred, shaped around the individual child and their circumstances.

A meta-analysis of 22 randomised controlled trials, covering around 1,900 children and adolescents with reading disabilities, found that explicit phonics instruction was the only treatment approach whose effect on reading and spelling was statistically confirmed. Reading fluency training, auditory training and coloured overlays did not show a significant effect.

A meta-analysis of 53 studies covering 6,053 children found that structured reading intervention produces a real, statistically significant gain for children with or at risk of dyslexia. The one thing that reliably made interventions stronger was dosage — the more instruction a child received, the bigger the effect. Gains in word reading and spelling came through more strongly than gains in comprehension, which is why we build the foundations first and keep sessions regular.

A cluster-randomised trial in Pakistan added early child development counselling for mothers — play and stimulation, nutrition and maternal mental health — to routine visits at private clinics in poor urban areas. At twelve months, significantly fewer children in the intervention group had delays in two or more developmental domains than in the control group.

A randomised controlled trial found that preschool children who received the parent-delivered, therapist-guided Lidcombe Program had substantially less stuttering than untreated children — strong support for helping early rather than waiting.

Parents often want to know what they did wrong. The Merck Manual notes that even with advances in genetics and chromosome analysis, a specific cause of intellectual disability often cannot be identified — and that many people with intellectual disability can support themselves, live independently and be successfully employed with appropriate support.

A systematic review of paediatric occupational therapy found strong evidence that task-specific handwriting practice improves children’s handwriting.

A systematic review of paediatric occupational therapy found strong evidence that task-specific handwriting practice improves children’s handwriting performance.

An IQ score on its own does not define an intellectual disability or its severity. A clinical review states that the level of adaptive functioning — how a child manages everyday life — and the intensity of support they need are the main criteria used to categorise severity, and that measured IQ alone is not sufficient either to make the diagnosis or to grade it.

A randomised controlled trial of 261 pre-school children with moderate to severe intellectual disability tested a group parent-training programme against usual care. It did not find a significant difference in challenging behaviour after a year, and the authors put that partly down to how hard it was for families to attend. Children whose families joined before the COVID-19 pandemic did show a benefit, and the programme cost services less than usual care. We would rather tell you that honestly than promise you a result the evidence does not support: parent training is worth doing, and it works best when a family is genuinely able to attend.

A systematic review of studies published between 2006 and 2017, appraised against Council for Exceptional Children standards, concluded that Ayres Sensory Integration can be considered an evidence-based practice for autistic children aged four to twelve. The honest caveat matters as much as the headline: only three of the nineteen studies identified met the review’s methodological bar. Ayres Sensory Integration is a licensed occupational-therapy speciality, so this is research we point parents towards rather than a service we deliver ourselves.

A systematic review appraised the 2006–2017 research on Ayres Sensory Integration against Council for Exceptional Children standards and concluded it can be considered an evidence-based practice for autistic children aged four to twelve — on the strength of just three studies that met the methodological bar, two of them randomised controlled trials. Being straight about it: that protocol is delivered by licensed occupational therapists, so it is not what we run — we borrow its principle of graded, play-based sensory input.

A systematic review found that 9 of 11 studies reported positive language and communication outcomes for children with Down syndrome aged 0 to 6, and every one of those interventions was delivered by parents and clinicians together.

A large study found that children with hearing loss who met all three early benchmarks — screened by one month, identified by three months, and in early intervention by six months — had significantly better vocabulary than those who did not.