1. 1
Dyslexia, Dyspraxia, Autism Spectrum
Disorders, ADHD:
Assessment and Intervention
Dr Madeleine Portwood
Dubai Feb 2015
‘Movement is a child’s first language – it is
the first medium of expansion of the
physical and emotional conditions of an
individual. Self control begins with the
control of movement’.
Kiphard and Schilling 1994.
Dyslexia, Dyspraxia ADHD and ASD
Dyslexia specific problems with written
language skills (reading / spelling)
Dyspraxia problems in planning / execution, poor
motor coordination, attention, perception
ADHD hyperactivity / impulsivity
attentional problems
impaired social & communication skillsAutism
Spectrum
Disorders
-

2. 2
Dyslexia, Dyspraxia, ADHD and the
Autism Spectrum – the Overlap
Dyspraxia
Autistic SpectrumDyslexia
ADHD
Studies of the effects of nutrition on brain development
Information based on a multi-centre study from Cambridge and East Anglia carried
out by Professor Alan Lucas
1990 Pre-term vs term formula.
Period of nutritional intervention. 4 weeks showed
significant developmental advantages at 18 months
1992 Lucas reported 8.3 IQ advantage in 7 ½ - 8 year old children born pre-term
when fed mothers’ milk by tube vs donor breastmilk and formula.
Hypothesis : Since human milk is lower in most nutrients compared with formula milk it
must contain something more specific which helps the development of the
C.N.S.
1994 Donor breastmilk vs pre-term formula reports no difference In developmental
outcome at 18 months.
1996 Maureen Hack, Nancy Klein and Gerry Taylor (Semin Neonatal 1996:1:277-
288) studies of school-age outcomes In children of low birthweight and
gestational age.
M Makrides and R Gibson (Recent developments in Infant Nutrition 202-211)
defining the LCPUFA (long chain polyunsaturated fatty acids) requirement of
term infants. Suggested that LCPUFAs are the probable explanation for the
substance in breastmilk responsible for the results observed by Lucas.
Linoleic acid (LA)
▼
Gamma-linolenic acid (GLA)
▼
Dihomogammalinolenic acid
(DGLA)
▼
Arachidonic acid (AA)
▼
Adrenic acid (AdrA)
▼
Docosapentaenoic acid (ω6-DPA)
Alpha-linolenic acid (ALA)
▼
Stearidonic acid (SA)
▼
Eicosatetraenoic acid (ETA)
▼
Eicosapentaenoic acid (EPA)
▼
Docosapentaenoic acid (ω3-DPA)
▼
Docosahexaenoic acid (DHA)
Synthesis of HUFA from EFA
The omega-6 EFA’s The omega-3 EFA’s

3. 3
Formula Vs Breastmilk
0
2
4
6
8
10
12
14
16
LA AA ALA DHA
Formula
Breastmilk
‘Maternal Malnutrition Is
the Most Significant
Factor for Adverse
Outcomes in Pregnancy’
Symptoms of EFA Deficiency
n Dry itchy skin
n Coarse bumpy patches particularly at the back of
the arms
n Soft broken nails
n Frequent urination
n Excessive thirst
n Dull dry hair
n Allergies

4. 4
LA to ALA Ratios of Foods
OILS LA ALA LA/ALA
Rapeseed 13.02 6.50
Soybean 51.50 7.30
Olive 7.50 0.70
Corn 50.40 0.90
Sesame 43.10 0.30
Sunflower 63.20 0.10
2
7
11
56
144
632
LA to ALA Ratios of Foods
FATS LA ALA LA/ALA
Butter 0.95 0.46 2
Cream 1.95 0.65 3
Chocolate 7.34 0.67 11
Ice Cream 14.70 0.98 15
Fat Spread (70% fat,
polyunsaturated)
33.26 0.09 370
Study Design
n This was a randomised, double-blind placebo-controlled trial,
with a total duration of 6 months. On recruitment, children
were allocated at random to either the active treatment (the
HUFA supplement, ‘eye-q’) or an identical-looking placebo (1).
At the three-month point there was a one-way treatment
crossover (placebo to active treatment) and all children were
then followed up for a further 3 months.
Assessments at: baseline 3 months 6 months.
Group 1 (N=50) active active |.
Group 2 (N=50) placebo active |.
(1) Randomisation and blinding of treatments were organised by
the suppliers, Equazen ltd, who kept the register of treatment
codes. Allocation of subjects to treatments was pre-
randomised with the constraint that the numbers of active and
placebo-treated subjects were balanced within males and
females.

5. 5
Study Design
Treatments.
n Eye Q is on open sale in the UK as a food supplement, and contains
premium quality fish oil and evening primrose oil. Study dosage will be
fixed at the recommended initial intake of 6 small capsules / day,
supplying omega-3 HUFA (EPA , DHA), and the omega-6 HUFA GLA and
AA plus vitamin E (alpha-tocopherol).
n The placebo treatment was an identical-looking capsules of an oil
containing medium-chain triglycerides (MCT) – derived from tropical oils
such as coconut, pal etc). These fatty acids contain neither omega-3 nor
omega-6 HUFA, but are often used in food supplements designed as an
energy source, e.g. For athletes.
Exclusion criteria.
n Significant neurological psychiatric, or other medical problems,current
medication (unless this is judged irrelevant by the GP).
n NB: GP consent was required for all participants, but we excluded a
priori children receiving treatment for major health problems e.G.
Cerebral palsy, epilepsy, MS. ME or any other major physical condition.
Gains in Reading and Spelling
-2
-1
0
1
2
3
4
5
6
7
Agegain(inmonths)
Reading Spelling
Reading age and Spelling age gains
beyond expectation after 3 months
Active
placebo
0
1
2
3
4
5
6
7
8
9
10
Agegain(inmonths)
Reading Spelling
Reading and Spelling gains after 0-3 months'
supplementation
Active
placebo
Effect size of Active and Placebo treatments on ADHD
Global Scales (CTRS-R:L)
-0.1 0 0.1 0.2 0.3 0.4 0.5 0.6 0.7
Emotional Lability
DSM Hyperactive -Impulsive
DSM Global Total
Global Total
DSM Inattention
Restless-Impulsive
ADHD Index
placebo
LC-PUFA

6. 6
The Durham Trial
We need to
remember that this
is not about
chemistry.
This is about
children.
What’s the issue?
n we try to help before we know what the
issue is.
n importance of effective, timely screening
and simple interventions
What we discovered
n less excitability
n greater memory and concentration
n improved reading and spelling

7. 7
Eston Park School
n 40% made better than expected gains in reading (in some cases 2yrs 3 mths over 3
months).
n 62% showed improvements in auditory memory.
n At the beginning of the trial, 35% of children reported having mild-moderate emotional
difficulties. After the trial only one pupil reported mild-moderate problems in this area.
n The results the Head Teacher and senior management noted for themselves on individual
pupils was enough for the sceptical Head Teacher to subsidise continuing the
supplements. He is not known for parting with school money easily.
Ian Hoy, Inclusions Officer, Eston Park School
Changing how we do things
n longer sequence of instructions can be remembered
n more able to stay ‘on task’ and less likely to be disruptive
n more able to access texts (so less adult input needed)
n writing less physically exhausting
n more energy for creative processes
n self esteem raised
Clinical Features in Infancy
Hyperactive Hypoactive
Sleep Problems
Feeding Difficulties Undemanding
‘Colic’
High Levels of Motor Activity Repetitive Behaviour
Slow to achieve independent sitting
Usually do NOT go through crawling stage
Late to walk
Delayed Acquisition of Language

8. 8
Pre-School (3 – 5 Years)
n Very High levels of motor activity
u Feet swinging and tapping when seated
u Hands clapping or twisting
u Unable to stay in place longer than 5
minutes
n Poor figure ground awareness
u No sense of danger
u Jump from inappropriate heights
n Very Excitable
u Voice Loud and Shrill
u Easily distressed, temper Tantrums
n Continue to be messy eaters
u Often spill liquid from drinking cups
u Prefer to use fingers to feed
n Move Awkwardly
u Constantly bumping into objects and
falling
u Associated Mirror movements, hands
flap when running or jumping
n Avoid Constructional Toys
u Jigsaws
u Building Blocks (Lego)
n Difficulty pedalling tricycle or similar toy
Pre-school (3 – 5 years) continued
n Poor Fine Motor Skills
u Pencil grip
u Use of scissors
u Immature drawings
n Language difficulties persist
u Children often referred to speech
therapist
n Lack of imaginative play
u Does not enjoy ‘dressing up’ or playing
in home corner/ Wendy House
n Sensitive to sensory stimulation
u High levels of noise
u Dislike being touched or wearing new
clothes
n Limited Creative Play
n Isolated in Peer group
u Rejected by peers – prefer adult
company
n Limited response to verbal instructions
u Slower response time
u Problems with comprehension
n Laterality still not established
u Problems crossing mid-line
n Limited concentration
u Tasks often left unfinished
The differences between the processing styles of the left and
right hemispheres represented both verbally and visually
Left Hemisphere Right Hemisphere
CAT
Words Images
6
Numbers Patterns
Parts Wholes
Sequential
Linear
Simultaneous
Patterns
Connections

9. 9
The Effects of a Motor-Skills
Programme
Assessing Motor Skills
Age 3+
Gross Motor Skills
• Crawling through a tunnel (two metres length) coordinating arms and legs
appropriately.
• Walking backwards, forwards and sideways, arms alongside the body
• Running a distance of 10 metres without tripping or falling over
• Jumping from a low step, or on the spot with feet together
• Climbing up and down stairs in an adult fashion, placing one foot on each step
• Walking heel / toe along a measured distance of three metres
• Balancing along a bench/ plank raised (10cm) from the floor

10. 10
Fine Motor Skills
• Established hand preference
• Building a tower of 6+ (2.5cm) bricks
• Reassemble a screw toy or remove the top from a jar or bottle
• Thread a determined sequence of large beads e.g. two red, one
blue, two yellow
• Complete a 6-piece inset puzzle / jigsaw
• Copy simple shapes e.g. line, cross, circle, square

11. 11
Handedness
RIGHT LEFT
School-based Primary Programme

12. 12
Emotional Wellbeing
Conners Rating Scales
n Self Assessment
n Parents’
n Teachers’
Completing Teacher Rating Scale

13. 13
Letter Parent Teacher
A Oppositional Oppositional
B Cognitive Problems/ Inattention Cognitive Problems/ Inattention
C Hyperactivity Hyperactivity
D Anxious – Shy Anxious – Shy
E Perfectionism Perfectionism
F Social Problems Social Problems
G Psychosomatic
H ADHD Index ADHD Index
I Connors’ Global Index:
Restless-Impulsive
Connors’ Global Index:
Restless-Impulsive
J Connors’ Global Index:
Emotional Lability
Connors’ Global Index:
Emotional Lability
K Connors’ Global Index:
Total
Connors’ Global Index:
Total
L DSM-IV Symptoms: Inattentive DSM-IV Symptoms: Inattentive
M DSM-IV Symptoms: Hyperactive-
Impulsive
DSM-IV Symptoms: Hyperactive- Impulsive
N DSM-IV Symptoms: Total DSM-IV Symptoms: Total
Long Form Scoring Grid Subscale
Autism Spectrum Disorder
Childhood Autism Rating Scales (CARS)
Resources
n Text Checker
n Supporting the SENCO
n Ideas to support children with ASD at home
and in school
n Developing Speech and Language
n Building Self Esteem
n Managing Behaviour

14. 14
References
n Portwood et al (2014) The role of essential fatty acids in improving language skills in children with ASD
Durham University International Conference
n Portwood M: (2011) The Co-ordination Conundrum. SEN Magazine (September / October)
n Portwood M: (2008) Movement Difficulties in the early years: a planned programme of support in The
Dyslexia Handbook 2208/2009, British Dyslexia Association, Bracknall
n Portwood M: (2006) Effect of Diet on children’s behaviour and learning. Br. Journal Nutrition & Health
Vol. 18, pp. 219–232
n Portwood M: (2006) Essential Fatty Acids (EFAs) and their effect on children’s behaviour and learning.
Journal of the Dyslexia Institute 14. (2) 4 - 7
n Portwood M: (2005) Dyspraxia in Special Teaching for Special Children: A Pedagogy for Inclusion? Eds
Lewis & Norwich McGraw & Hill Open University Press
n Portwood M: (2004) Children with movement difficulties – an epidemic Professional Journal of the
Dyspraxia Foundation (Oct)
n Portwood M. (2003) Dyslexia and P.E. BDA/ David Fulton, London
n Portwood M. (2000) Understanding Developmental Dyspraxia – A Textbook for Students and Professionals,
David Fulton London
n Portwood M. (2000) Dyspraxia, British Journal of Teaching Physical Education 31(1), 22 - 25
n Portwood M. (1999) Developmental Dyspraxia: Identification and Intervention. David Fulton London