Dear Jacqui, My child is in Reception and has difficulties with speech, language, learning and memory. He is also clumsy, has poor pencil grip, is a fussy eater and poor sleeper. He is lovely but can be difficult. Please advise?

Thank you for raising these very important issues. Early assessment and intervention is best. What you are describing sounds like a pattern of neurodevelopmental difficulties, which may or may not link to a primary disorder such as attention deficit hyperactivity disorder, autistic spectrum, dyslexia, dyspraxia, sensory integration disorder or traits of one or a number of these. The secondary symptoms such as you describe are often overlooked as difficult to fit specifically into a primary diagnosis. Secondary symptoms refer to subtle impairments in motor coordination, complex motor sequencing, sensory integration and regulation, sleep and feeding difficulties, as well as difficulties in self-regulation. This relates to clumsiness, handwriting, speech, attention, auditory processing, language processing, memory, sleep, feeding, and behaviours. Neurologists believe that secondary symptoms reflect non-localizable disturbances in connections between subcortical and cortical regions or among cortical regions in the brain. However regarding implications for interventions, once secondary symptoms are detected, intervention could reduce vulnerability and prevent or curtail the development of the primary disorder. Preliminary evidence suggests that interventions targeting basic processes associated with secondary symptoms e.g. sensory, motor or sleep, seem to alleviate vulnerability in preterm infants and in individuals already diagnosed with a primary disorder. This suggests secondary symptoms can provide important information that can guide clinical diagnosis and treatment.