Developmental Delay

Developmental delay means a child is not reaching expected milestones for their age in one or more areas of development. It can affect how a child learns, moves, communicates, plays or cares for themselves, and may be temporary or part of a longer-term condition.

Common areas affected

• Communication and language (speech, understanding)
• Social and emotional skills (interacting, managing feelings)
• Thinking and learning (problem solving, attention)
• Motor skills (sitting, crawling, walking, fine motor tasks like grasping)
• Self-care (feeding, dressing, toileting)
• Sensory processing (over- or under-reacting to sights, sounds, touch)

Issues to look out for (red flags)

• By 6 months: little or no smiling, poor eye contact, limited response to sounds or voices
• By 12 months: not babbling or using gestures, not sitting steadily, not responding to name
• By 18 months: few single words, limited interest in social games, not pointing to request or show
• By 2 years: few two-word phrases, difficulty walking or loss of motor skills, little pretend play
• By 3 years: limited speech intelligibility, trouble interacting with peers, persistent difficulty with coordination or self-care
• Any age: sudden loss of skills, extreme sensitivity or lack of reaction to sensory input, very repetitive behaviours that limit learning, persistent feeding or sleeping problems

Fine Motor Skills

Fine motor skills are the small movements made with the hands and fingers that allow a child to grasp, manipulate and control objects—things like holding a pencil, buttoning clothes, using scissors, fastening zips, turning pages and feeding themselves. These skills are built from hand strength, finger coordination, bilateral hand use, hand-eye coordination and precise fingertip control.

Why they matter

• Support independence in self-care (dressing, eating, toileting)
• Enable school tasks (writing, cutting, using classroom tools)
• Promote play, creativity and confidence

What to look out for (possible concerns)

• Babies/toddlers: weak or inconsistent grasp of toys, difficulty transferring objects between hands, poor hand opening, not bringing hands to mouth
• 1–2 years: trouble picking up small objects (cheerios, small toys), persistent fisted hands, difficulty stacking simple blocks
• 2–3 years: limited ability to use a spoon/fork, difficulty turning pages, trouble scribbling or imitating straight lines
• 3–5 years: difficulty managing buttons, zips or shoe fastenings, poor scissor control, scribbles that don’t progress to more controlled marks
• 5+ years: messy or illegible handwriting, slow or tiring when writing or drawing, difficulty using classroom tools (rulers, glue sticks), poor bilateral coordination (stabilising with one hand while working with the other)
• Any age: very weak grip, avoiding play that involves hands, frequent dropping of objects, pain or tightness in hands, noticeable difference between hands

Gross Motor Skills (Movement, Strength & Balance)

Gross motor skills are the large movements that use the arms, legs and trunk to control posture, balance and whole-body movement—things like rolling, sitting, crawling, walking, running, jumping, climbing and riding a bike.

Why they matter

• Support independence (moving safely around environments)
• Enable participation in play, PE and daily routines
• Provide the foundation for coordination, endurance and confidence

Issues to look out for (possible concerns / red flags)

• Infancy (0–12 months): poor head control, not rolling or sitting by expected ages, floppy or very stiff tone, little interest in moving or reaching
• 12–18 months: not cruising or taking steps, persistent toe-walking, difficulty bearing weight through legs
• 18–24 months: not walking independently, very unsteady gait, frequent falls, limited ability to squat or climb
• 2–3 years: difficulty running, jumping, throwing or catching; trouble negotiating stairs; poor balance
• 3–5 years: struggles with hopping, balancing on one foot briefly, pedalling a tricycle, catching a large ball
• School age (5+): poor coordination in sports, frequent clumsiness, tiring quickly, difficulty with tasks requiring balance or agility (e.g., skipping, jumping rope)
• Any age: rapid loss of previously acquired skills, persistently one-sided weakness, persistent pain with movement, or skills significantly behind same-age peers

Sensory

Sensory modulation and sensory discrimination are ways children process information from their body and environment so they can respond appropriately.

• Sensory modulation (regulation): how a child notices and reacts to sensory input (sounds, touch, movement, taste, smell, sights, body position). Healthy modulation means alertness and reactions match the situation; difficulties can cause over‑reactivity (easily upset by noise, light, touch), under‑reactivity (slow to notice pain, not responding to name), or seeking sensory input (craving movement, heavy touch, or mouthing objects) to feel organised.
• Sensory discrimination: the ability to notice, interpret and distinguish different sensory details (e.g., telling hot vs warm, hard vs soft, left vs right, or locating where on the body you were touched). Good discrimination supports accurate motor planning, coordination, handwriting, dressing and knowing how to move safely.

Signs to look out for

• Over‑sensitivity: covers ears, avoids certain clothes/textures, gags at small food changes, distressed by busy environments, avoids messy play.
• Under‑sensitivity: seems unaware of dirt, pain, or temperature, misses social cues, constantly bumps into things, appears lethargic or slow to respond.
• Sensory seeking: constant fidgeting, excessive climbing or crashing, chewing non‑food items, loud vocalising.
• Poor sensory discrimination: clumsy movements, frequent dropping or spilling, trouble locating body parts, difficulty with fine motor tasks (buttoning, handwriting), inaccurate foot placement on stairs, poor balance or spatial awareness.
• Functional impacts: difficulty following instructions, meltdowns in noisy or crowded places, avoidance of self‑care tasks, trouble with school activities or play.

Physiological Regulation

Physiological regulation is the body’s automatic system for staying calm, alert and ready to respond. It controls breathing, heart rate, muscle tension, sleep–wake cycles and the stress responses known as fight, flight and freeze. When this system works well, children can settle, pay attention, learn and manage emotions. When it’s out of balance, behaviour and learning are affected.

What fight, flight and freeze look like

• Fight: aggressive, angry outbursts, hitting, shouting, oppositional behaviour, tense body, rapid breathing.
• Flight: withdrawing, running away, hiding, avoidance of tasks or people, appearing anxious or frantic.
• Freeze: shutdown, very quiet, glazed look, low movement, slow or absent responses, difficulty thinking or speaking.

Signs of poor physiological regulation

• Frequent or intense meltdowns or shutdowns disproportionate to events
• Extreme hyperactivity or constant agitation without settling
• Persistent anxiety, panic attacks, constant vigilance or exaggerated startle
• Sudden loss of skills, long periods of dissociation or zoning out
• Sleep problems, poor appetite, frequent stomachaches or headaches linked to stress
• Difficulty concentrating, poor tolerance of sensory input, or rapid swings between over‑arousal and shutdown
• Physical signs during episodes: racing heart, shallow breathing, sweating, tremors, faintness, shallow voice

Impact

• Interferes with learning, relationships, self‑care and participation in daily activities
• May look like behaviour problems but often reflect unmet regulation needs

Social Engagement and Interaction Skills

Social engagement and interaction skills are the abilities children use to connect with others: making eye contact, taking turns, using and understanding language and nonverbal cues (facial expressions, gestures, tone), sharing attention, starting and maintaining play or conversations, and responding to social cues. These skills support friendships, learning, cooperation and emotional wellbeing.

What to look out for (possible concerns)

• Rarely makes eye contact or uses facial expressions
• Limited interest in or difficulty joining play with peers
• Doesn’t respond to name or social bids, or only on own terms
• Difficulty taking turns, sharing, or waiting
• Literal or one-sided conversation, trouble understanding jokes or sarcasm
• Few gestures (pointing, waving) or unusual nonverbal behaviours
• Repeats scripts or monologues instead of back-and-forth interaction
• Overly passive (withdrawn) or overly intrusive (doesn’t respect personal space)
• Difficulty adjusting behaviour to different social situations
• Anxiety in social settings, persistent peer rejection, or struggles forming friendships

Visual Processing

Visual processing skills are the brain’s ability to interpret and make sense of what the eyes see — not just eyesight. They include skills such as visual attention, tracking, spatial awareness, visual discrimination (telling similar shapes or letters apart), visual memory, visual closure (recognising a whole from partial information) and visual–motor integration (coordinating eyes and hands).

Why they matter

• Support reading, writing, maths, copying from the board, and completing puzzles or class tasks
• Enable safe movement through space, catching/throwing, and accurate handwriting
• Affect organisation, following visual instructions and completing multi‑step tasks

Signs to look out for

• Difficulty copying from the board, messy or inconsistent handwriting, poor letter/number formation
• Frequently loses place while reading, skips or re‑reads lines, confuses similar letters (b/d/p/q)
• Trouble with puzzles, mazes or visual problem‑solving, slow to complete visual tasks
• Poor eye–hand coordination: inaccurate cutting, dropping objects, trouble catching a ball
• Difficulty judging distance or tripping/colliding with objects, clumsy in sports or navigating crowds
• Trouble recognising familiar faces or objects from different viewpoints, or needing more time to process visual information
• Poor visual memory: can’t remember visual sequences, struggle to recall shapes or letter sequences
• Avoidance of near tasks (reading, homework) or frequent headaches/eye strain during visual tasks

Executive Functioning and Learning Challenges

Executive functioning refers to the mental skills that help a child plan, organise, start and finish tasks, manage time, control impulses, hold information in mind (working memory) and shift attention as needed. Strong executive skills are essential for learning, homework, classroom behaviour and everyday independence; weaknesses can look like learning difficulties even when the child understands the material.

Issues and signs to look out for

• Planning & organisation: trouble breaking tasks into steps, poor homework planning, messy schoolbag or desk, losing materials
• Time management & prioritising: underestimates how long tasks take, rushes or never finishes work, misses deadlines
• Working memory: forgets multi‑step instructions, loses place when reading, needs frequent reminders
• Task initiation & sustained attention: struggles to get started, procrastinates, drifts off or can’t sustain effort on longer tasks
• Task completion & follow‑through: starts many activities but rarely completes them, frequent unfinished assignments
• Cognitive flexibility & shifting: difficulty moving between tasks or adapting to changes, gets stuck on one idea or approach
• Self‑monitoring & error correction: doesn’t notice mistakes, repeats same errors, difficulty using feedback
• Impulse control & emotional regulation: blurting out, interrupting, difficulty tolerating frustration, emotional outbursts when challenged
• Organisation of thoughts & written work: poor planning of essays, disorganised answers, difficulty sequencing ideas
• Inconsistent performance: capable at times but unpredictable performance under busy or demanding conditions

Play Skills

Play skills are the abilities children use to explore, learn and connect through play — including curiosity, imagination, sharing, taking turns, problem‑solving, symbolic/pretend play, cooperative play, use of toys and play materials, and adapting play to different settings and partners. Play is how children practise language, social rules, motor skills and thinking.

What to look out for (possible concerns)

• Limited interest in play or difficulty engaging with toys
• Very repetitive or parallel play (playing alongside but not with peers) after the expected age for social play
• Little or no pretend or symbolic play (using objects to represent other things)
• Difficulty taking turns, sharing, or joining group games
• Plays in a rigid, repetitive or highly scripted way with limited flexibility
• Trouble initiating play or responding to play invitations or social bids
• Short play sessions, quick loss of interest, or overwhelming frustration during play
• Plays only with parts of toys (spinning wheels) rather than whole‑toy use
• Difficulty using toys functionally (e.g., cannot build simple block structures) or poor play sequencing
• Avoidance of messy, imaginative or sensory play activities

Why it matters

• Supports language, social skills, creativity, emotional regulation and problem‑solving
• Predicts school readiness, peer relationships and adaptive functioning

Wondering if your child needs Occupational Therapy? Get in touch.