How do you know if a toddler has a hidden disability when her behaviour is also typical of other problems? Jill Curtis weighs up the possibilities.

Raisingkids member's problem
A 4 yr-old girl at my nursery is giving concern to the staff. She's very small for her age, has a slight problem with one of her eyes and she also suffers from glue ear. Her development in key areas is average but her speech is slow. She can repeat words and short sentences, but seldom offers verbal communication unless asked questions. Her concentration span is very poor and only reaches 2 minutes on a good day.

She has problems differentiating opposite concepts such as hot and cold, sweet and sour, cold and dry etc. She is not very good at making her needs known even through non verbal language. Her physical co-ordination both gross motor and fine motor are very good. Her favourite activity is role-play with dolls and home play in the kitchen area. We've cared for children with different disabilities at our nursery over the years but these children have mostly displayed characteristic symtoms of their disorder. Perhaps this child's intellectual development is slow!

Jill Curtis's advice
It's frustrating when one can't pinpoint just what's wrong with a 4 yr-old. It seems as if the child you ask about has physical difficulties, a sight problem and also glue ear that are being attended to. Of course, glue ear can cause temporary hearing loss and the result may be delayed speech development in young children. This in turn can affect their educational progress and of course, these early years are crucial in so many areas of development.

I wonder if her parents share your concern? As you'll know, an alliance between parents and nursery carers is very important. Certainly one of the signs which may point to a child having learning difficulties, is when there's a language problem. Other difficulties are concentrating and being easily distracted but it may be that this little girl needs more time to catch up with her peers because of her physical difficulties.

You seem to be a very experienced nursery carer and are keeping a close eye on this little girl's behaviour and development. This is vitally important in case this 4 yr-old needs further assessment.

• More Answers From Hidden Disabilities Specialist, Jill Curtis
• Development: What To Expect Of A 4 Yr-Old
• Early Education: Support Organisations & Resources