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Identification of the underlying cause of this wide and varied presentation requires a systematic, targeted and judicious use of investigations. We use our clinical skills supported by our experience in considering specific investigative tools in reaching a diagnosis. Once a diagnosis has been made appropriate therapeutic and conservative treatment options are offered. These include establishing a package to include physiotherapy, speech therapy, occupational therapy and educational psychology. Following a multidisciplinary assessment a detailed report is provided to parents +/- school.