Infants and children learn through the interaction of their nervous systems with their physical, social, and cultural environments, helped by their peers, parents, and teachers. The failure of such learning to progress normally in preschool children delays their acquisition of developmental skills and may lead to the identification of the child as being “developmentally delayed”.

There is increasing understanding of processes underlying learning at different levels of complexity: from changes in synaptic function, through the identification of specific neuronal systems, to the cognitive and perceptual faculties which such systems may support,1 and extending to the logical structures required to represent what is learnt and to guide further learning.2 This has a counterpart in the considerable literature on how a child’s learning may be influenced by social and cultural environments,3 4 by the attitude and responses of parents and carers, and by the child’s ability to interact with them.

It is important clinically that we are able to identify impediments to learning in individual children, at such different levels, so that we can assess their effects and develop strategies to optimise subsequent learning for that child. We do not know how to influence damaged brain systems directly, but may be able to reduce the effects of neurological damage on subsequent learning and skill acquisition, which may in turn improve impaired perceptual or memory abilities. How can the child with neurological impairment be enabled to perceive, understand, respond to and explore their environment?