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Cognitive
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Signs & concerns
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Signs & concerns
When should a frontline worker refer a child with possible Dysgraphia?
Refer a child for possible Dysgraphia when written-output difficulty is persistent, age-inappropriate and unexplained by other causes — clearly from age 7–8, once formal writing instruction has had time to work. Before that, monitor and support. Refer promptly for any sudden skill loss, hand weakness or vision concern.
Read the answer AnswerWhen should a frontline health worker refer a child with possible dyslexia?
Refer a school-age child (around 6–7+) when reading stays slow and effortful despite proper instruction, once hearing, vision, schooling and language barriers are ruled out. Look for a persistent cluster of signs, not one bad day. The frontline worker opens the door; only a clinician confirms dyslexia.
Read the answer AnswerWhen should a frontline health worker refer a child with possible Intellectual Disability?
Refer when a child shows persistent delay across two or more areas — motor, language, understanding, self-care or social — that is not catching up, or any loss of skills. Frontline workers spot the pattern; only a clinician confirms it.
Read the answer AnswerWhen should a frontline health worker refer a child with possible School Readiness Gap to a specialist?
Refer a child aged roughly 4–6 when a school readiness gap persists despite simple support, or sits alongside a developmental red flag — limited language, poor attention, motor or self-care difficulty, or any loss of skills. When in doubt, refer; early assessment is low-risk. Diagnosis is made only by a clinician.
Read the answer AnswerWhen should a frontline health worker refer a child with possible Specific Learning Disability?
Refer once academic difficulty is persistent (6+ months despite help), well below age expectation, and not explained by schooling, hearing, vision or another condition — typically from age 6–7 when formal learning has begun. Rule out simple causes first; only a clinician confirms it.
Read the answer AnswerWhen should an ASHA or PHC worker escalate a child showing signs of ADHD?
Escalate a school-age child (around 6+) when inattention, hyperactivity or impulsivity persists for 6+ months across two settings (home and school) and disrupts learning or relationships — confirmed by parent and teacher. Refer promptly if red flags suggest another cause. The worker notices and routes; only a clinician diagnoses.
Read the answer AnswerWhen should an ASHA or PHC worker escalate a child showing signs of dyscalculia?
Escalate when a child aged 7 or older shows persistent maths difficulty across two school terms that is out of step with other skills and not explained by missed schooling, language or sensory issues. Below that age, observe and support. Rule out hearing, vision and attendance first, then route to the PHC medical officer or RBSK pathway. Only a clinician can confirm dyscalculia.
Read the answer AnswerWhen should an ASHA or PHC worker escalate a child showing signs of Dysgraphia?
Escalate a school-age child (7+ years) showing persistent, clustered written-expression difficulty despite adequate teaching, normal vision and no obvious intellectual delay. Below 6–7, reassure and monitor. Route urgent signs — seizures, skill loss, motor weakness — for prompt medical review. ASHA/PHC workers recognise and refer; they do not diagnose.
Read the answer AnswerWhen should an ASHA or PHC worker escalate a child with signs of dyslexia?
Escalate a school-age child (roughly 6–8 years or older) with persistent reading difficulty that does not match their ability, once hearing and vision are ruled out, and especially if it persists beyond one school term or causes distress. Below 6, monitor rather than label. Diagnosis is made only by a clinician.
Read the answer AnswerWhen Should an ASHA or PHC Worker Escalate a Child Showing Signs of Intellectual Disability?
Escalate when a child shows persistent, cross-domain developmental delay, when a caregiver is worried, or — urgently — when previously gained skills are lost. A single late milestone in an otherwise responsive child usually needs only monitoring. ASHA and PHC workers recognise and refer; diagnosis happens only with a clinician.
Read the answer AnswerWhen to Escalate a School Readiness Gap
Escalate a 4–6 year old when a persistent pattern spans two or more readiness domains — speech, following instructions, pre-number concepts, group attention or self-care — over several weeks. A single lagging area in a thriving child can be watched; loss of skills or no clear speech by age 4 needs prompt referral. Diagnosis is never made at village level.
Read the answer AnswerWhen should an ASHA or PHC worker escalate suspected SLD?
ASHA/PHC workers should escalate when a school-age child (about 6+) shows persistent, unexplained difficulty with reading, writing or maths despite adequate schooling and normal effort — after first ruling out vision, hearing and attendance issues. Refer to the Medical Officer or DEIC; SLD is not diagnosed before formal schooling, and never at community level.
Read the answer AnswerWhen should I worry that my child cannot sit still?
From 2 to 7 years, high energy and fidgeting are usually normal — young children are made to move, and sitting still comes slowly with age. Seek a developmental check when restlessness is far greater than peers, happens in every setting, gets in the way of play, learning or friendships, or comes with delays in talking or listening. This is a reason to look calmly and early, not a diagnosis.
Read the answer AnswerWhen Should I Worry About Lining Up Toys?
Lining up toys is common and usually typical play between 18 months and 6 years, showing a child exploring order and patterns. Worry is warranted only when lining up replaces all other play, cannot be interrupted without big distress, or travels alongside delays in talking, shared attention or social connection. These are reasons for an early developmental check, not a diagnosis.
Read the answer AnswerWhen should I worry about my child's cognitive development?
Cognitive development — thinking, learning, memory, attention and problem-solving — varies widely, and one delay rarely means trouble. Seek a developmental check when your child is clearly behind peers across several areas, has stopped progressing, or has lost a skill once mastered. This is a reason to assess early, not a diagnosis, because early support works best.
Read the answer AnswerWhen should I worry about my child not following instructions?
Not following instructions is very common and usually normal between 18 months and 6 years — toddlers are distracted, building language and learning their own will. Seek a developmental check when your child seems not to hear or understand instructions (rather than choosing to ignore), when it comes with delays in talking, attention or social connection, or when it's constant across all settings. A hearing check is a sensible first step. This is a reason to observe and assess early, not a diagnosis.
Read the answer AnswerWhen should I worry that my 12–18 month old might have ADHD?
At 12–18 months ADHD cannot be diagnosed, and high energy or short attention is normal toddler behaviour. Rather than ADHD signs, watch milestones — connection, communication, play and movement. A general developmental check, not ADHD screening, is the right next step, and only a clinician can assess.
Read the answer AnswerWhen should I worry about dyscalculia at 12–18 months?
Dyscalculia cannot be identified in a 12-to-18-month-old — it is a specific maths-learning difficulty only meaningfully recognised from around 7–8 years, once a child engages with formal arithmetic. At toddler age there is no number skill to assess, so there is nothing to worry about on this front. Enjoy and gently observe broad early development — play, sorting, pointing, first words — and seek a general developmental check only if overall development feels off. Any assessment is by a Pinnacle clinician, never an online form.
Read the answer AnswerWhen to worry about dysgraphia at 12–18 months
Dysgraphia is a writing difficulty and cannot be identified at 12–18 months, because writing skills do not yet exist at this age — there is nothing to worry about regarding dysgraphia now. What matters at this stage are the foundations: grip, hand use, scribbling for fun, gestures and babble. Writing concerns only become meaningful around age 6–7 after teaching. Only a Pinnacle clinician forms any assessment, never an online form.
Read the answer AnswerWhen to worry about dyslexia in a 12–18 month old
Dyslexia is a reading difficulty and cannot be identified at 12–18 months, because reading itself develops years later — typically assessed from around 6–8 years. There are no toddler dyslexia signs to worry about. At this age, watch and nurture early language: babbling, first words, responding to their name, pointing and enjoying books. Concerns about hearing, speech or understanding deserve a gentle check now; only a Pinnacle clinician can assess, never an online form.
Read the answer AnswerWhen should I worry about Intellectual Disability at 12–18 months?
At 12–18 months it is too early to diagnose Intellectual Disability — this is a watch-and-support stage, not a labelling one. Track the overall pattern across play, communication and movement; a persistent lag across several areas, or loss of skills, is a reason for a friendly developmental check. Only a clinician can assess, and meaningful assessment comes later.
Read the answer AnswerWhen to worry about School Readiness Gap at 12–18 months
School readiness is not measured in a 12-to-18-month-old — it is a picture that forms years later, around ages 4 to 6. At this age the right focus is the broad developmental foundations: communicating, connecting and exploring. A true School Readiness Gap cannot be identified this young; review with a clinician if general milestones are delayed.
Read the answer AnswerWhen should I worry about SLD in a 12-to-18-month-old?
Specific Learning Disability is about reading, writing and maths — skills that haven't begun at 12–18 months, so it can't be identified or worried about this early. It usually becomes clear around ages 6–8. For now, watch broad milestones like babbling, pointing, understanding and walking; a persistent pattern of several delays is reason for a general developmental check, not a label.
Read the answer AnswerWhen should I worry my 18–24-month-old has ADHD?
At 18–24 months, ADHD cannot yet be meaningfully identified — high energy and short attention are normal toddler behaviour. ADHD is reliably assessed only from around age 4–5. Channel any worry into a general developmental check, never a premature label. Only a clinician can assess.
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