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Concern
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Signs & concerns
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Signs & concerns
When to Refer a Child with a Genetic Syndrome for Developmental Therapy
For a suspected or confirmed genetic/chromosomal syndrome, refer for developmental therapy at the point of suspicion or diagnosis — not after delay appears. Therapy is anticipatory scaffolding; there is no minimum severity threshold. Medical red flags (seizures, feeding/swallowing risk, regression) need prompt medical referral first.
Read the answer AnswerWhen should a doctor refer a child with suspected Global Developmental Delay for developmental therapy?
Refer at first reasonable suspicion — you do not need a confirmed diagnosis. Once two or more developmental domains lag, or after a failed screen, regression, or persistent parental concern, refer for developmental therapy in parallel with aetiological workup. Therapy should not wait on diagnostics.
Read the answer AnswerWhen to refer a child with suspected gross motor delay
Refer for developmental therapy when a motor milestone window is clearly missed (e.g. no independent sitting by 9 months, no walking by 18 months), when skills regress, or when tone/asymmetry red flags appear — concurrently with medical work-up, not after it.
Read the answer AnswerWhen should a doctor refer a child with suspected Hearing Impairment for developmental therapy?
Refer the moment hearing loss is suspected — in parallel with audiology, not after it. Follow the 1-3-6 rule: screen by 1 month, confirm by 3, begin early intervention by 6. A failed screen, missed auditory milestone, or persistent parental concern each warrants concurrent developmental and speech-language referral.
Read the answer AnswerWhen should a doctor refer a child with suspected hypotonia for developmental therapy?
Refer early and in parallel — do not wait for an aetiological diagnosis. Any infant or child with persistent hypotonia plus functional impact (head lag, motor delay, feeding difficulty, fatigue) warrants concurrent physiotherapy and developmental therapy alongside neurological workup. Hypotonia is a sign, not a diagnosis.
Read the answer AnswerWhen to refer suspected Intellectual Disability for developmental therapy
Refer on suspicion, not on confirmation. A failed validated screen, multi-domain delay, skill regression, or significant adaptive deficit each warrant onward referral — with therapy initiated in parallel to aetiological work-up. Formal diagnosis of intellectual developmental disorder follows later under clinician-administered cognitive and adaptive testing.
Read the answer AnswerWhen to refer suspected motor planning difficulties for developmental therapy
Refer when motor-planning difficulty is persistent, functionally limiting and shows a clear plan–execute gap despite intact strength, tone and comprehension — and when no acute or progressive cause is suspected. A formal DCD label is not required to refer; early assessment improves outcomes. Diagnosis is made only by a clinician.
Read the answer AnswerWhen should a doctor refer a child with suspected Non-Verbal / Minimally Verbal Presentation for developmental therapy?
Refer on clinical suspicion, not after diagnosis. Key thresholds: no babble/gesture by 12 months, no words by 16 months, no two-word phrases by 24 months, or any regression at any age. Run audiology in parallel, and initiate therapy while differential workup proceeds — early AAC does not suppress speech.
Read the answer AnswerWhen to Refer Suspected ODD for Developmental Therapy
Refer when oppositional behaviour is persistent and cross-setting, when first-line parent guidance underdelivers, or when a developmental driver (language, ADHD, autism, regulation) may underlie the defiance. The referral is for clarification and skill-building, not the label itself.
Read the answer AnswerWhen to Refer Persistent Toe-Walking for Developmental Therapy
Refer when toe-walking persists beyond age 2, is idiopathic and habitual, shows fixed or reducing ankle dorsiflexion, or — most importantly — coexists with developmental, sensory or communication flags. Unilateral, asymmetric or regressive presentations need urgent neuromuscular evaluation, not therapy first. Idiopathic toe-walking is a diagnosis of exclusion.
Read the answer AnswerWhen to Refer a Preterm Child for Developmental Therapy
Refer high-risk preterm infants (<32 weeks, VLBW, or neonatal neurological insult) into early-intervention therapy at NICU discharge, and promptly at any age when corrected-age milestones, tone, movement, or feeding deviate. Early therapy in the neuroplastic window is preventive — refer on risk and early signs, not on a confirmed diagnosis.
Read the answer AnswerWhen to refer suspected Rett syndrome for developmental therapy
Refer for developmental therapy at the point of clinical suspicion — in parallel with genetic and neurological workup, not after it. The regression phase (6–18 months) is when speech/AAC, OT and physiotherapy best preserve function. Co-refer seizures and airway concerns to paediatric neurology urgently.
Read the answer AnswerWhen to refer a suspected School Readiness Gap for therapy
Refer a child approaching school entry (age 4–6) when a foundational gap persists across communication, cognition, motor, social-emotional or self-care domains and across settings. Refer sooner for regression or marked single-domain delay. Watchful waiting is appropriate only for mild, isolated, environment-linked lags.
Read the answer AnswerWhen should a doctor refer suspected selective mutism for therapy?
Refer when a child's failure to speak in specific settings persists beyond one month (excluding the first month of school), causes educational or social impairment, and isn't explained by a language disorder or unfamiliarity with the language. Selective mutism is anxiety-based — early referral, not watchful waiting, gives the best outcomes.
Read the answer AnswerWhen should a doctor refer a child with suspected Self-Regulation Difficulties for developmental therapy?
Refer when self-regulation difficulties are persistent (beyond ~4–6 weeks), pervasive across settings, and functionally impairing sleep, feeding, engagement or family life — after excluding treatable medical causes. Refer sooner when developmental red flags or caregiver distress co-occur. Only a clinician confirms findings.
Read the answer AnswerWhen to Refer Sensory-Based Feeding Selectivity
Refer a child with suspected Sensory-Based Feeding Selectivity once the pattern is persistent, narrowing or functionally impairing — fewer foods over time, whole-texture exclusion, or mealtime distress — and after medical red flags (choking, faltering growth, painful swallow) are excluded or co-managed. Earlier referral means a wider repertoire to build on.
Read the answer AnswerWhen should a doctor refer a child with suspected Sensory Processing Differences for developmental therapy?
Refer when sensory differences are functionally impairing — disrupting feeding, sleep, self-care, play, peer participation or classroom function persistently — not for occasional preferences the child self-regulates. Functional impact alone justifies referral; no co-occurring diagnosis is required to act, and earlier is better.
Read the answer AnswerWhen to refer a child with suspected Separation Anxiety Disorder
Refer when separation distress is excessive for the child's developmental age, persists ≥4 weeks (ICD-11 6B05) and impairs function — school refusal, somatic complaints, sleep disruption. First-line is CBT-based psychological therapy; escalate promptly for low mood, self-harm ideation, or a suspected underlying developmental condition.
Read the answer AnswerWhen to Refer Suspected Social Communication Difficulties
Refer when a child shows a persistent pattern of difficulty with the social use of language — reciprocity, pragmatic adjustment, non-verbal cues — that impacts function, after excluding hearing loss. Parental or clinical concern is sufficient grounds; do not adopt watchful waiting past age 4–5. Assessment is how Social Communication Difficulties is differentiated from autism, DLD and intellectual disability.
Read the answer AnswerWhen should a doctor refer a child with suspected SLD for developmental therapy?
Refer when academic skills fall persistently and significantly below age expectation despite adequate instruction, the difficulty lasts at least six months, and other causes (intellectual, sensory, neurological, psychosocial) are excluded. This typically clusters at ages 6–8 once formal instruction begins, but refer at the first persistent gap rather than waiting for failure.
Read the answer AnswerWhen should a doctor refer a child with suspected Speech and Language Delay?
Refer when language delay is persistent rather than transient, when milestone red flags appear at any age, or when there is regression or loss of skills — and run audiology in parallel, not before. Wait-and-see is inappropriate once thresholds are crossed. Diagnosis is confirmed only by a clinician.
Read the answer AnswerWhen to Refer Suspected Stereotyped Movement Disorder
Refer when stereotypies are functionally impairing, self-injurious, or co-occur with developmental delay — not for benign movements alone. Atypical or urgent features need medical work-up first. Therapy targets participation and safety, never mere suppression.
Read the answer AnswerWhen to Refer Suspected Tourette Syndrome for Developmental Therapy
Refer when functional impairment — not tic severity — limits the child, which is most cases given 80–90% comorbidity (ADHD, OCD, anxiety, learning difficulties). Begin supportive therapy at suspicion; CBIT is first-line for disabling tics, with prompt neurology/psychiatry review for red flags.
Read the answer AnswerWhen to Refer a Child with Suspected Visual Impairment for Developmental Therapy
Refer for developmental therapy as soon as visual impairment is confirmed or strongly suspected — in parallel with ophthalmology, not after it. Early habilitation during the plasticity window mitigates secondary motor, cognitive and communication delays. Diagnosis and AbilityScore® are formed only at a Pinnacle centre.
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