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Signs & concerns
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Signs & concerns
When 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.
Read the answer AnswerWhen should a frontline health worker refer a child with possible ADHD?
Refer a child for specialist ADHD assessment when inattention, hyperactivity or impulsivity is persistent (6+ months), present in more than one setting, beyond age expectations, and impairing learning or daily life. ADHD isn't diagnosed before about age 5–6; route younger or borderline cases to a general developmental check. Only a clinician diagnoses.
Read the answer AnswerWhen to refer a child with possible Auditory Processing Difficulties
Refer a child when listening difficulties persist beyond 6–9 months, appear across home and school, and aren't explained by an ear infection. Always arrange a hearing check first; formal auditory-processing testing is meaningful from around age 7. When in doubt, refer early — only a clinician can assess and diagnose.
Read the answer AnswerWhen should a frontline health worker refer a child with possible autism?
Refer on suspicion, not certainty. Any recognised red flag, any loss of skills at any age, or a worried parent is reason enough to refer for specialist assessment. Screen hearing first. A referral opens the door to early support — only a clinician diagnoses.
Read the answer AnswerWhen should a frontline health worker refer a child with possible Cerebral Palsy?
Refer early — don't wait for certainty. Persistent motor delay, abnormal tone (stiff or floppy), early hand preference before 12 months, feeding difficulty, or a high-risk birth history all warrant prompt specialist referral. The frontline rule: when in doubt, refer.
Read the answer AnswerWhen should a frontline health worker refer a child with possible childhood anxiety?
Refer a child for specialist assessment when anxiety is persistent (most days for 4+ weeks), out of proportion, and disrupting school, sleep, eating or friendships. Mild situational nervousness does not need referral. Any mention of self-harm needs same-day urgent referral. Frontline workers notice the pattern; clinicians confirm and support.
Read the answer AnswerWhen to Refer for Childhood Apraxia of Speech
Refer any child with markedly delayed, effortful or inconsistent speech to a speech-language pathologist without waiting — especially when comprehension outpaces output, or you see visible struggle to form sounds. Early referral improves outcomes; only a clinician can confirm CAS.
Read the answer AnswerWhen should a frontline health worker refer a child with possible Childhood Sleep Difficulties?
Refer a child for specialist assessment when sleep problems persist beyond a few weeks despite routine advice, affect daytime behaviour or growth, or carry red flags like snoring with breathing pauses, possible seizures, or a developmental concern. Most short-lived sleep trouble settles with reassurance and a steady bedtime routine.
Read the answer AnswerWhen to Refer Conduct-Dissocial Disorder
Refer when difficult behaviour is severe, persistent (six months or more), spans more than one setting, and harms the child's safety, schooling or family — and refer urgently if anyone is at risk. A specialist confirms what is happening; the frontline worker's early referral changes outcomes.
Read the answer AnswerWhen should a frontline health worker refer a child with possible DLD?
Refer when language difficulty persists past age markers — or immediately for red flags like loss of words, no response to sound, or no babble/gesture by 12 months. Always pair the referral with a hearing check. When in doubt, refer; early checking never harms a child, and only a clinician diagnoses DLD.
Read the answer AnswerWhen to Refer Developmental Regression
Developmental regression — losing skills a child once had — is a red flag, not a wait-and-see sign. Refer promptly: same-day if there are seizures, weakness or altered alertness; within the week for clear loss of language, social or motor skills. Believe the parent's history and route it onward.
Read the answer AnswerWhen should a frontline health worker refer a child with possible Developmental Trauma?
Refer whenever a child shows a persistent change in relating, feeling or developing — especially after a known adversity — or any safety concern. You needn't be certain; recognising the pattern and routing it onward is your role. When in doubt, refer early.
Read the answer AnswerWhen should a frontline health worker refer a child with possible Down syndrome?
Refer promptly: any newborn or infant with a cluster of recognisable features — low tone, single palmar crease, upward-slanting eyes, flat nasal bridge, feeding difficulty — needs paediatric referral within days. Confirmation is by clinical exam and karyotype only. Escalate same-day for breathing or heart concerns.
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