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Behaviour Therapy
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Signs & concerns
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Signs & concerns
When to escalate impulse-control concerns
Toddlers acting on impulse is normal; self-regulation matures slowly across early childhood. A frontline health worker should escalate for a developmental check when difficulty waiting, stopping or controlling actions is markedly beyond peers, persists across settings, causes frequent danger or injury, or travels with delays in speech, attention, sleep or social connection. Formal labels are not given to infants or very young toddlers — escalate the pattern, not a label, because early support works best.
Read the answer AnswerIf a child cannot regulate impulses at the expected age, when should a frontline health worker escalate?
Brief impulsiveness is normal at every young age, as the skill of waiting grows slowly. A frontline health worker should escalate when impulsiveness is far greater than same-age peers, persists across home and anganwadi for several months, causes danger or injury, or travels with delays in speech, attention, learning or social connection. Any sudden loss of control, or staring/stiffening spells, needs prompt medical review. This is a reason for an early developmental check, not a diagnosis.
Read the answer AnswerWhen to escalate internalising behaviours in children
Internalising behaviours — sadness, fear, worry, withdrawal — are emotional signals to watch, not a skill a child must develop. A frontline health worker should escalate to the PHC medical officer or a developmental centre when low mood, marked anxiety, social withdrawal or unexplained physical complaints last more than 2–3 weeks, worsen, or disrupt eating, sleep, play or school. Any mention of self-harm needs immediate escalation. This is screening, not diagnosis.
Read the answer AnswerWhen to escalate a child's listening-skill concern
Frontline workers should escalate when a child consistently does not respond to their name by around 12 months, does not follow simple spoken instructions by 18–24 months, or shows no reaction to everyday sounds at any age. A child who loses a listening skill they once had, or whose listening difficulty travels with delays in talking or playing, also needs prompt referral. Always ask about ear infections and arrange a hearing check first, as many listening difficulties respond well to early treatment. This is screening that opens the door to support, never a diagnosis.
Read the answer AnswerMood regulation: when frontline workers should escalate
Big feelings, tantrums and tears are normal in young children and ease as language and routine grow. A frontline health worker should escalate to a Medical Officer or developmental check when distress is severe, very frequent, lasts well beyond the age peers settle, causes harm, or comes with delays in talking, play or social connection. Any self-injury or sudden loss of skills needs prompt medical referral. This is a reason to assess early, never a diagnosis.
Read the answer AnswerWhen to escalate a child's need for sameness
Need for sameness (ICF b152) is a temperament trait, not a milestone, so a frontline worker does not escalate simply because a child likes routine. Escalate for a developmental check when the rigidity causes extreme, prolonged distress, blocks everyday activities like eating or dressing, or travels with delays in speech, social connection or play, or loss of a skill. This signals a closer look — not a diagnosis — and early review works best.
Read the answer AnswerWhen should a frontline health worker escalate repetitive behaviours?
Repetitive movements like rocking or flapping are usually normal self-soothing in young children, not a skill to pass or fail. A frontline health worker should escalate to the Medical Officer or a developmental check when movements cause self-injury, are very hard to interrupt, crowd out play and learning, or come with delays in talking, eye contact or social connection. Any stare-and-stiffen episode needs prompt medical review. This guides referral, never a diagnosis.
Read the answer AnswerRestlessness — When to Escalate
Some restlessness is normal in young children and settles with age. A frontline worker should escalate for a developmental check when restlessness is persistent across settings, markedly out of step for age, causes harm, or travels with delays in speech, social connection or learning. This signals early assessment, not a diagnosis — and a formal attention label is generally not made in very young children.
Read the answer AnswerWhen to escalate restricted interests as a frontline worker
"Restricted interests" is not a skill a child achieves — it is a pattern of intense, inflexible focus. A frontline worker should escalate to a developmental check when a narrow interest is hard to interrupt, crowds out varied play and learning, or travels with other signs like few words, little eye contact or not responding to name. Trust caregiver concern, refer early, and never label the child — escalation is an opportunity for support, not a diagnosis.
Read the answer AnswerWhen to Escalate Rigid Behaviours in Young Children
Rigid behaviours like insisting on sameness or distress at change are often typical in early childhood. A frontline health worker should escalate for a developmental check when the rigidity is intense, hard to interrupt, causes real distress, crowds out play and learning, or travels with delays in talking, social connection or motor skills. This is not a diagnosis — it signals the right time for a clinician's review, because early support works best.
Read the answer AnswerWhen should a frontline worker escalate rigid routines?
A child's love of routine and sameness is normal in toddlers and preschoolers. A frontline health worker should escalate to a medical officer or developmental check when changes to routine trigger severe, prolonged distress, when rigidity crowds out play, learning and family life, or when it travels with delays in talking, social connection or play. This is a reason to assess early — not a diagnosis — because early support works best.
Read the answer AnswerWhen to escalate concerns about a child's routine adaptability
Routine adaptability — coping with small changes to daily rhythm — develops gradually in early childhood. A frontline health worker should escalate to a Medical Officer or developmental check when a child shows intense, prolonged distress with routine changes that cannot be comforted or redirected, when it disrupts eating, sleep or family life, or when it travels with delays in talking, social connection or play. This signals a need to assess early, not a diagnosis.
Read the answer AnswerWhen to escalate if a child cannot follow routines
A frontline health worker should escalate a child who cannot follow age-expected daily routines when the difficulty is persistent, present across more than one setting, and accompanied by delays in language, social connection or understanding. This is not a diagnosis — it is a decision to refer for a developmental check through the RBSK/DEIC pathway, because early support works best.
Read the answer AnswerWhen to escalate delayed self-awareness
Self-awareness — name response, mirror recognition, using "me" and "mine", showing pride or embarrassment — emerges across the second and third years. A frontline health worker should escalate when a child clearly misses these age markers, shows no progress across follow-up visits, or has self-awareness gaps alongside delays in language, social connection or play. This signals a need for early assessment, not a diagnosis — earlier review means gentler, more effective support.
Read the answer AnswerWhen should a frontline health worker escalate a self-control concern?
Some difficulty with self-control is normal in young children and matures with age. A frontline health worker should escalate for a developmental check when the difficulty is far greater than same-age peers, persists across home and anganwadi, risks harm, or travels with delays in speech, learning or social connection. Escalate promptly for any safety concern or sudden loss of skills. This is a referral for assessment, never a field diagnosis.
Read the answer AnswerWhen should a frontline worker escalate self-regulation concerns?
Self-regulation grows gradually through the toddler and preschool years. A frontline worker should escalate to a developmental check when difficulties calming, waiting or settling are frequent, intense, well beyond the expected age, or disrupt feeding, sleep, play and family life — especially alongside delays in talking, social connection or understanding. Refer early; this is a reason to assess, not a diagnosis.
Read the answer AnswerEscalating Sensory Sensitivity Concerns: A Frontline Guide
Sensory sensitivity (ICF b156) is not a skill a child passes or fails at a set age — children vary widely in how they respond to sound, touch, light and texture. A frontline health worker should escalate when sensory reactions disrupt feeding, sleep, play or daily routines, cannot be soothed, or travel with delays in talking, social connection or motor skills, or when a parent is worried. This is a reason to refer for a developmental check, not a diagnosis, because early support works best.
Read the answer AnswerWhen should a frontline worker escalate a social-adaptation delay?
A frontline health worker should escalate a child's social-adaptation concern when two or more age-expected social steps are missed, a clear gap from peers is seen, a social skill once present is lost, or social difficulty appears with speech, hearing or play delays. Always pair with a hearing and vision check. This is a timely referral, not a diagnosis — early support works best, and any loss of skill or worried parent warrants prompt review.
Read the answer AnswerWhen to escalate if a child isn't socialising at the expected age
A frontline health worker should escalate when a child consistently misses social milestones for their age — no social smile by 6 months, no response to name or shared attention by 9–12 months, no pointing or shared joy by 18 months, no pretend play or peer interest by 24 months — and the pattern persists across visits or worsens. Loss of a social skill once present, or a parent's worry, are always reasons to refer onward promptly. This is early action, not a diagnosis, because support works best when it begins soon.
Read the answer AnswerWhen should a health worker escalate delayed social engagement?
A frontline health worker should escalate when a child clearly misses social milestones for their age and the gap persists — no shared smiles by ~6 months, no response to name or following a point by 9–12 months, no pointing to share by 18 months, or little interest in others by 2 years. Any loss of a previously held social skill, at any age, is an immediate flag, as is persistent parental concern. This is screening to open the door to support, not a diagnosis.
Read the answer AnswerWhen to Escalate a Child's Social-Function Delay
A frontline health worker should escalate when a child shows a clear, persistent gap in social connection for their age — and escalate immediately, without waiting, if the child has lost skills once present, or shows social differences alongside delays in talking or other red flags. Use a quick screen at every routine contact and act on caregiver concern. This is screening, not diagnosis; early referral opens the door to early support.
Read the answer AnswerWhen to escalate a child's social interaction delay
Frontline health workers should escalate when a child clearly misses age-expected social milestones — no social smile by 2–3 months, no shared babble or joy by 9 months, no pointing or showing by 12 months, little eye contact or gesture by 18 months — and the gap persists across visits, or a skill is lost, or a parent is worried. One quiet day is not a flag; a persistent pattern is. Escalation means a developmental check, not a diagnosis, because early support works best.
Read the answer AnswerIf a child cannot use social language at the expected age, when should a frontline health worker escalate?
Frontline workers should escalate social-language concerns against clear age milestones: no babble or gesture by 12 months, no words by 16 months, no two-word phrases by 24 months, no response to name with little shared smiling, or any loss of a skill once had. Loss of skills and strong parent concern always mean refer now rather than wait. These are reasons to assess early, not a diagnosis — early support works best.
Read the answer AnswerWhen to escalate social reciprocity concerns
Frontline health workers should escalate social reciprocity gaps when a child consistently misses age expectations — no shared smiles by 6 months, no back-and-forth sounds and gestures by 9 months, no response to name or pointing by 12 months, no shared attention or words by 16–18 months, or any loss of a skill. A single isolated lag can be re-screened in 4–6 weeks; a cluster, regression or strong parent concern means refer now. This is not a diagnosis — it is the right moment for a closer look.
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