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Book Assessment
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Signs & concerns
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Signs & concerns
How long will my child need therapy?
There is no fixed timeline — some children need a few focused months, others a year or more, with most stepping down gradually as skills grow. The length depends on your child's starting point, the goals set, how early you begin, and how much practice happens at home. Therapy is a series of milestones to tick off and review, not an open-ended commitment — and good therapy is designed to make itself unnecessary.
Read the answer AnswerWhen to escalate a child's difficulty with adaptability
Adaptability (ICF d5) is how a child copes with change — new routines, places and transitions. A frontline health worker should escalate to a developmental check when difficulty adapting is persistent, age-inappropriate, disrupts daily life, or travels with delays in talking, play or social connection. This is a reason to assess early, not a diagnosis, because early support works best.
Read the answer AnswerWhen should a frontline health worker escalate an adaptive-skill delay?
Adaptive skills are everyday self-care abilities (ICF d5) — feeding, dressing, toileting, washing. A frontline worker should escalate for a developmental check when a child shows a persistent gap behind peers, no progress over 3–6 months, delays across several domains, loss of a learned skill, or clear parent concern. Escalation means a gentle referral, not a diagnosis — early support works best.
Read the answer AnswerAttachment Response: When a Frontline Worker Should Escalate
Attachment response is how a baby seeks and finds comfort in a familiar caregiver — the social smile, calming when held, looking for a parent's face. Frontline workers should escalate for a developmental check when there is no social smile by 3–4 months, no comfort-seeking or settling with the caregiver, very little eye contact or response to a familiar voice, or any clear loss of a connection once present. This is not a diagnosis — it is an early, sensible step, and early support works best.
Read the answer AnswerWhen should a frontline worker escalate attention and inhibition concerns?
A frontline health worker should escalate when a child's difficulty with attention and inhibition is persistent over weeks, clearly out of step with same-age peers, shows across settings (home, play, preschool), affects safety or learning, or travels with delays in talking or social connection. Attention and self-control mature slowly through the early years, so a single restless day is normal — a steady pattern is the trigger to refer for a developmental check. Referral is early opportunity, not a diagnosis.
Read the answer AnswerWhen to escalate a child's attention concern
A child's attention span grows with age, so a frontline worker should escalate when attention is clearly below the expected level for the child's age, is not improving across a few visits, or travels with delays in speech, social connection or learning. Loss of a skill, staring spells or sudden behaviour change need prompt medical review. Escalation is for assessment, not diagnosis, and early action works best.
Read the answer AnswerWhen to escalate auditory memory concerns
Auditory memory develops gradually, so occasional forgetting is normal. A frontline worker should escalate when difficulty holding and recalling spoken information is consistent across settings, the child cannot follow age-expected simple instructions, or it travels with delays in talking, attention or possible hearing loss. Rule out hearing first. This is a reason to assess early, not a diagnosis.
Read the answer AnswerIf a child struggles with auditory processing, when should a frontline health worker escalate?
A frontline worker should escalate when a child hears but consistently struggles to understand, follow or respond to spoken language at the expected age. The first, essential step is a hearing test and ENT review to rule out hearing loss or ear infection — auditory processing (ICF b156) is only considered once hearing is confirmed clear. Escalate promptly when difficulties persist across settings, do not improve over weeks, or come with speech-language delay. This is a referral decision, not a diagnosis.
Read the answer AnswerIf a child cannot balance at the expected age, when should a frontline health worker escalate?
Balance develops on a wide range — sitting by ~9 months, walking by ~18 months, brief one-foot balance by ~3 years. A frontline worker should escalate to a medical officer or developmental check when a child clearly misses the balance milestone for their age, loses a skill once present, shows floppy or stiff muscles, frequent falls or asymmetry, or has delays alongside in walking or talking. Sudden loss of balance, head tilt or staring spells need same-day medical referral. This is screening, not diagnosis — early referral opens early support.
Read the answer AnswerWhen should a frontline worker escalate behavioural observation concerns?
Behavioural observation (ICF b152) is watching how a child attends, plays, responds and connects. A frontline health worker should escalate to the PHC medical officer or a developmental check when expected age responses are absent across more than one visit, when a parent shares the same concern, or when there are paired delays in talking, hearing or motor skills. Prompt medical referral is needed for any regression, staring episodes or self-harm. Escalation is not alarm — it opens early support, which works best.
Read the answer AnswerWhen to escalate a cause-and-effect delay
Cause-and-effect understanding usually emerges between 8 and 12 months. A frontline health worker should escalate to a developmental check if a child well past 12 months shows no intentional, repeated actions to make things happen, or if this gap comes with delays in pointing, response to name, babble or shared attention. Stiffening spells or abnormal muscle tone need prompt medical review. This is early routing, not a diagnosis.
Read the answer AnswerWhen to Escalate a Delayed Milestone
Escalate when a child shows a clear, persistent age-expected skill delay, two or more delays together, or any loss of a skill already gained — without long watch-and-wait. One missed milestone is a note; a clear or widening gap, a worried parent, or red-flag medical signs need prompt referral. This is timely action, not diagnosis, because early support works best.
Read the answer AnswerWhen to escalate a climbing delay
Climbing usually emerges between roughly 18 months and 3 years, with wide normal variation. A frontline worker should escalate for a developmental check when a child is clearly behind peers in gross-motor play, has not begun walking by 18 months or stair-climbing by around 3 years, has lost a skill, or shows motor delay with floppy/stiff muscles or speech and social delays. Lost skills and caregiver worry warrant prompt referral. This is escalation for assessment, not a diagnosis.
Read the answer AnswerWhen should a frontline health worker escalate a child's cognitive delay?
Frontline health workers should escalate when a child misses a cognitive milestone for their age band, has clearly fallen behind same-age children, loses a skill once had, or fails a routine developmental screen. Parent concern alone is also a valid reason to refer. A flag means arrange a check, not a diagnosis — and prompt referral gives the child the best chance, because early support works best.
Read the answer AnswerWhen to escalate concerns about a child's cognitive flexibility
Cognitive flexibility develops gradually, so rigidity and difficulty with change are common in young children. A frontline health worker should escalate to a developmental check when difficulty switching tasks, rules or routines is persistent, clearly beyond age peers, and interfering with play, learning or daily life — especially alongside delays in language, social connection or self-care, or loss of a skill. This is a reason to assess early, not a diagnosis.
Read the answer AnswerWhen to escalate a child with cohesion delays
Frontline workers should escalate a child who cannot link skills like words, play and actions (cohesion) when the child is clearly behind same-age peers, when the gap widens instead of narrowing over a few months, when a caregiver is worried, or when the difficulty travels with delays in speech, social connection or daily skills. Staring spells, regression or fits need prompt medical referral. This is an early referral, not a diagnosis — community screening is the bridge to timely, effective support.
Read the answer AnswerWhen should a frontline worker escalate a communication delay?
A frontline health worker should escalate whenever a child clearly lags expected communication milestones, or loses words or gestures once present, without waiting. Key red lines: no babbling or pointing by 12 months, no words by 16 months, no two-word phrases by 24 months, or any loss of speech, social skills or response to sound at any age. These are reasons to refer for assessment — not a diagnosis — because early support works best.
Read the answer AnswerWhen to escalate social-communication (pragmatics) concerns
Pragmatics is the social use of language — turn-taking, gestures, eye contact and staying on topic. A frontline health worker should escalate when a child consistently misses age-expected social-communication milestones (e.g. no pointing or response to name by 12–18 months, no two-word phrases or pretend play by 24 months, no conversational turn-taking by 3 years), when concerns travel with other delays, when a skill is lost, or whenever a parent's worry persists. Referral is for identification, not diagnosis — early support works best.
Read the answer AnswerWhen to escalate concerns about concept formation
Concept formation — sorting, matching, and grasping ideas like big/small and same/different — develops through play across the toddler and preschool years. A frontline health worker should escalate to a developmental check when a child is clearly behind peers, has stalled or lost ground, or shows concept difficulty alongside delays in language, play or daily skills. Always check hearing and vision first. This is a reason to assess early, not a diagnosis, because early support works best.
Read the answer AnswerWhen to escalate conceptual thinking concerns
Conceptual thinking — sorting, matching, same-versus-different, cause and effect — develops through the preschool years. A frontline health worker should escalate when a child is clearly behind same-age peers across several visits, shows no progress between two screenings, or has difficulty alongside delays in speech, play, understanding or self-care. This is a referral decision, not a diagnosis, and early routing enables early support.
Read the answer AnswerWhen to escalate if a child struggles with conflict
Managing conflict is a social skill that grows gradually, not a single-age milestone, so frontline workers should not escalate for ordinary arguing, grabbing or refusing to share. Escalate to a developmental check when social-interaction difficulty is persistent and marked for age AND paired with broader concerns — few words, no response to name, little eye contact, no interest in other children, or loss of a skill. This is early support, not a diagnosis.
Read the answer AnswerWhen to escalate a child's contextual language delay
Contextual language use means using words to suit the situation — greeting, requesting, answering and adjusting to a listener. A frontline health worker should escalate when a child is clearly behind same-age milestones, when concern persists across two visits, when parents or anganwadi staff also flag it, or when language delay travels with red flags like no response to name or loss of skills. Rule out hearing first, and when in doubt, refer — early review is never wasted.
Read the answer AnswerWhen to Escalate Delayed Conversation Skills
Conversation skills — turn-taking, answering and staying on topic — develop through the toddler and preschool years. A frontline health worker should escalate to a doctor or developmental check when a child is clearly behind peers, has lost words or social skills once present, shows little response to name or speech, or when a parent is worried. Referral is not a diagnosis; it opens early support. A hearing check is often the sensible first step, as undetected hearing loss is common and treatable.
Read the answer AnswerWhen to escalate a conversational-skills delay
Conversational skills — turn-taking, responding and staying on topic — build gradually across the toddler and preschool years. A frontline health worker should escalate for a developmental check when a child is well past the expected stage (no words by 18 months, no two-word phrases by 24 months, very limited conversation by 3–4 years), when a delay travels with poor eye contact, no pointing, no response to name or loss of skills, or whenever a parent voices concern. Always pair a language concern with a hearing check. This is a timely referral, not a diagnosis.
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