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Book Assessment
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Signs & concerns
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Signs & concerns
When should a doctor investigate throwing objects in a young child?
Throwing objects is developmentally normal from 12–18 months and through the preschool years. Investigate when it is frequent, intense and persists beyond about 4 years, causes harm, is disproportionate, fails to respond to consistent strategies, or co-occurs with developmental delay, communication difficulty, regression or sensory/regulation concerns. The behaviour is a symptom in context — escalate to developmental–behavioural assessment when impairment or red flags are present.
Read the answer AnswerWhen should a doctor investigate toe-walking in a young child?
Investigate toe-walking when it persists beyond about 2 years, is unilateral or asymmetric, shows reduced ankle dorsiflexion or calf contracture, is regressive, or carries neurological or developmental red flags such as spasticity, calf pseudohypertrophy or co-occurring communication and sensory differences. Bilateral intermittent toe-walking with full range and a normal neurological examination is usually idiopathic and warrants monitoring. Idiopathic toe-walking is a diagnosis of exclusion — examine, screen developmentally, and refer onward where indicated.
Read the answer AnswerWhen should a doctor investigate toilet-training resistance?
Most toilet-training resistance in 2–4-year-olds is a normal autonomy struggle that resolves with a relaxed, child-led approach. A doctor should investigate when there are organic flags (constipation/encopaenia, dysuria, abnormal stream, neurological signs), regression after established continence, delayed readiness beyond ~4 years, or resistance within a broader developmental or psychosocial picture. Treat occult constipation first; refer for developmental assessment where resistance is one strand of a wider pattern.
Read the answer AnswerWhen should a doctor investigate very early rising in a young child?
Very early rising in young children is usually a benign circadian or short-sleeper variant needing reassurance and sleep-hygiene review. Investigate when it carries daytime impairment, snoring or apnoea, paroxysmal events on waking, regression, or red-flag medical features. In a thriving, well-rested child with no impairment, optimise sleep environment and routine rather than work up.
Read the answer AnswerWhen should a doctor refer a child with suspected ADHD for developmental therapy?
Refer when attention, hyperactivity or impulsivity persistently impairs function across settings — not after diagnosis is confirmed, but in parallel. Under 6, parent-led behavioural therapy is first-line ahead of medication. Diagnosis is made only by a Pinnacle clinician.
Read the answer AnswerWhen to refer suspected attachment difficulties for developmental therapy
Refer when relational disturbance is persistent, pervasive across caregivers and settings, and functionally impairing — not after one distressed episode. Screen first for maltreatment and safeguarding, begin with dyadic caregiver-inclusive support, and add developmental therapy where comorbid delay, communication or regulatory difficulties coexist. Diagnosis is made only by a Pinnacle clinician.
Read the answer AnswerWhen to Refer a Child with Suspected Auditory Processing Difficulties
Refer once normal peripheral hearing is confirmed yet persistent, cross-setting listening difficulties affect language, literacy or learning. Diagnostic auditory processing testing is valid from around 7 years; refer earlier for language support when concerns coexist. Begin functional support without waiting for a formal label.
Read the answer AnswerWhen should a doctor refer a child with suspected autism for developmental therapy?
Refer at the point of suspicion, not after diagnosis. A failed autism screen, any loss of skills, missed social-communication milestones or persistent parental concern should trigger dual-track referral: diagnostic evaluation plus concurrent developmental therapy, without waiting for a formal label.
Read the answer AnswerWhen should a doctor refer a child with suspected Cerebral Palsy for developmental therapy?
Refer at the point of suspicion, not after diagnostic confirmation. High-risk history, abnormal tone, asymmetry, early hand preference or delayed motor milestones all warrant parallel referral. GMA and HINE enable detection before 6 months — and neuroplasticity makes early therapy most effective.
Read the answer AnswerWhen should a doctor refer a child with suspected Childhood Anxiety for developmental therapy?
Refer when childhood anxiety is persistent (≥4 weeks), functionally impairing across home, school or peers, or developmentally disproportionate — especially with school refusal, unexplained somatic complaints, or suspected co-occurring neurodevelopmental concerns. Mild situational worry warrants monitoring; safety concerns warrant urgent escalation.
Read the answer AnswerWhen to refer suspected Childhood Apraxia of Speech
Refer at suspicion, not at certainty. A cluster of motor-speech markers — inconsistent productions, groping, prosodic disruption, expressive-receptive gap — warrants prompt referral to a paediatric SLP, as CAS rarely self-resolves and benefits from early intensive intervention.
Read the answer AnswerWhen to Refer Suspected Childhood Epilepsy for Developmental Therapy
Refer for developmental therapy in parallel with epilepsy work-up — not after — whenever developmental, language, motor, behavioural or learning concerns accompany suspected childhood epilepsy. Early-onset, frequent or drug-resistant seizures and any regression warrant concurrent referral at diagnosis. A clinician confirms diagnosis and baseline.
Read the answer AnswerWhen to refer a child with sleep difficulties for developmental therapy
Refer for developmental therapy when childhood sleep difficulty persists despite optimised routines and co-occurs with developmental concerns — communication, sensory or regulation differences — or when daytime function is affected. Exclude medical sleep pathology (apnoea, suspected seizures) first via the appropriate medical pathway.
Read the answer AnswerWhen to refer suspected Conduct-Dissocial Disorder for therapy
Refer when the pattern is persistent (months), pervasive across settings and functionally impairing — and refer early to surface treatable drivers like language disorder, ADHD or trauma. Escalate urgently where there is risk of serious harm. Diagnosis is formed only at a Pinnacle centre.
Read the answer AnswerWhen to Refer Suspected DCD for Developmental Therapy
Refer when motor difficulties are persistent, age-inappropriate and functionally limiting — affecting self-care, handwriting or participation — and not explained by another condition. You needn't wait for a confirmed DCD diagnosis; suspected functional motor impairment is enough, and earlier referral reduces secondary academic and emotional sequelae.
Read the answer AnswerWhen should a doctor refer suspected DLD for developmental therapy?
Refer once a language delay is persistent, age-inappropriate and not explained by a transient cause — typically no two-word combinations by 24–30 months, clear lag at 3–4 years, receptive involvement, functional impact, or any regression. Referral should not wait for a confirmed DLD diagnosis; assessment and therapy run in parallel.
Read the answer AnswerWhen to refer suspected developmental regression for therapy
Developmental regression is a refer-now sign, not a watch-and-wait one. Pursue urgent medical/neurology evaluation to exclude treatable causes, and refer in parallel for developmental therapy once acute risk is addressed. Escalate immediately when regression co-occurs with seizures or rapid deterioration.
Read the answer AnswerWhen to refer suspected Developmental Trauma for developmental therapy
Refer a child with suspected Developmental Trauma for developmental therapy when functional impairment is evident across settings and persists in a safe, stable environment — do not wait for a formal label. Address safeguarding and medical risks in parallel. Diagnosis and AbilityScore® are formed only at a Pinnacle centre.
Read the answer AnswerWhen should a doctor refer a child with suspected Down syndrome for developmental therapy?
Refer at the point of clinical suspicion, not after karyotype confirmation. Down syndrome carries a well-characterised developmental trajectory, so developmental therapy should begin in the neonatal period or earliest infancy, running concurrently with the medical work-up.
Read the answer AnswerWhen to refer suspected dyscalculia for developmental therapy
Refer when a child shows persistent, unexpected difficulty with number sense and arithmetic disproportionate to age and ability, unresponsive to good teaching over one to two terms. Dyscalculia is reliably identifiable from age 7–8; earlier numerical red flags warrant monitoring and a developmental check. Diagnosis is formed only at a Pinnacle centre.
Read the answer AnswerWhen should a doctor refer suspected dysgraphia for developmental therapy?
Refer a child with suspected dysgraphia when written-expression difficulty is persistent, unexpected for ability, and impairing — typically actionable from age 7–8 once formal writing demands are set. Refer promptly rather than waiting out the school year, and rule out vision, motor and instructional causes first.
Read the answer AnswerWhen should a doctor refer a child with suspected dyslexia for developmental therapy?
Refer when reading difficulty is persistent and unexpected despite adequate instruction and intact ability — typically lagging peers and not responding to a 6–8 week classroom boost. Formal dyslexia is identified from around age 7–8; before that, refer for early screening, not watch-and-wait. Only a clinician confirms it.
Read the answer AnswerWhen should a doctor refer a child with suspected Emotional & Behavioural Difficulties for developmental therapy?
Refer when emotional–behavioural difficulties are persistent (~6 months), pervasive across settings, and functionally impairing — and refer urgently for red flags such as regression, self-harm or safety risk. Exclude treatable and medical causes first; a structured developmental assessment then clarifies whether behaviour is primary or a co-occurring signal.
Read the answer AnswerWhen should a doctor refer a child with suspected Feeding & Eating Difficulties for developmental therapy?
Refer for developmental therapy once acute medical causes are excluded or stabilised and the difficulty is persistent and functional: faltering growth, mealtimes over 30 minutes or daily distress, severe food selectivity, prolonged tube/supplement dependence, or feeding difficulty with a co-occurring developmental condition. Refer urgently for medical review where aspiration or dysphagia is suspected.
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