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Book Assessment
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Signs & concerns
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Signs & concerns
When 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 an ASHA or PHC worker escalate a child showing signs of ADHD?
Escalate a school-age child (around 6+) when inattention, hyperactivity or impulsivity persists for 6+ months across two settings (home and school) and disrupts learning or relationships — confirmed by parent and teacher. Refer promptly if red flags suggest another cause. The worker notices and routes; only a clinician diagnoses.
Read the answer AnswerWhen should an ASHA or PHC worker escalate a child showing signs of Attachment Difficulties?
Escalate when a child shows a persistent pattern — not a single episode — of not seeking comfort, emotional withdrawal, or indiscriminate friendliness, especially with neglect, caregiver instability or growth faltering. Escalate urgently if abuse or failure to thrive is suspected. Observe, document, reassure, route — never label.
Read the answer AnswerWhen should an ASHA or PHC worker escalate a child showing signs of Auditory Processing Difficulties?
Escalate when a child hears sound but consistently struggles to understand speech — especially in noise or with multi-step directions — and it persists. Always rule out hearing loss first with an audiology referral. Refer urgent flags (no response to sound, lost skills, ear discharge) promptly; route routine concerns for assessment. The community worker notices and routes; only a clinician confirms.
Read the answer AnswerWhen should an ASHA or PHC worker escalate a child showing signs of Autism Spectrum?
Escalate whenever a child fails a routine developmental check, a parent raises a real concern, or any red flag persists — and treat loss of previously acquired skills as urgent. A community health worker catches and routes; only a clinician diagnoses. When in doubt, refer for a developmental check.
Read the answer AnswerWhen should an ASHA or PHC worker escalate signs of cerebral palsy?
Escalate promptly — do not wait-and-watch — when an infant shows persistent stiff or floppy tone, early hand preference before 12 months, a missed motor milestone, or feeding difficulty, especially with a high-risk birth history. Cerebral palsy is a medical referral; any seizure is an emergency. Early referral is always the safer call.
Read the answer AnswerWhen should an ASHA or PHC worker escalate a child showing signs of childhood anxiety?
Worry is normal in childhood; a persistent pattern that disrupts daily life is the flag. ASHA and PHC workers should route — not diagnose — referring children with weeks-long fearfulness, school refusal or unexplained physical complaints, and escalating same-day for self-harm talk, severe panic or refusal to eat.
Read the answer AnswerWhen to escalate a child with signs of Childhood Apraxia of Speech
Escalate when a child shows persistent, effortful speech difficulty that doesn't match their understanding — groping mouth movements, inconsistent errors, very limited intelligible speech past age, or no steady progress. The worker's job is to recognise and route; only a clinician confirms CAS.
Read the answer AnswerWhen should an ASHA or PHC worker escalate childhood epilepsy?
Childhood epilepsy is referred to a doctor first, not therapy first. Escalate immediately by calling 108 for a seizure over 5 minutes, repeated seizures, breathing trouble, or a first-ever seizure with red flags. Arrange prompt 24–48 hour medical referral for any first seizure or changing seizure pattern. The community worker's role is recognition, first-aid safety and fast escalation.
Read the answer AnswerWhen should an ASHA or PHC worker escalate a child with sleep difficulties?
Occasional broken sleep is normal and settles with simple routine support. Escalate to the Medical Officer or paediatrician when sleep difficulty is persistent for weeks, involves snoring or breathing pauses, affects daytime development and growth, or comes with seizure-like night events or a developmental concern. The ASHA/PHC role is to spot, support and route — never diagnose.
Read the answer AnswerWhen should an ASHA or PHC worker escalate Conduct-Dissocial Disorder?
Escalate when a child of school age shows a persistent pattern (6 months or more) of harmful, rights-violating or seriously norm-breaking behaviour across settings — not a one-off tantrum. Escalate the same day for any safety risk. Frontline workers document and route; only a Pinnacle clinician diagnoses.
Read the answer AnswerWhen to Escalate a Child Showing Signs of DCD
Escalate when motor clumsiness is persistent past age 5, interferes with daily life, is out of step with other development, and has no obvious cause — routing through the Medical Officer. Loss of skills or neurological signs need urgent medical referral. The worker flags; only a clinician diagnoses.
Read the answer AnswerEscalating signs of Developmental Language Disorder: a guide for ASHA and PHC workers
Escalate when a child shows a persistent, age-inappropriate language difficulty — no words by 18 months, no two-word phrases by 2.5–3 years, not understood by age 3, or jumbled speech past age 4 — and especially on any loss of skills. Rule out hearing first and route to a clinician; only a qualified clinician can confirm DLD.
Read the answer AnswerWhen should an ASHA or PHC worker escalate developmental regression?
Developmental regression — the loss of skills a child once had — always warrants prompt escalation, never watch-and-wait. ASHA/PHC workers should refer to the Medical Officer the same week, and the same day if seizures, fever or acute signs appear. Diagnosis is never made in the field.
Read the answer AnswerWhen should an ASHA or PHC worker escalate a child showing signs of developmental trauma?
Escalate when stress-related behavioural, emotional or developmental signs persist beyond 2–4 weeks, occur alongside known adversity, or carry any safety risk. ASHA/PHC workers notice, document, support and route to the Medical Officer and child-protection services — never diagnose. When in doubt, refer.
Read the answer AnswerWhen should an ASHA or PHC worker escalate signs of Down syndrome?
Down syndrome is recognisable at or near birth, so an ASHA or PHC worker should escalate promptly — refer to the Medical Officer the same day when a cluster of newborn signs is seen, and urgently if there are breathing, feeding or heart-related red flags. Diagnosis is by paediatric karyotype, never a checklist.
Read the answer AnswerWhen should an ASHA or PHC worker escalate a child showing signs of dyscalculia?
Escalate when a child aged 7 or older shows persistent maths difficulty across two school terms that is out of step with other skills and not explained by missed schooling, language or sensory issues. Below that age, observe and support. Rule out hearing, vision and attendance first, then route to the PHC medical officer or RBSK pathway. Only a clinician can confirm dyscalculia.
Read the answer AnswerWhen should an ASHA or PHC worker escalate a child showing signs of Dysgraphia?
Escalate a school-age child (7+ years) showing persistent, clustered written-expression difficulty despite adequate teaching, normal vision and no obvious intellectual delay. Below 6–7, reassure and monitor. Route urgent signs — seizures, skill loss, motor weakness — for prompt medical review. ASHA/PHC workers recognise and refer; they do not diagnose.
Read the answer AnswerWhen should an ASHA or PHC worker escalate a child with signs of dyslexia?
Escalate a school-age child (roughly 6–8 years or older) with persistent reading difficulty that does not match their ability, once hearing and vision are ruled out, and especially if it persists beyond one school term or causes distress. Below 6, monitor rather than label. Diagnosis is made only by a clinician.
Read the answer AnswerEscalating Emotional & Behavioural Difficulties from ASHA/PHC
Escalate when an emotional or behavioural difficulty is persistent (beyond 4–6 weeks), severe, or disrupting daily life — and immediately for self-harm, harm to others, or sudden regression. ASHA/PHC workers recognise the pattern and route; clinicians diagnose.
Read the answer AnswerWhen to Escalate Feeding & Eating Difficulties
Escalate promptly when feeding difficulty threatens safety, hydration or growth: choking or gurgly breathing during feeds, signs of dehydration, faltering growth, or any infant under 6 months feeding poorly need same-day medical referral. Persistent but stable difficulties warrant routine developmental assessment. When in doubt, refer — feeding is a safety domain.
Read the answer AnswerWhen should an ASHA or PHC worker escalate a child showing signs of FASD?
An ASHA or PHC worker should escalate when a child shows growth faltering plus developmental or behavioural concerns — especially with suspected prenatal alcohol exposure. The worker recognises the pattern and refers to the Medical Officer or DEIC; FASD is confirmed only by a clinician, never in the field.
Read the answer AnswerWhen should an ASHA or PHC worker escalate Fine Motor Delay?
Escalate when a fine motor delay is persistent across visits, when a milestone is clearly missed for age, or when red flags appear — regression, asymmetry, stiffness/floppiness, or delay alongside other developmental concerns. A single off-day observation is not enough; a documented pattern or any red flag warrants prompt referral. Workers screen and route — clinicians diagnose.
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