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Special Education
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Signs & concerns
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Signs & concerns
When to Refer a Non-Verbal or Minimally Verbal Child
Refer when speech milestones are clearly missed — no gestures by 12 months, no words by 18, no two-word phrases by 24 — or whenever a child loses words they once had. Always check hearing first. Minimally verbal is a description, not a diagnosis; only a clinician can find the cause.
Read the answer AnswerWhen should a frontline health worker refer a child with possible ODD?
Refer when defiant, angry behaviour has lasted six months or more, occurs across more than one setting, and is harming relationships, learning or family life — and urgently if there is aggression, self-harm or suspected abuse. ODD is recognised from about age 4; only a clinician confirms it.
Read the answer AnswerWhen should a frontline health worker refer persistent toe-walking?
Occasional tiptoe walking under age three is usually normal and settles with growth. A frontline worker should refer when toe-walking persists beyond three, happens on most steps, is one-sided, comes with tight calves or heel cords, or appears alongside delays in speech, play or motor skills. Loss of a previously gained skill needs prompt medical referral. When unsure, a developmental check reassures the family and catches treatable causes early.
Read the answer AnswerWhen to Refer a Preterm Child for Developmental Risk
Link every preterm baby to specialist follow-up from discharge, and refer promptly on red flags judged by corrected age — stiffness or floppiness, feeding or growth trouble, vision/hearing concerns, delayed babble or words, or any lost skill. When in doubt, refer; field workers screen and route, clinicians diagnose.
Read the answer AnswerWhen should a frontline health worker refer a child with possible Rett Syndrome?
Refer promptly when a girl who was developing normally (typically 6–18 months) slows, stalls, or loses skills — especially loss of purposeful hand use with repetitive hand-wringing, slowing head growth, and lost eye contact. You don't need certainty; recognise and route. Diagnosis is made only by a specialist.
Read the answer AnswerWhen should a frontline health worker refer a child with possible School Readiness Gap to a specialist?
Refer a child aged roughly 4–6 when a school readiness gap persists despite simple support, or sits alongside a developmental red flag — limited language, poor attention, motor or self-care difficulty, or any loss of skills. When in doubt, refer; early assessment is low-risk. Diagnosis is made only by a clinician.
Read the answer AnswerWhen should a frontline health worker refer a child with possible Selective Mutism?
Refer when a child speaks freely at home but stays consistently silent in select settings such as school for more than about a month, and it disrupts learning or friendships — after ruling out a general language delay or a new-language situation. It is anxiety-based and highly treatable; only a clinician confirms it.
Read the answer AnswerWhen to refer a child with self-regulation difficulties
Refer a child with possible self-regulation difficulties when the struggles are frequent, intense and lasting beyond what is typical for the child's age, or when they disrupt sleep, feeding, play, learning or relationships. A single tantrum is normal; a pattern continuing for weeks that interferes with daily life — or persistent parent worry — deserves a developmental check. Sudden skill loss, staring spells or faltering growth need prompt medical review. When in doubt, refer; early support is always safe.
Read the answer AnswerWhen should a frontline health worker refer Sensory-Based Feeding Selectivity?
Refer when feeding selectivity is persistent or narrowing, affects growth, causes mealtime distress, or limits function beyond a normal fussy phase. Any swallowing difficulty or dehydration needs same-day medical review. Frontline workers notice and route; diagnosis happens only at a Pinnacle centre.
Read the answer AnswerWhen to refer possible Separation Anxiety Disorder
Refer when separation distress is persistent (around 4 weeks or more), out of step with the child's age, and causing real impairment — school refusal, sleep problems, or unexplained physical complaints. Brief clinginess settles; an escalating, impairing pattern needs a specialist. Only a clinician can diagnose.
Read the answer AnswerWhen should a frontline health worker refer a child with possible Social Communication Difficulties?
Refer when a communication concern is persistent, affects everyday social interaction, or keeps being raised by parents or teachers. You needn't confirm anything — notice the pattern, check hearing, and route it. When in doubt, refer; only a clinician diagnoses.
Read the answer AnswerWhen should a frontline health worker refer a child with possible Specific Learning Disability?
Refer once academic difficulty is persistent (6+ months despite help), well below age expectation, and not explained by schooling, hearing, vision or another condition — typically from age 6–7 when formal learning has begun. Rule out simple causes first; only a clinician confirms it.
Read the answer AnswerWhen should a frontline health worker refer a child with possible Stereotyped Movement Disorder?
Refer a child with possible Stereotyped Movement Disorder when movements cause self-injury, persist past the toddler years, interfere with daily life, or come with developmental concerns. Refer the same day for medical red flags like sudden onset or loss of awareness. Diagnosis is made only by a clinician.
Read the answer AnswerWhen to Refer a Child with Possible Tourette Syndrome
Refer a child with tics that have lasted several weeks or more — especially both movement and sound tics — or that disrupt school, sleep or wellbeing, or distress the family. Frontline workers screen and route; only a specialist diagnoses.
Read the answer AnswerWhen should a frontline health worker refer a child with possible visual impairment?
Refer promptly, never wait and watch. Any white pupil, persistent squint past 3 months, no following of a face/light by 3 months, wobbling eyes, or any preterm baby needs urgent specialist eye referral. Frontline screening flags the concern; only a clinician diagnoses.
Read the answer AnswerWhen should I worry that my child cannot sit still?
From 2 to 7 years, high energy and fidgeting are usually normal — young children are made to move, and sitting still comes slowly with age. Seek a developmental check when restlessness is far greater than peers, happens in every setting, gets in the way of play, learning or friendships, or comes with delays in talking or listening. This is a reason to look calmly and early, not a diagnosis.
Read the answer AnswerWhen Should I Worry About Lining Up Toys?
Lining up toys is common and usually typical play between 18 months and 6 years, showing a child exploring order and patterns. Worry is warranted only when lining up replaces all other play, cannot be interrupted without big distress, or travels alongside delays in talking, shared attention or social connection. These are reasons for an early developmental check, not a diagnosis.
Read the answer AnswerWhen should I worry about my child's cognitive development?
Cognitive development — thinking, learning, memory, attention and problem-solving — varies widely, and one delay rarely means trouble. Seek a developmental check when your child is clearly behind peers across several areas, has stopped progressing, or has lost a skill once mastered. This is a reason to assess early, not a diagnosis, because early support works best.
Read the answer AnswerWhen should I worry about my child not following instructions?
Not following instructions is very common and usually normal between 18 months and 6 years — toddlers are distracted, building language and learning their own will. Seek a developmental check when your child seems not to hear or understand instructions (rather than choosing to ignore), when it comes with delays in talking, attention or social connection, or when it's constant across all settings. A hearing check is a sensible first step. This is a reason to observe and assess early, not a diagnosis.
Read the answer AnswerWhen to Worry About Attachment Difficulties at 12–18 Months
At 12–18 months, attachment is still forming, so clinginess, separation upset and stranger wariness are healthy signs — not worries. A gentle check makes sense only if a toddler persistently fails to seek comfort, seems consistently withdrawn, or is strikingly over-friendly with strangers, especially after disrupted early care. These are patterns to observe, never a diagnosis — only a Pinnacle clinician can assess.
Read the answer AnswerWhen should I worry about Auditory Processing Difficulties at 12–18 months?
Auditory Processing Difficulties cannot be diagnosed at 12–18 months — this label is only meaningful from around age 7, once hearing is confirmed normal and a child can do listening tasks. At this age, watch hearing and early communication instead: does your toddler respond to sound, to their name, and begin babbling and gestures? If not, the first step is a prompt hearing check, never a processing assessment.
Read the answer AnswerAnxiety in a 12–18-Month-Old
At 12–18 months, clinginess, crying at separation and stranger wariness are normal, healthy signs of secure attachment — not Childhood Anxiety, which is not a meaningful diagnosis at this age. There is no frightening signs list to fear. Offer steady, predictable, warm care, and seek a general developmental check if distress never settles with a familiar carer, skills are lost, or sleep and feeding are severely disrupted. Only a Pinnacle clinician can assess; never an online form.
Read the answer AnswerWhen to Worry About Apraxia of Speech at 12–18 Months
At 12–18 months, Childhood Apraxia of Speech cannot be reliably identified — a child needs to be attempting words before its tell-tale inconsistency shows, usually from age 2–3. The right focus now is the foundations: babbling, gestures, understanding and social connection. Absent babbling, no gestures, no response to name, or lost skills deserve a general developmental check. Only a Pinnacle clinician can assess, never an online form.
Read the answer AnswerWhen should I worry about epilepsy in my 12–18 month old?
Epilepsy in a 12-to-18-month-old is a medical question first, not a therapy one. Any seizure or repeated unusual episode — stiffening, clustered jerks, blank unreachable stares, going limp or blue — deserves a prompt paediatric or neurology review, not home-watching. A single episode is not a diagnosis, but it warrants a same-week medical opinion; call emergency services for any seizure over 5 minutes or breathing trouble. Only a clinician can assess; AbilityScore® is never a substitute for urgent medical care.
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