Assessment of learning and developmental problems in children

Specialty: Children's developmental concerns
Age group: Children

Criteria for referral to public hospital service

Primary school aged or younger children:

• with confirmed developmental regression in any developmental domain (gross or fine motor skills, cognitive/learning skills, social/emotional, language/speech or self-care)
• where developmental screening suggests the child has either
  • delays across two or more developmental domains (gross or fine motor skills, cognitive/learning skills, social/emotional, language/speech or self-care), or
  • one or more developmental domains (gross or fine motor skills, cognitive/learning skills, social/emotional, language/speech or self-care) and with any of the following:
    • abnormal neurological signs (e.g. abnormal muscle tone or weakness issues, asymmetry in body strength or movement) or physical findings (e.g. macrocephaly or microcephaly)
    • medical conditions that are the suspected cause of the developmental delay
    • the child is at risk of or has been excluded from childcare, kindergarten or school due to physical aggression or other behaviours that place themselves or others at risk or
    • significant psychosocial risk factors such as family violence, maternal drug or alcohol use during pregnancy or early childhood, parental mental health issues, experiencing homelessness or at risk of homelessness, or the child lives in out-of-home care.

Information to be included in the referral

Information that must be provided

• Reason for referral and expectation or outcome, anticipated by the patient or their carer, and the referring clinician from referral to the health service
• Current growth measurements, including height, weight and head circumference, as well as previous growth measurements where there has been slow weight gain or concern for growth trajectory (indicate if these measurements cannot be provided due to the child’s sensory sensitivity or behavioural issues)
• If confirmed developmental regression:
  • description of onset, nature and level of developmental regression in each affected developmental domain (gross or fine motor skills, cognitive/learning skills, social/emotional, language/speech or self-care).
  • the functional or psychological impact on quality of life or activities of daily living including impact on sleeping, eating, school, study, or social activities
• If developmental screening suggests developmental delays across developmental domains provide the relevant information, including the name of completed screening tool and where applicable the outcome score, such as
  • child health nurse assessment
  • General Practitioner (GP) assessment
  • speech therapy assessment for communication, language, comprehension, or speech concerns
  • physiotherapy assessment for gait, balance, coordination, plagiocephaly, or abnormal tone
  • occupational therapy assessment for sensory problems, motor skills and social or emotional skills
  • psychology assessment for cognitive, behaviour, emotion or social skills
  • psychiatric assessment
  • school cognitive, education or language assessments (e.g. through The Students with Disability Assessment Service)
• Relevant history of any abnormal neurological or physical findings, medical conditions or psychosocial risks suspected as being linked to the child’s developmental delay (e.g. faltering growth, maternal drug or alcohol use during pregnancy, family violence, parental mental health issues, homeless or at risk of homelessness, the child lives in out-of-home care, signs of abuse or neglect)
• Any family history of developmental problems, particularly in siblings
• If the child has been excluded, or is it at risk of exclusion from childcare, kindergarten or school due to physical aggression or other behaviours that place themselves or others at risk
• Details of previous management including the course of treatment(s) and outcome of treatment(s)
• Details of current medical and non-medical management (e.g. community health services, supports or services through the National Disability Insurance Scheme (NDIS) or Early Childhood Australia (ECA), speech therapy, physiotherapy, psychology).

Provide if available

• Teacher reports, school assessments or school cognitive, education or language assessments (these often assist with identifying clinical urgency and the most appropriate specialist clinic or service)
• Other relevant assessments such as
  • Parents’ Evaluations of Developmental Status-Revised (PEDS-R^®), BRIGANCE^® Early Childhood Screen, Ages and Stages Questionnaires^®
  • diagnostic audiology assessment (this often assists with identifying clinical urgency and the most appropriate specialist clinic or service)
  • comprehensive eye and vision assessment including cycloplegic refraction and dilated retinal examination (usually performed by an optometrist or ophthalmologist) with best corrected visual acuity (i.e. measured with spectacles or contact lenses) for both eyes or visual behaviour assessment if the child is pre-literate or non-verbal
  • child health nurse assessment
  • speech therapy assessment
  • physiotherapy assessment
  • occupational therapy assessment
  • psychology assessment
  • psychiatric assessment
• Neuroimaging results including when and where imaging was performed
• Genetic test results including chromosome microarray and Fragile X syndrome
• Any relevant pathology tests results (such as free thyroxine (T4) and thyroid stimulating hormone level (TSH))
• If the child identifies as an Aboriginal and/or Torres Strait Islander
• If the child is neurodiverse
• If the child is gender diverse
• If the child has a disability
• If the child lives in out-of-home care (foster care, kinship care, permanent care or residential care) or is at risk of moving to out-of-home care
• If the child has a preferred language other than English and if they rely on cultural or linguistic support (e.g. Aboriginal cultural support, an interpreter)
• If the child is a refugee, seeking asylum or has a bridging visa while waiting for an immigration outcome.

Additional comments

The Minimum information for referrals to non-admitted specialist services lists the information that should be included in a referral request.

Note there are statewide referral criteria for Faltering growth (failure to thrive) in infants, Diagnosis and management of attention deficit hyperactivity disorder (ADHD) in children and Assessment of functional disability in adolescents.

Do not delay assistance or treatment initiation or modification while awaiting paediatrician review. If audiology and vision assessments have not been performed a referral should be made immediately to inform future review/treatment.

The referral should note if the request is for a second or subsequent opinion as requests for a second opinion will usually not be accepted.

Instances of suspected or attempted self-harm, self-harm, suicidal ideation, suicide or suspected suicide should be referred to a mental health service that best aligns with the developmental age of the child.

Developmental optometry and auditory processing assessments are not supported by evidence and are not recommended in developmental screening.

Where appropriate and available the referral may be directed to an alternative specialist clinic or service.

Referral to a public hospital is not appropriate for

• Delays within a single developmental domain (gross or fine motor skills, cognitive/learning skills, social/emotional, language/speech or self-care) without any of the following:
  • abnormal neurological signs (e.g. abnormal muscle tone or weakness issues, asymmetry in body strength or movement) or physical findings (e.g. macrocephaly or microcephaly)
  • medical conditions that are the suspected cause of the developmental delay
  • the child is at risk of or has been excluded from childcare, kindergarten or school due to physical aggression or other behaviours that place themselves or others at risk or
  • significant psychosocial risk factors such as family violence, maternal drug or alcohol use during pregnancy or early childhood, parental mental health issues, experiencing homelessness or at risk of homelessness, or the child lives in out-of-home care.
• Where correcting the child’s hearing or vision would address the issues of concern.