Neurodevelopmental Presentation in a Child Greater Than 6 Years of Age - Paediatric CPC

For clinical advice, please telephone the relevant specialty service.

Northern Adelaide Local Health Network

• Lyell McEwin Hospital (08) 8182 9000

Southern Adelaide Local Health Network

• Flinders Medical Centre (08) 8204 5511

Women's and Children's Health Network

• Women’s and Children’s Hospital (08) 8161 7000

Regional Health Networks 

Eyre and Far North Local Health Network

• Port Lincoln Hospital (08) 8682 5831
  

Flinders and Upper North Local Health Network

• Port Augusta Hospital (08) 8668 7500

Limestone Coast Local Health Network

• Mount Gambier District Hospital (08) 8721 1200

Inclusions

• children with suspected or diagnosed complex presentations who require ongoing medical management such as
  • autism spectrum disorder (ASD)
  • fetal alcohol spectrum disorder (FASD)
  • attention deficit hyperactive disorder (ADHD)
  • intellectual impairment
  • global developmental delay

Exclusions

• assessment for suspected complex neurodevelopmental disorders such as autism spectrum disorder (ASD)/Foetal Alcohol spectrum disorder (FASD), refer to the Diagnostic assessment for Developmental Concerns (Developmental Assessment Services) Paediatric CPC
• auditory processing disorder
• oppositional defiance disorder, refer to child and adolescent mental health services (CAMHS)
• primary mental health presentations
  • aggressive behaviour with high risk of significant injury to vulnerable family members/children who may be at risk of self-harm, refer to CAMHS
• specific learning difficulties including dyslexia/reading
• stuttering without associated speech and language disorder

Triage categories

Category 1 (appointment clinically indicated within 30 days)

• child aged older than 6 years with any of the following:
  • new onset or unstable physiological concerns such as
    • abnormal neurological features
    • seizures
    • developmental regression

Category 2 (appointment clinically indicated within 90 days)

• child aged older than 6 years with any of the following:
  • physiological concerns
    • premature birth (less than 32 weeks gestation)
    • significant unmanaged co-morbidities which could affect behaviour
  • psychosocial concerns
    • acute behaviour changes in known developmental disorder
    • investigated by child protective services/under the custody or guardianship of the Chief Executive

Category 3 (appointment clinically indicated within 365 days)

• ongoing management of a child with complex presentation:
  • autism spectrum disorder (ASD)
  • fetal alcohol spectrum disorder (FASD)
  • global developmental delay

Essential referral information

Completion required before first appointment to ensure patients are ready for care. Please indicate in the referral if the patient is unable to access mandatory tests or investigations as they incur a cost or are unavailable locally.

• past medical history, provide any relevant features as relating triage categories
• medications and allergies
• previous management trialled and outcomes
• height and weight
• physical examination findings
• neurological examination findings

Concerning features including

• developmental regression
• significant physical illness
• unintentional weight loss
• seizure or neurological features
• functional impairment including feeding, toileting or sleep issues
• behaviours of concern including:
  • features of autism spectrum disorder (ASD)
  • features of attention deficit hyperactive disorder (ADHD)
  • features of oppositional defiant disorder
  • potential for aggression

Additional information to assist triage categorisation

• family history, including family members affected with ASD, attention deficit disorder (ADD), learning difficulties or mental illness
• psychosocial factors including parental relationship issues, mental illness, substance abuse, parental disability, family in crisis, or child protection involvement
• body mass index (BMI) if child is aged ≥ 16 years
• growth chart trends
• blood pressure trends
• visual acuity examination within last 6 months
• audiometry examination findings
• investigations if appropriate:
  • genetic test screening
  • speech assessment
  • occupational assessment
  • physiotherapy assessment
  • psychology assessment
• relevant allied health, diagnostic, imaging reports including location of company and accession number

Clinical management advice

Behavioural disorders in children encompass a range of conditions characterised by persistent patterns of disruptive or problematic behaviours. Recognising and understanding symptoms is crucial for commencement of early intervention approaches with parents, educators, and mental health professionals to improve outcomes for children and their families.

Clinical resources

• Emerging Minds
• Parenting SA – Milestones: Children 0 to 4 years – Parent Easy Guide, log in required
• Royal Australian College of General Practitioners – Problem behaviour in children (an approach for general practice)
• Autism CRC - National Guideline for supporting the learning, participation, and wellbeing of autistic children and their families in Australia 
• Therapeutic Guidelines – Assessing developmental delay and disability

Consumer resources

• ADHDFoundation Australia - ADHD and the facts
• Cerebral Palsy Alliance - What is cerebral palsy
• Emerging Minds
• FASD HUB Australia – For People with FASD, Parents and Carers
• Global Developmental Delay – Understanding Global Developmental Delay
• Inclusion Australia – What is intellectual disability?
• Language Disorder Australia - Developmental Language Disorder
• Parenting SA – Children with disability - Parent Easy Guide
• Raising Children Network - Suitable for 5-18 years Conduct disorder: children and teenagers
• Raising Children Network - Suitable for 5-8 years School age: development share (aged 5-8 years)

Reason for request

• to establish a diagnosis
• for treatment or intervention
• for advice and management
• for specialist to take over management
• for a specified test/investigation the General Practitioner cannot order
• for other reason (e.g. rapidly accelerating disease progression)
• transfer of care from another tertiary service
• clinical judgement indicates a referral for specialist review is necessary.

Patient demographic details

• full name, including aliases
• date of birth
• residential and postal address
• telephone contact number/s – home, mobile and alternative
• Medicare number, where eligible
• name of the parent or caregiver, if appropriate
• preferred language and interpreter requirements
• identifies as Aboriginal and/or Torres Strait Islander

Clinical modifiers

• impact on employment
• impact on education
• impact on home
• impact on activities of daily living
• impact on ability to care for others
• impact on personal frailty or safety
• identifies as Aboriginal and/or Torres Strait Islander

Other relevant information

• Willingness to have surgery, where surgery is a likely intervention.
• Choice to be treated as a public or private patient.
• Compensable status, e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.
• Relevant social history, including identifying if you feel your patient is from a vulnerable population, under guardianship/out-of-home care arrangements and/or requires a third party to receive correspondence on their behalf.
• Triage of a specialist outpatient referral is based on clinical decision making to allocate an appropriate urgency categorisation.
  
• Where appropriate and where available, the referral may be streamed to an associated public allied health and/or nursing service. Access to some specific services may include initial assessment and management by associated public allied health and/or nursing, which may either facilitate or negate the need to see the public medical specialist.
• A change in patient circumstance (such as condition deteriorating or pregnancy) may affect the urgency categorisation and should be communicated as soon as possible.
• All new referrals will be triaged by a consultant and appointment times scheduled according to clinical urgency.

Adolescents transitioning from paediatric to adult specialist services require a formal handover from paediatric specialist clinician to adult specialist clinician as well as a formal referral from the referring specialist to ensure initial transfer of care is completed.

The General Practitioners role in this process is to provide support to patients as part of holistic care. All ongoing referrals to specialists can subsequently be provided by the General Practitioner once the transfer of care has occurred.