Developmental screening OSCE — tool pathway and counselling

Station objectives

1. Embed screening in an 18-month preventive visit without losing family agenda. [1]
2. Run or describe M-CHAT-R/F two-stage interpretation correctly. [2]
3. Counsel that a screen is not a diagnosis. [1] [2]
4. Plan referral, hearing pathway and closed-loop follow-up. [14]
5. Address language access when relevant. [11]

Candidate brief

You are the doctor in a community clinic. Station A is 12 minutes with a parent and toddler. Station B is 8 minutes focused on result counselling and system actions. [1]

Station A — Eighteen-month screening visit

Setup: Parent booked for “needles and check.” General developmental screen is borderline for communication. M-CHAT-R total score is 4. No follow-up interview yet. Parent says “he is fine, just quiet.” [1] [2]

Expected actions:

• Confirm the child is well enough for preventive care. [1]
• Elicit parent agenda and concerns explicitly. [1]
• Explain surveillance plus standardised screening purpose in plain language. [1]
• Complete or arrange M-CHAT Follow-Up Interview before final risk banding. [2]
• Observe social communication and play briefly; do not rely on forms alone. [1]
• Mention hearing pathway if communication is the issue. [1]
• Avoid diagnosing autism in the room from the initial score. [2]

Station B — Positive pathway counselling

Setup: After follow-up, score remains ≥2. Parent is tearful. Optional twist: family needs an interpreter. [2] [11]

Expected actions:

• Use clear words: high-risk screen, not final diagnosis; many children need developmental support. [2]
• Quote pathway logic without false precision theatre. [2]
• Refer to developmental/autism evaluation and early intervention supports. [1] [2]
• Name owner, timeframe and how the family can chase the clinic. [14]
• Give interim strategies and safety-net for regression. [1]
• If language discordance: stop and get a professional interpreter before completing counselling. [11]
• Offer behavioural/relationship support resources if emotional-behavioural strain is present. [5]

Marking anchors

Clear pass: two-stage M-CHAT handled correctly; screen ≠ diagnosis; referral with closed loop; hearing considered; compassionate clear language. [1] [2] [14]
Borderline: kind tone but skips follow-up interview or leaves no owner for referral. [2]
Fail: diagnoses autism from stage-one form; dismisses parent or score; no referral plan; continues English-only counselling when interpreter is needed. [2] [11]

Debrief pearls

• Key-age screening is a system, not a complaint-triggered optional extra. [1]
• Follow-up interview is part of the tool. [2]
• Closed loops are the intervention after the stamp. [14]
• Equity includes language access. [11]