Intellectual developmental disorder OSCE — diagnosis counselling and care planning

Station objectives

1. Elicit adaptive and developmental history that can support an IDD formulation. [5]
2. Explain that IDD needs intellectual and adaptive criteria, not IQ alone. [5]
3. Start supports without waiting for every genetic result. [1] [16]
4. Outline first-line aetiological testing including microarray. [2] [3]
5. Use clear, non-stigmatising language and safety-net regression or acute change. [1]

Candidate brief

You are the paediatric doctor in clinic. Station A is 10 minutes with a parent and child history focus. Station B is 8 minutes of explanation and shared planning after psychology testing confirms intellectual developmental disorder of mild severity by adaptive support need. [5]

Station A — History and formulation

Setup: Six-year-old referred for “slow learning.” Parent says homework is impossible. Child still needs help with buttons and wiping. Hearing screen at school was incomplete. No regression. English is the second language for the parent. [1] [19]

Expected actions: [1] [5]

• Offer a professional interpreter before detailed history if language discordance is present. [19]
• Map conceptual, social and practical adaptive examples. [5]
• Ask pregnancy, neonatal, milestone, seizure, family history and school trajectory. [1]
• Check hearing/vision status and prior developmental services. [1]
• Avoid diagnosing from school report alone. [5]
• Signal that supports can start while assessment continues. [16]

Station B — Counselling after diagnosis

Setup: Formal cognitive and adaptive testing supports mild intellectual developmental disorder. Parent asks, “Does this mean he cannot learn anything?” and “Can we wait for the gene test before therapy?” [5] [1]

Expected actions: [5] [1]

• Explain IDD in plain language: thinking skills and everyday skills both affected, present from development, severity by support need. [5]
• State hope and specificity: children learn; they need the right teaching and supports. [5]
• Plan education adjustments, therapy referrals and care coordination. [16]
• Outline CMA as first-tier genetics; mention possible later exome/genome sequencing per specialist pathway. [2] [3]
• Refuse the “wait for genetics before help” trap. [1]
• Safety-net: return sooner for skill loss, new seizures, major behaviour change or safety concerns. [1]
• Teach-back the plan and name owners/dates. [16]

Examiner marking cues

• Uses adaptive domains, not IQ-only language. [5]
• Parallel intervention + aetiology. [1] [2]
• Interpreter when needed. [19]
• No false certainty about a single cause before testing. [3]