Paeds Cases · growth-development-and-behaviour
Toddler social communication concern — autism recognition OSCE
OSCE on autism red flags, screening limits, hearing check and referral counselling.
osce development and communication
On this page & tools
Target exams
MRCPCH ClinicalRACP DCE
Prompt
19-month-old with caregiver concern about limited pointing and reduced social response.
Objectives
- Elicit social communication concerns with open then structured probes. [1]
- Observe joint attention, gesture, response to name and play. [4]
- Explain autism-specific screening limits and plan hearing check. [2] [3]
- Counsel referral, interim supports and safety-net with teach-back. [7] [8]
Candidate brief
12-minute station. Caregiver and toddler present. [1]
Expected actions
- Open concern-focused history without dismissing caregiver worry. [1]
- Observe social communication behaviours, not vocabulary alone. [4]
- Explain surveillance vs autism-specific screening in plain language. [3]
- Plan validated autism-specific tool with follow-up when indicated; state screen ≠ diagnosis. [2]
- Arrange hearing assessment and early referral with interim supports. [1] [3]
- Safety-net wait time; document and hand over clearly. [7] [10]
Marking
Pass: structured recognition, correct tool limits, hearing considered, early referral, clear counselling. [1] [2]
Fail: pure wait-and-see despite red flags; screen treated as diagnosis; child used as interpreter; no safety-net. [1] [2] [5]
References
- [1]Hyman SL Identification, Evaluation, and Management of Children With Autism Spectrum Disorder. Pediatrics, 2020.PMID 31843864
- [2]Robins DL Validation of the modified checklist for Autism in toddlers, revised with follow-up (M-CHAT-R/F). Pediatrics, 2014.PMID 24366990
- [3]Lipkin PH Promoting Optimal Development: Identifying Infants and Young Children With Developmental Disorders Through Developmental Surveillance and Screening. Pediatrics, 2020.PMID 31843861
- [4]Zubler JM Evidence-Informed Milestones for Developmental Surveillance Tools. Pediatrics, 2022.PMID 35132439
- [5]Boylen S Impact of professional interpreters on outcomes for hospitalized children from migrant and refugee families with limited English proficiency: a systematic review. JBI evidence synthesis, 2020.PMID 32813387
- [6]Forkey H Trauma-Informed Care. Pediatrics, 2021.PMID 34312292
- [7]Burvenich R Effectiveness of safety-netting approaches for acutely ill children: a network meta-analysis. The British journal of general practice : the journal of the Royal College of General Practitioners, 2025.PMID 39117428
- [8]Katz AL Informed Consent in Decision-Making in Pediatric Practice. Pediatrics, 2016.PMID 27456510
- [9]Kuo DZ Recognition and Management of Medical Complexity. Pediatrics, 2016.PMID 27940731
- [10]Starmer AJ Changes in medical errors after implementation of a handoff program. The New England journal of medicine, 2014.PMID 25372088