Developmental and behavioural screening — formative SAQs

SAQ 1 — Programme design and M-CHAT pathway (10 marks)

A registrar says developmental screening “is just ASQ when parents complain.” An 18-month visit has a completed M-CHAT-R with total score 4. No follow-up interview has been done. The mother is not worried. [1] [2]

Questions

1. Distinguish surveillance, standardised screening and evaluation, and state the Lipkin key ages for general developmental screening. (3 marks) [1]
2. Outline the correct M-CHAT-R/F two-stage pathway for this score, including cited risk figures after a positive follow-up. (4 marks) [2]
3. State three actions that close the loop after a high-risk autism screen. (3 marks) [1] [14]

Model answer

Nested jobs and ages (3). Surveillance is every-visit concern elicitation, observation and domain documentation. Standardised screening uses a validated tool at key ages or on concern. Evaluation is diagnostic assessment after fail or strong worry. Lipkin frames standardised developmental screening at 9, 18 and 30 months, with surveillance at every health supervision visit. [1]

M-CHAT pathway (4). Initial total ≥3 requires the structured Follow-Up Interview. If the score remains ≥2 after follow-up, the child is high risk: about 47.5% ASD and about 94.6% any developmental delay or concern in the Robins validation cohort. Absence of parental worry does not cancel a positive pathway. Do not diagnose ASD from the form. [2]

Close the loop (3). Refer for autism/developmental evaluation and early intervention supports; name an owner and date; counsel that the screen is not a diagnosis; arrange hearing pathway if communication is impaired; safety-net for regression; chase no-shows and document interim supports. [1] [2] [14]

SAQ 2 — Behaviour, equity and borderline results (10 marks)

A. A 30-month ASQ is borderline in language only. B. A preschooler has severe aggression at childcare with no prior behavioural screen. C. A refugee family completes tools without an interpreter. [4] [5] [11]

Questions

1. Give a safe plan for the borderline language result, including what not to do. (3 marks) [1] [4]
2. Explain why early emotional-behavioural problems belong in the medical home and one limit of medication-first care. (3 marks) [5]
3. Why is interpreter-free tool completion a validity and equity failure, and what do you do instead? (4 marks) [11]

Model answer

Borderline language (3). Structured early recheck with a named date; interim language-rich strategies; check hearing pathway; continue surveillance; escalate to referral if concern is high or scores worsen. Do not invent proprietary cut-offs, do not discharge from the pathway, and do not order shotgun genetics from a single mild domain alone. [1] [4]

Behavioural problems (3). More than 10% of young children have clinically significant mental health problems; impairment can persist. The paediatric medical home often sees the dyad first and should screen, support relationships and refer to effective psychosocial interventions. Rigorous evidence for early childhood psychopharmacology is limited — medication-first without assessment of sleep, hearing, trauma, development and therapy access is poor care. [5]

Language access (4). Validated performance assumes comprehensible items. Without professional interpreting, history and scores are degraded and counselling of results fails. Arrange a professional interpreter, re-administer or complete tools properly, and do not record an invalid “pass.” Equity is part of screening quality. [11]