Developmental and behavioural screening — branching viva

Stem

The examiner starts with clinic programme design, then adds an 18-month autism screen, a behavioural crisis, and a language-discordant family. [1] [2]

Branch 1 — Definitions and ages

Examiner: What is developmental screening, and how does it differ from surveillance? [1]

Strong answer: Screening is periodic use of a standardised tool with known performance to find children who need evaluation. Surveillance is the continuous every-visit process of concerns, observation and domain documentation. Evaluation is the diagnostic assessment after fail or strong worry. [1]

Examiner: Which key ages for general developmental screening will you defend from AAP guidance? [1]

Strong answer: Standardised screening at 9, 18 and 30 months, with surveillance at every health supervision visit. Local programmes may map tools differently — I name the principle and the local operational source. [1]

Branch 2 — M-CHAT-R/F

Examiner: M-CHAT-R total is 5 at 18 months. Mother is calm. What next? [2]

Strong answer: Complete the structured Follow-Up Interview. Initial total ≥3 is not final. If post-follow-up score is ≥2, treat as high risk: about 47.5% ASD and about 94.6% any developmental delay/concern in Robins 2014. Refer for evaluation and early intervention; counsel that this is not a diagnosis; arrange hearing pathway if needed; close the loop. [2]

Branch 3 — Behavioural screening

Examiner: Why bother with emotional-behavioural screening before school age? [5]

Strong answer: More than 10% of young children have clinically significant mental health problems with real impairment. Effective psychosocial treatments exist; access is limited; early psychopharmacology evidence is narrow. The medical home must identify, support relationships and refer — not only growth and vaccines. [5]

Branch 4 — Equity and systems

Examiner: Tools were completed in English by a family that needs an interpreter. Score is pass. [11]

Strong answer: Invalid administration. Re-do with a professional interpreter. Do not file a false pass. Language access is part of screening validity and equity. [11]

Examiner: Why does medical-home continuity matter? [6]

Strong answer: Monitoring and screening inside a medical home associate with earlier autism identification pathways. Continuity supports closed loops, not one-off forms. [6] [14]

Branch 5 — Conversion

Examiner: During a “screen day” the toddler has lost words and seems encephalopathic. [1]

Strong answer: Convert immediately. Regression with encephalopathy is an emergency pathway, not a rescheduled ASQ. Stabilise, investigate urgently, and involve senior/neurology as indicated. [1]

Examiner extras

• Screen ≠ diagnosis. [1] [2]
• Caregiver concern can outweigh a lonely pass. [1]
• Milestone technique detail lives on the D01 surveillance page — cross-link, do not bluff full lists. [3]
• Close every referral loop. [14]