Developmental assessment — branching viva

Opening stem

You are the paediatric registrar in developmental clinic. An 18-month-old is referred for “not talking.” How do you structure the assessment? [1]

Branch A — Candidate opens with history and observation

Examiner: Good. What domains do you document, and how do milestones fit? [2]

Strong answer: Gross motor, fine motor, language, social-emotional, cognitive/adaptive. Use evidence-informed milestones; ask about regression; observe free play before tools. [1] [2]

Branch B — Tool choice

Examiner: Which tools might you use today and what can they not do? [1] [3]

Strong answer: Service general developmental screen; M-CHAT-R/F with follow-up if social communication concern; screens identify risk only. Formal Bayley-type testing is trained evaluation, not a waiting-room game. [1] [3] [5]

Branch C — Preterm history revealed (born 29 weeks)

Examiner: How does prematurity change your interpretation? [1] [5]

Strong answer: Use corrected age early as local protocol directs; still take caregiver concern seriously; high-risk follow-up may include formal developmental testing. [1] [5]

Branch D — Hearing and next steps

Examiner: The screen is borderline and the caregiver remains very worried. What do you do? [1]

Strong answer: Do not dismiss concern; arrange hearing; refer early; explain screen versus diagnosis; safety-net and clear handover. [1] [9]

Branch E — Red flag

Examiner: Caregiver now says words were lost after a febrile illness with ongoing drowsiness. [1] [3]

Strong answer: Urgent medical pathway for regression/encephalopathy risk — not routine rebooking. [1] [3]

Closing marks map

• Structured history and domain documentation. [1]
• Observation and examination. [1] [2]
• Correct tool hierarchy and limits. [3] [5]
• Hearing/vision and referral. [1] [4]
• Corrected age and equity/interpreter awareness when relevant. [5] [8]