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Clinical Atlas Prestige · Evidence-first

Psych CASC / OSCEChild and adolescent psychiatry — neurodevelopmental

Psych CASC / OSCE · Child and adolescent psychiatry — neurodevelopmental

Explain language disorder and the school plan to parents — CASC communication station

MRCPsych/FRANZCP-style communication station: explain language disorder/DLD, correct bilingual and autism myths, outline SLT-first care and school strategies, and set realistic prognosis.

communication
On this page & tools

Target exams

FRANZCPMRCPsychABPNMD-DNB

Target exams

FRANZCPMRCPsychABPNMD-DNB
Prompt
Parents of a 5-year-old attend after the preschool teacher said he is 'behind in talking', 'doesn't listen', and may need 'autism testing'. History supports delayed phrases, limited vocabulary, and need for visual cues. No restricted interests or repetitive behaviours. Mild sound repetitions when tired. Home is bilingual. Parents fear lifelong disability, blame the second language, and ask for a medicine that will make him talk.

Station brief

Format. Communication station, approximately 7–10 minutes active time after reading. You are the psychiatry registrar in the child development clinic. [1]

Candidate instructions. Explain the working formulation of a developmental language difficulty (language disorder/DLD pathway), address autism fear without dismissing need for careful assessment, correct the bilingual-cause myth, outline SLT-first care and preschool strategies, mention hearing check, discuss mild fluency features if asked, and agree a collaborative plan. The examiner plays a parent. [2][3][5]

Candidate scenario

Assessment supports a primary language disorder profile (limited vocabulary/phrases, comprehension support needs) without clear ASD markers. Mild intermittent sound repetitions may represent early fluency features for SLP review. Hearing must be confirmed. You plan SLP referral, preschool accommodations, parent language strategies, and watchful ASD re-evaluation only if new signs emerge — not a medication to 'make him talk'. Parents are anxious and information-seeking. [1][2][6]

Marking domains

  • Empathy, agenda-setting (autism fear, bilingual guilt, medicine request, lifelong disability fear)
  • Plain-language explanation of language disorder vs autism vs 'not listening'
  • Accurate bilingual counselling
  • Clear plan: hearing, SLP/SLT, preschool strategies; no drug for core language
  • Balanced prognosis (many late talkers improve; persistent difficulties need support)
  • Checks understanding; shared decision; follow-up [3][4][5][6]
Reveal assessor key

Open and agenda-set. Name time; invite priorities (is it autism, did two languages cause this, will he ever talk well, does he need medicine). Validate worry without catastrophising. [1]

Explain formulation. Your child is having trouble learning and using language — the words he understands and the sentences he can say — more than we expect for his age. This is different from simply being naughty or not listening. Many children have language difficulties; it is a common developmental problem. We use names like language disorder or developmental language disorder when the difficulties are clear and affect everyday communication or learning, and we have checked for other explanations.[1][2]

Autism differential. Autism involves social communication differences and restricted or repetitive behaviours/interests. From what we know so far, we do not see those restricted patterns, so autism is not our leading label — but we always keep an open mind if new concerns appear. Social (pragmatic) communication disorder is a different label for social-use problems and is not used when autism criteria are met.[5]

Bilingualism. Using two languages at home does not cause language disorder. Keep speaking the language of your heart at home; it supports family bonds and identity. We assess skills carefully across languages.[1][2]

Plan. (1) Confirm hearing. (2) Speech-language therapy is the main treatment — evidence supports therapy for many speech and language difficulties. (3) Preschool: short instructions, show as well as tell, visual supports, patience with frustration. (4) If stuttering features persist, SLP may discuss programmes such as Lidcombe for preschool fluency. (5) There is no medicine that fixes the core language problem; we treat other conditions like ADHD or anxiety only if they are clearly present and impairing.[3][4]

Prognosis. Some late talkers catch up; others need longer support, including for reading later. Early help and supportive adults improve outcomes. Agree written points, SLP referral, and review date.[6]

References

  1. [1]Bishop DVM, Snowling MJ, Thompson PA, Greenhalgh T; CATALISE consortium CATALISE: A Multinational and Multidisciplinary Delphi Consensus Study. Identifying Language Impairments in Children PLoS One, 2016.PMID 27392128
  2. [2]Bishop DVM, Snowling MJ, Thompson PA, Greenhalgh T; CATALISE-2 consortium Phase 2 of CATALISE: a multinational and multidisciplinary Delphi consensus study of problems with language development: Terminology J Child Psychol Psychiatry, 2017.PMID 28369935
  3. [3]Law J, Garrett Z, Nye C The efficacy of treatment for children with developmental speech and language delay/disorder: a meta-analysis J Speech Lang Hear Res, 2004.PMID 15324296
  4. [4]Jones M, Onslow M, Packman A, et al. Randomised controlled trial of the Lidcombe programme of early stuttering intervention BMJ, 2005.PMID 16096286
  5. [5]Norbury CF Practitioner review: Social (pragmatic) communication disorder conceptualization, evidence and clinical implications J Child Psychol Psychiatry, 2014.PMID 24117874
  6. [6]Zubrick SR, Taylor CL, Rice ML, Slegers DW Late language emergence at 24 months: an epidemiological study of prevalence, predictors, and covariates J Speech Lang Hear Res, 2007.PMID 18055773