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Clinical Atlas Prestige · Evidence-first

Psych MEQs / SAQsChild and adolescent psychiatry — developmental assessment

Psych MEQs / SAQs · Child and adolescent psychiatry — developmental assessment

Developmental assessment in CAP — history, tools, adaptive function and formulation (MEQ)

FRANZCP-style MEQ on developmental assessment in CAP: history, milestones, psychometrics hierarchy, adaptive function, formulation and multiagency care.

20 marks20 min
On this page & tools

Target exams

FRANZCPMRCPsychABPNMD-DNB

Target exams

FRANZCPMRCPsychABPNMD-DNB
Prompt
A 4-year-old boy is referred by his GP after nursery staff report limited phrases, poor peer play and delayed self-care. Parents say they have been 'worried about speech since age 2' but were told to wait. Pregnancy was complicated by preterm birth at 32 weeks. There is no known hearing test. He has not lost skills. Teachers complete an SDQ with elevated peer and hyperactivity scales. Parents ask whether he is 'autistic or just slow,' whether an IQ test alone will answer everything, and whether medication will make him catch up. (i) Outline a structured developmental history and domain milestone map. (ii) Distinguish surveillance, screening and diagnostic testing; name appropriate tool classes including ASD risk screening. (iii) Explain why adaptive function is essential alongside intellectual assessment. (iv) List key differentials and early investigations. (v) Write a brief 4P/biopsychosocial formulation skeleton and multiagency plan. (20 marks)

Model answer

Reveal model answer

(i) History and milestones. Structured developmental history: pregnancy/preterm course, neonatal period, hearing/vision, milestone ages by motor, language (receptive/expressive), social-emotional, cognitive/play, adaptive domains; regression screen (none here); family developmental history; nursery function; prior advice and services. Map against evidence-informed milestone expectations (most children by age) rather than passive wait-and-see when clearly behind. Multi-informant: parents + nursery.[1][2]

(ii) Tool hierarchy. Surveillance = ongoing concerns + observation + milestone update. Screening = standardised tools (milestone questionnaires; parental-concern tools; age-appropriate ASD risk screens such as M-CHAT-R/F class if within age/window historically or analogue pathway). Diagnostic testing = formal cognitive (age-appropriate battery) and adaptive scales, speech assessment. SDQ is dimensional emotional-behavioural data, not IQ. Screens do not diagnose ASD or ID.[1][3][8]

(iii) Adaptive function. ID/GDD formulation requires intellectual and adaptive deficits with developmental onset. Adaptive domains: conceptual, social, practical everyday skills. IQ alone cannot define disability or support needs.[4][5]

(iv) Differentials and investigations. Language disorder, GDD, ASD, ADHD traits, hearing impairment, sequelae of prematurity, psychosocial contributors. Early: hearing, vision, medical/developmental paediatrics review; consider genetics pathway if GDD/ID confirmed; formal psychometrics and SALT/OT as indicated. EEG/imaging only if neurological red flags.[7][8]

(v) Formulation and plan. Predisposing: prematurity. Precipitating: school entry demand. Perpetuating: delayed access after wait-and-see, unassessed hearing, limited early intervention. Protective: concerned engaged parents, nursery support. Biopsychosocial layers as above. Plan: hearing now; early intervention/SALT; multi-source ASD/developmental evaluation; adaptive + cognitive testing when indicated; educational supports; treat comorbidity later if confirmed; no medication to "create development." Communicate findings with formulation, not score dump.[1][4][6]

Common errors

  • Equating M-CHAT or SDQ with diagnosis
  • IQ without adaptive function
  • Ignoring hearing
  • Wait-and-see after clear multi-domain delay
  • Medication as first-line for developmental catch-up
[1] [3] [5]

References

  1. [1]Lipkin PH, Macias MM Promoting Optimal Development: Identifying Infants and Young Children With Developmental Disorders Through Developmental Surveillance and Screening Pediatrics, 2020.PMID 31843861
  2. [2]Zubler JM, Wiggins LD, Macias MM, et al. Evidence-Informed Milestones for Developmental Surveillance Tools Pediatrics, 2022.PMID 35132439
  3. [3]Robins DL, Casagrande K, Barton M, et al. Validation of the modified checklist for Autism in toddlers, revised with follow-up (M-CHAT-R/F) Pediatrics, 2014.PMID 24366990
  4. [4]Siegel M, McGuire K, Veenstra-VanderWeele J, et al. Practice Parameter for the Assessment and Treatment of Psychiatric Disorders in Children and Adolescents With Intellectual Disability J Am Acad Child Adolesc Psychiatry, 2020.PMID 33928910
  5. [5]Tassé MJ, Luckasson R, Schalock RL The Relation Between Intellectual Functioning and Adaptive Behavior in the Diagnosis of Intellectual Disability Intellect Dev Disabil, 2016.PMID 27893317
  6. [6]Winters NC, Hanson G, Stoyanova V The case formulation in child and adolescent psychiatry Child Adolesc Psychiatr Clin N Am, 2007.PMID 17141121
  7. [7]Moeschler JB, Shevell M Comprehensive evaluation of the child with intellectual disability or global developmental delays Pediatrics, 2014.PMID 25157020
  8. [8]Volkmar F, Siegel M, Woodbury-Smith M, et al. Practice parameter for the assessment and treatment of children and adolescents with autism spectrum disorder J Am Acad Child Adolesc Psychiatry, 2014.PMID 24472258