Paediatric developmental assessment

The differential diagnosis of a child's behavioural signs and symptoms includes the possibility of organic and developmental disorders. The child psychiatrist's toolkit must include competency to assess a child's development, and a working knowledge of key milestones and 'red flag' alerts for recognizing the abnormal. Clinicians need to be aware that normal development is a dynamic process, it varies enormously and is determined by a complex interplay between environmental factors (maternal health antenatally, in utero conditions, the birth process, economic and social conditions facing the family) and genetic factors. With sound knowledge of typical child development, it is possible to recognize when development is going wrong. The clinician needs to develop the knowledge and skills for eliciting a good history, using suitable age-appropriate material for developmental examination, creating varied and near natural situations for eliciting behaviour and making close observations of the child's responses. The quality of interpretation improves by combining personally observed information with that from parents or carers, quality of performance across the domains, and, often, monitoring the child's progress over time. Knowledge of relevant baseline investigations and local referral pathways is needed for management of children who are identified as having a significant developmental delay or a disorder.