Assessment of functional disability in adolescents

Specialty: Children's developmental concerns
Age group: Children

Criteria for referral to public hospital service

Adolescents with:

• inability to attain or loss of age-appropriate gross motor or mobility skills, fine motor skills, age-appropriate activities of daily living, social and cognitive skills, language and communications, that cannot be attributed to a transient condition (e.g. limb fractures, hearing loss)
• severe pain or loss of function leading to inability to manage age-appropriate activities of daily living and social responsibilities (e.g. work, study, social activities)
• developmental screening suggestive of functional impairment across either
  • two or more developmental domains (gross or fine motor skills, cognitive/learning skills, social/emotional, language/speech or self-care), or
  • one or more developmental domains (gross or fine motor skills, cognitive/learning skills, social/emotional, language/speech or self-care) and with any of the following:
    • abnormal neurological signs (e.g. abnormal muscle tone or weakness issues, asymmetry in body strength or movement) or physical findings (e.g. macrocephaly or microcephaly)
    • medical conditions that are the suspected cause of the developmental delay
    • the child is at risk of or has been excluded from school due to physical aggression or other behaviours that place themselves or others at risk or
    • significant psychosocial risk factors such as family violence, maternal drug or alcohol use during pregnancy or early childhood, parental mental health issues, experiencing homelessness or at risk of homelessness, or the child lives in out-of-home care.

Information to be included in the referral

Information that must be provided

• Reason for referral and expectation or outcome, anticipated by the patient or their carer, and the referring clinician from referral to the health service
• Any safety concerns, behaviour management strategies in use or current crises management plan
• Relevant history of any abnormal neurological or physical findings, medical conditions or psychosocial risks that may be linked to issues of concern such as significant weight loss or gain, maternal drug or alcohol use during pregnancy, family violence, parental mental health issues, experiencing homelessness or at risk of homelessness, the adolescent child lives in out-of-home care, signs of abuse or neglect
• Any family history of developmental problems or functional disability, particularly in siblings
• The functional or psychological impact on quality of life or activities of daily living including impact on work, study, social activities or carer role
• History of alcohol, recreational or injectable drugs, or prescription medicine misuse
• Teacher reports, school assessments or school cognitive, education or language assessments
• If the adolescent child has been excluded, or is it at risk of exclusion from school due to physical aggression or other behaviours that place themselves or others at risk
• Details of previous and current medical and non-medical management (e.g. community health services, supports or services through the National Disability Insurance Scheme (NDIS) or Early Childhood Australia (ECA), speech therapy, physiotherapy, psychology)
• Details of previous management including the course of treatment(s) and outcome of treatment(s)
• If the adolescent child is in the criminal justice system or under Youth Justice supervision in the community.

Provide if available

• Current growth measurements, including height, weight and head circumference, as well as previous growth measurements where there has been slow weight gain or concern for growth trajectory (indicate if these measurements cannot be provided due to the child’s sensory sensitivity or behavioural issues)
• Relevant assessments such as:
  • diagnostic audiology assessment (this often assists with identifying clinical urgency and the most appropriate specialist clinic or service)
  • comprehensive eye and vision assessment including cycloplegic refraction and dilated retinal examination (usually performed by an optometrist or ophthalmologist) with best corrected visual acuity (i.e. measured with spectacles or contact lenses) for both eyes or visual behaviour assessment if the child is pre-literate or non-verbal
  • speech therapy assessment
  • physiotherapy assessment
  • occupational therapy assessment
  • psychology assessment
  • psychiatric assessment
• Neuroimaging results including when and where imaging was performed
• Genetic test results including chromosome microarray and Fragile X syndrome
• Any relevant pathology tests results (such as free thyroxine (T4) and thyroid stimulating hormone level (TSH))
• If the adolescent child identifies as an Aboriginal and/or Torres Strait Islander
• If the adolescent child is neurodiverse
• If the adolescent child is gender diverse
• If the adolescent child has a disability
• If the adolescent child lives in out-of-home care (foster care, kinship care, permanent care or residential care) or is at risk of moving to out-of-home care
• If the adolescent child has a preferred language other than English and if they rely on cultural or linguistic support (e.g. Aboriginal cultural support, an interpreter)
• If the adolescent child is a refugee, seeking asylum or has a bridging visa while waiting for an immigration outcome
• If the adolescent child is aged 14-18 years, do they consent that their health information is shared with their parent, guardian or carer.

Additional comments

The Minimum information for referrals to non-admitted specialist services lists the information that should be included in a referral request.

Note there are statewide referral criteria for Assessment of developmental problems in children and Diagnosis and management of attention deficit hyperactivity disorder (ADHD) in children.

Do not delay assistance or treatment initiation or modification while awaiting paediatrician review.

Instances of suspected or attempted self-harm, self-harm, suicidal ideation, suicide or suspected suicide should be referred to a mental health service that best aligns with the age of the child involved.

Adolescents with known or suspected eating disorders may be referred to an alternative mental health service that best aligns with the age of the child involved.

The referral should note if the request is for a second or subsequent opinion as requests for a second opinion will usually not be accepted.

Where appropriate and available the referral may be directed to an alternative specialist clinic or service.

Referral to a public hospital is not appropriate for

• Where correcting the child’s hearing or vision would address the issues of concern.