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Neurobehavioural/developmental delay/learning disability Glos Care Pathway overview

What's New - 2019

This pathway has been designed to support colleagues in primary care by providing guidance and referral criteria for the assessment of children with neurodevelopmental concerns, developmental delay or learning disability.  

ATS – Advisory Teaching Service
EPS – Educational Psychology Service
EYFS – Early Years Foundation Stage
SENCo – Special Educational Needs Co-ordinator
SENDIASS - Special Educational Needs and Disability Information, Advice and Support Service
TAC – Team around the child
TAF – Team around the family
SALT – Speech and language therapy
CYPS – Children and Young People’s Service

Please click the relevant flowchart box to be taken directly to textual information


Red Flags

Presenting also with:

  • Boys with progressive motor difficulty
  • Regression / progressive loss of previously acquired developmental attainments
  • Dysmorphology with developmental impairment

Please refer directly to Community Paediatric consultants without delay

Child Aged ≤5yrs old with Developmental Delay

Provide the pathway 'Development Difficulties’ information leaflet to parents/carers


Roles of the different services/Agencies

GP/Primary Care Clinicians

If mild developmental delay and no medical concern: refer to Health Visitor and Education setting to monitor and support on the Graduated Pathway

If developmental concern is in a single domain (e.g. speech delay only): involve Health Visitor and the relevant therapy services.

If developmental regression and/or severe delay and/or evidence of medical anomaly indicating possible underlying medical cause (genetic/neurologic/neuromuscular) as identified by GP or therapist:

  • Refer to paediatric clinic:
    • Referral documentation must include:
    1. Health Visitor ASQ report
    2. Education reports (EYFS & nursery SENCo report) – please use form ‘Supporting Evidence from Education Setting’ form
    3. Therapy reports


Health Visitor Service:

  • Complete ASQ (a developmental assessment tool)
  • Assess family-social context
  • Engage with Education Setting
  • Consider audiology and referral to therapy services.


Education Setting:

  • Supports and assesses using the Graduated Pathway Complete EYFS (EYFS = Early Years Foundation Stage assessment – a measure of developmental stage)
  • Consider wider needs of the family and potential support (e.g. Early Help services)
Child Aged ≤5yrs old with Suspected ASD
Child Age 5 ≤10 - ASD / ADHD / LD

Provide the pathway 'Development Difficulties’ information leaflet to parents/carers


Roles of the different services/agencies:

Parents/Schoolnurse (SN)/Teachers:

  • Ensure no hearing deficit. If concern and not recently tested, then refer to audiology etc. (School nurse or GP).
  • Consider if therapy service indicated i.e. Speech therapist, Physiotherapist, Occupational therapist, and if needed make referral (GP, school nurse or SENCO can do so)r
  • Involve SENCo
  • SENCO coordinates the support of the child using the Gloucestershire Graduated Pathway of support, involving specialist education professionals (e.g. ATS or EPS) when indicated by child’s level of need
  • Assess wider family-social context: If child and/or family in need of support: SENCo/School nurse to initiate TAC/F process and consider involving Families First Team.
  • With significant emotional and behavioural symptoms, ensure first line steps have been completed – e.g. parent support programmes and/or support from the local family support/Families First Team; and/or advice taken and followed from the CYPS practitioner advice line


GP/Primary Care Clinicians:
If symptoms persist and the child has been fully supported on the Graduated pathway, and is now at My Plan Plus , then referral to paediatrics may be indicated with the right supporting information.

GP primary assessment of the child:

  • Review child’s physical wellbeing, and exclude signs of an alternative mental health condition (e.g. conduct disorder, anxiety or mood disorder)

GP to refer to paediatrics with their own clinical findings and the education evidence – please use form ‘Supporting Evidence from Education Setting’

Please include completed senior education professional assessment reports e.g.:

  • SENCO and/or teacher report (including confirmation of child’s status on the Graduated Pathway) – please use form ‘Supporting Evidence from Education Setting’
  • Educational Psychology report and/or Advisory Teacher report
  • Speech Therapy report if seen by SALT

Key Point

If the family requests a referral but the education information does not support this (see above for required information), then a referral to paediatrics is unlikely to be helpful.

Contact the paediatrician for Advice and Guidance if needed. Please see this list of GP surgeries and their allocated locality community consultant.

Child ≥ 11yrs old with Suspected ADHD/ASD

GP/Primary Care Clinicians:

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