Learning, developmental and behavioural difficulties

​Note: these guidelines are best suited to community paediatric services. Refer to local HealthPathways for more information.

​​​​​​​​Emergency

If any of the following are suspected, seek emergency medical advice or refer the patient to the emergency department (via ambulance if necessary)

  • Acute, severe mental health symptoms, including psychosis, mania, deliberate self-harm and suicidal intent or plan
    Note: these symptoms require urgent review by a psychiatrist
  • Aggressive behaviour with immediate threatening risk to others
    Note: these symptoms require urgent review by a psychiatrist
  • Food and fluid refusal
  • Non-speaking with acute distress and unable to examine adequately for medical conditions causing pain (e.g. tooth abscess, bone infections or osteopaenic fractures)
  • Signs of physical abuse (i.e. inflicted injury) or at imminent risk of harm
  • Symptoms suggestive of serious underlying medical condition

When public outpatient services are not routinely provided​

  • Academic or specific learning difficulties (e.g. dyslexia or reading), including cognitive assessments for intellectual capacity or disability
    Note: commonly diagnosed by a school counsellor or psychologist
  • Cognitive assessments for intellectual disability and specific learning difficulties (e.g. dyslexia or reading)
    Note: commonly diagnosed by a school counsellor or psychologist
  • Defiance without developmental concern
    Note: refer to a local family support service
  • Extended standardised diagnostic assessments for complex neurodevelopmental conditions (e.g. ADOS)
    Note: these assessments can be performed by allied health professionals (e.g. clinical psychologists, speech pathologists and occupational therapists) independent of referral to a general paediatrician
  • Primary communication delay or disorder
    Note: commonly managed by a community speech pathologist
  • Primary mental health presentations without medical co-morbidity
    Note: commonly managed by a general practitioner, child and adolescent mental health service, school counsellor or psychologist
  • Repeat prescriptions for a child stabilised on medication(s) available through their approved General Practitioner without a new concern

Criteria to access public outpatient services

CategoryCriteria
Category 1
Recommended to be seen within 30 calendar days.​​
  • Acute, severe functional deterioration with an existing neuro-disability
  • Definite history of developmental regression in cognition or milestones suggestive of neurological disease
  • Severe developmental delay or disability (i.e. across multiple domains or within a single developmental domain) and any of the following features:
    • Acute onset seizures
    • History of regression, loss of skills, asymmetry (particularly motor skills), or lack of early motor milestones (e.g. not sitting, rolling, crawling), particularly in an infant aged < 12 months
    • New neurological symptoms or signs
    • Increasing head circumference
    • Significant medical co-morbidities
    • Suspected metabolic disorders


Note: if urgent assessment is clinically indicated within 1 week, consider contacting the on-call paediatrician

​Category 2
Recommended to be seen within 90 calendar days.

  • Acute change in behaviour with suspected medical or underlying developmental co-morbidity as a possible cause
  • Aged < 6 years with moderate to severe developmental delay across multiple domains for medical assessment
  • Aged < 6 years with persistent developmental delay within a single developmental domain who has previously received allied health management where a comorbid medical problem is suspected
  • Chronic or stable abnormalities in neurological examination (e.g. marked low or high tone,
    muscle weakness, strength, movement or tone differences between right and left sides of the body, microcephaly or macrocephaly)
  • Long-term behavioural difficulties outside expected developmental norms where the child cannot attend childcare or school, or poses a risk of physical harm to self or others, and is already accessing support services (e.g., psychology or child health behavioural service)​
​Category 3

Recommended to be seen within 365 calendar days.

  • ​Aged < 6 years with mild to moderate developmental delay and any of the following features:
    • Impacting their day-to-day functioning or participation
    • Persisting despite allied health management
    • Requiring ongoing medical management
  • Behavioural concerns affecting expected social development and performance in daily routines (e.g. home, school). Concerns may include, but are not limited to:
    • Difficulty with emotional regulation
    • Difficulty with social reciprocity or joint attention
    • Hyperactivity
    • Inattention
    • Restricted and repetitive behaviours
  • Aged > 6 years with known moderate to severe developmental delay or intellectual disability for specialist medical review
  • Requiring medical review for known complex neurodevelopmental, or genetic disorder, or intellectual disability
  • Compulsive behaviours and rituals

Information to include within a referral

Required

  • Reason for referral
  • Details of the presenting condition, including symptoms and their duration
  • Provisional diagnosis
  • Patient health summary (such as relevant medical history, relevant investigations, current medications and dosages, immunisations, allergies and/or adverse reactions), including specifically:
    • Details of the parent(s) or carer(s) concern about behaviour that leads to the concern about communication, social skills and behaviour
    • Details from developmental milestones (history or screening tool)
    • Observations of behaviour by referrer and in educational setting
    • Letter from previous paediatrician or psychiatrist in the setting of transfer of care
    • Any behaviours of concern (e.g. significant school refusal, exclusions, suspensions and expulsions, high-risk behaviours, potential for aggression)
    • Visual acuity examination and hearing test result within last 1-2 years
    • Current allied health or early intervention services involved (if so, include letter or report)
    • Behaviour Support Plan and/or communication support plan (if relevant)
      ​

If available

  • If the child is in foster care, provide name and regional office for the Child Safety Officer who is the responsible case manager
  • Pregnancy and birth history
  • Height, weight, head circumference and growth charts with prior measurements
  • Brief comment on current school educational attainments (good, average, poor, very poor (> 2 years behind))
  • Psychosocial factors (e.g. parental relationship issues, mental illness, substance abuse, parental disability, family in crisis or child protection involvement)
  • Reports and diagnostic assessments, including, but not limited to:
    • Allied health reports (e.g. speech pathology, occupational therapy, physiotherapy, psychology)
    • Hearing Australia or audiology
    • Functional adaptive assessment (e.g. Vineland, ABAS)
    • Preschool developmental assessment (e.g. Bayley, Griffiths)
    • Cognitive assessment (e.g. school counsellor, psychologist)
    • Formal autism assessment (e.g. ADOS, ADI-R)
    • Formal attention-deficit hyperactivity disorder (ADHD) assessment questionnaire
  • Relevant laboratory or medical imaging

Important information for referring health professionals

If there is a change to a patient’s condition while waiting for their appointment, referring health professionals may further investigate and manage the situation, or send an updated referral to the outpatient service. Where there are significant concerns about a patient's condition, referring health professionals may check HealthPathways for urgent/same day advice or contact the relevant clinical team.

Current as at: Monday 23 March 2026
Contact page owner: System Purchasing