Learning difficulty/disability in children ≥ 6 years

PAEDIATRIC

  • If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or follow local emergency care protocols or seek emergent medical advice if in a remote region.

    • No emergency indicators identified; routine prioritisation applies
    • Refer to local HealthPathways or local guidelines
    • All children referred for learning difficulty require visual acuity and audiometry results.
    • Developmental optometry and auditory processing assessments are not supported by evidence
    • Are there significant behavioural or emotional issues suggesting that this referral would be better assessed under a behavioural category?
    • In the majority of cases, it is thought inappropriate for children to wait more than 6 months for an outpatient initial appointment
    • Next of kin or person(s) who is legally responsible for patient consent, with the exception of children under guardianship orders with the Department of Child Safety, Seniors and Disability Services, should be present at the first outpatient appointment.
    • If you have a reason to suspect a child in Queensland is experiencing harm, or is at risk of experiencing harm, you need to contact Child Safety Services
    • Statement of intent – the prioritisation of health services for children and young people in the child protection system
Minimum Referral Criteria
Category 1
(appointment within 30 calendar days)
  • Child in out of home, where there is imminent threat of breakdown of current foster placement due to the complexity of the child's developmental concerns.
Category 2
(appointment within 90 calendar days)
  • Definite history of loss of academic ability suggestive of neurological disease. Child excluded from school due to these concerns
  • A child:
    • at risk of entering the child protection system (0 – 18 years of age)
    • currently in out of home care (OOHC) (0 – 18 years of age), or
    • Adolescents transitioning to adult healthcare following an out of home care experience (15 – 25 years of age)

    • where they have previously been on a waiting list for this problem and were removed without receiving a service
Category 3
(appointment within 365 calendar days)
  • Child with suspected moderate to severe learning difficulty / disability who requires timely assessment for purpose of diagnostic formulation, accessing NDIS and / or support for verification of disability in education setting.
  • Educational psychology assessment suggests intellectual impairment and the child has never been seen by a paediatrician for assessment.
  • Suspected attention-deficit hyperactivity disorder

Please insert the below information and minimum referral criteria into referral

1. Reason for request Indicate on the referral

  • To establish a diagnosis
  • For treatment or intervention
  • For advice and management
  • For specialist to take over management
  • Reassurance for GP/second opinion
  • For a specified test/investigation the GP can't order, or the patient can't afford or access
  • Reassurance for the patient/family
  • For other reason (e.g. rapidly accelerating disease progression)
  • Clinical judgement indicates a referral for specialist review is necessary

2. Essential referral information Referral will be returned without this

  • WISC or other formal assessment within the previous 3 years or detailed information regarding learning abilities (such as NAPLAN report or reading, spelling, maths age equivalent levels) (provided by the school or another external provider). This is not required if there is a concern about developmental regression.
  • Are there significant behavioural or emotional issues suggesting that this referral would be better assessed under a behavioural category? It is acknowledged that behavioural difficulties can be secondary to learning problems.
  • Report presence or absence of concerning features:
    • Is there definite history of developmental regression, and if so what specific loss of skills has been noted?
    • Is the child expected to be in out of home care supervised by the Department of Child Safety, Seniors and Disability Services for more than 6 months?
  • Confirmation of OOHC (where appropriate)

3. Additional referral information Useful for processing the referral

Highly desirable information – may change triage category

  • Significant psychosocial risk factors (especially parents mental health, family violence, housing and financial stress, Department of Child Safety, Seniors and Disability Services involvement).

Desirable information- will assist at consultation

  • Classroom reports of school performance and engagement with school work
  • Other assessments of academic ability and achievement
  • Audiometry
  • Medical history
  • Family history, including family members affected with ASD, ADHD, learning difficulty or mental illness
  • Copies of previous speech, occupational therapy, physiotherapy, or cognitive assessments if available
  • If the child is in foster care, please provide the name and regional office for the child safety officer who is the responsible case manager
  • Pregnancy and birth history
  • Other past medical history
  • Immunisation history
  • Developmental history
  • Medication history
  • Height/weight/head circumference and growth charts with prior measurements if available.
  • Other physical examination findings inclusive of CNS, birth marks or dysmorphology
  • Any relevant laboratory results or medical imaging reports

4. Request

  • Patient's Demographic Details

    • Full name (including aliases)
    • Date of birth
    • Residential and postal address
    • Telephone contact number/s – home, mobile and alternative
    • Medicare number (where eligible)
    • Name of the parent or caregiver (if appropriate)
    • Preferred language and interpreter requirements
    • Identifies as Aboriginal and/or Torres Strait Islander

    Referring Practitioner Details

    • Full name
    • Full address
    • Contact details – telephone, fax, email
    • Provider number
    • Date of referral
    • Signature

    Relevant clinical information about the condition

    • Presenting symptoms (evolution and duration)
    • Physical findings
    • Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
    • Body mass index (BMI)
    • Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes), noting these must be stable and controlled prior to referral
    • Current medications and dosages
    • Drug allergies
    • Alcohol, tobacco and other drugs use

    Reason for request

    • To establish a diagnosis
    • For treatment or intervention
    • For advice and management
    • For specialist to take over management
    • Reassurance for GP/second opinion
    • For a specified test/investigation the GP can't order, or the patient can't afford or access
    • Reassurance for the patient/family
    • For other reason (e.g. rapidly accelerating disease progression)
    • Clinical judgement indicates a referral for specialist review is necessary

    Clinical modifiers

    • Impact on employment
    • Impact on education
    • Impact on home
    • Impact on activities of daily living
    • Impact on ability to care for others
    • Impact on personal frailty or safety
    • Identifies as Aboriginal and/or Torres Strait Islander

    Other relevant information

    • Willingness to have surgery (where surgery is a likely intervention)
    • Choice to be treated as a public or private patient
    • Compensable status (e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.)

  • If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or follow local emergency care protocols or seek emergent medical advice if in a remote region.

    • Please note that where appropriate and where available, the referral may be streamed to an associated public allied health and/or nursing service.  Access to some specific services may include initial assessment and management by associated public allied health and/or nursing, which may either facilitate or negate the need to see the public medical specialist.

    • A change in patient circumstance (such as condition deteriorating, or becoming pregnant) may affect the urgency categorisation and should be communicated as soon as possible.

    • Please indicate in the referral if the patient is unable to access mandatory tests or investigations as they incur a cost or are unavailable locally.

Last updated: 4 December 2024

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