Referral guideline – Behavioural problems in child under 6 years

Introduction

  • Behavioural problems in children under 6 years of age are very common. In most cases this is best managed by family support services and behaviour specialists in the first instance.
  • Behavioural disorders such as ADHD, ASD, ODD or conduct disorder are uncommon.
  • Behaviour is more likely to be abnormal if it is prolonged, extreme, dangerous and occurs in at least 2 of the following settings – home, school/preschool, or social situations.

GP management

  • Arrange hearing test (not central auditory processing) and visual acuity (not behavioural optometry).
  • If behaviour is a problem at child care, preschool/school – ask for a letter detailing the concern.
  • Consider and manage underlying medical issues such as ear problems, vision problems, constipation etc.

When to refer

  • Refer to a community child health nurse, parent support service (e.g. Triple P, Management of Young Children Program or similar) or psychologist in the first instance for most children.
  • Refer to the nearest general paediatric service if an underlying disorder needs to be excluded.
  • Referral to a sub-specialist child development service should be considered if there are developmental delays in multiple domains, or a complex neurodevelopmental disorder is suspected.

Please note: where appropriate and available, referrals may be redirected to a more appropriate service e.g. public allied health and/or child health service. Such a service may be an interim service prior to seeing the public medical specialist or, if appropriate, may negate the need to see the public medical specialist.

Essential referral info

  • Generic demographic information
  • Description of the concerning behaviour
  • Letter from school (if school based behaviour is the primary concern)
  • For children in Out of Home Care, report if child expected to be in care for more than 6 months, or if foster placement at risk of breaking down due to the child’s behaviour

From 1 May 2019 referral criteria will apply at CHQ. This condition has minimum demographic and essential clinical referral information that is required to be included prior to submission of the referral. Visit the CPC website for the required condition. If you are unable to provide the required “essential information” please state the reason when you submit the referral.

Highly desirable information (may determine triage category)

  • GP impression of current developmental status (e.g. age appropriate, some delay, significant delay, PEDS result)
  • Hearing test (not central auditory processing)
  • Visual acuity (not behavioural optometry)
  • School information (History of suspensions, exclusions; Guidance Officer assessment if applicable)
  • Family history of behavioural disorders or mental illness
  • Copies of any allied health assessments performed
  • If child is in Out of Home Care, name of Child Safety Officer if applicable
  • Significant psychosocial risk factors

Helpful referral info

  • Vanderbilt Assessment Scale if performed
  • Previous investigations if performed
  • Birth history
  • Other past medical history
  • Immunisation history
  • Developmental history
  • Medication history
  • Height/weight/head circumference and, if available, growth charts with earlier measurements
  • Physical examination findings incl. dysmorphic features, birth marks, neurological exam

Parent service

Child Development Program

Contact details

Child Health Service
Hospital Switchboard

(Ask for the general paediatric registrar)
t: 07 3068 1111

Child Development Program (CDP)
t: 1300 731 805 

Resources

Raising Children Network
Ages and Stages Questionnaire
Find a private psychologist
Management of Young Children Program
Triple P
Vanderbilt Assessment Scales