Detailed referrals may support earlier identification of autism and developmental delay, NSW research finds

Detailed information provided when a child is referred for developmental assessment may help clinicians identify and prioritise those who could benefit from earlier specialist support, new research from Nepean Hospital has found.

The study examined the relationship between concerns recorded in children’s referrals and the diagnoses they later received, offering practical insights for health professionals, allied health practitioners and early childhood educators who may be among the first to identify developmental differences.

Published in the Journal of Paediatrics and Child Health, the research reviewed the referrals and clinical outcomes of 161 children assessed through the Nepean Hospital Child Development Clinic between 2015 and 2019.

The researchers found that speech delay was the strongest referral-based predictor of a subsequent autism diagnosis, while behavioural and motor concerns were more closely associated with global developmental delay and attention-deficit/hyperactivity disorder.

Speech delay and concerns relating to social interaction were also the most commonly documented referral issues among the children included in the study.

Clinical Associate Professor Dr Habib Bhurawala, Head of Paediatrics at Nepean Hospital and senior co-author of the study, said demand for developmental assessment services had increased significantly, particularly for autism and related developmental conditions.

The findings may help services improve how children are prioritised for specialist assessment at a time when developmental clinics are experiencing growing demand.

Senior Paediatrician Dr Alison Poulton said detailed, symptom-based referral information could help clinicians identify children who may benefit from earlier multidisciplinary assessment and support.

The study also highlighted the contribution of allied health professionals, particularly speech pathologists, in recognising developmental concerns and supporting timely referral.

The findings reinforce the importance of referrers clearly documenting the nature, frequency and impact of any developmental concerns rather than relying on general descriptions.

For early childhood educators, this may include recording specific observations about a child’s communication, social engagement, behaviour, movement and participation across different routines and environments.

The research found that not every concern documented in a referral was strongly associated with a later diagnosis.

Observed sensory differences, repetitive behaviours, motor mannerisms and fixated interests showed no predictive value when considered in isolation.

The researchers said that, without more substantial developmental concerns, these observations alone may not be sufficient to indicate the need for a multidisciplinary developmental assessment.

This does not mean such behaviours should be dismissed. Rather, they should be considered within the broader context of a child’s communication, development, relationships and everyday functioning.

Early childhood educators are often well placed to notice emerging developmental differences because they observe children over time, across routines and in social environments involving both adults and peers.

While educators do not diagnose developmental conditions, clear and objective observations can assist families, GPs and allied health professionals when determining whether further assessment or support may be appropriate.

Services can strengthen this process by documenting:

• what has been observed
• when and how often it occurs
• the environments or routines in which it occurs
• how it affects the child’s participation, communication or relationships
• strategies already used and how the child responded.

Meaningful collaboration with families is also essential, ensuring developmental concerns are discussed respectfully and families are supported to seek professional advice where appropriate.

The research forms part of a broader focus within the Nepean Blue Mountains Local Health District on using real-world clinical data to improve patient care, service planning and access to specialist services.

The project involved clinicians and researchers from Nepean Hospital, the Nepean Blue Mountains Local Health District, the University of Sydney and the University of Notre Dame Australia.

Dr Bhurawala said better understanding the relationship between referral patterns and diagnostic outcomes could support earlier identification and contribute to more effective care pathways for children.

For the early childhood sector, the findings provide a timely reminder that detailed, evidence-based observations can make an important contribution to referral quality and help health professionals make more informed decisions about assessment and support.

Read the research here.