Developmental assessment in CAP — history, tools, adaptive function and formulation (MEQ)

(i) History and milestones. Structured developmental history: pregnancy/preterm course, neonatal period, hearing/vision, milestone ages by motor, language (receptive/expressive), social-emotional, cognitive/play, adaptive domains; regression screen (none here); family developmental history; nursery function; prior advice and services. Map against evidence-informed milestone expectations (most children by age) rather than passive wait-and-see when clearly behind. Multi-informant: parents + nursery.^[1][2]

(ii) Tool hierarchy. Surveillance = ongoing concerns + observation + milestone update. Screening = standardised tools (milestone questionnaires; parental-concern tools; age-appropriate ASD risk screens such as M-CHAT-R/F class if within age/window historically or analogue pathway). Diagnostic testing = formal cognitive (age-appropriate battery) and adaptive scales, speech assessment. SDQ is dimensional emotional-behavioural data, not IQ. Screens do not diagnose ASD or ID.^[1][3][8]

(iii) Adaptive function. ID/GDD formulation requires intellectual and adaptive deficits with developmental onset. Adaptive domains: conceptual, social, practical everyday skills. IQ alone cannot define disability or support needs.^[4][5]

(iv) Differentials and investigations. Language disorder, GDD, ASD, ADHD traits, hearing impairment, sequelae of prematurity, psychosocial contributors. Early: hearing, vision, medical/developmental paediatrics review; consider genetics pathway if GDD/ID confirmed; formal psychometrics and SALT/OT as indicated. EEG/imaging only if neurological red flags.^[7][8]

(v) Formulation and plan. Predisposing: prematurity. Precipitating: school entry demand. Perpetuating: delayed access after wait-and-see, unassessed hearing, limited early intervention. Protective: concerned engaged parents, nursery support. Biopsychosocial layers as above. Plan: hearing now; early intervention/SALT; multi-source ASD/developmental evaluation; adaptive + cognitive testing when indicated; educational supports; treat comorbidity later if confirmed; no medication to "create development." Communicate findings with formulation, not score dump.^[1][4][6]