Table 3.

When to refer for treatment and specialist* diagnostic evaluation for developmental or behavioural disorder (35,36)

Scenario-based parent concern	Features of concern
All scenario topics	Concerns on behaviour screen Limited progress at follow up with appropriate strategies Academic difficulty Developmental delay Family stress Suspected abuse
Noncompliance	‘Red flags’ (frequent and chronic arguing and noncompliance to reasonable requests, annoying others on purpose)
Aggression	‘Red flag’ behaviours (frequent and chronic aggression, fights with peers, swearing in inappropriate settings, aggression toward self, disruption to family routines or school, negative responses from peers or teachers)
Short attention	‘Red flags’ (problems completing play, chores, self-care tasks, and schoolwork, easily distracted, difficulty listening, misses social cues, often forgetful, cannot sit still, makes disruptive noises, frequently interrupts)
Bedtime worrying	Child significantly distressed, daytime functional impairment, persistent fears

*Decision to refer versus performing the evaluation oneself depends on clinician scope of practice and experience.