Developmental paediatrics: what the specialty covers, conditions assessed and what to expect

A developmental paediatrician is a children's doctor who has trained in general paediatrics and then specialised in child development and disability. Their job is to work out why a child is not developing as expected in movement, speech and language, learning, attention, social interaction or behaviour, and to arrange the support that follows. They look at the whole child, including medical history, birth and family history, sleep, vision and hearing, and life at home and school.

The specialty sits between several others. Paediatric neurology deals with conditions of the nervous system, child and adolescent psychiatry with mental health, and speech and language therapy and occupational therapy with specific skills. In many NHS areas developmental paediatricians run the neurodevelopmental pathway; the Royal College of Psychiatrists notes that autism and ADHD assessment is sometimes provided by community paediatrics rather than CAMHS.

These are the groups of difficulty that most often lead to a referral.

• Autism: the NHS describes differences in how a person communicates, behaves and reacts. In young children it lists later speech, not responding to their name, using less eye contact, preferring repetitive actions, very strong interests, sensory sensitivities and distress at changes in routine, while noting every autistic child is different.

• ADHD: the NHS says symptoms usually start before the age of 12, involving inattention, hyperactivity and impulsivity, with most children showing both types. It adds that ADHD is thought to be recognised less often in girls.

• Developmental co-ordination disorder (dyspraxia): the NHS describes a condition affecting physical co-ordination, with delays in crawling, walking, dressing and self-feeding, and difficulty with drawing, writing and sport.

• Learning disability: the NHS says it affects the way a person learns new things throughout their life and is different for everyone; some people need more support than others.

• Speech and language difficulties, including childhood apraxia of speech, and sensory processing differences.

• Tics and Tourette syndrome, sleep problems and feeding difficulties that sit alongside developmental conditions.

For autism the NHS says to speak to a GP about getting an assessment locally. For children, the school may need to make the referral, and if the child is not yet at school, a health visitor may need to. A mental health professional may also recommend a referral. For ADHD the NHS suggests talking first to a teacher, who will usually involve the school's special educational needs co-ordinator (SENCO), and then to a GP if support in school is not enough. Paediatric concerns about movement can start with a GP, health visitor, school nurse or SENCO, who may refer on to an occupational therapist or paediatrician.

The NHS says that once a referral is accepted, an autism assessment can take a few months or longer, and that waits for an ADHD assessment can run to several months or years. Meanwhile a child should keep getting support at home and school, and a GP or education professional can tell you what is available while you wait. If it is difficult to obtain a referral, you can ask another GP for a second opinion.

In England, the NHS says families can use Right to Choose to have an assessment at any provider commissioned to offer it, including some private clinics, which may have shorter waits. The 18-week referral-to-treatment standard applies to many consultant-led pathways, but neurodevelopmental waits depend heavily on local capacity, so ask the service for its current expected wait.

The NHS says that in an autism assessment for a child, the team may ask about development, such as when the child started talking, take a medical history and do a physical examination, ask the child to do tasks showing how they communicate, move, think and react, see how they play and interact with you, read reports from the GP, nursery or school, and speak to people who know the child well. A member of the team may visit the school to see the child in class and at break time. The team will look for other conditions common in autistic people, such as ADHD or epilepsy.

For ADHD, the NHS says the specialist asks about the child's symptoms and how they affect family life, as well as developmental milestones such as when they began to walk or read. There may be forms to complete, the specialist will usually contact a teacher or SENCO, and a computer-based test may be used.

After the assessment the NHS says you should be given a report saying whether the child is autistic, what they are good at, what they may need help with and any other conditions found. If you disagree with the outcome, you can ask the team to explain their reasoning and request a second opinion.

• Bring school reports, any speech therapy or educational psychology reports and nursery records.

• Bring the child's red book or a summary of early milestones if you have one.

• Bring a short written account of the main concerns with a few concrete examples.

• Bring a list of medicines and any hearing or vision test results.

Diagnosis is a starting point, not an endpoint. For DCD the NHS says there is no cure but therapies can help, such as breaking difficult movements into smaller parts and practising them, and adapting tasks, for example using special grips on pens. It stresses that DCD does not affect how intelligent a child is, but that written work can be harder and extra help may be needed in school.

For ADHD the NHS lists changes at home and school, such as splitting tasks into short slots with breaks, giving clear instructions one at a time and using praise or reward charts. Medicines such as methylphenidate must be started and monitored by an ADHD specialist, and a GP may take over prescribing only if a shared care agreement exists. Not every child needs or wants medicine. The NHS notes that melatonin can be used for sleep problems when other methods have not worked.

Education support matters as much as health care. In England, an education, health and care plan or SEN support at school can bring adjustments, and a family hub may help; the NHS notes family hubs support children and young people up to 19, or up to 25 where there are special educational needs or disability.

Private assessment is available for most of these concerns, usually by GP letter or direct approach. Check whether the clinician is on the GMC specialist register in paediatrics or a related specialty, whether the assessment is a single visit or a staged process, and whether information from school is gathered. Costs depend on the number of professionals involved, whether standardised tests and observation are included, and whether a written report suitable for school and the NHS is part of the fee.

Insurance policies often exclude neurodevelopmental assessment, so ask for the position in writing. The NHS says that if you do not agree with an NHS result you can pay for another assessment by a professional outside the NHS; whether an NHS service or school accepts a private diagnosis varies, so ask before relying on it. Shared care for medicines is not automatic, so ask how prescribing and monitoring would work.

A child who has lost skills they previously had, such as speech or walking, who has repeated seizures, or who seems very unwell, should be seen urgently by a GP, NHS 111 or A&E. If a young person with a neurodevelopmental condition is in distress and talks about harming themselves, call 999 or go to A&E. The NHS notes that people with ADHD are at higher risk of anxiety, depression and suicide, so low mood should always be taken seriously.