Developmental assessment in the over 5s

The paediatrician's role in the developmental assessment of children under the age of 5 is well established, and so he/she might also have a role in the assessment of school-age children, particularly as (i) it is increasingly recognised that subtle presentations of developmental disorders may escape professional notice until school age, (ii) these disorders are interweaving and overlapping, necessitating a truly holistic view and (iii) no another professional group is equipped to deliver a single diagnostic assessment encompassing cognitive, communication, social, emotional and physical domains. However, assessment in the over-5s requires a different set of skills to the under-5s. The emphasis in this age group shifts from assessing developmental impairment, for example, a specific delay in walking or talking or a low developmental quotient, to assessing factors affecting the child's social or academic function. The paediatrician's task is to apply their knowledge of risks and vulnerabilities, using their experience in general and developmental paediatrics, paediatric neurology and child and adolescent mental health to identify environmental and/or biological factors affecting the child. The diagnostic focus that is a strength of paediatric practice needs to be tempered by a more flexible approach taking account of the child's strengths and difficulties. Finally, the clinician needs to decide if further assessment and investigations are required and make recommendations to help improve the outcome for the child. In this paper, the author will set out the context for these assessments, and then guide the reader through a clinical approach that the author has found useful.