Learning difficulty/disability in children ≥ 6 years

Emergency department referrals

All urgent cases must be discussed with the on-call Registrar to obtain appropriate prioritisation and treatment.

Contact through:

Caboolture Hospital (07) 5433 8888
Redcliffe Hospital (07) 3883 7777
Royal Brisbane and Women's Hospital (07) 3646 8111

Urgent cases accepted via phone must be accompanied with a written referral and a copy faxed immediately to the Central Patient Intake Unit: 1300 364 952.

If any of the following are present or suspected, refer the patient to the emergency department (via ambulance if necessary) or seek emergent medical advice if in a remote region.

Non-verbal child with acute distress and possible acute pain where medical condition needs exclusion, e.g. tooth abscess, bone infections or osteopaenic fractures

Does your patient wish to be referred?

Minimum referral criteria

Does your patient meet the minimum referral criteria?

Category 1

Appointment within 30 days is desirable

Definite history of loss of academic ability with deterioration in cognition suggestive of neurological disease. (IQ measurement is not required in order to accept this referral)
Child in out of home, where there is imminent threat of breakdown of current foster placement due to the complexity of the child’s developmental concerns.

Category 2

Appointment within 90 days is desirable

Acute severe functional deterioration in a child diagnosed with a learning disability or underlying developmental disorder
Child with recurrent suspensions, or at risk of expulsion from school or is unable to attend due to their learning and / or associated behavioural challenges
A child currently in out of home care (OOHC) or at risk of entering or leaving OOHC, where they have previously been on a waiting list for this problem and were removed without receiving a service

Category 3

Appointment within 365 days is desirable

Child with suspected moderate to severe learning difficulty / disability who requires timely assessment for purpose of diagnostic formulation, accessing NDIS and / or support for verification of disability in education setting.
Educational psychology assessment suggests presence of an intellectual impairment or underlying developmental disorder and the child has never seen by a Paediatrician for assessment
Suspected attention deficit disorder

If your patient does not meet the minimum referral criteria

Consider other treatment pathways or an alternative diagnosis.

If you still need to refer your patient:

Please explain why (e.g. warning signs or symptoms, clinical modifiers, uncertain about diagnosis, etc.)
Please note that your referral may not be accepted or may be redirected to another service

Other important information for referring practitioners

Not an exhaustive list

Refer to HealthPathways for assessment and management information if available
All children referred for learning difficulty require visual acuity and audiometry results.
Developmental optometry and auditory processing assessments are not supported by evidence
Are there significant behavioural or emotional issues suggesting that this referral would be better assessed under a behavioural category?
In the majority of cases it is thought inappropriate for children to wait more than 6 months for an outpatient initial appointment
If you have a reason to suspect a child in Queensland is experiencing harm, or is at risk of experiencing harm, you need to contact Child Safety Services: Department of Children, Youth Justice and Multicultural Affairs
Clinical urgency is the dominant consideration in the prioritisation of a referral for a child currently in out of home care (OOHC), or at risk of entering or leaving OOHC.

Referral requirements

A referral may be rejected without the following information.

Essential referral information

History and Examination

WISC or other equivalent IQ measurement within the previous 3 years or detailed information regarding learning abilities (such as NAPLAN report or reading, spelling, maths age equivalent levels) (provided by the school or another external provider). This is not required if there is a concern about developmental regression.
Review by school/private psychologist outlining area of difficulty, including report on school performance and engagement with schoolwork, copies of most recent school reports, other assessments of academic ability and achievement, what learning support or target academic interventions / remediation has been received by child to date. It is strongly recommended that school guidance officers complete formal cognitive assessments if the child is achieving below grade expectations
Nature of parents’ concerns
Are there significant behavioural or emotional issues suggesting that this referral would be better assessed under a behavioural category? It is acknowledged that behavioural difficulties can be secondary to learning problems
Report presence or absence of concerning features
- Is the child able to actively engage in learning, is there reduced school hours attendance, recurrent suspensions, at risk of expulsion due to their learning and / or associated behavioural challenges
- Is there definite history of developmental regression, and if so what specific loss of skills has been noted?
- Is the child expected to be in out of home care supervised by the Department of Children, Youth Justice and Multicultural Affairs for more than 6 months?
Confirmation of OOHC (where appropriate)

Additional referral information (useful for processing the referral)

Highly desirable information – may change triage category

Classroom reports of school performance and engagement with schoolwork.
Other assessments of academic ability and achievement
Audiometry
Medical history
Family history, including family members affected with ASD, ADHD, learning difficulty or mental illness.
Copies of previous speech, occupational therapy, physiotherapy or cognitive assessments if available.
If the child is in foster care, please provide the name and regional office for the child safety officer who is the responsible case manager.
Significant psychosocial risk factors (especially parents mental health, family violence, housing and financial stress, Department of Children, Youth Justice and Multicultural Affairs involvement)
School history –exclusions or suspensions.

Desirable information- will assist at consultation

Pregnancy and birth history
Other past medical history
Immunisation history
Developmental history
Medication history
Height/weight/head circumference and growth charts with prior measurements if available.
Other physical examination findings inclusive of CNS, birth marks or dysmorphology
Any relevant laboratory results or medical imaging reports

Out of catchment

Metro North Health is responsible for providing public health services to the people who reside within its boundaries. Special consideration is made for patients requiring tertiary care or services that are not provided by their local Hospital and Health Service. If your patient lives outside the Metro North Health area and you wish to refer them to one of our services, inclusion of information regarding their particular medical and social factors will assist with the triaging of your referral.

Clinical Modifiers (where relevant)

Impact on employment
Impact on education
Impact on home
Impact on activities of daily living
Impact on ability to care for others
Impact on personal frailty or safety
Identifies as Aboriginal and/or Torres Strait Islander

Reason for Referral (essential)

To establish a diagnosis
For treatment or intervention
For advice and management
For specialist to take over management
Reassurance for GP/second opinion
For a specified test/investigation the GP can’t order, or the patient can’t afford or access
Reassurance for the patient/family
For other reason (e.g. rapidly accelerating disease progression)
Clinical judgement indicates a referral for specialist review is necessary

Clinical Information (essential)

Presenting symptoms (evolution and duration)
Physical findings
Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
Body mass index (BMI)
Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes), noting these must be stable and controlled prior to referral
Current medications and dosages
Drug allergies
Alcohol, tobacco and other drugs use