Counselling · Intermediate · Paediatrics

Parental Concerns About Child Development

Practise this PLAB 2 counselling station on Global Developmental Delay. 8-minute voice AI simulation with feedback on all 3 marking domains.

Clinical scenario

You are an FY2 doctor in a GP surgery. Mrs Elaine Miles has brought her 18-month-old son Rohan to see you. She is concerned that Rohan is not developing as quickly as her friends' children of similar age. He is not yet walking independently, uses only a few words, and seems less interested in playing with toys. Please assess his development and discuss whether referral for specialist assessment is needed.

Background notes: PMH: Born 38+5 weeks, birthweight 2.8kg, normal delivery. Hearing checks normal. No chronic illnesses

What this station tests

  • Systematic developmental assessment across all four domains: gross motor, fine motor, language, and social
  • 18-month milestones: walking, tower of blocks, 6-20 words, pointing, pretend play
  • Bilingualism does not cause developmental delay: may affect expressive language timing but not receptive or non-verbal
  • Hearing assessment as the first investigation for language delay: commonest treatable cause
  • Red flag: loss of previously acquired skills (regression) suggests neurodegenerative condition and needs urgent referral

How to use your 8 minutes

  • 0-1 min — Introduction: Introduce yourself, establish what patient already knows and understands.
  • 1-3 min — Explain Condition: Explain diagnosis or condition using chunk-and-check technique. Use simple language, avoid jargon.
  • 3-5 min — Management Options: Discuss treatment options. Shared decision-making. Risks, benefits, alternatives.
  • 5-7 min — Address Concerns: Explore and address specific concerns. Check understanding. Discuss lifestyle implications.
  • 7-8 min — Closing: Summarise agreed plan. Safety netting. Arrange follow-up. Written information offer.

Consultation approach

The opening

Parental concerns about development must always be taken seriously. The candidate must assess each developmental domain, acknowledge normal variation while identifying genuine delay, and communicate sensitively. Rohan is 18 months old. His mother Elaine is concerned he is not developing as quickly as friends' children. Open with: 'Elaine, tell me specifically what you have noticed about Rohan's development that concerns you.'

Core approach

Assess each developmental domain against 18-month milestones. Gross motor: is he walking? (Expected by 18 months; if not walking by 18 months, this warrants assessment.) Fine motor: can he build a tower of 2 to 3 blocks? Use a spoon? Scribble? Language: how many words? (Expected 6 to 20 words at 18 months; fewer than 6 is concerning.) Does he understand simple instructions? Social: does he point to show you things (proto-declarative pointing)? Does he make eye contact? Does he engage in pretend play?

Consider the context. Rohan is from a bilingual household (Hindi and English). Bilingualism can affect the timing of expressive language but should not affect receptive language or non-verbal communication. He was born at 38+5 weeks (borderline early term, minimal adjustment needed). Birth weight was appropriate.

Red flags for significant delay: no words at 18 months, not walking by 18 months, loss of previously acquired skills (regression, which suggests a neurodegenerative condition), absence of pointing or joint attention (raises ASD concern), no response to name.

Check hearing: has he had his newborn hearing screen? (Normal.) Hearing loss is the commonest treatable cause of language delay.

Closing and safety netting

If delay is confirmed across domains: refer to community paediatrics for formal developmental assessment. If delay is in one domain only (e.g., language): arrange hearing test (even if newborn screen was normal, as acquired hearing loss can develop), speech and language therapy referral, and review in 3 months.

Reassure proportionately. 'There is a wide range of normal development. Some children are late walkers or late talkers and catch up completely. But because you have noticed some areas where Rohan is not quite where we would expect, I want to get a specialist opinion to make sure we support him in the right way.'

Address the bilingual concern: 'Speaking two languages at home is excellent for Rohan's development. It does not cause delays.' Safety net: 'If Rohan loses any skills he already has, come back urgently.' Follow-up after specialist assessment.

How examiners mark this station

Examiners will assess your ability to explain global developmental delay and its management in a patient-centred way. Domain 2 (Clinical Management) and Domain 3 (Interpersonal Skills) are equally weighted and primary. Expect marks for accurate information delivery, shared decision-making, chunk-and-check technique, and addressing the patient's specific concerns. Domain 1 (Data Gathering) is assessed through how well you establish the patient's baseline understanding and elicit their concerns.

Domain 1: Data Gathering, Technical and Assessment Skills (Primary focus)

Scores well: All four domains assessed against milestones. Birth history reviewed. Hearing checked. Bilingual context considered. Red flags screened (regression, joint attention). Parental concern validated.

Costs marks: Not assessing all domains. Dismissing parental concern. Not checking hearing. Attributing to bilingualism.

Domain 2: Clinical Management Skills (Primary focus)

Scores well: Appropriate referral (community paediatrics or SALT depending on findings). Hearing test arranged. Follow-up plan. Regression safety netting.

Costs marks: No referral. No hearing test. Dismissing without assessment.

Domain 3: Interpersonal Skills (Primary focus)

Scores well: Taking parental concern seriously. Explaining normal variation while acting on concern. Reassuring about bilingualism. Not being alarmist while not being dismissive.

Costs marks: Dismissing concern. Being alarmist. Making parent feel they caused the delay.

Common examiner feedback (and how to fix it)

Did not provide adequate explanation or plan to the patient

Fix: Use chunk-and-check: deliver one concept, check understanding, then move to the next. Offer all relevant treatment options with risks and benefits before helping the patient decide.

Did not sufficiently recognise or respond to the patient's feelings, concerns, or expectations

Fix: Before and during counselling, explicitly ask what concerns the patient most. Respond to emotional cues with empathic statements before continuing with information.

Common mistakes in this station

  1. Dismissing parental concern. Parents who notice developmental differences are usually right. Candidates who say 'he'll catch up, don't worry' without formal assessment miss genuine delays.
  2. Attributing language delay to bilingualism. Bilingualism does not cause developmental delay. Candidates who reassure based on the bilingual household without assessing receptive language and non-verbal communication may miss a real problem.
  3. Not checking hearing. Hearing loss is the commonest treatable cause of language delay. Even if the newborn screen was normal, acquired hearing loss can develop. Candidates who do not arrange hearing testing miss this.

Resitting PLAB 2?

If counselling stations have been a challenge, the most common issue is information overload: delivering too much clinical detail without checking understanding. Practise the chunk-and-check technique until it becomes automatic. Remember that shared decision-making, not lecturing, is what scores highly in Domain 3.

Example opening

Hello, my name is Dr [Name]. I understand you've come in today to discuss [topic]. Before I explain things, could you tell me what you've been told so far, so I know where to start?

Frequently asked questions

What is the best way to structure this global developmental delay counselling consultation?

Parental concerns about development must always be taken seriously. The candidate must assess each developmental domain, acknowledge normal variation while identifying genuine delay, and communicate sensitively. Rohan is 18 months old.

Where are marks won and lost in this global developmental delay station?

Examiners reward: All four domains assessed against milestones. Birth history reviewed. Hearing checked. Bilingual context considered. Red flags screened (regression, joint attention). Candidates are penalised for: Not assessing all domains. Dismissing parental concern. Not checking hearing. Attributing to bilingualism.

Where do candidates most often go wrong in this station?

Dismissing parental concern. Parents who notice developmental differences are usually right. Candidates who say 'he'll catch up, don't worry' without formal assessment miss genuine delays.

Can I do well in this station without real-world experience of global developmental delay?

Structure beats experience here. Focus on 18-month milestones: walking, tower of blocks, 6-20 words, pointing, pretend play. Use the domain breakdown on this page to target your preparation, then practise the station aloud so your structure survives exam pressure.

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