Developmental observation and referral

What observation actually is here

Written notes on every child, kept as a matter of routine rather than because something is wrong. What they did, with whom, for how long, what they said, what they found hard. Nora keeps the most detailed records in the building and shows them to families rather than summarising them.

It is not a checklist and it is not scored. We do not rate children against milestones on a form, partly because we are not qualified to and partly because a scored form produces a number that families then carry to appointments as though it meant something.

The value is longitudinal. A single observation is anecdote; the same thing noted across four months by three different adults is worth taking to a physician, and it is exactly the kind of evidence that makes a referral go well.

How we raise a concern

Early, in person, and specifically. Not at a scheduled review three months later, and not in a note at the door on a Friday. If we are worried enough to think about it twice, you should know.

We describe what we have seen rather than what we think it means. He has not combined two words in the four months we have been noting it, and here are the notes, rather than a suggestion about a diagnosis. That distinction is the whole of our competence and we stay inside it.

And we accept that we are sometimes wrong. A fair number of the children we have raised concerns about turned out to be entirely typical and simply on their own schedule. Raising it early and being wrong is a much better failure than waiting and being right.

Where the referral routes go

For children under three: Early Intervention, a free New York State programme. A parent can refer their own child directly and does not need a physician or a nursery to do it — which is the single most useful thing on this page.

For children three and over: the Committee on Preschool Special Education through the Department of Education, also free, which handles evaluation and any services that follow.

Both are public and neither costs a family money. We will help with the paperwork, we will provide our written observations for an evaluation, and we will accommodate what a resulting plan asks of us in the room.

What we will not do

Diagnose, screen, assess or use any instrument that produces a score. Suggest a condition by name. Recommend a private evaluation over the free public route, which is a place where money quietly enters this conversation elsewhere.

Or wait. The commonest failure in this trade is a nursery that noticed something in October and mentioned it in June, because raising it felt like an intrusion. A year of Early Intervention starting in November rather than the following September is a materially different thing for a child.