| Course | NU 632 Healthcare of Infants, Children and Adolescents |
|---|---|
| Unit | Unit 3 |
| Paper type | Developmental screening and referral |
| Length | About 1,020 words, 6 pages |
| Format | APA 7 student paper |
| School | Herzing University |
| Program | MSN Family Nurse Practitioner |
| Updated | October 2026 |
Free sample paper for NU 632 Unit 3
Developmental Screening and Parallel Referral for an 18-Month-Old With a Positive M-CHAT-R/F and Few Words
Student Name
Department of Nursing, Herzing University
NU 632: Healthcare of Infants, Children and Adolescents
Instructor Name
February 4, 2026
Developmental Screening and Parallel Referral for an 18-Month-Old With a Positive M-CHAT-R/F and Few Words
The Child and What Was Already Noticed
Liam, a composite 18-month-old boy, attends his scheduled 18-month visit with his mother. He was born at term, has had no serious illnesses, and passed his newborn hearing screen. His mother says: "He doesn't say many words, and he doesn't really point at things like his cousin did. Sometimes I call him and he doesn't look." She has wondered about this for a few months but was told by relatives that boys talk later. Her concerns are recorded here in her words because parental concerns about development are a meaningful predictor of developmental problems and deserve weight rather than reassurance (Lipkin et al., 2020).
Instruments Used
Two instruments were used, because the 18-month visit calls for both general developmental screening and autism-specific screening (Hyman et al., 2020). The Ages and Stages Questionnaire, third edition, 18-month form, covers five areas of development, from movement (large and small muscle skills) to language, problem solving, and social and self-help skills. It is completed by the parent and scored against age-based cutoffs. The M-CHAT-R/F, the revised version of the modified toddler autism checklist that adds a structured follow-up interview, validated for children aged 16 to 30 months, screens for autism risk with 20 yes-or-no items and a clinician interview that revisits each positive item, which reduces false positives (Robins et al., 2014). Both forms were in English, his mother's first language, and were filled in while they waited; both were scored during the visit rather than after it, so that the results could be discussed with his mother before she left, and the M-CHAT-R/F follow-up interview was conducted by the nurse practitioner.
Results
Ages and Stages Questionnaire: communication score below the cutoff, indicating a need for further assessment. Personal-social score in the monitoring zone, close to the cutoff. The two motor domains and problem solving were comfortably above their cutoffs, which fits what was seen in the room and makes a global delay less likely than a delay centered on communication and social connection.
M-CHAT-R/F: initial score 6, in the medium-risk range of 3 to 7. On the follow-up interview, 4 items remained positive: he does not point to show interest, does not bring objects to show his mother, does not respond consistently to his name, and does not follow her gaze when she looks at something. A follow-up score of 2 or more is a positive screen.
Observed during the visit: he used two words, "mama" and "ba" for ball; he did not point to request or to share interest; he made brief eye contact; he lined up the office's toy cars along the edge of the table; he walked well and stacked three blocks.
What a Positive Screen Means and Does Not Mean
A positive M-CHAT-R/F after the follow-up interview means Liam has a higher chance of autism spectrum disorder or another developmental difference, and that a diagnostic evaluation is needed. In the validation study, about half of the children who screened positive after follow-up were diagnosed with autism, and nearly all of the others had another developmental delay or concern (Robins et al., 2014). It does not mean he has autism. The communication result on the Ages and Stages Questionnaire likewise identifies a delay that needs evaluation but does not identify its cause. Screening identifies children who need a closer look; diagnosis requires a comprehensive evaluation by a specialist or team.
Two Referrals, in Parallel
Referral 1, diagnostic evaluation: to the regional developmental-behavioral pediatrics clinic, which evaluates children for autism and other developmental conditions. The referral asks a specific question: "Please evaluate for autism spectrum disorder and language disorder in an 18-month-old with a positive M-CHAT-R/F follow-up score of 4 and a communication score below cutoff on the ASQ-3." The clinic's current wait is about five months.
Referral 2, early intervention: to the state's early intervention program under Part C of the Individuals with Disabilities Education Act, which provides evaluation and services for children under three with developmental delays. Families can be referred directly, and services can begin once eligibility is established, without waiting for a medical diagnosis. This referral is made today, at the same time as the diagnostic referral, because waiting for the diagnostic evaluation would lose five months of services at an age when intervention matters. The referral was sent electronically during the visit, with his mother's consent, and she was given the program's phone number in case she has not heard from them in two weeks.
Current guidance recommends exactly this parallel approach: referring for diagnostic evaluation and to early intervention at the same time, rather than sequentially (Hyman et al., 2020).
Hearing and Vision
Any child with a language delay or inconsistent response to name needs a formal hearing assessment, because hearing loss can cause both and can develop after a normal newborn screen. Referral to pediatric audiology was made today. Vision was screened with an instrument-based photoscreener and was normal.
What the Family Was Told
His mother was told: "You were right to raise this. The screening tests show that Liam needs a closer look at how he communicates and connects with people. This doesn't give us a diagnosis. It tells us he'd benefit from an evaluation and from starting early intervention now, which is free and can begin in the next few weeks." She asked whether it was her fault because he watches television; she was told it is not. She was given written information about early intervention and the autism evaluation process.
Tracking
Referrals made are not assumed to be referrals attended. The clinic's referral coordinator will confirm, at two weeks, that early intervention has contacted the family and, at four weeks, that the audiology appointment is scheduled. The developmental-behavioral pediatrics appointment date will be recorded when it is booked. Liam's next visit is in three months, rather than at 24 months, to review early intervention progress, and his mother was asked to call if she has not been contacted by any service within two weeks.
References
Hyman, S. L., Levy, S. E., Myers, S. M., & Council on Children With Disabilities, Section on Developmental and Behavioral Pediatrics. (2020). Identification, evaluation, and management of children with autism spectrum disorder. Pediatrics, 145(1), Article e20193447. https://doi.org/10.1542/peds.2019-3447
Lipkin, P. H., Macias, M. M., & Council on Children With Disabilities, Section on Developmental and Behavioral Pediatrics. (2020). Promoting optimal development: Identifying infants and young children with developmental disorders through developmental surveillance and screening. Pediatrics, 145(1), Article e20193449. https://doi.org/10.1542/peds.2019-3449
Robins, D. L., Casagrande, K., Barton, M., Chen, C.-M. A., Dumont-Mathieu, T., & Fein, D. (2014). Validation of the Modified Checklist for Autism in Toddlers, Revised with Follow-up (M-CHAT-R/F). Pediatrics, 133(1), 37-45. https://doi.org/10.1542/peds.2013-1813
What the NU 632 Unit 3 instructions ask for
The Unit 3 assignment asks you to screen a young child's development, interpret the results and plan referral. Expect to name the instruments used at the visit, usually a general developmental screen and, at 18 and 24 months, an autism-specific screen, and report the scores with cutoffs. The paper should explain what a positive screen means, emphasizing that it is not a diagnosis. Referrals are typically expected in parallel: diagnostic evaluation and early intervention, without waiting for one to finish. Hearing and vision checks are commonly required for language delay. Many sections ask what the family was told, in plain words, and how referrals will be tracked. Cite AAP guidance and the instruments' validation studies in APA 7. The child should be a composite, and the wording to the family should be kind and direct.
How this NU 632 Unit 3 example is built
The paper opens with Liam's history and his mother's worry that he does not point or answer to his name consistently. Both instruments are described with what they measure and why both are used at this age. Results are reported with domain scores and the M-CHAT-R/F result after the follow-up interview. The interpretation section explains that a positive screen raises the chance of autism or another developmental condition and that only an evaluation can diagnose. Two referrals are written in parallel with what each provides: diagnostic evaluation at a regional clinic and early intervention services that can start now. A section explains why hearing loss must be ruled out. What the family was told is quoted, beginning with validating the mother's concern. Tracking names who confirms contact at two weeks and what happens if it has not occurred.
Reading the NU 632 Unit 3 rubric
Herzing rubrics for a screening and referral paper usually reward instrument selection, accurate scoring and interpretation, referral decisions, hearing and vision assessment, family communication and follow-up. Instrument points depend on using recommended tools at the right age. Interpretation is credited when the paper explains what a positive screen means and does not claim a diagnosis. Referral decisions often weigh heavily; graders expect early intervention started alongside diagnostic evaluation rather than after it. Hearing and vision points require a formal assessment for language concerns. Family communication earns points for plain, supportive language that answers the parent's concern. Follow-up points go to tracking that confirms referrals were attended. Evidence and writing points cover AAP guidance cited in APA format and a clear sequence.
Common NU 632 Unit 3 mistakes, and how to avoid them
Screening papers often lose points by waiting for a diagnosis before referring to early intervention. Students also call a positive M-CHAT-R/F a diagnosis of autism. The follow-up interview, which reduces false positives, is commonly skipped. Hearing assessment is frequently left out, though hearing loss can cause both speech delay and poor response to name. Another common problem is reporting scores without cutoffs or domains. Family communication is sometimes missing or written in clinical terms. Referrals without tracking leave a known gap, since many families never connect with services. Finally, use the screening ages recommended by current guidance, since some sections check that the autism screen is done at both 18 and 24 months.
Get a NU 632 Unit 3 example written to your instructions
Send the Unit 3 instructions and the rubric from your NU 632 classroom, plus the child's age and the screening result your submission covers. We write a custom example with parallel referrals, clear interpretation and completion tracking, returned in 24 to 48 hours. The first custom sample is free.
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NU 632 Unit 3 questions, answered
Why refer to early intervention before a diagnosis?
Because eligibility usually rests on delay rather than on a diagnosis, and the evaluation can take months. Referring in parallel means services can begin while the diagnostic process runs, and the earliest period is when intervention does most good. Waiting for a diagnosis first is the single most common way these pathways lose time.
What should the family be told about a positive screen?
That it identifies a child who needs a closer look, not that it establishes a diagnosis. Screens are designed to catch more children than have a condition, so a positive result frequently resolves. Say what the next steps are, what they will involve, and that starting support now is worthwhile regardless of what the evaluation eventually finds.
Why check hearing and vision?
Because both produce patterns that look like developmental delay. A child with unrecognized hearing loss will screen positive on language domains, and the correct response is entirely different. Confirming sensory status is quick, and a pathway that omits it can send a child through a developmental evaluation for something an audiologist would have identified.
Where can I find a free NU 632 Unit 3 sample paper?
This page gives the full NU 632 Unit 3 screening and referral paper at no cost, with both instruments, the meaning of a positive screen, the parallel referrals and the tracking plan. If your child's results differ, send them and a free custom paper comes back, typically within a couple of days.
Should a child with a positive autism screen wait for a diagnosis before early intervention?
No. Current guidance supports referring to early intervention at the same time as the diagnostic evaluation, because services can start based on delays and early support helps regardless of the final diagnosis.