MBBS OSCE · Psychiatry
OSCE — Intellectual Disability (Developmental Delay)
Eight-minute OSCE station on Intellectual Disability (Developmental Delay): focused history, examination priorities, investigations, emergency and definitive management.
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Brief (to candidate)
You will assess a patient with a presentation consistent with Intellectual Disability (Developmental Delay).
You have 8 minutes to take a focused history, outline examination, investigations, and management including red flags.
Clinical context
Intellectual disability (ID) is a neurodevelopmental disorder defined by deficits in intellectual functioning (IQ under 70) AND in adaptive functioning (conceptual, social and practical domains), with onset during the developmental period (before age 18). Severity by DSM-5 / ICD-11: mild (IQ 50 to 69, approximately 85 percent), moderate (IQ 35 to 49, 10 percent), severe (IQ 20 to 34, 3 to 4 percent), profound (IQ under 20, 1 to 2 percent). Causes are genetic (Down syndrome is the commonest chromosomal cause; Fragile X the commonest inherited single-gene cause; Rett, PKU, Prader-Willi, Angelman), prenatal (TORCH, fetal alcohol syndrome), perinatal (hypoxic-ischaemic encephalopathy, prematurit
Candidate tasks
- Clarify onset, severity, associated features, and red-flag symptoms.
- State focused examination priorities.
- List first-line investigations and any named score/criteria.
- Give immediate resuscitation steps.
- Outline definitive management with doses/routes where standard.
- Name complications and disposition (ward / HDU / theatre / discharge safety-net).
- Mention one special-population modifier (pregnancy, child, elderly, CKD).
Examiner checklist
| Domain | Pass behaviours |
|---|---|
| Definition | Correct working diagnosis language |
| Assessment | Focused, prioritised, red flags sought |
| Investigations | Appropriate first-line + interpretation |
| Emergency care | ABC / time-critical actions first |
| Definitive care | Specific drugs/procedures, not generic phrases |
| Safety | Child with global developmental delay (delayed milestones in 2 or more domains) |
| Safety | Regression of previously acquired milestones - urgent neurology; exclude Rett, L |
| Safety | New-onset behavioural change in an adult with ID - exclude physical illness (UTI |
| Communication | Clear plan and safety-netting |
Model outline
Lead with the working diagnosis and life threats. Resuscitate before definitive tests when unstable. Use guideline-standard therapy with named agents and doses. Document escalation criteria and follow-up. A safe candidate is specific, structured, and never delays critical care for non-urgent imaging.