Parent-reported warning signs preceding specialist consultation for neurodevelopmental and communication disorders in children: A retrospective descriptive study in Elbasan, Albania

Abstract

Parental concerns often initiate the pathway to developmental assessment, but the types of warning signs reported by families in Albania remain insufficiently described. This study aimed to describe parent-reported warning signs that prompted consultation for language, communication, and neurodevelopmental problems and to explore their distribution across parent-reported diagnostic categories. A retrospective descriptive survey was conducted in October-November 2025 among a convenience sample of parents whose children were receiving therapeutic services in one public and one private institution in Elbasan, Albania. Of 73 parents approached, 53 completed an author-developed, semistructured questionnaire; three incomplete forms were excluded, leaving 50 analyzable records (response rate, 68.5%). The questionnaire had undergone expert review and pilot testing in 10 parents outside the final sample. Warning signs were analyzed as multiple-response variables. Parent-reported diagnostic labels were cross-checked against available clinical records, while the reported wording was retained for analysis. Autism spectrum disorder was reported in 28 cases (56.0%); 14 parents (28.0%) did not report a specific diagnosis. Parents themselves recognized a concern in 47 cases (94.0%), whereas another person prompted consultation in 3 cases (6.0%). Language delay was the most frequent warning sign (36/50, 72.0%), followed by hyperactivity or attention difficulties (11/50, 22.0%) and unusual behavior (9/50, 18.0%); any language-related concern was reported in 38 cases (76.0%). In an exploratory sensitivity analysis restricted to the 36 children for whom the parent named a diagnostic category, none of the individual warning signs differed significantly between autism spectrum disorder and the other named parent-reported diagnostic categories. Parent-reported language and behavioral concerns are useful developmental-surveillance information and should prompt structured clinical assessment, but the retrospective design does not permit conclusions about diagnostic accuracy or predictive value. Prospective, standardized developmental screening in primary care is warranted.