Difficult situation indeed. Unless you are looking in terminating these clients because you are not able to provide the care she needs and meet the parents goals for her I think I would just bring it up casualy. Like 'Have you noticed how she holds her crayon still ?, I think she may have some difficulty there'' Hopefully they will catch on and seek help.

I've had 2 sibblings (temporarly thank goodness) the 4 year old boy was still putting everything in his mouth, had NO words, was still drooling, not close to beeing potty trained and not eating with ustensils. Same for his 2 yo sister. If they had sent them to me in daycare in the hopes that they would start talking and eating and all before starting shcool I would have raised my concerns and told them I could simply not meet their goals as I felt the needed 'special' type of care. But in this case I new it was temporary and they were seeking medical help.

Difficult for sure ... Good luck !