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12 Cards in this Set
- Front
- Back
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Background |
Significantly challenging behaviours are apparent in around 20% of children. These behaviours:
lie outside of the range of normal developmental behaviour. cause considerable stress to the child and/or their families. have a negative impact on their social or educational experience. persist. Mild to moderate behaviour problems may be developmentally appropriate, occurring as a child begins to negotiate a new area of independence, but in a way which causes stress for their families or support people.
Some behaviours may be more extreme and escalate in severity. They may occur in a family context where resources for managing them are limited.
Severe antisocial behaviour in childhood is a strong predictor of long-term negative outcome in adulthood. |
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What are some concerning behaviour |
Any previous difficult behaviours Nature of the behaviour Frequency of occurrence Length of time the behaviour has been causing concern Impact of behaviour on others Response to the behaviour – does it reinforce or maintain the behaviour? Actions taken to address the behaviour and what impact they have had on behaviour What the child gains from demonstrating behaviour Where the behaviour occurs and what triggers it Context in which the behaviour occurs. If ≥ 2 settings, this is of greater concern. Patterns of escalation, degree of persistence of behaviour |
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History |
Take a detailed history of concerning behaviour, gathering information from several sources if possible. Consider the behaviour in context. Challenging behaviour may be a stage or an understandable response to family or school stressors. Events or stressors Changes in family setting Family history Personal and developmental history Psychiatric history Medical history Alcohol and drug exposure (including in utero), and forensic history if relevant. |
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Exam |
Development milestones
Look for dysmorphic features. Consider more subtle features of fragile X, Turner syndrome, Klinefelter syndrome, foetal alcohol syndrome. Consider the possibility of hearing and vision difficulties. Examine the throat for tonsillar hypertrophy. Check skin for neurocutaneous signs e.g., hypopigmented macules (tuberous sclerosis), café au lait spots (neurofibromatosis). Also look for signs of trauma e.g., bruising, scars. Assess for neurologic status and strength status to identify conditions such as tuberous sclerosis, seizures, muscular dystrophy. Check blood pressure and heart rate as clues for hyperthyroidism or pheochromocytoma. Check for goitre. |
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If concerning behaviour significantly impacts the child's schooling, ensure
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concurrent involvement of the school.
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If concerning behaviour significantly impacts the child's schooling, ensure concurrent involvement of the school.
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Download the developmental school report form and give it to the parent.
Ask the parent to: make an appointment with the school principal, SENCO, or RTLB. It is important the principal is involved to ensure they are aware of the concerns and appropriate action taken. give the developmental school report form to the principal for the class teacher to complete. Ask the teacher to return the completed questionnaire to the general practitioner. |
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are investigations needed |
generally no |
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Consider possible underlying causes, being aware that behaviour is a symptom and not a disorder of its own in most children.
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Vision
Hearing Attention deficit hyperactivity disorder (ADHD) Autism spectrum disorder (ASD) Anxiety Developmental concerns Psychosis Child abuse and neglect, family violence, parental mental health or substance use Substance abuse Conduct disorder (CD) Oppositional defiant disorder (ODD) Depression Sleep apnoea Learning difficulties |
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Decide whether the challenging behaviour is mild, moderate, or severe, and
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determine what resources the family and school have to manage it.
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Management
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Manage any immediate risk
Consider notifying Oranga Tamariki: Ministry for Children if: Provide advice on general behaviour strategies. These are usually adequate for mild to moderate behavioural concerns with no underlying cause. If general behaviour strategies do not help improve behaviour, consider group programmes for managing child behavioural problems. Incredible Years (for parents of children aged 3 to 8 years) is the treatment modality with the greatest evidence of benefit in this age group. If severe behavioural challenges and/or suspicion of underlying developmental, medical, or psychiatric cause, request assessment according to the possible diagnosis. Consider recommending psychosocial support, If prominent school issues, encourage parents to seek support from school. If confirmed intellectual disability or ASD with significant behavioural difficulties, request needs assessment and service coordination (NASC) through Taikura Trust. If the patient is the child of a parent with mental illness or addiction, consider Supporting Parents – Healthy Children. |
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Management
Provide advice on general behaviour strategies. These are usually adequate for mild to moderate behavioural concerns with no underlying cause. |
Reassure the parent, when appropriate.
Provide patient information, e.g.: MOH info sheet Recommend healthy lifestyle choices. Introduce age-appropriate behaviour interventions, reinforcing parental control. |
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Behaviour interventions
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Be firm, fair, and friendly.
Work together with carers. Distract an escalating child. Use time out to remove a child from an escalating situation, and to give carers time to calm down before addressing the behaviour. Reinforce behaviours that are desirable and that prevent problem behaviours. Avoid reinforcing bad behaviour through giving behaviour attention. Implement planned ignoring of inappropriate behaviour, unless there are safety risks. Remove privileges or use time out for difficult behaviours. Direct parents to the Raising Children Network for advice on dealing with behaviour in children: Encourage caregivers to spend quality one-on-one time with their child, engaging in fun activities which assist with bonding. See Raising Children Network – Enjoying Time With Your Child: Ways to Connect. |
