Behaviour Flashcards
What are key features on history to identify for child presenting with behavioural issues?
What the main concern is, chronicity of the issue, what they’ve done to address it already and why they are presenting today
Antenatal/developmental hx
- gestation, birth weight
- smoking, alcohol, drugs, toxins, infections during pregnancy
- birth trauma or early issues
- separation anxiety
- concerns about growth?
- concerns about development? When walked and talked
Current symptoms
- tantrums
- screen for ADHD (impulsivity, inattentention, hyperactivity, ODD (loose temper, defiant, blame others), ASD (speech, stereotypies, social)
- Issues at school - spelling, reading/writing, maths
- friends at school, play
- trouble at school?
- Sleep issues?
- Diet issues?
- current function - academic progress, ADLs
Strengths - what they’re good at
Social hx
- issues at home - parent MH, relationships, financial, stressors
- social support
- impact on parents and family function
Medical hx
Family hx - ADHD, ASD, learning disabilities, MH
Have they had any previous Ix or assessments?
What are the DDx for behavioural issues?
Developmental/behavioural - ADHD, ODD, ASD, developmental delay, learning disability, ID, language disorder
Medical - vision/hearing impairment, lead poisoning, Fe deficiency, thyroid, iatrogenic, genetic conditions, metabolic conditions, OSA
Psychosocial - abuse/neglect, lack of opportunity, poor parenting, reaction to social problem or trauma, child’s temperament, attention seeking
What is ADHD?
Neurodevelopmental disorder - most common one of childhood
Delay or deficit in development of executive functioning
Core symptoms - impulsivity with one/both of hyperactivity and inattention
What conditions are commonly associated with ADHD?
ASD ODD Learning disability Anxiety disorder Tics
What are the general diagnostic features of ADHD?
Need 6+ symptoms from 2 of the 3 core symptoms
Present at least 6 months
Signs/symptoms must be present <7 years
Difficult to diagnose <7 as significant overlap with normal behaviour
What are the general Rx principles of ADHD?
Behavioural modification
Education strategies - child and care givers
Medication
What are some examples of behavioural modification strategies for ADHD and tantrums?
Time outs
Positive reinforcement for good behaviour
Role modelling
Clear goals and targets and clear rules/boundaries with immediate consequences
Reinforcement of same message/rules across all domains i.e. home and school
What are general principles for education strategies for ADHD?
Individualised education and management plan - maximise learning and promote good behaviour
1:1 adult supervision i.e. teacher’s aid
Sit child at front of class, near good role models
Give them jobs to break up work and increase sense of responsibility/self-esteem
Regular breaks
Indivudalised, short, clear instructions with reminders
Minimise distractions and enviornmental modifications
What are the medication options for ADHD?
1 = methylphenidate (ritalin), dexamphetamine 2 = atomoxetine 3 = clonidine, imipramine, risperidone
What are general features and principles of medication Rx for ADHD?
Psychostimulant medication is most effective intervention - 80% cases reduces symptoms
Secondary benefits - improvements in long-term outcomes - reduced risk of substance abuse
Need to monitor for side effects, BP, weight and height
Need a clear plan for review, crisis plan, monitoring of side effects and plan for treatment and withdrawal
What is the prognosis for ADHD?
Most continue to have difficulties in adolescence and adulthood - psychostimulant medication Rx reduces this
Generally develop good compensation techniques
Long-term consequences = substance use, delinquency, educational underacheivement, relationship issues, MH issues
