Post on 10-Jun-2015
description
Peaditric Neuro Update:Management of BehaviourCrisis
Yunice Ong Ee Lan, Clinical Psychologist
Penang Hospital
Island Hospital Penang
Outline
Behaviour Crisis
Underlying Reason
Function
Ways to assessment
Steps in managing
Case illustration
Aggression
Self-injurious
Anxiety
Depression & Suicide
? Behaviour Regression
“Never dry”
What is a Crisis behavior/ Challenging Behaviour
Behaviour that could occur in school, home and community settings.
Behaviour impedes and reduces
Social relationships, learning, quality of life (child/family members).
Example:
Self-injury, aggression, temper tantrums, excessive anxious, depressed and crisis etc.
Cognitive•Low cognitive functioning•Abstract Concept thinking
Why do the crisis behavior develop?
Lack of adaptive functioning skills
•Disability•Learning
Family dynamic•Parenting•Disciplinary•Expectation•Family disharmony•Family rejection•Lack of quality
time
Others•Abuse•Bully•Personality•Environment•Schooling experience & demand•Sick
Sensory•Hyper•Hypo
Underlying Reason
Underlying Reason
FunctionChallenging Behaviour
Lack of quality time. Parents are busy with their work
Obtain attention
Self-injuries behavior when parents are around but doing their own work
To avoid or escape from non-preferred stimuli
Previous bad experience of oral sensitivity
Self-injuries behavior when ask to brush the teeth
InterventionPrompt/ Acute
Management
FunctionTo get or obtainattention from
others
To avoid or escape from non-preferred
stimuli
To access to tangible items (i.e. favourite food, toy and
activity)
To obtain or avoid from
sensory stimuli
Prompt/ Acute
Management
Cognitive•Low cognitive functioning•Abstract Concept thinking
Lack of adaptive functioning skills
•Disability•Learning
Family dynamic•Parenting•Disciplinary•Expectation•Family disharmony•Family rejection•Lack of quality
time
Others•Abuse•Bully•Personality•Environment•Schooling experience & demand•Sick
Sensory•Hyper•Hypo
Underlying Reason
Intervention
Underlying Reason
FunctionChallenging Behaviour
Lack of adaptive functioning skillsFamily dynamicSensoryOthers
To get or obtain attention from othersTo access to tangible items (i.e. favourite food, toy and activity)To avoid or escapefrom non-preferred stimuliTo obtain or avoidfrom sensory stimuli
aggressive behaviourtemper tantrumsself-injury behaviorSucide
Reminder
The objective:
Not just to reduce the problematic behaviours
To understand their structure, function & underlying reason in order to teach and promote effective alternatives/replacement.
Understand the challenging behaviour
Challenging behaviour
Continue to monitor
Intervention/ skills training session
• Function
• Underlying Reason
Understand & analyzing behaviour: Using ABC ChartDate/ Time
Who Antecedent Behaviour Consequence Duration Comment/Setting event
Antecedent
Occur before & influence behaviour(stimulus, setting and context)
i.e. instruction, gestures or a look from others
Behaviour
Define the behaviour(Observable, measurable)
Consequence
An event follow behaviour
May increase, reduce or maintain the behaviour.
Duration
Time frame of the challenging behaviour
Sometimes its indicates the intensity or the degree of the challenging behavior
Setting event
Ecological events that make the problematic behaviour occur
i.e. biological, physical condition, socio-cultural
Understand the & Analyzing Behaviour: Motivation Assessment Scale (MAS)
by V. Mark Durrand & Daniel B. Crimmins
quick, user-friendly indirect assessment tool that assesses the functions or motivations of behaviour problems:
social attention
Tangibles
Escape
sensory input.
Then intervention can be implement based on the result
highest is the primary function
2nd is the secondary function.
Define the Crisis/challenging
behaviour
Record the behaviour
Understand & assess the function
Prompt management:
-Extinction/ ignore
-Change Event Setting
-Simplify the task & proceed
-Remove the non-preferred/ fear stimuli
-Calming technique
-Distraction etc.
Understand & assess the underlying Reason
Intervention:
-New Skills Training (Adaptive/ Specific)
-Continue reinforcing skills training
-Sensory integration
-Parenting skills training
-Family/ Marital counseling
-Individual psychological Intervention (CBT, Play Therapy, Sandplay Therapy, Art Therapy).
ABC Chart, MSA, Beh Ob
Clin Int,AssmtBeh Ob
Continue to Monitor