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