Behaviour

Question 1

Sequence of events and symptom analysis

Answer 1

Open question
When was it first noticed, by whom, where, looking back, have they always been this way, have things changed over time
Has anything triggered the behaviour

Question 2

Environments

Answer 2

Home- how are they at home, who else is at home, relationships with people at home
School- how are they are school, what do teachers say, mainstream school or specialist, how are they doing academically
Social- how are they elsewhere, can you take them to public places eg. restaurants

Question 3

Conduct

Answer 3

Do they get into trouble often (if so, in what way). If conduct is an issue explore in more detail;

• disobedience: do they respect rules or authority
• truancy: have they ever missed school
• bullying (other children)
• violence: are they violent to people or animals
• law: trouble with the law, for what
• substances: alcohol, cigarettes, illicit drugs

Question 4

ADHD features

Answer 4

Hyperactivity- fidget etc.
Impulsiveness
Inattention- how are their concertation levels/ distractibility

Question 5

Autistic features

Answer 5

Communication- problems
Social impairment- friends, play with other children, do they enjoy imaginary play
Repetitive behaviours- strict routine, what would happen if this changed

Question 6

Systems review

Answer 6

See paediatric history template

Question 7

Background history

Answer 7

PMH
DH
FH- anyone with learning disability
SH- how are things at home, school, siblings, trouble with the law

Question 8

ADHD

Answer 8

3-7 years usually diagnosed

Symptoms must be present for >6months across at least 2 environments (ie. home and school)

Question 9

Conduct disorder

Answer 9

Children and adolescents (above 7)
Violence bullying theft vandalism cruelty to animals
Problems at school and lack of respect for law/authority
Risk factors at home- parental drug or alcohol addiction, family conflict, big changes eg. divorce

Question 10

ASD

Answer 10

Social impairment
Communication impairment
Repetitive behaviours (deviating causes great difficulty)

Question 11

Other differentials

Answer 11

Oppositional defiant disorder (less severe variant of conduct disorder)
Hearing or visual impairment- evidence of developmental delay
Learning difficulties
Tic disorder eg. Tourette’s syndrome

Question 12

Investigations

Answer 12

Bedside- physical exam,
Bloods-
Specialist- hearing assessment eg. audiometry, SALT assessment

Question 13

Management

Answer 13

MDT- parents, paediatricians, GP, psychologists, SALT, teachers, special education needs co-ordinators etc.