MANAGING BEHAVIOUR
Dr Chris ElliotConsultant Paediatricianwww.drchriselliot.com.au Paediatrics.online December 2016
OBJECTIVES WHAT’S MY ROLE? WHERE’S MY MAP? WHO ARE MY ALLIES?
ALL BEHAVIOUR IS COMMUNICATION
“DON’T FORGET BEFORE AND AFTER”
THE TECHNICIAN’S APPROACH5 diagnoses ADHD Autism Oppositional Defiant Disorder Anxiety Trauma
5 interventions Stimulant medication Risperidone Anxiolytics Clonidine Discharge to psychologist
WHAT’S MY ROLE? Medical assessment and management
Discovering child and family goals Synthesising disparate views Formulating the issues Hypothesis generation Making a plan Empowering the family with a strengths-based approach
Advocating for the child Within the family With other providers With school and other organisations
MEDICAL ASSESSMENT A thorough medical history as normal …
… but I’m still lost…
WHERE’S MY MAP? Build a map of the child in their environment.
Happens over one or several visits
Helps clarify what we know and what we need to find out
A MAP OF THE CHILD IN THEIR ENVIRONMENTVisionHearing HealthSleepDiet
IQ / Learning Attention Social Communication / Interest
Behaviour Sensory Profile Anxiety Fine Motor Gross Motor / Tone Language
Attachment Temperament Self Esteem Resilience
Family Environment
School Environment
Body Brain
Wellbeing
Practice
CASE FORMULATION AND HYPOTHESIS Formulation and hypotheses Hypotheses help you know your limits What do I know? What am I missing? Who can help me?
Find missing information Manage problems I don’t have experience in
WHAT’S MY ROLE? Medical assessment and management Discovering child and family goals Synthesising disparate views Formulating the issues Hypothesis generation Making a plan Empowering the family with a strengths-based approach
Advocating for the child Within the family With other providers With school and other organisations
CHILD AND FAMILY GOALS Six ‘F’s of a Fullfiling LifeFamilyFriendsFunctionFitnessFun Future
[click here for the original article by Rosenbaum P and Gorter JW]
TOOLS TO HELP FILL IN THE GAPS We have a map with some gaps We know what the goals are Helps prioritise what else we need to know
SNAP-IV parent and teacher report ASQ-3 Functional Behaviour Analysis Psychometric / Academic testing Other testing eg: Griffiths / ADOS
WHO ARE MY ALLIES? School Colleagues Psychologist Speech pathology Occupational therapy Medical specialists Physiotherapists - How do i find them? - How do i communicate with them?
BE A DOCTOR NOT A TECHNICIAN History Empathy Tools Allies Hypotheses Advocacy Limits
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