Presentation at Paed Neuro Update 2014

1. PeaditricNeuro Update: Management of BehaviourCrisis
Yunice Ong Ee Lan,
Clinical Psychologist
Penang Hospital
Island Hospital Penang

2. Outline
Behaviour Crisis
Underlying Reason
Function
Ways to assessment
Steps in managing
Case illustration
Aggression
Self-injurious
Anxiety
Depression & Suicide
? Behaviour Regression
“Never dry”

3. 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.

4. 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

5. Underlying Reason
Function
Challenging 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
Intervention
Prompt/ Acute Management

6. Function
To 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

7. 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

8. Underlying Reason
Function
Challenging Behaviour
Lack of adaptive functioning skills
Family dynamic
Sensory
Others
To get or obtain attention from others
To access to tangible items (i.e. favourite food, toy and activity)
To avoid or escapefrom non-preferred stimuli
To obtain or avoidfrom sensory stimuli
aggressive behaviour
temper tantrums
self-injury behavior
Sucide

9. Reminder
The objective:
Notjust to reducethe problematic behaviours
To understand their structure, function & underlying reason in order to teach and promote effective alternatives/replacement.

10. Understand the challenging behaviour
Challenging behaviour
Continue to monitor
Intervention/ skills training session
•Function
•Underlying
Reason

11. Understand & analyzing behaviour: Using ABC Chart
Date/ 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

12. 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
2ndis the secondary function.

13. 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, SandplayTherapy, Art Therapy).
ABC Chart,
MSA,
BehOb
ClinInt,
Assmt
BehOb
Continue to Monitor