managing behaviour - chris elliot

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