Behavioural Disturbances

Differentials

Psychosocial

• Parenting challenges, anxiety, post-traumatic stress, oppositional defiant disorder, abuse or neglect

• Impact of family stressors, socioeconomic factors, and cultural influences

Neurodevelopmental or Medical

• Autism spectrum disorder, attention-deficit/hyperactivity disorder, intellectual disability, sensory impairments, speech and language delays

• Genetic syndromes or metabolic conditions influencing behaviour

Other Medical

• Iron deficiency, thyroid dysfunction, obstructive sleep apnoea

• Chronic illnesses such as epilepsy or neurological disorders contributing to behavioural changes

History Questions

Medical

• Antenatal and perinatal complications, head trauma, recurrent ear infections, nutritional status (iron), family history of developmental or psychiatric conditions

• Immunisation history and early growth patterns

Development

• Milestones, including fine and gross motor skills, social skills, and language acquisition

• Visual and hearing assessments, rule out sensory deficits

• Any signs of regression in previously attained milestones

Behavioural

• Parenting style, consistency of rules, child’s behaviour across different environments (home, school, community)

• Sleep habits, possible snoring or frequent night-time awakenings (OSA)

• Frequency, context, and severity of tantrums, aggression, or defiance

Red Flags

• Indicators of physical, emotional, or sexual abuse

• Developmental regression or loss of previously learned skills

• Significant family dysfunction or domestic violence

Management

Referral

• Paediatrician or developmental specialist for thorough assessment

• Psychologist or psychiatrist for complex emotional or behavioural presentations

Parental Support

• Evidence-based parenting programmes focusing on consistent boundaries and positive reinforcement

• Counselling or stress management for parents facing high levels of psychosocial stress

• Encouragement of positive parent-child interactions to strengthen attachment

Treat Causes

• Correct iron deficiency, assess and manage thyroid problems, investigate and treat sleep apnoea

• Address sensory impairments through audiological or visual assessments

• Provide speech therapy for communication delays

• Offer occupational therapy for sensory integration if indicated

Medication

• Consider stimulant or non-stimulant medication for ADHD when functional impairment is significant

• Ensure regular reviews for efficacy, side effects, and adherence

• Combine pharmacotherapy with behavioural interventions or psychological therapy

Notes

• Involve a multidisciplinary team including educators, allied health professionals, and social services

• Personalise interventions to meet specific child and family needs

• Emphasise early intervention and continued follow-up for long-term improvement