Neurodevelopmental & Behavioural Paediatric Society of Australasia ,ttt~.tt
Behaviour Support and Medication in Paediatric Practice
Neurodiverse children have This means that for some children there is a need to consider the impact of risk factors,varying levels of disability arising such as parental mental health, poor health from complex, brain-based literacy and financial adversity on parental conditions. These conditions can capacity to advocate for their own needs, and change rapidly as a child develops. those of their child.
The early years can decide the While employing a social model for care, children with neurodisability have multiple
degree of disability a child may needs that require a team approach with input face as an adult. from health, education and other professionals.
NDB Paediatrics
For some children, an accurate diagnosis mayPaediatricians with a specialist interest in not be clear, or even possible, early in their lifeneurodevelopmental and behavioural (NDB) course. In relation to children with Autismconditions diagnose and treat children who Spectrum Disorder, research suggests that it ishave problems in functional areas of child important that complexity, includingdevelopment, such as learning, behaviour and psychosocial context, is considered withmood. These doctors treat children and young therapy targeted at the child holistically ratherpeople for a range of conditions and support than at any particular symptom.v This researchfamilies and carers towards agreed short, and reinforces a need for caution in early diagnosis.long-term goals. In the short-term there is a focus on any Positive Behaviour Support immediate problems restricting learning and All periods of childhood and adolescence are development. The long-term goal is that the sensitive periods for neurodevelopment and child will have the best quality of life as they management of clinical issues in children is transition into adulthood.i complex. During early childhood it is often not NDB paediatricians use a family focused possible to separate discreet mental health approach. Families are supported to be in conditions from behaviours of concern due to control and take ownership of any treatment other reasons. decisions they make for their child. This Displaying concerning behaviours may also be includes where medication may assist in the only way some children with meeting short, and long-term goals. neurodiversity can communicate their needs. Background These behaviours can often indicate a poor match between the needs of the child andIt is estimated that 7.3 per cent of those aged 0 their environment.to 17 years in Australia have a disability.ii Recent data also indicates almost one in seven Positive behaviour support helps understand (13.9 per cent) of those aged four to 17 years behaviours of concern as a form of were assessed as having mental disorders in communication. Often where opportunities are the previous 12 months. This is equivalent to not well integrated into the child’s life or they 560,000 Australian children and adolescents.iii are not being stretched, they can become bored and start displaying concerningThere is a positive relationship between a behaviours. Considering why a child displays ahistory of exposure to childhood or household certain type of behaviour can help find the besttrauma and multiple risk factors for several of type of behavioural support.the leading causes of death in adults.iv
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Neurodevelopmental & Behavioural Paediatric Society of Australasia ttt~j ,
The outcomes of behavioural support It is also important to recognise that skilled programs are varied, and may include: prescribing of psychotropic medications can
support children to function at their best, with• Creating more opportunities and routines no alteration of their authentic selves. that suit the capacity of the child Psychotropic medications used in this way• Designing communication systems that help should be considered therapeutic, not understand the environment and exercise restrictive practice. some control
• Introducing coping strategies and carefully Families think very carefully about what
designed reactive strategies to help keep medication or other treatments will be best, families and carers safe and suggesting they are chemically restraining
• Learning adaptive skills for daily life. their child is unnecessarily emotive for those
who may already be feeling judged.
Role of Psychotropic Medicationvi
The goal of using psychotropic medication for Medication Review children with NDB conditions is to help the Ideally the initiation and continued use of child maintain self-control so they can be medication by a paediatrician or child engaged in appropriate therapies and continue psychiatrist would have ongoing engagement to progress during sensitive of a child’s general practitioner, pharmacist neurodevelopmental stages to adulthood. and other health professional teams. The purpose of medication is to help reduce a Families and carers are advised that it is not child’s distress and any associated self-harm; always safe to change the dose of a medicine and, to enable developmental opportunities or to stop it without help from a doctor. for gaining behavioural, social and academic Medications may need to be weaned gradually skills, for example by improving attention and over time for safety reasons, as well as self-control or reducing impulsivity. ensuring no rapid return of distressing symptoms or behaviours. Where psychotropic medications are indicated, families or carers and, where possible, the Once the desired outcome is achieved from child or young person, help decide whether medication, then the discussion with families, these are used as part of a collaborative plan. children and young people shifts toward how it can be maintained at a lower dose or ceased, Regardless of the location or family preserving any benefits. circumstances of the child there is a clear and compelling need to uphold their human rights For children with NDB conditions who are in and ensure the reduction and elimination of out of home care, or where another person or unnecessary medication. This is a particularly organisation takes on parental responsibilities, important consideration for children and there needs to be ongoing access to specialised adolescents in out of home care or in the medical expertise whenever medication is used judicial system where organisations assume to help a child reach their potential. the role of parent/carer/substitute decision maker.
i McDowell M, Efron D: Psychotropic medication in NB Paediatrics, NBPSA 2020 (in development) ii Australian Bureau of Statistics – Disability, Ageing and Carers, Australia: Summary of Findings, 2012
iii Lawrence D. Johnson S. Hafekost J. Boterhoven de Haan K. Sawyer M. Ainley J. & Zubrick S. R. (2015). The mental health of children and adolescents: Report on the second
Australian child and adolescent survey of mental health and wellbeing. iv ivFelitti V Anda R et al Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults. The Adverse Childhood Experiences (ACE) Study American Journal of Preventive Medicine May 1998 Vol 14 Issue 4 Pages 245-258 31 October 2019 5.30pm. v Sandback M et al, Project AIM: Autism Intervention Meta-Analysis for Studies of Young Children, Psychological Bulletin, American Psychological Association 2020, Vol.146, No1,1-29 5 vi McDowell M, Efron D: Op cit
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