Neurodevelopmental & Behavioural Paediatric Society of Australasia

##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 literacy and financial adversity on parental capacity to advocate for their own needs, and 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 possible to separate discreet mental health conditions from behaviours of concern due to other reasons. This 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 generally be addressed through positive their environment.to 17 years in Australia have a disability.ii behaviour supports such as teaching newRecent data also indicates almost one in seven skills or changing environments.(13.9 per cent) of those aged four to 17 years were assessed as having mental disorders in Positive behaviour support helps understand the previous 12 months. This is equivalent to behaviours of concern as a form of 560,000 Australian children and adolescents.iii communication. Often where opportunities are 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

Page 1 of 2

Neurodevelopmental & Behavioural Paediatric Society of Australasia

The outcomes of behavioural support programs are varied, and may include:

• Creating more opportunities and routines that suit the capacity of the child
• Designing communication systems that help understand the environment and exercise some control
• Introducing coping strategies and carefully designed reactive strategies to help keep families and carers safe
• Learning adaptive skills for daily life.

Role of Psychotropic Medication

The goal of using psychotropic medication for children with NDB conditions is to help the child maintain self-control so they can be engaged in appropriate therapies and continue to progress during sensitive neurodevelopmental stages to adulthood.

The purpose of medication is to help reduce a child’s distress and any associated self-harm; and, to enable developmental opportunities for gaining behavioural, social and academic skills, for example by improving attention and self-control or reducing impulsivity.

Where psychotropic medications are indicated, families or carers and, where possible, the child or young person, help decide whether these are used as part of a collaborative plan.

Regardless of the location or family circumstances of the child there is a clear and compelling need to uphold their human rights and ensure the reduction and elimination of unnecessary medication. This is a particularly important consideration for children and adolescents in out of home care or in the judicial system where organisations assume the role of parent/carer/substitute decision maker.

Medication Review

Ideally the initiation and continued use of medication by a paediatrician or child psychiatrist would have ongoing engagement of a child’s general practitioner, pharmacist and other health professional teams.

Families and carers are advised that it is not always safe to change the dose of a medicine or to stop it without help from a doctor.

Medications may need to be weaned gradually over time for safety reasons, as well as ensuring no rapid return of distressing symptoms or behaviours.

Once the desired outcome is achieved from medication, then the discussion with families, children and young people shifts toward how it can be maintained at a lower dose or ceased, preserving any benefits.

For children with NDB conditions who are in out of home care, or where another person or organisation takes on parental responsibilities, there needs to be ongoing access to specialised medical expertise whenever medication is used to help a child reach their potential.