Most behaviour problems in general practice are common, self-limiting and part of a spectrum of normal behaviour which can be managed in primary care. It is important to recognise more serious problems and take the right action. While secondary care leads the treatment of complex disorders like autism and attention deficit hyperactivity disorder (ADHD), the GP has a significant role in early recognition, supporting a family under pressure, and guiding them through the system.

Whatever the problem, early intervention is important. By the time the parents attend they may be stressed and exhausted, arguing about managing the child plus dealing with the impact on siblings.

History

• Your history needs to be tailored to each patient but always ask what exactly happens and how long the problem has existed.
  
• Take a past medical and developmental history to exclude any possible causes.
  
• The parents’ own experience of being parented is important in developing their own skills.
  
• Have there been any precipitating factors such as illness in the child or family, a new house/school, family crisis or depression in the parents?
  
• Are there triggers at the time (e.g. tiredness or hunger)?
  
• Does the behaviour only happen at home?
  
• How do the parents or carers manage the problem? What have they tried? Be specific (e.g. do they get angry, give in or offer bribes?)
  
• Do the parents agree on their management and are they consistent?
  
• Evaluate how much disruption is being caused to the family.
  Explore any underlying fears or worries the child may have.
  Are there any parental problems, e.g. alcohol or drug misuse?
  
• Do the parents have support?
  
• If the parents come alone ask them to return with the child.

Ask yourself:

Is the behaviour age appropriate for the child? For example, temper tantrums are common in a 2-year-old but abnormal in a 10-year-old.

Remember the possibility of child abuse or neglect.

Stay updated, free articles. Join our Telegram channel

Join