In this episode of PodMD, Australian trained Paediatrician Dr Kai Ismail will be discussing the topic of behavioural problems in children and adolescents, including the warning signs of behavioural problems, the long-term risks, treatment and management options, when a GP should refer and more.
Please note this is a machine generated transcription and may contain some errors.
*As always, all in this PODMD podcast is intended for health professionals and the comments are of a general nature. Information given is not intended as specific medical advice pertaining to any given patient. If you have a clinical issue with one of your patients please seek appropriate advice from a colleague with expertise in the area.
Today I’d like to welcome to the PodMD studio Dr Kai Ismail
Kai is an Australian trained Paediatrician with a special interest in developmental and behavioural problems, neonatology and newborns, respiratory and gastroenterological conditions as well as paediatric acute care.
Today, we’ll be discussing the topic of Behavioural Problems in Children and Adolescents.
*We do hope you enjoy this podcast but please remember that the advice here is of a general nature and is not intended as specific advice about a given patient. The views and opinions expressed in this podcast are those of the doctor, not PodMD.
If you do have a patient on whom you require specific advice, then please seek advice from a colleague with appropriate expertise in that area.
Kai, thanks for talking with us on Pod MD today.
Kai: Thank you for having me.
The topic of today’s discussion is Behavioural Problems in Children and Adolescents. Kai, can you describe for our listeners what behavioural problems entail and what the difference is between this and general normal ‘naughtiness’?
Kai: Okay so in children, they are a bit different. It is always important for us to consider their developmental stage, the problems that arise when the stress or the maladaptive behaviour is outside the normal limits for the child’s age, and their development. They may often be seen as having the emotional or behavior problem, according to the Adults perception, but this may be misunderstood. So we give you an example of a three-year-old boy who is hyper active, restless, always on the go, and just not like to go to sleep. So is this boy hyper active? And I can give you the answer is no. So this history sounds very common and also most parents they’re concerned that their children may have ADHD where in fact their behavior is in a normal range. So it’s normal and common for a two to three year old children who are over active and have a shor attention span.
And besides that for any significant behavioral problem we do not only just look on the symptoms itself. We also have to examine on how these interfere with the child’s functioning, for example, because of the behavior problem do they have any issue to go to school and has the child stopped going to the school or loss of a friendship. And also, is there any component of very disruptive behaviour where we involve a lot of physical act, aggression, hurting the other children at kindy or at school or any involvement of yelling and screaming.
What are some of the warning signs or red flags that show up in children and adolescents with serious behavioural problems?
Kai: So, first number one, we always have to think about is there any triggers that cause the problem? So the warning signs such as like learning difficulties at school, or is there any symptoms of intellectual impairment? Is there any problem with the sleeping? This is as simple as when you do not sleep well, you be grumpy and you can’t focus the next day. Is there any evidence of has the child has been interacting less with friends and the family? You also have to always screen for depression and anxiety disorder. Is there any thoughts about suicidal or self-harming? Always concerned about, is there any underlying hearing or visual impairment, especially for the young children, less than four years of age, and also always think about, is there any evidence of global developmental delays such as any gross motto, fine motto or speech impairment.
What are the long-term risks of leaving behavioural problems undiagnosed and untreated?
Kai: So if this behaviour problem is left untreated, this can lead to a severe anxiety and depression, this also will affect on the academic way. It will start to decline further and the risk of the child to leaving the school earlier. The next is if they are unable to maintain the friendship and also to lose them also putting the child into the risk of isolation. There is also a few theories of conduct disorder, which involve stealing, using substance abuse or sexual abuse, and also how sometimes it can affect the dynamic of the,family. And also I have seen that because of the severe behavior problem there is, both of the mom and the father separated just because of the child.
What are the treatment and management options?
Kai: So there are a few things that we, as a pediatrician and also the GP can do. Number one is always essential to screen for hearing and vision impairment, and also to assess for any reason, stressor in life. For example, is there any bullies at school, recent death, which include death family members or the pets, and also, is there any parental separation. Number two is be a good listener. So parents always attend to their doctors seeking help for their child’s emotion and behaviour problem. The consultation itself can be therapeutic, especially when the GP is skilled at listening, communicating, and convey empathy to the family. So always allow for adequate time for appointment and listen well. Also always talk to the children as well. Sometimes you’d be surprised by doing all this, It can lead the family to, or even the child himself to find a solution themself. Third things is they will always need the cognitive and behaviour management to the child as a psychologist.
They are other behavior management programs, but also depends on the local resources. For example, in gold coast, we are lucky to have the Griffith university where they have a program called parent-child interaction therapy the PCIT and also they have like a group, a session for the anger management class. The next thing that we can consider of the management is to start on the antidepressant and anti anxiety medication and the two most common being used in children are Ravenna and Luvox. And we always combine this medication with the CBT management. We also have to tackle a poor sleep and,it’s always important to advise the parents about a good sleep hygiene. The next thing is always thinking about the parents, as I mentioned to you before sometimes the challenging behaviour can be overwhelmed for the parents, and it’s always important to assess how the parents are doing and to offer them help. Lastly, there is a free online parenting program called like triple P program and the circle of security, which the parents can access online.
Considering the GP will often be the first point of contact for patients and their families, what can you recommend GPs look out for with patients with serious behavioural problems?
Kai: So, as I mentioned to you before, always look for profound hearing defecits or vision inpairments. It’s very important, especially, and also for us pediatrician to always have the, for the child to have the hearing tests and the vision tests. Second thing is always screen for any developmental delays, such as any evidence or speech delay or fine motor or gross motto impairment, which can be contributing factors for the behaviour problem. Also always ensure that the child has a good sleep. So the GP can always consider to start on the melatonin, and also, again, always assess does the child have any friends and how is the school is doing.
What is the likelihood of behavioural problems continuing into early adulthood and beyond?
Kai: So if left and untreated, this may have some short and long-term effects, so they tend to fail to complete the school. They will have a poor school sorry, the poor academic school, poor interpersonal relationship, family breakdowns, and divorce. And also the child may experience a long-term unemployment. They also, there is a risk of, they can be abusive to their own offspring and also for their children to have some behaviour problem to. The other problem that may arise is anxiety and depression, panic disorder, manic, and OCD.
When should a GP refer?
Kai: So the GP can always do the referral to pediatrician when there is any suspected neuro developmental problem such as autism, ADHD, interlectual impairment or global developmental delay, or any time where the GP thinks that the child’s behavior is normal for the age, but sometimes parents does need some, a bit of a assurance.
Thank you for your time here today in the PodMD studio. To sum up for us, could you please identify the three key take home messages from today’s podcast on Behavioural Problems in Children and Adolescents.
Kai: So the take home message number one that some challenging behavior it can be in fact, a normal development for the child. Number two, always think about, is there any underlying neuro developmental problems such as ASD, ADHD, poor sleep or any issue with the vision or the hearing. And lastly always, always refer to a child psychologist for the behavior management. So we do not need a paediatric review prior to the referral to the child psychologist. We even appreciate if this can be done earlier, because sometime this psychologist, they can do assessment for us. And also we can base on their psychology report to for [inaduible] our diagnosis and management for the child.
Thanks for your time and the insights you’ve provided.
Kai: Thank you again. And also thank you for listening. I hope that you have learned a lot