Behavioural assessment OSCE — function formulation and family counselling

Station objectives

1. Operationalise target behaviour and collect ABC-pattern history. [1] [2]
2. Screen medical, communication and safety drivers. [10]
3. State a function hypothesis and matched PBS/FCT steps. [4] [5]
4. Counsel against medication-first escalation with evidence anchors. [6] [8]
5. Close the loop with multi-agency ownership. [17]

Candidate brief

You are the doctor in a community paediatric clinic. Station A is 12 minutes with a parent. Station B is 8 minutes counselling a support-worker request for higher risperidone. [10]

Station A — History and formulation

Setup: Parent of an 8-year-old with autism and limited speech. Open-hand hits during homework and teeth-brushing. Hits stop when the task is cancelled. Sleep is poor. Last dental review was years ago. School reports similar demand-linked pattern. [2] [10]

Expected actions:

• Confirm current safety and injury history. [10]
• Operationalise hits (when, how often, intensity, what stops them). [2]
• Elicit antecedents and consequences across home and school. [1]
• Ask about pain, teeth, ears, bowels, sleep, seizures, medication effects. [10]
• Assess communication methods and AAC access. [4]
• State escape/avoidance as leading function hypothesis with possible pain/sensory contributors. [2]
• Avoid diagnosing character or escalating drugs in Station A. [8]

Station B — Medication request counselling

Setup: Support worker: “Increase the risperidone or we cannot keep him.” Parent is torn. [6] [8]

Expected actions:

• Validate safety concerns without accepting medication-only framing. [10]
• Explain function-first plan: medical/dental review, demand redesign, FCT for break/help, consistent caregiver training. [4] [5]
• Name evidence anchors in plain language: parent training skills matter; antipsychotics are not automatic first-line for all challenging behaviour; autism irritability medicines exist for severe cases after formulation with monitoring. [5] [6] [8]
• Agree owners, review date, school liaison and safety-net triggers. [17]
• Document shared plan; do not shame staff. [17]

Marking domains

Common fails

• Immediate dose increase without formulation.
• No pain screen.
• Single-setting history only.
• No replacement communication skill.
• No review owner or date. [8] [10]