Tantrums and aggression OSCE — assessment, parenting counsel and safety

Station objectives

1. Take a structured tantrum/aggression history with severity metrics and multi-setting data. [1] [4]
2. Map likely behavioural function using ABC language. [15]
3. Counsel positive parenting and explicitly advise against corporal punishment. [2] [3]
4. Create a practical safety plan and closed-loop referral to parent training/supports. [1] [6]
5. Recognise conversion triggers (medical red flags, safeguarding, acute injury risk). [1]

Candidate brief

You are the doctor in a general paediatric clinic. Station A is 10 minutes of history and formulation with a parent. Station B is 8 minutes of counselling and planning. The child is not acutely unwell in the room. [1]

Station A — History and formulation

Setup: Parent of a 3-year-old. Tantrums “all day.” Childcare reports hitting. Parent has tried yelling and occasional smacking. Sleep is late. Language is delayed. No fever or injury today. [1]

Expected actions:

• Open with empathy; avoid shaming. [1]
• Quantify frequency, duration, recovery, settings, injuries. [4]
• Elicit antecedents and consequences (tablet given to stop screaming). [15]
• Ask about sleep, pain, hearing concerns, development and social communication. [1]
• Ask directly about physical punishment and home safety. [2]
• Screen briefly for safeguarding risk. [1]
• Formulate aloud: impairing multi-setting dysregulation with likely tangible/attention functions, language and sleep drivers — not a medication-first problem. [1] [15]

Station B — Counselling and plan

Expected actions:

• Explain expected versus impairing temper loss in plain language. [4]
• Teach 3–5 concrete strategies: routines, labelled praise, planned ignoring of safe attention tantrums, calm limits, special play time. [2] [6]
• State clearly that smacking is not recommended and offer alternatives. [2] [3]
• Address sleep and speech/language pathways as parallel actions. [1]
• Safety plan for hitting: supervise high-risk times, protect sibling, remove unsafe objects, when to present urgently. [1]
• Refer parent-training programme; name interim follow-up owner and date. [6]
• Teach-back: parent restates two strategies and one return precaution. [1]

Marking domains

Common fails

• Recommending smacking “if nothing else works.” [2]
• Starting medication for preschool tantrums in this station. [1]
• No multi-setting or function history. [15]
• Open-loop “see psychology sometime.” [1]