Behavioural assessment and functional analysis — formative SAQs

SAQ 1 — Escape-maintained aggression and assessment method (10 marks)

A 7-year-old with limited speech and autism hits support workers during showering about four times weekly. Staff want risperidone increased. No dental or medical review is documented. ABC notes show hits at demand onset and stop when showering is abandoned. [1] [2] [10]

Questions

1. Define challenging behaviour and distinguish it from a psychiatric diagnosis. (2 marks) [10]
2. Outline a paediatric functional assessment for this presentation, including the likely primary function. (4 marks) [1] [2]
3. State three immediate non-drug actions before any medication change. (4 marks) [4] [5] [10]

Model answer

Definition (2). Challenging behaviour describes intensity, frequency or duration that risks safety or seriously limits ordinary life. It is not itself a DSM/ICD diagnosis. Psychiatric disorders need their own criteria and may coexist. [10]

Assessment and function (4). Operationalise hits (topography, rate, intensity, context). Multi-informant history and multi-setting ABC charts. Medical/pain screen (dental, ENT, constipation, skin, sleep, seizures, medication adverse effects). Communication and sensory assessment. Hypothesise escape/avoidance of personal-care demand (and possible sensory aversion) because behaviour starts at demand and ends when the demand is removed. Consider experimental FA only via specialist teams if needed. [1] [2] [10]

Non-drug actions (4). Do not escalate risperidone by default. Complete medical/pain review. Redesign personal care (predictability, shorter steps, preferred sequence, sensory adaptations). Teach functional communication for “stop/help/break” and honour it while building tolerance. Active parent/carer training with practice (Bearss-type principle). Write a PBS plan with data review and least-restrictive reactive strategies. [4] [5] [10]

SAQ 2 — Medication thresholds and evidence (10 marks)

A registrar says “Tyrer means never use antipsychotics in children” and also says “RUPP means start risperidone first for any autism behaviour.” [6] [8]

Questions

1. Correct both misunderstandings with the trial principles. (4 marks) [6] [8]
2. List monitoring priorities if risperidone is used for severe irritability after formulation. (3 marks) [6] [10]
3. Name four classic maintaining functions of problem behaviour. (3 marks) [2]

Model answer

Trials (4). Tyrer 2008: in adults with intellectual disability, risperidone and haloperidol were not superior to placebo for aggressive challenging behaviour — so antipsychotics are not routine first-line for CB as a class, especially without formulation. RUPP: risperidone reduced serious behavioural problems/irritability in children with autism in a controlled trial — after, not instead of, behavioural and environmental care; it does not treat core autism social deficits and is not “any behaviour, first tablet.” [6] [8] [10]

Monitoring (3). Weight/BMI, metabolic panel (glucose/lipids), extrapyramidal symptoms, prolactin-related symptoms/signs, sedation; named target behaviour, lowest effective dose, time-limited goals and review date. [6] [10]

Functions (3). Attention; escape/avoidance; tangible access; automatic/sensory. [2]