Paeds Cases · mental-behavioural-and-psychosomatic
Acute behavioural disturbance and agitation — OSCE communication and management station
Observed structured encounter testing environmental safety, verbal de-escalation as first-line treatment, the least-restrictive ladder, organic-cause exclusion, restraint minimisation and a trauma-informed recovery and debrief.
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Target exams
RACP General PaediatricsRACP DCEMRCPCH ClinicalRCPSC Pediatrics
Prompt
Station A is an escalating autistic adolescent requiring de-escalation and organic-cause exclusion. Station B is a deterioration requiring the parenteral rung, restraint decision-making and a trauma-informed debrief.
Station objectives
- Make the environment safe and call for help early in a behavioural emergency. [1] [3]
- Apply verbal de-escalation as the first-line treatment of acute agitation. [5] [1]
- Climb the least-restrictive ladder correctly and justify each step. [1] [4]
- Exclude organic causes before and after sedation. [3] [2]
- Minimise restraint harms and debrief in a trauma-informed way. [6] [5]
References7ShowHide
- [1]Gerson R Best Practices for Evaluation and Treatment of Agitated Children and Adolescents (BETA) in the Emergency Department: Consensus Statement of the American Association for Emergency Psychiatry. West J Emerg Med, 2019.PMID 30881565
- [2]Hoffmann JA Pharmacologic Management of Acute Agitation in Youth in the Emergency Department. Pediatr Emerg Care, 2021.PMID 34397677
- [3]Foster AA Approach to acute agitation in the pediatric emergency department. Curr Opin Pediatr, 2024.PMID 38299972
- [4]Bourke EM PEAChY-O: Pharmacological Emergency Management of Agitation in Children and Young People: A Randomized Controlled Trial of Oral Medication. Ann Emerg Med, 2025.PMID 39955661
- [5]Klein K Non-pharmacological de-escalation techniques used to manage acute severe behavioural disturbance in children and adolescents presenting to emergency departments: secondary analysis of a randomised controlled trial. Arch Dis Child, 2026.PMID 41015487
- [6]Perers C Methods and Strategies for Reducing Seclusion and Restraint in Child and Adolescent Psychiatric Inpatient Care. Psychiatr Q, 2022.PMID 33629229
- [7]Bourke EM Acute Severe Behavioral Disturbance Requiring Parenteral Sedation in Pediatric Mental Health Presentations to Emergency Medical Services: A Retrospective Chart Review. Ann Emerg Med, 2023.PMID 37389492