Paeds · growth-development-and-behaviour
Behavioural assessment and functional analysis
Also known as Functional behaviour assessment · ABC chart behavioural assessment · Functional analysis of problem behaviour · Positive behaviour support assessment · Challenging behaviour formulation
Fellowship guide to paediatric behavioural assessment and functional analysis: operational definitions, medical and communication screens, multi-setting ABC data, four maintaining functions, descriptive versus experimental FA, PBS and FCT linkage, limited medication after formulation, and multi-agency plan leadership.
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Target exams
Red flags
- Severe self-injury with tissue damage, head injury risk or weapon-involved aggression
- Sudden behaviour change with fever, encephalopathy, seizures or suspected pain in a non-verbal child
- Safeguarding concern, family violence or severe neglect uncovered during behavioural history
- Escalating chemical restraint or antipsychotic dose without functional formulation
- Akathisia, dystonia or paradoxical disinhibition after a new psychotropic
- School or residential exclusion with no safety plan and rising injury risk
- Caregiver crisis with imminent inability to keep the child safe
Life stages
Care settings
Clinical exam formats
Board mappings
- Growth and development
- Behavioural and mental health
- General and Community Paediatrics
- Learning goal 10 developmental and behavioural paediatrics
- Learning goal 15 essential general paediatrics
- Child and adolescent mental health collaboration
- Clinical Applications
- Behavioural and developmental paediatrics
- Long Cases
- Short Cases
- Communication
- Neurodevelopment and Neurodisability
- Patient management
- Health promotion and illness prevention
- Foundation of Practice (FOP)
- Applied Knowledge in Practice (AKP)
- History
- Development
- Clinical
- General Pediatrics Content Outline — Domain 2: Growth and Development
- General Pediatrics Content Outline — Domain 5: Behavioral/Mental Health
- General Pediatrics EPA: Assess and manage common behavioral and mental health concerns
- Patient Care 1: History
- Patient Care 4: Clinical Reasoning
- Patient Care 5: Patient Management
- Systems-Based Practice 3: System Navigation for Patient Centered Care – Coordination of Care
- Interpersonal and Communication Skills 1: Patient- and Family-Centered Communication
- Medical Expert
- Communicator
- Collaborator
- Health Advocate
- Pediatrics: Core EPA — Assessing and managing a child with a behavioural or mental health concern
Overview & Definition
A childcare worker says a five-year-old “just snaps.” A school email asks for “something for aggression.” A parent wants a tablet increased because shower time is a war. Your job is not to name a villain. Your job is to run a behavioural assessment that finds what the behaviour does for the child, what medical or communication problem sits underneath, and what support will change the contingency rather than only the volume of the noise. [1] [10] [11]
Challenging behaviour is a description of impact — intensity, frequency or duration that risks safety or seriously limits ordinary life — not a DSM diagnosis by itself. Psychiatric disorders may coexist and need their own criteria. Emerson’s total-population work framed challenging behaviour as a common service-level problem in intellectual disability, not a rare curiosity. [9]
Functional assessment asks: under what conditions does this behaviour occur, and what consequence keeps it going? Experimental functional analysis (FA) tests those hypotheses under controlled conditions, classically associated with Iwata’s work on self-injury. Decades of FA research show that most identified functions are social (attention, escape, tangible), with a meaningful automatic/sensory subset. [1] [2] [3]
This leaf owns assessment method and formulation. Condition-specific treatment depth lives on linked pages for tantrums, oppositional behaviour, school refusal, ASD, ADHD and intellectual disability. Cross-link them. Do not hide a second disorder textbook here. [10] [14]
Assessment spine in one clinic block
- 1
Is anyone unsafe now?
Injury risk, medical emergency or safeguarding converts the visit.
- 2
Define the behaviour
What exactly happens, how often, how hard, where and with whom.
- 3
Medical and communication screen
Pain, sleep, seizures, sensory load, hearing, speech/AAC.
- 4
ABC data multi-setting
Home, school, care — not a single bad day story.
- 5
Function hypothesis and matched plan
PBS, FCT, caregiver training; medication only if residual severe risk.
References18ShowHide
- [1]Iwata BA, Dorsey MF, Slifer KJ, Bauman KE, Richman GS Toward a functional analysis of self-injury. Journal of applied behavior analysis, 1994.PMID 8063622
- [2]Beavers GA, Iwata BA, Lerman DC Thirty years of research on the functional analysis of problem behavior. Journal of applied behavior analysis, 2013.PMID 24114081
- [3]Melanson IJ, Fahmie TA Functional analysis of problem behavior: A 40-year review. Journal of applied behavior analysis, 2023.PMID 36892835
- [4]Ghaemmaghami M, Hanley GP, Jessel J Functional communication training: From efficacy to effectiveness. Journal of applied behavior analysis, 2021.PMID 32929757
- [5]Bearss K, Johnson C, Smith T, et al. Effect of parent training vs parent education on behavioral problems in children with autism spectrum disorder: a randomized clinical trial. JAMA, 2015.PMID 25898050
- [6]McCracken JT, McGough J, Shah B, et al. Risperidone in children with autism and serious behavioral problems. The New England journal of medicine, 2002.PMID 12151468
- [7]Owen R, Sikich L, Marcus RN, et al. Aripiprazole in the treatment of irritability in children and adolescents with autistic disorder. Pediatrics, 2009.PMID 19948625
- [8]Tyrer P, Oliver-Africano PC, Ahmed Z, et al. Risperidone, haloperidol, and placebo in the treatment of aggressive challenging behaviour in patients with intellectual disability: a randomised controlled trial. Lancet, 2008.PMID 18177776
- [9]Emerson E, Kiernan C, Alborz A, et al. The prevalence of challenging behaviors: a total population study. Research in developmental disabilities, 2001.PMID 11263632
- [10]Hyman SL, Levy SE, Myers SM Identification, Evaluation, and Management of Children With Autism Spectrum Disorder. Pediatrics, 2020.PMID 31843864
- [11]Gleason MM, Goldson E, Yogman MW; Council on Early Childhood; Committee on Psychosocial Aspects of Child and Family Health; Section on Developmental and Behavioral Pediatrics Addressing Early Childhood Emotional and Behavioral Problems. Pediatrics, 2016.PMID 27940734
- [12]Kearney CA, Albano AM The functional profiles of school refusal behavior. Diagnostic aspects. Behavior modification, 2004.PMID 14710711
- [13]Fung LK, Mahajan R, Nozzolillo A, et al. Pharmacologic Treatment of Severe Irritability and Problem Behaviors in Autism: A Systematic Review and Meta-analysis. Pediatrics, 2016.PMID 26908468
- [14]Volkmar F, Siegel M, Woodbury-Smith M, King B, McCracken J, State M; American Academy of Child and Adolescent Psychiatry (AACAP) Committee on Quality Issues (CQI) Practice parameter for the assessment and treatment of children and adolescents with autism spectrum disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 2014.PMID 24472258
- [15]Deb S, Kwok H, Bertelli M, et al. International guide to prescribing psychotropic medication for the management of problem behaviours in adults with intellectual disabilities. World psychiatry, 2009.PMID 19812757
- [16]Sheehan R, Hassiotis A Reduction or discontinuation of antipsychotics for challenging behaviour in adults with intellectual disability: a systematic review. The lancet. Psychiatry, 2017.PMID 27838214
- [17]Council on Children with Disabilities and Medical Home Implementation Project Advisory Committee Patient- and family-centered care coordination: a framework for integrating care for children and youth across multiple systems. Pediatrics, 2014.PMID 24777209
- [18]Garner AS, Shonkoff JP Early childhood adversity, toxic stress, and the role of the pediatrician: translating developmental science into lifelong health. Pediatrics, 2012.PMID 22201148