Behavioural problems of children: Navigating the Journey from Assessment to Support

One of the most common referrals we receive as paediatricians is for behavioural concerns in children. These issues are becoming increasingly prevalent in the community and contribute to growing waitlists for specialist services. This article provides a general overview of behavioural conditions in children, the evaluation process, and the steps families can take while waiting for specialist care.

Common Causes and Conditions

Behavioural concerns can stem from a wide range of causes. Some children may be dealing with neurodevelopmental conditions such as ADHD or autism spectrum disorder. Others may be affected by learning difficulties, anxiety, depression, temperament, emotional responses to stress in the home or school environment or mental health issues. 

Each child’s situation is unique, and the conditions we assess can be complex and overlapping. That’s why a comprehensive evaluation is essential before making a diagnosis.

Medical Evaluation

When a child presents with behavioural difficulties, one of the first steps is a thorough medical assessment by a paediatrician. This involves (depending on clinical judgement):

• Exploring possible medical contributors, such as iron deficiency anaemia, nutritional deficiencies, genetic conditions, chronic medical conditions, side effects of medications (ex, anticonvulsants, Montelukast for asthma), etc.
• Gathering detailed history from the family and school – details of behavioural conditions, triggers for behavioural issues and evolution of symptoms. 
• Understanding whether stress, environmental factors, or developmental delays play a role.

This information helps determine the subsequent steps, including whether additional investigations or referrals are needed.

A Team-Based Approach

Diagnosing and managing behavioural conditions often involves multiple professionals working together. While the paediatrician typically leads the initial assessment, further input may be needed from:

• Occupational therapists
• Psychologists
• Speech and language therapists
• Educational specialists
• Child psychiatrists (if mental health issues are significant)
• Clinical Nurse Consultant 

Although all these team members may not be available in all situations, it would be desirable to have them. Clinical Nurse Consultants are crucial team members because they work closely with the family, collate reports, liaise with the school, and support ongoing management. This collaborative approach ensures that no aspect of the child’s development is overlooked and that interventions are well-coordinated and tailored to their needs. 

What You Can Do While Waiting for a paediatrician appointment 

We understand that waiting for a specialist appointment can be difficult, especially when concerns are pressing. However, there are meaningful steps families and General practitioners can take in the meantime:

• Hearing and Vision Tests are necessary assessments that rule out issues affecting behaviour.
• Baseline Blood Tests: Screening for nutritional, genetic, or medical concerns can help guide early treatment. For example, iron deficiency might be associated with irritability, poor attention, and behavioural problems. Any chronic medical condition can have a substantial emotional toll on children and may be tested based on the clinical picture. 
• Behavioural checklist—Practitioners may understand behavioural issues using standardised checklists and other forms, which can vary. 
• Early Supports: Parents can access psychologists or occupational therapists in the community for behavioural strategies while waiting for a formal diagnosis.
• Parenting Courses: Programs that teach practical ways to manage challenging behaviour can be beneficial. Similar to how health care professionals receive training in communication skills, including managing difficult situations, parents can benefit from learning techniques that build confidence and skills, such as the Triple P program. 

Management Strategies

Management depends on the underlying diagnosis and often involves a mix of therapies and supports:

• Behavioural Therapies are usually the first line of support and help children learn appropriate skills while giving parents practical tools. Occupational therapists, behavioural specialists, and Psychologists could provide these. 
• Medication: In many cases (e.g. ADHD, anxiety, autism), medication may be used alongside therapy to help with behavioural issues. In most cases, allied health specialists are the key, and medications are generally supportive. 
• Psychiatric Support: If a child has ongoing emotional or mental health needs, a child psychiatrist may be recommended for specialist advice.

Families play a central role in this journey. A behaviour diary—tracking triggers and responses—can be helpful, and therapists often guide parents in managing challenging behaviours through structured strategies.

Navigating Different Systems

Accessing support can vary depending on where you live. In some hospitals, all allied health services may be available on-site. Families may need to seek out community-based therapists or clinics in other cases.

This comprehensive assessment process can be time-consuming and, at times, frustrating. However, the long-term benefits of a thorough, team-based approach are significant. Every professional works toward the same goal: to optimise your child’s functioning and overall well-being.

Final Thoughts

The paediatricians recognise and acknowledge the challenges of parenting a child with behavioural concerns. With the proper support, patience, and persistence, families can find effective strategies that make a real difference in their child’s life. This journey is a partnership between families and healthcare professionals, and together, we can help every child reach their potential.

Disclaimer: The contents of this article are a general overview of an approach to behavioural problems in children. The suggestions are not prescriptive, and your treating physician will advise you on the most appropriate course of action based on several factors. There is more than one perspective to managing a child’s complex behavioural issues, and clinicians can have different viewpoints on the same issue.