Behavioural Problems

Objectives

1. In all patients, when working up a behavioural problem,
   • Ensure a thorough assessment of medical and mental health conditions (e.g., schizophrenia in adolescents and young adults) and psychosocial factors before offering a diagnosis or definitive advice (i.e., do not dismiss the problem as being “a phase,” or “hormones,” or “just adolescence”)
   • Use a validated assessment tool if available
   • Use multiple sources of information (e.g., workplace, family, school) with consent
   • Explore the patient’s own perspective, not just that of the caregiver
2. In assessing behavioural problems in adolescents specifically look for substance use, peer issues, abuse, and other stressors.
3. While assessing behavioural problems in a patient,
   • Evaluate the impact of the behaviour
   • Explore any underlying emotional distress with the patient
   • Destigmatize embarrassing behaviours
4. When making a diagnosis of a behavioural problem in a patient,
   • Avoid premature labelling of a behaviour as a disorder
   • Follow up with support and regular visits until the situation is clearer and any therapeutic requirements are more evident
5. When managing behavioural problems:
   • Assess and address immediate risk for the patient and others
   • Do not limit treatment to medication; address other dimensions (e.g., do not just use amphetamines to treat ADD, but add social skills teaching, time management, etc.) and match to available community resources
6. When there is a challenging relationship with a patient with behavioural problems maintain a continuous, therapeutic, and nonjudgmental relationship with the patient and family