Assessing disruptive behaviors in young children As simple as OPQRST! O Onset When did it start? Sudden? Gradual? P Precipitating What is going on when the behavior happens? Related to sleep events patterns? hunger? frustration? Palliative factors What makes it better? What has been done to address the problem (including punishment strategies)? What has worked? Q Qualities & What does it look like? Does it include hyperactivity? Not following Characteristics directions? Talking back or defiance? Disobedience? Aggressive behaviors? Inattention? Crying? Emotions? R Region/ Where does it happen? Home? school? which people does it happen with? Relationshi ps parent? teacher? children? S Severity How does it compare to developmentally typical behavior in this age group? What level of impairment is associated? suspensions? expulsions? lacerations? fractures? T Timing When does it usually happen? End of day? Beginning of day? Only weekends? Only weekdays? AND How long does it last? how does it end? Signs of ADHD? Who lives in Physical exam for Signs of anxiety? Prematurity? Anyone with ADHD, dysmorphology, size for depression, anxiety, home/is in family Signs of mood disord er Lead exposure? School/child care age, vital signs, signs of non- (irritability, sadness?) Sleep apnea? bipolar disorder, accidental injury psychosis, substance History of adversit y Signs of autism spectrum ? Evidence of of traumatic events Observe: parent-ch ild Developmental status? thyroid use disorder interactions In biological famil y OR Family support Sleep, growth dysfunction? USE SEEK SCREEN ! Labs: consider Pb, g enetics CNS issue (LOC , in home Screens: SEEK for all Sz) ECSA if < 5 yo; VADRS if > 5 Review of Medical history Family history Social history PE, labs, systems screens .