Introduction

Developmental disabilities (also called developmental disorders) are a group of conditions involving impairments in physical, language, learning, or behaviour, and are common in children and adolescents. Some examples include attention deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD), cerebral palsy, and hearing loss.¹ Early assessment is crucial as providing care at earlier stages of child development results in improved outcomes.² Child behaviour assessments are not only used to identify problems, but also aid understanding of the child’s strengths, preferences, and unique ways of interacting with the world. 

What is child behaviour assessment?

Child behaviour assessments aim to identify behavioural patterns and their causes. They can be carried out in the form of behavioural observation, thorough reports of medical and developmental history from caregivers, and/or speech and language or motor development assessments. Standardised tests, questionnaires filled out by parent or teacher, and interviews with the children themselves are additional methods that aid in the analysis of behavioural issues. These assessments evaluate a child’s behaviour across various settings and provide the basis of a diagnosis so that early intervention can be implemented. 

Early assessment is vital because it can identify issues before they become severe, and often lead to improved future outcomes. It can even provide a baseline to track progress over time, and assist in developing targeted strategies for care.

When and why should you consider a behaviour assessment?

Routine preventative healthcare visits should involve behavioural assessments even for children without symptoms of delayed development. The developmental-behavioural screening on routine visits of children under the age of 4 usually takes place when the child is 9-months, 14-months, 18-months, and 30-months old. After the age of 4, screening of asymptomatic children should be assessed annually for mental health disorders and impaired psychosocial functioning with screening tests.³

In instances where there are signs alluding to missed developmental milestones, or when the screening of asymptomatic children turn up positive, the child should undergo developmental-behavioural and medical evaluations. Some signs include:

• Concerns raised by parents or caregivers
• Unusual behavioural patterns
• Family disruption
• Poor school performance 
• Behavioural difficulty

Behavioural assessments are important because early detection leads to early intervention. The assessment tools help in identifying developmental disabilities or delays early, allowing for timely implementation of appropriate intervention, which can significantly improve a child’s future.⁴

Types of child behaviour assessments

Child behaviour assessments include developmental and/or behavioural screening tests. The steps of diagnosing a condition begin with surveillance, then screening. If the assessment screening test returns ‘positive’, it signifies that the child has signs pointing to developmental delays or behavioural disorders and should be directed to receive further medical evaluation or intervention. 

Developmental screening tests

Developmental screening tests are concerned with cognitive, language, motor, and social domains. Some focus primarily on one, while others examine general development. 

A few of the methods commonly utilized in primary care settings are:

• Ages & stages questionnaire (ASQ-3)
  • Assesses developmental progress in children
• Communication and symbolic behaviour scales infant toddler checklist (CSBS DP ITC)
  • Screening test for language delays in infants and toddlers aged 6 months to 24 months 
• Parents’ evaluation of developmental status (PEDS)
  • Parents’ evaluation on their child’s language, motor, self-help, early academic skills, behaviour, and social-emotional/ mental health 
• Survey of well-being of young children (SWYC)
  • A comprehensive screening procedure for children under 5 years of age

Behavioural screening tests

Behavioural screening tests are tools focused on behavioural conditions (e.g. ADHD), social-emotional development, and self-help skills (e.g. feeding, sleeping, toileting). Unusual or delayed behaviours and self-help skills are important to watch out for, as in children these may be the only manifestation of social-emotional distress. 

Behavioural screening tests commonly used in primary care setting are:

• Behaviour assessment system for children (BASC-3)
  • A comprehensive set of scales and forms that help you understand the behaviours and emotions of children and adolescents
• Conners parent and teacher rating scales
  • Assesses behavioural, social, and academic issues, particularly in children with ADHD
• Functional behavioural assessment (FBA)
  • A behavioural assessment used to figure out what is causing challenging behaviour
• Ages & stages questionnaire
• Also used for developmental screening 
• Moods and feelings questionnaire 
  • Screens for emotional distress and mood disorders
• Paediatric symptoms checklist
  • Identifies cognitive, emotional, and behavioural problems
• Strengths and difficulties questionnaire 
  • Measures behavioural attributes and emotional symptoms

Alongside these standardised tests, structured interviews with the child, parents, and teachers are also used to provide a comprehensive picture. Direct observation of the child in different settings (eg. classroom, home, playground) is also essential in understanding their behaviour in natural contexts.

Psychological testing 

Psychological testing methods are used to assess cognitive, emotional, and behavioural functions of children. Some of the more common psychological tools used are as follows: 

• Vineland adaptive behaviour scales
  • Measures adaptive behaviours, including communication, daily living skills, and socialisation
• Vanderbilt assessment scales
  • Evaluates ADHD symptoms and other behavioural concerns
• Wechsler intelligence scale for children (WISC-V)
  • Assessment tool used to measure a child’s intellectual ability 
• Draw-a-person test
  • Screening for emotional disturbance in a child

Using a combination of these tools is recommended as multiple assessment methods provide a clearer picture of the child’s behaviour.

Medical evaluation

A positive result in the behavioural assessment warrants medical evaluations to rule out or identify underlying conditions that may be contributing to the child’s behaviour. Medical assessments involve:

• Hearing evaluation 
  • Along with neurological damage, inner/outer ear damage can cause hearing impairments and lead to developmental delays and behavioural changes
• Vision screen
  • Conditions such as nearsightedness, farsightedness, astigmatism, myopia, colour blindness, and other conditions impacting vision may affect a child’s behaviour 
• Review of metabolic screen
  • Tests metabolic disorders such as diabetes, thyroid dysfunction, electrolyte imbalances, and other genetic abnormalities 
• Review of growth parameters
  • By tracking development and identifying growth delays, abnormalities can be detected and proper intervention can be implemented 

Follow-up on assessment 

Positive screening test

Children with screening tests that have returned positive should undergo developmental-behavioural or mental health evaluation, paired with medical evaluation. They should then be referred for early intervention. 

Negative screening test

For negative screening results, if neither the caregiver or clinician have concerns, regular surveillance will suffice. However, if the caregiver or clinician remain apprehensive, follow-ups should be carried out. 

Specific disorders

Further specialised testing may be needed to identify specific disorders, which may require medical intervention.

• Autism spectrum disorder (ASD)
  • Diagnosis of ASD requires evaluation by specialists using the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) criteria. There are multiple useful tools available that aid in evaluation, such as Autism Diagnostic Interview-Revised (ADI-R), Autism Diagnostic Observation Schedule edition (ADOS-2), and more⁵
• Cerebral palsy 
  • Magnetic resonance imaging (MRI) or computed tomography (CT) scans, developmental screening and physical examinations with emphasis on assessment of muscle tone aids the diagnosis of cerebral palsy
• Intellectual disability
  • Expert evaluation and standardised testing are conducted to assess intellectual functions

These disorders require specialist consultation and planning that require not only behavioural intervention strategies, but also medical therapeutic plans. A multidisciplinary approach involving paediatricians, neurologists, occupational therapists, and speech therapists are required to provide holistic care to the child.

Interventions

Behaviour intervention plans (BIP) are strategies tailored according to a child’s needs based on their assessment. A method of intervention is positive behaviour support (PBS) which involves identifying the triggers and causes of behaviour, while teaching the skills to communicate openly and reinforce positive behaviours. PBS is particularly used in educational settings and focuses on prevention and skill development. Applied behaviour analysis (ABA) is another management method utilising techniques that place emphasis on behaviour and how it is affected by the environment. 

Apart from these structured treatment plans, environmental changes within the home to reduce challenging behaviours by setting up clear routines and expectations are important. Informing and equipping parents, teachers, and other caregivers involved in the day-to-day of the child is equally as important as any intervention strategy. 

Supporting your child through the process

Prepare your child for the assessment by explaining in simple terms and reassuring them that it’s not a test they can pass or fail. The goal of the assessment is to understand how to help them better, so provide support by maintaining a positive attitude and listen to their concerns without judgment. Encourage positive behaviour and development at home by setting clear expectations for the management of their conditions. Progress can be gradual, so patience and encouragement are key.

Summary

Child behaviour assessments help identify developmental disabilities and behavioural patterns in children through multiple assessment tools and methods. These methods include interviews with your child, caregivers, standardised tests and scales, and observance of your child’s behavioural patterns. Performing child behaviour assessments can provide a complete picture of child development, allowing appropriate interventions to be implemented in a timely manner, resulting in significantly improved outcomes. Continuous follow-up and support from caregivers, teachers, and healthcare professionals is pivotal in enhancing a child’s developmental journey.