Child and Adolescent Psychiatry

Behaviourally-based Treatments 329

may behave antisocially to get attention, even though this may be of
a negative kind. Treatments based on this model increase the attention
paid by carers to children when they behave desirably (for example, by
speaking warmly to a child who is playing quietly) and withdraw attention
when the child is behaving undesirably (for example, by turning away and
stopping talking to a child who is screaming). An example of this approach
working well is the use of parent training to reduce a child’s antisocial
behaviour.

Behavioural methods in practice

Assessment
Rather than initially ascribing meaning to a behaviour, a functional anal-
ysis is performed. TheAntecedents,Behaviour itself, andConsequences
(ABC) are carefully characterised in great detail (see Box 39.1). Examples
of antecedents: before a tantrum in a 4-year-old: mother’s nagging de-
mand at bedtime, or, sibling takes toy; before a panic attack in a 15-year-
old: outdoors on a big playing field, or, in a crowded marketplace; before
psychogenic abdominal pain in a 10-year-old: a row between parents, or,
due to hand in difficult homework. Sometimes changing the antecedents
alone (‘stimulus control’) is sufficient to alleviate the problem.

Box 39.1An ABC analysis

Antecedent events

(the setting)

Experiences for child just prior to behaviour

People present

Places

Times of day

Situations

Behaviour Nature: detailed description of what actually happened

Onset date

Frequency

Severity

Duration of episodes

Consequences Changes in demands and expectations of child by others

Changes in attention and social set-up

Attainment of child’s immediate goals and wants

Impact on siblings and parents

Methods for gathering information include: detailed behavioural de-
scriptions from parents, charts, diaries, visits to home or school to observe
behaviour in context, or videos of this.