PI Brief Update

Assessing Children with Behaviour Problems for the Family Court - Dr Mark Burgin

10/03/23. Dr. Mark Burgin BM BCh (oxon) MRCGP explains the difficulties in determining the origins of behaviour problems in children from troubled families.

Many children in troubled families have a diagnosis of behaviour problems but it can be difficult for the court to differentiate between a family that is stressed because of the child or vice versa.

The behaviour problems can be so severe thatit is impossible to work with the child directly and the expert will need to observe the family interacting to get evidence.

Social workers develop expertise in this assessment as a result of their training and experience in watching families and many use a structured approach to assessment.

Although this has been called the ABC (antecedent, behaviour, consequences) model there have been developments that make the process more sophisticated.

Triggers

A trigger is those things that happen before the child shows the behaviour and sometimes can be difficult to identify, the parents will say that ‘anything’ causes the behaviour.

Other times it can be when the child is asked to do something, in extreme cases as soon as the parent says their name they will react.

Other children will react to passive aggression or symbolic issues and it can take many repetitions before the trigger can be identified.

Triggers have meaning for the child which are explored when looking at the behaviour that is elicited by the trigger for clues as to what is happening.

Typical behaviour patterns

The narrower the pattern of behaviour the more pathological it is so a child who uses a number of different ways of responding is less likely to be the problem.

It is easier to video a few of the patterns and look at them slowly for a beginner but with practice an expert can recognise the key elements and describe it clearly.

Thinking about the pattern and working out what it means and how it associates with the trigger gives the expert a model that can be tested in further episodes.

There is a natural variation in behaviour problems that allows the expert to consider whether the child or the parent is driving the issues.

Family responses

The audience of the behaviour might be a teacher and peer group, strangers in a public space but the expert will most commonly watch family dynamics.

Understanding the family’s response needs to consider that the behaviour is being played out for the expert and to some extent is directed at the expert.

There will be some pressure on the family to make the child react in their way and provocation can be suspected where the child does not give a warning or the trigger occurs out of sight.

Equally embarrassment may alter the pattern so it is better to have another reason to be observing the family that takes the pressure off the child’s behaviour.

Conclusions

The modern social worker has expertise in the parent-child interaction and can assist the court when trying to determine the extent that behaviour problems are due to the parents.

Using a systematic approach to describe the ABC of the behaviour, presenting facts rather than opinions and avoiding diagnosing the parent or child are expert skills.

Where the social worker report on the parent-child interaction is a combination of skill and organisation it can greatly assist the court make the right choice.

Courts can put pressure upon junior social workers to step outside of their expertise but to do so would put the social worker at risk of professional challenge and even attack.

Doctor Mark Burgin, BM BCh (oxon) MRCGP is on the General Practitioner Specialist Register.

Dr. Burgin can be contacted This email address is being protected from spambots. You need JavaScript enabled to view it. and 0845 331 3304 website drmarkburgin.co.uk

This is part of a series of articles by Dr. Mark Burgin. The opinions expressed in this article are the author's own, not those of Law Brief Publishing Ltd, and are not necessarily commensurate with general legal or medico-legal expert consensus of opinion and/or literature. Any medical content is not exhaustive but at a level for the non-medical reader to understand.

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