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Behaviour Therapy
Explore explanations, everyday questions and next steps connected with behaviour therapy.
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Signs & concerns
Social Relationship and Reciprocity on a Home Visit
On a home visit, a frontline worker should observe a child's social give-and-take: eye contact, shared smiles, responding to their name, back-and-forth babble or gestures, pointing to share, joining simple turn-taking play, and seeking comfort from carers. These are observations to note and discuss with the family, never a home diagnosis. When several signs of limited social reciprocity appear together for the child's age, route the family for a general developmental check (and a hearing check).
Read the answer AnswerObserving social responsiveness on a home visit
On a home visit, a frontline worker should observe how a child connects socially — eye contact, social smiling, turning to a familiar voice, responding to their name, taking turns in coos and games, and sharing attention between a toy and a parent. These are signs to observe and note over several visits, not to diagnose. Where social responses seem consistently limited for the child's age, gently flag this to the family and PHC team and route for a developmental screen.
Read the answer AnswerWhat to observe about a child's social skills on a home visit
On a home visit, a frontline worker should observe how a child connects with people: making eye contact, sharing smiles, responding to their name, pointing to share interest, copying others, and joining simple turn-taking play. These are everyday social signs to watch and note — not diagnose. If a child consistently shows little interest in people, avoids eye contact, or doesn't share attention by the expected age, gently flag it and route the family to a developmental check. Early support never waits for a label.
Read the answer AnswerWhat to observe about socialization on a home visit
On a home visit, a frontline worker should observe how a child connects socially — eye contact, responsive smiling, responding to their name, sharing interest, turn-taking in play, seeking comfort, and joining family routines. Note how the child relates to familiar and new faces. These are observations to record and monitor, not to diagnose at home. Refer to the PHC medical officer or a developmental check when social response is consistently limited across months, more than one area is affected, or a parent raises a worry — after weighing hearing and vision.
Read the answer AnswerObserving special interests on a home visit
During a home visit, a frontline worker should observe whether a child shows interests at all, how flexibly they engage with favourite toys or topics, and crucially whether they share that interest with people — bringing objects, following a pointing gesture, taking turns. Narrow fixed interests, distress at interruption, or interest in objects but not people across visits are patterns worth noting and routing to a general developmental check, not diagnosing at home.
Read the answer AnswerWhat to observe about stereotyped behaviours on a home visit
On a home visit, a frontline worker should observe both the repeated movement itself (hand-flapping, rocking, spinning, head-banging) and the child around it — eye contact, response to name, gestures, play and language. A single self-soothing movement in a connecting child is usually ordinary; what matters is whether the behaviour is very frequent, hard to interrupt, self-injurious, or paired with delays. These are observations to note and refer, never to diagnose at home.
Read the answer AnswerWhat to Observe About a Child's Task Persistence on a Home Visit
On a home visit, a frontline worker should observe how long a child stays with an age-appropriate activity, whether they return after interruption, and how they cope when it gets hard — keep trying, ask for help, or give up instantly. Task persistence (ICF b152) grows with age, so observe the pattern across several activities and visits, not a single moment. These are observations to note and route, never to diagnose at home; a persistent pattern of giving up across activities is worth gently suggesting a developmental screen.
Read the answer AnswerHow do I know if my child has strong behaviour readiness?
Strong behaviour readiness shows in everyday life: following simple routines, managing transitions and waiting, recovering from upsets with comfort, and connecting through play. There is no single test — readiness grows with age, and tantrums are normal. Seek a calm developmental check if meltdowns are very frequent, intense or hard to soothe, if transitions are very hard, or if behaviour gets in the way of learning and connecting. This is a reason to assess early, not a diagnosis.
Read the answer AnswerWhen to escalate a child's aggression control
Most toddlers and preschoolers cannot fully control anger or aggression — hitting, biting and tantrums are common as self-regulation grows. A frontline health worker should escalate for a developmental check when aggression is frequent and intense, causes real harm, is not fading with age, or comes alongside delays in talking, play or social connection. This is a reason to assess early, not a diagnosis.
Read the answer AnswerAttention to Others: When a Frontline Worker Should Escalate
Attention to others — responding to name, eye contact, shared smiles, following a point and joint attention — develops across the first two years. A frontline health worker should escalate when a child consistently does not respond to their name, makes little eye contact, does not share smiles or follow a point, or shows no joint attention by around 12–18 months, especially with language delay or regression. Parental concern and clustered flags both warrant prompt referral for a structured developmental check — a reason to assess early, not a diagnosis.
Read the answer AnswerWhen to escalate concerns about a child's behaviour patterns
Behaviour patterns vary widely between healthy children, so a single difference rarely needs alarm. A frontline health worker should escalate when behaviour differences are persistent, get in the way of play, learning or family life, travel with delays in talking, social connection or motor skills, involve self-injury, or show loss of a skill once had. A caregiver's worry is valuable — honour it and refer. This is screening, not diagnosis; timely referral makes early support possible.
Read the answer AnswerBehavioural Regulation: When a Frontline Worker Should Escalate
Behavioural regulation — calming, waiting, recovering from upset — develops gradually with normal wobbles. A frontline worker should escalate to the Medical Officer when difficulties are persistent (weeks, not days), more intense than same-age peers, present across home and anganwadi, cause self-injury, or come with delays in talking, social connection or learning. This is a reason to assess early, not a diagnosis.
Read the answer AnswerWhen to escalate difficulty coping with change
Difficulty coping with change (ICF b152) is common in young children and often normal. A frontline health worker should escalate to a developmental check when the distress is intense, frequent, persists past the expected age, causes self-injury, blocks play, learning or family life, or travels with delays in talking, social connection or daily skills. This is a reason to assess early, not a diagnosis.
Read the answer AnswerWhen to escalate a child's decision-making delay
Decision-making (ICF b152) develops gradually through early childhood. A frontline health worker should escalate when a child lags clearly behind peers in making everyday choices AND shows wider delays in understanding, language, attention or self-care, or has lost a previously gained skill. Parent concern alone is reason enough to refer. This is a referral trigger, not a diagnosis — early support works best.
Read the answer AnswerEcholalia and language delay: when should a frontline health worker escalate?
Echolalia — repeating words and phrases — is a normal stepping stone towards original speech, often seen around 18–30 months. A frontline health worker should escalate not because echolalia appears, but when a child past 18–24 months shows little or no spoken or copied language, when echoed speech stays the only speech with no growth, or when any skill is lost. This signals an early developmental check, never a diagnosis.
Read the answer AnswerEmotional Awareness: When Should a Frontline Worker Escalate?
Emotional awareness develops gradually, so one missed milestone rarely needs alarm. A frontline health worker should escalate to a developmental check when the gap is clear for the child's age and persists, when it travels with delays in speech, social connection or eye contact, when emotional range is very flat, or whenever a parent is worried. This is a referral for assessment, never a diagnosis — early support works best.
Read the answer AnswerWhen to escalate a child's emotional-control concern
Difficulty with emotional control is normal in early childhood and usually eases with age. A frontline health worker should escalate to a developmental check when outbursts are far beyond peers, persist past the expected age, cause harm, are very long or frequent, or come with delays in talking, play or social connection. This is a reason to assess early, not a diagnosis.
Read the answer AnswerWhen should a frontline worker escalate emotional expression concerns?
Frontline health workers should escalate a child with concerns about emotional expression (ICF b152) when there is little or no social smiling by 3–4 months, flat or absent emotional reactions, no shared joy or comfort-seeking, or a loss of expressions once present — especially with other developmental delays. These are reasons to refer early for a developmental check, not a diagnosis, because early support works best.
Read the answer AnswerWhen should a frontline health worker escalate emotional regulation concerns?
Emotional regulation develops gradually and varies widely between children. Frontline health workers should escalate for a developmental check when difficulties managing feelings are frequent, intense, persist well beyond the expected age, interfere with play, sleep, feeding or family life, cause self-injury or aggression, or travel with delays in talking or social connection. This is an early, non-diagnostic step so the right support can begin sooner.
Read the answer AnswerWhen should a frontline health worker escalate emotional responsiveness concerns?
Emotional responsiveness (ICF b152) is a child's ability to share and react to feelings — smiling back, settling when comforted, connecting with people. A frontline health worker should escalate when a child persistently misses these social-emotional signs for their age across visits, when warmth and connection seem consistently absent, or whenever a parent is worried. This is a reason for an early developmental check, never a diagnosis.
Read the answer AnswerWhen to escalate a child's energy-regulation concern
Frontline health workers should escalate energy-regulation concerns when a child shows a persistent, marked pattern — constant lethargy and floppiness, or relentless overactivity that never settles — especially when it disrupts feeding, sleep, play or interaction, or travels with other developmental delays. Wide day-to-day swings are usually normal; a sustained pattern, sudden change, or worried family warrants prompt referral to the medical officer. This is a reason to assess early, not a diagnosis.
Read the answer AnswerWhen to escalate a child's externalizing behaviours
Some defiance, tantrums and aggression are normal in young children and ease as self-control grows. A frontline health worker should escalate for a developmental check when externalizing behaviours are frequent, intense, persist beyond the expected age, cause harm, or disrupt play, learning and family life — or travel with delays in speech or social connection. This is early identification, not a diagnosis, and early support works best.
Read the answer AnswerWhen should a frontline health worker escalate a face-recognition concern?
Most babies recognise a familiar caregiver's face and smile socially by 2–3 months, and grow wary of strangers by 6–9 months. A frontline worker should escalate when, by ~3 months, there is no eye contact or social smile; by ~6 months no recognition of the main carer; or at any age when there is a vision or hearing concern or a skill is lost. One persisting flag, or any vision/hearing worry, means refer now — this is screening, not diagnosis.
Read the answer AnswerWhen to escalate concerns about a child's frustration tolerance
Frustration tolerance builds slowly through the toddler and preschool years, so big reactions to small setbacks are normal early on. A frontline health worker should escalate for a developmental check when the difficulty is clearly out of step with the child's age, persists over weeks, causes self-injury or major daily disruption, or travels with delays in talking, play or social connection. This is a reason to assess early, not a diagnosis.
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