Managing Severe Behavioural Disturbances in Children: A Guide for Australian Families
Dr Amrit Jeevan, Consultant Paediatrician and Neonatologist, KCC Kids
Published Date: 5 Jan 2026
Introduction
Severe behavioural disturbances in children—such as prolonged aggression, intense tantrums, or self-injurious actions—can be incredibly challenging for families. These behaviours are often a sign of underlying distress and are commonly associated with neurodevelopmental disorders like Attention-Deficit/Hyperactivity Disorder (ADHD) or Autism Spectrum Disorder (ASD). Crucially, there is no one-size-fits-all solution. Effective management typically involves a carefully considered, individualised combination of evidence-based strategies, which may include behavioural therapies, environmental adjustments, and, in some cases, medication.
This guide explores the various pharmacological and non-pharmacological approaches available, emphasising the importance of a collaborative, multidisciplinary plan developed with healthcare professionals.
Part 1: Understanding the Foundations of Care
Before exploring specific treatments, it’s essential to establish a foundation of comprehensive care. Management should always be individualised and multimodal, focusing not just on reducing symptoms but on enhancing the child’s overall development, academic engagement, and emotional well-being.
A cornerstone of this process is a thorough assessment by a paediatrician or child psychiatrist.This assessment aims to:
• Identify any underlying causes (e.g., ADHD, ASD, anxiety, sleep disorders, or undiagnosed pain).
• Screen for common co-occurring conditions.
• Understand the function of the behaviour through strategies like a Functional Behavioural Assessment (FBA), which helps determine if a child is acting out to gain attention, access something, escape a demand, or manage sensory overload. This understanding forms the blueprint for all subsequent interventions.
Part 2: Non-Pharmacological (Behavioural and Psychological) Approaches
Behavioural strategies are often the first-line intervention and form the bedrock of long-term management. They empower both the child and their caregivers with new skills.
Core Evidence-Based Behavioural Strategies
Research supports several structured approaches, particularly for behaviours linked to ASD and
ADHD:
• Applied Behaviour Analysis (ABA): This is a therapeutic approach based on learning theory. For example, a therapist might use ABA to teach a non-verbal child to use a picture card to ask for a break instead of hitting when overwhelmed.
• Functional Communication Training (FCT): This involves teaching a child an appropriate way to communicate the need that was previously expressed through challenging behaviour. If a child bites to get a toy, FCT would teach them to point to or
say “toy” instead.
• Parent Management Training & Cognitive Behaviour Therapy (CBT): These therapies equip parents and older children with practical skills. Parents learn strategies for positive reinforcement, consistent routines, and effective communication. For the child, CBT can help manage frustration and develop problem-solving skills.
Implementing Strategies at Home: A Practical Framework
Experts often recommend a four-stage approach that families can adopt:
1. Identify: Keep a simple log of what happens before, during, and after an outburst (time, setting, triggers).
2. Understand: Work with a therapist to analyse the log and hypothesise why the behaviour is occurring (its function).
3. Manage: Develop and implement a proactive plan based on the understanding gained. This may include creating visual schedules for predictability, offering choices to increase a sense of control, and ensuring a calm, structured environment.
4. Prevent: Use the plan consistently to teach new skills and reduce triggers, aiming to prevent escalations before they start.
Part 3: Pharmacological Approaches
Medication may be considered when behavioural strategies alone are insufficient to manage severe symptoms that cause significant impairment in a child’s daily functioning, safety, or learning.
Medications for ADHD-Related Symptoms
For severe impulsivity, hyperactivity, and inattention associated with ADHD, medication can be a highly effective part of treatment.
• Stimulants (e.g., methylphenidate, dexamfetamine): These are recommended as first-line pharmacological treatment in Australia. They work by increasing activity in brain networks responsible for attention and self-control. Approximately 70% of children with ADHD respond positively to stimulants, showing improved attention and reduced
impulsivity.
• Non-Stimulants (e.g., atomoxetine, guanfacine, clonidine): These are alternatives if stimulants are not tolerated, are ineffective, or if there are specific co-occurring conditions like tics or anxiety. They may take several weeks to reach full effect.
The table below summarises key medications used in Australia:
| Medication Class | Common Examples (Brand Names) | Primary Use & Considerations |
|---|---|---|
| Stimulants | Methylphenidate (Ritalin®, Concerta®), Dexamfetamine, Lisdexamfetamine (Vyvanse®) | First-line for ADHD. Reduce core symptoms of inattention, hyperactivity, impulsivity. Available in short and long- acting forms. |
| Non-Stimulants | Atomoxetine (Strattera®), Guanfacine (Intuniv®), Clonidine (Catapres®) | Alternative or adjunct to stimulants. Useful if stimulants aren't tolerated or for co-occurring anxiety/tics. Slower onset of action. |
| Second- Generation Antipsychotics | Risperidone, Aripiprazole | Used for severe aggression, irritability, or self-injury, particularly in ASD. Employed when behavioural interventions are insufficient and symptoms are severe. |
Medications for Severe Aggression and Irritability
In cases of severe physical aggression or self-injurious behaviour, particularly within ASD, a different class of medication may be considered.
• Second-Generation Antipsychotics: Medications like risperidone and aripiprazole are
approved in Australia for treating “irritability” associated with autism in children. This includes symptoms of severe tantrums, aggression, and self-injury. They are typically used when behavioural interventions have not been adequate and the behaviours pose a significant risk.
Important Considerations for Medication Management
- A Collaborative Decision: The choice to start medication should follow detailed discussion between the family and the prescribing doctor (usually a paediatrician or child psychiatrist), weighing potential benefits against possible side effects.
- Careful Monitoring is Essential: Treatment usually starts with a very low dose, which is gradually adjusted (“titrated”) based on response and tolerability. Doctors will monitor for side effects, which can include appetite suppression, sleep issues, or mood changes with stimulants, or sedation and weight gain with antipsychotics. Regular check-ups for height, weight, heart rate, and blood pressure are standard.
- Not a Stand-Alone Solution: Medication is most effective when combined with ongoing behavioural and supportive therapies. Research shows that combining parent training with medication, for instance, can be more effective than medication alone.
Conclusion: An Integrated Path Forward
Managing severe behavioural disturbances is a journey that requires patience, persistence, and partnership. The most effective path forward is almost always an integrated one, combining compassionate understanding of the child’s world with structured behavioural support and, when carefully indicated, medication to reduce the most challenging symptoms.
The goal is to help your child develop the skills they need to navigate their emotions and environment more successfully, improving their quality of life and that of your entire family.
At KCC Kids, our specialist paediatricians are experienced in assessing complex behavioural concerns and developing individualised, multimodal management plans for children across Australia. Through our secure telehealth platform, we can work collaboratively with you, your child, and local support networks to build a tailored strategy for progress and stability.
References:
1. European ADHD Guidelines Group (2023). Non-pharmacological interventions for attention-deficit hyperactivity disorder. The Lancet Child & Adolescent Health.
2. Australian Prescriber (2025). Pharmacological management of attention deficit hyperactivity disorder in children and adolescents.
3. Autism spectrum disorder: presentation and treatment options (2016). Neuropsychiatric Disease and Treatment.
4. Autism Speaks (n.d.). Autism aggression: What can help?
5. U.S. Food and Drug Administration (2025). Extended-release stimulants for ADHD: FDA Drug Safety Communication.
6. Australian ADHD Professionals Association (AADPA) Clinical Practice Guideline (2022).
Disclaimer: This information is for educational purposes and does not replace personalised medical advice. Consult a qualified healthcare professional for guidance tailored to your child’s specific needs.