11 Assessment of socio-emotional and behavioural functioning

Children with neuromotor disorders have a higher risk for mental health problems compared to the general population. This may include difficulties with behaviour (including aggression or self-injurious behaviour), anxiety, mood, or attention. Socio-emotional functioning may also be complicated by related factors including problems with sleep, pain, constipation, swallowing, and difficulty with communication. Our standardized questionnaires are often not very useful in this population as many of the questions are inappropriate. This makes an interview format the most appropriate way of assessing functioning. 

Socio-emotional functioning interview

• What are the child’s likes and dislikes? What motivates them? Do certain experiences cause the child distress (e.g., changes in routine/caregivers, sensory overload)? What calms and comforts, is there a calming routine?
• Document issues with pain and ask about pain on the day of the assessment. Is the child able to communicate when and where they are in pain or uncomfortable?
• Interaction with peers (e.g., watches from a distance, waits to be approached, makes social overtures, has favored peers).
• What activities does the child do for pleasure? Are there ways to increase independence with leisure activities?

Safety issues/Behaviour interview

• Ability to judge personal safety (choking risk, stranger safety, wandering off, falling, unbuckling seat belt, etc.).
• Aggression towards self (self-injurious behaviour).
• Aggression towards others.
• Are there behaviours that are getting in the way of social functioning or learning?

Questionnaires

Behavioural and socio-emotional questionnaires (e.g., BASC, BRIEF, autism questionnaires) are typically not appropriate for this population. For example, here are some items from the BASC-3:

• “Says ‘I hate myself’” (does not talk)
• “Is organized” (the person who is nonverbal with quadriplegia may never have had the opportunity to try organizing materials)
• “Is a picky eater” (tube fed)
• “Avoids eye contact” (cannot see unless close up)
• “Listens to directions” (not able to follow commands)
• “Cleans up after self” (very limited use of hands)
• The same problems can be found in everyday executive functioning and autism questionnaires in this population!

The Maladaptive Behavior Domain of the Vineland-3 is brief and targeted to evaluate internalizing, externalizing and critical behavioural problems.  While some questions may be inappropriate for this population, most are applicable. In addition, the Developmental Behavior Checklist – Version 2 (available online through WPS) was designed specifically to evaluate behavioural, social, and emotional problems of individuals with an intellectual disability, ages 4 and older.