Behaviour change

Reassure

Short lived change in behaviour (lethargy, mood disturbance, withdrawal, disinhibition) with clear cause and without other symptoms, signs or associated high risk conditions

Action

Reassure

Change in behaviour (less than four weeks) without clear cause and without other symptom(s), signs or associated high risk conditions

Action

Observe and review at four weeks after onset of change in behaviour, repeat physical examination. If persistent refer for expert assessment

Pervasive change in behaviour (occurring in all environments) without clear cause, and;
- One or more additional symptoms/signs that may occur with a brain tumour or;
- Associated high risk conditions

Action

Refer for an MRI scan

Delayed diagnosis has been associated with:

Assuming that deterioration in academic performance at school/college is unrelated to a physical cause
Assuming that pervasive change in behaviour in adolescence is normal

Any child presenting with a pervasive change in behaviour requires a full physical, developmental and social assessment to look for possible underlying causes.
Ask specifically about associated symptoms and risk factors:
- Personal or family history of a brain tumour
- Leukaemia
- Sarcoma and early onset breast or bowel cancer prior therapeutic CNS irritation
- Neurofibromatosis types 1 and 2
- Tuberous Sclerosis
- Li Fraumeni Syndrome
- Family history of colorectal polyposis
- Gorlins Syndrome
- Other familial genetic syndromes
Perform a HEADSSS assessment – a structured assessment of factors that can influence behaviour in young people
Pervasive behaviour change should be assessed with independent reports from teachers and other carers/professionals to seek evidence of its pervasive nature.
Plot growth in all children and pubertal status if applicable
Plot head circumference in children under two

Pervasive lethargy i.e. occurring in multiple environments (school, home, “fun” activities).
New onset mood disturbance/withdrawal/disinhibition