Child Disability Payment decision making guide

Element 2: Does the Individual have Severe Behavioural Difficulties?

An individual is taken to have severe behavioural difficulties if they exhibit disruptive behaviour which:

  • is extreme (CDP regs, reg. 13(8)(a))
  • regularly requires another person to intervene in order to prevent or reduce the likelihood of physical injury to the individual or another person (CDP regs, reg. 13(8)(b)); and
  • is so unpredictable that another person is required to be awake and watching over the individual while the individual is awake. (CDP regs, reg. 13(8)(c))

Behaviour which is “extreme”

“Extreme”, in relation to disruptive behaviour, means that substantial intervention to respond to or manage challenging behaviour is regularly needed.

The disruptive behaviour does not need to be constant, continuous or present all of the time. However, it must be regular. There is no hard and fast rule on what ‘regular’ means in this context. Case managers must consider each case individually.

The individual’s behaviour may be extreme if they can:

  • be disruptive
  • not consider their safety with dangerous things
  • be aggressive
  • injure themselves or others
  • be hyperactive
  • display persistent body movements
  • disrupt the household during the night
  • require intensive support (meaning support while outdoors). For example, an individual who requires continuous intervention from specialist support staff or a caregiver experienced in their needs to maintain their safety outdoors.

This list is not intended to be exhaustive.

Another potential indicator for extreme behaviour is if the individual has been picked up by the police repeatedly. In such cases a Compulsory Supervision Order (CSO) might be in place through the Children’s Hearing System. The Children’s Hearing system is a system of justice that aims to protect children and young people from the risk of harm and neglect.

A Compulsory Supervision Order (CSO) indicates that a child has been assessed as being at risk or presenting as a risk to others. If a child is on a CSO due to severe behavioural difficulties, it is likely to be on one or more of the following grounds:

  • the child has committed an offence
  • the child's conduct has had, or is likely to have, a serious adverse affect on the health, safety or development of the child or another person.
  • the child is beyond the control of a relevant person.

Behaviour does not have to be violent to be classed as disruptive. For example, falls caused by seizures, "melt-downs" and sensory overload may all be considered disruptive behaviour.

Behaviour which regularly requires another person to intervene

An individual who exhibits severe behavioural difficulties may require intervention if they show:

  • aggression
  • destructive behaviour
  • hyperactivity
  • behaviour that is likely to result in injury.

The individual’s unpredictable and destructive behaviour must require the presence of another person to intervene to prevent risk of injury to the individual or others.

In this context, intervention means providing either care and support, or treatment of the individual (1 CDP regs, reg. 13(9)).

Case managers should consider whether the individual is unable to go outside alone in a way that can be done safely. However, they should not focus only on how the child is outdoors or in a structured safe environment and must consider their need for and the nature of intervention in all environments.

Case managers should consider how often intervention is needed to reach a determination of whether intervention is required in the normal course of the individual’s day.

‘Requires’ in this context means ‘reasonably requires’. This means that it depends on the individual circumstances of each case. The requirement to intervene must be to prevent or reduce the likelihood of physical injury occurring.

Case managers should consider whether the individual has a positive behaviour support plan. See below for more information. This describes how the individual’s behaviour is challenging and the types of intervention or strategies that

are used to help the individual.

A positive behaviour support plan is one type of supporting information that may be relevant. However, the eligibility criteria for CDP do not require the individual to have such a plan. Alternative types of supporting information may be available from social work teams, schools or paediatricians.

Use of physical intervention and medication to calm an individual who experiences challenging behaviour are generally not a good long-term solution.

There is no requirement that the individual must be physically restrained. Case managers should consider more generally what strategies are required to prevent or manage episodes of challenging behaviour.

Positive behaviour support plan

A positive behaviour support plan is created by the child’s Child and Adolescent Mental Health Services (CAMHS) team. Its function is to help understand and support children, young people and adults who have a learning disability and display behaviour that others find challenging.

Children, young people and their families should be involved as much as possible in developing and reviewing the plan.

The plan will usually include the following elements:

  • proactive strategies designed to improve quality of life and remove conditions that promote challenging behaviour
  • identification of environmental adaptations and strategies to support the development of new skills
  • preventative and calming strategies in response to early signs of distress
  • reactive strategies to manage behaviours that are not preventable.

Behaviour which is so unpredictable that another person is required to be awake and watching over the individual while the individual is awake

Examples of behaviour which can be characterised as so unpredictable that another person is required to be awake and watching over the individual include:

  • the individual will attempt to leave the house if unattended
  • the individual does not have a basic understanding of safety or danger awareness
  • the individual might hurt themselves or others
  • the individual’s nursery or school have had to implement additional measures to ensure the child's safety, or that the child is prohibited from entering certain areas / activities
  • using reins or a buggy for a child aged 3 or above
  • locks and alarm systems (used when the family are inside the house)
  • high fences
  • the individual will lie down or drop in the middle of the road and refuse to walk
  • using baby cameras at an age when baby cameras would not normally be required
  • the individual will run out into the road without consideration of their safety
  • the individual will engage in impulsive or dangerous behaviours like touching a hot hob or playing with knives
  • the individual is registered with the police due to frequent running away
  • the family use cameras to monitor the child when they are not in the same room (3 years and above)
  • the individual tries to climb out of car seats, whilst the car is moving
  • there is a specialist evacuation plan in nursery or school for emergencies (e.g., fire)
  • the parent or carer will sleep beside the individual, so they are aware if they are awake during the night for safety, not for comfort.

These behaviours would occur despite:

  • attempts from parents or caregivers to teach an awareness of danger, road safety
  • parents or caregivers making attempts to stop the individual verbally or physically.

The behaviour indicates a lack of understanding and comprehension of the consequences of their actions which places the individual at increased risk.

NHS Greater Glasgow and Clyde advise that an individual should typically be developing an awareness of common dangers (e.g., the cooker is hot, stay away from the road) between the ages of 37 and 42 months.

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