Behaviour change


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




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


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


Refer for an MRI scan

Diagnostic pitfalls

  • 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.

  • • Assess motor skills including:

    • • Sitting/crawling in infants.

    • • Walking/running in older children

    • • Co-ordination e.g. heel-toe walking, finger-nose testing

    • • Fine motor skills, e.g. handling of a small toy / cup in young children.

    • • Handwriting in school age children and young people

    • • Touching tip of thumb with tip of each finger of the same hand in turn in school age children and young people

  • • 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

  • Worrying features

    • • Pervasive lethargy i.e. occurring in multiple environments (school, home, "fun" activities).

    • • New onset mood disturbance/withdrawal/disinhibition

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