Kennedy Krieger's Specialties

Severe Behavior Problems

What are Severe Behavior Problems?

Individuals with mental retardation, autism or developmental disabilities may exhibit severe behavioral difficulties such as self-injurious behavior, aggression, and property destruction.  Self-injurious behavior (SIB) such as head hitting, head banging, hand biting or eye poking may result in physical injury to the child.  Aggressive behaviors such as hitting, biting, or kicking may result in injuries to others.  Sometimes other severe behavior problems, such as destroying property, running away or eating inedible objects may be observed.

Behavior problems may vary in frequency, severity, and/or intensity.  In mild cases, behavior problems do not put the child or others at risk for injury, and do not interfere with daily activities.  In severe cases, frequent or chronic injuries to the child or to others may occur. Physical restraint, medication trials, emergency room visits or repeated hospitalizations may be necessary.  The child’s health, services, and or living arrangement may be at risk.

When to Refer a Child

The Neurobehavioral team evaluates individuals with mental retardation, autism and/or developmental disabilities who exhibit severe behavior problems as described above, and who have not improved with other less intensive treatments. The Neurobehavioral Unit (NBU) Programs at Kennedy Krieger Institute include the possibility for both inpatient and outpatient treatment. Families of children with severe behavior problems who are able to participate in 1-3 weeks of potential outpatient sessions or in a 3-4 month potential inpatient stay are appropriate candidates for referral.  Referrals may come from family members, pediatricians or other professionals working with the child.

The Neurobehavioral Unit Team

Kennedy Krieger’s Neurobehavioral team is comprised of an interdisciplinary group of professionals who work together with families to meet children’s individual needs. The team of specialists conducting the initial evaluation is chosen to meet the specific needs of each patient, so not all patients will meet with all specialists. The purpose of this evaluation is to determine whether the Neurobehavioral Unit Programs can meet the child’s and family’s needs. Individualized assessment and treatment are provided during the course of Outpatient or Inpatient Services. The Neurobehavioral Unit team is comprised of the following professionals:

Child Psychiatrist
Evaluates children for possible complicating conditions such as depression or mood disorders and prescribes medication when indicated.

Behavioral Psychologist
Uses a systematic approach to analyze parent/child interactions and children’s responses. Suggests interventions designed to reduce problem behavior and trains parents in using these interventions at home and in other settings.

Neurologist
Evaluates and monitors children’s medical conditions.

Nurse
Monitors child’s physical condition and provides child/parent with educational information regarding medication and patient care.

Social Worker
Supports caregivers, coordinates discharge planning and helps access community services.

Special Educator
Ensures children are able to continue their educational development while receiving treatment.

Speech-Language Therapist
Provides interventions to improve children’s communication skills. 


What You Can Expect

A Severe Behavior evaluation is strictly an outpatient assessment that usually takes approximately 3 hours. Treatment plans, prescriptions for medication, and/or immediate admission to the NBU programs are not provided as a part of the evaluation. In some cases, general recommendations for treatment may be provided after the evaluation.

Following this evaluation, the NBU interdisciplinary team will review the case and determine the appropriate level of service.  The child may be referred to either the Outpatient or Inpatient Neurobehavioral Unit Programs, or in some cases, referred to other clinics/programs within or outside of Kennedy Krieger Institute. Currently, there is a wait of approximately 3-6 months for beginning services in the Inpatient or Outpatient NBU Programs. 

Once the child is admitted into the Inpatient or Outpatient Program, the NBU team will formulate a treatment plan individual to the child’s needs.

Outpatient NBU Program
Patients are seen by a team of behavioral therapists for 3-5 hours per day, 4-5 days per week for 1-3 weeks.  Our assessment and treatment approach is based upon the principles of Applied Behavior Analysis.  A typical course of treatment involves Functional Behavioral Assessment/functional analyses; reinforcer assessment, systematic treatment development and evaluation, and parent/caregiver training.  Parent/caregiver participation is required, as discharge recommendations will include parent/caregiver implementation of an intensive behavior management program.  In some cases, psychiatric diagnostic clarification and appropriate medication interventions may also be incorporated into the Outpatient Program.

Inpatient NBU Program
Patients are admitted to the hospital for a 4-month stay.  Interdisciplinary assessment and treatment are provided by psychiatry, behavioral psychology, neurology, social work, special education, nursing, and speech-language.  Services include 3 ½  hours of daily behavioral assessment and treatment (3:1 staff to child ratio); 24 hour per day behavioral data collection and treatment implementation; and 1:1 staffing during waking hours. Psychiatric assessment and treatment is also emphasized. The behavioral treatment approach is based upon the principles of Applied Behavior Analysis.  Parent/caregiver participation and training are required, as discharge recommendations will include parent/caregiver implementation of an intensive behavior management program.