Seizures and Uncontrollable Behavior

Among individuals with autism, anywhere from 25% to 40% may also have a seizure disorder. Parents and other caregivers of these individuals must learn to recognize triggers for seizures, how to help during a seizure, and what to do after a seizure. Parents and caregivers must also deal with medications and complementary and alternative medications to control the seizures. It is certainly an aspect of the caregiver duties that none of us signed up for.

I (Missy) know first hand because my brother has been having seizures since the day he was born almost 33 years ago. I do not proclaim to be an expert on seizures by any means. However, I am certainly an expert on my brother’s seizures, or at least so I thought.

Recovering from a series of seizures

Recently, my brother contracted a stomach bug which resulted in massive diarrhea and a trip to the ER. The following day, he had a seizure. While he sometimes has a postictal phase, he seemed fine because he responded to questions and he was mobile. Usually, his postictal phase is brief and uncomplicated. For example, he may forget how to put on his shoes, or he may not remember where the towel goes. Sometimes, he is sleepy and prefers to lie down and rest. (For additional information on postictal phases, you may read here.) On this day, it was all different.

About 3-4 minutes immediately following the seizure, my brother walked right past our hotel room door (He has the memory of an elephant!). I called his name and asked him to stop and he continued walking. Then I realized he was in a postictal phase.

I walked ahead to get him and guide him back to our room. He immediately began screaming and physically attacking me. I grabbed my phone and called 911. My brother was engaging in behaviors we have never seen before. I grabbed a cool rag and began rubbing it on his head. The sirens became audible and I told him that help was on the way. He said, “uh oh” but continued to scream and attempt to run away. When the first responders arrived in our room, my brother was still in a postictal phase but he was beginning to settle down. Finally, after about 10 more minutes, he returned to normal.

You are probably wondering why I’m telling you this story. I’m telling you this story so that you increase your awareness of seizures and all the phases of a seizure. You realize that if I had not seen the seizure, I would not have recognized that my brother was in a postictal phase. I would have wrongly assumed he was having a fit/tantrum and all of my reactions would have been different (and potentially contra-indicative to his needs).

And you see, this happened to a dear friend about 3 months ago. She did not see her son’s seizure. When he entered the postictal phase and began attacking her, they were in a very public place. The police were called instead of paramedics. Everyone treated the individual as a criminal instead of a medical patient. He was arrested instead of being treated.

Parents and caregivers, if your loved one has a history of seizures, become the expert on your child so that you may help clinicians recognize your loved one’s unique needs. Behavior analysts and teachers, we must train our front line behavior therapists and technicians to recognize seizures so that we respond appropriately to behaviors.

Winter Break Travel Blues Part 2

I’m not sure if you’ve heard the saying, but rumor on the street is that behavior analysts make the worst parents as well as the worst pet owners.

Lucky for me, I am (Missy) neither. Rebecca, on the other hand, is both! I bring this point up because I am hoping that I will be able to use all of my best behavior analysis skills today. I am packing up my family and dragging them across the country to Austin, Texas to see Rebecca and her family, visit dear friends, and show the girls why I love Austin so much.

My wonderful family in Bar Harbor (with a couple of friends)

Our travel group today will include my other half and his two children ages almost 8 and 10 going on 16. Sadly, my brother is not going with us. He took off a week from his day program in January to go to Florida so he must stay behind. We will miss him. Well, actually, we may not miss him much when we are on the plane. He has autism and an intellectual disability and that makes travel difficult for us all.

Yesterday we wrote about how difficult travel is for families, particularly when traveling with a child with disabilities. I believe strongly that traveling with children is difficult, regardless of their abilities. As such, I know that I will be following our own advice for readers today as we make our trek.

I have a couple of strategies that I use with regularly our girls to help the travel go smoothly. I follow much of the advice from yesterday, minus the visuals. We count down the days, we review the schedule, and we definitely pack snacks. The other strategy that I use has worked well thus far.

We Pack Together

• I sit down with the girls and we brainstorm all of the things that we think we will need on the trip.
• I take notes using simple words in handwriting they can read.
• I break the packing into categories (clothing, toiletries, backpack stuff, and other)
• I make a copy of the notes so that each child has a list
• I send the girls off to their rooms to lay it all out

Why This Works

1. First, the girls now feel that this trip belongs to them (at least in part).
2. The girls cannot complain about their outfits–they picked them!
3. The girls cannot complain about being bored on the plane–they picked out their backpack items
4. It keeps the girls out of our hair while we are packing
5. All I have to do is check their work and put their items in the bag

See you in Austin!

For our readers in the Austin area, Rebecca and I will be at Central market for coffee and conversation on Wednesday, February 22 at 9am. We are looking forward to seeing old friends and making new ones.

Winter Break Travel Blues

Hi and welcome to Ask Missy Mondays where I respond to email questions from readers who have questions about behavior.

It’s the start of winter break for many families in New England. For those of you who are unfamiliar with the tradition, many families in the north-east plan trips to much warmer locations. This means that the stress level for many families is high right now due to packing, planning, and other cortisol-raising activities. All of this is exacerbated for families who have children with disabilities. Traveling with children is difficult but traveling with children with disabilities is even more so.

One question we receive often is “How can we travel with our child with disabilities? What can we do to make travel easier for him/her? What strategies do you recommend to help?”

One of our first recommendations is to help prepare your child for the trip using visual schedules. We have written about visual schedules previously (and we just recently learned it continues to be our most visited post).

So, we have created a sample schedule that may be used to support your child if you are traveling by plane.

Even if your child does not have a disability, preparing them for safe travel by reviewing the steps involved will help alleviate some of the stress associated with travel.

Safe travels to our New England Readers. To those of you in warmer locations, some of us are headed your way!

Will the Playground Behavior Continue?

Our poll last week was such a success that we thought we would continue the fun. Please take a look at our cartoon. Thanks go out to Rick Detorie, creator of One Big Happy for such great humor.

So tell us, why do you think the behavior will continue?

100 Posts!

Wow! How did we get to 100 posts? It feels like we just started this blog!

Readers, we simply cannot thank you enough for visiting our blog, sharing our blog with others, and communicating with us about your needs. THANK YOU!

In honor of our 100th post, we thought we would highlight the top 10 posts on our blog and we’ll do it Letterman Style.

10. My Child Won’t Poop in the Toilet: HELP!

9. Homework Habits that Work

8. Using ABA to Teach Math

7. Children Do Not Outgrow Autism!

6. Toilet Training: How Long Will It Take?

5. Scream Rooms Violate Children’s Rights

4. Mary Lea and Sonic Grilled Cheese Sandwiches

3. Peanut Butter and Bread: Battle It Out?

2. Updated iPad List

And the number one most frequently visited post on our blog…………………………………

1. Do You Use Visual Schedules?

Who knew that visual schedules would be such a hot topic? We sure didn’t. We will certainly add some more information on this important topic.

In the meantime, thank you to all of our readers for letting us in to your homes and offices. Here’s to another 100 posts!

Now we want to hear from you! What topics do you need more information about? What topic would you like to learn about? Do you have any suggestions for us as authors?

Inclusion is an Individualized Decision

Hi and welcome to What Works Wednesdays where we share a success story from one of our clinical cases. All names have been changed to preserve the privacy of the child and family. Our intent is to show readers how successful ABA can be.

Today’s post is about a 4-year-old little girl named Nahir who carries a dual diagnosis of Down syndrome and autism. Nahir began receiving early intervention services early in life. She began receiving ABA services shortly after she was diagnosed with autism. She began receiving ABA services from us last year.

Nahir’s parents wanted Nahir to be a community member in her neighborhood and they wanted her to learn alongside other children her age without disabilities. We designed an ABA program that consisted of about 10 hours per week of supported inclusion and 10-15 hours per week of 1:1 ABA instruction. Nahir responded to the intervention and began showing an interest in her peers at school and she began learning many skills at home. She even began using the toilet!

After several months, Nahir’s parents wanted to increase the amount of time in inclusive settings to 20 hours per week combined with 10-15 hours of 1:1 ABA. Nahir began engaging in non-compliant behavior and her rapid learning tapered off. We discussed our concerns about this change in learning with the parents and we encouraged them to consider making a change.

As a result, the family agreed to decrease inclusion time and increase 1:1 ABA time. Watch out! Nahir’s learning took off. She began imitating, her non-compliance decreased, and she started to communicate using her new iPad and Proloquo2go.

You see, inclusion is not all or nothing. Decisions about inclusion should be made individually for each child based on his or her unique situation.

We would love to hear from readers! Share your successful ABA and inclusion stories!

Help Me with My Toddler!

Hi and welcome to Ask Missy Mondays where I respond to email questions from readers who have questions about behavior. Today’s question comes from Dawn who asks:

“I have 3 situations that I need help on. My daughter is 2 and some change.

1. She insists on turning the lights off and on repeatedly
2. She throws her toys
3. She tried to run out in the street

What do you recommend?”

Lights and Toys

Because I see so many children with autism, I always have my “A-dar” on. By that, I mean that I screen every child that I see by running down the red flag checklist in my head. Once I realized that Dawn’s little angel did not have any of the red flags, I recognized that the light switch game had actually become just that–a game. Dawn’s little angel learned that when she flipped the lights off and on, that Mommy instantly gave her attention.

Please know that Dawn provides her little angel with loads of attention. However, for a toddler, being able to control Mommy’s behavior is extremely powerful (and quite fun). The same holds true for toy throwing. When little angel throws toys, she is instantly reminded that only balls can be thrown. Again, instant attention from mommy. Look at my “Toddler Power”! I will also recommend that you check out our cartoon from last week. See PJ? He is up to the same old tricks. He wants his Mommy’s attention!

So, for those two behaviors, do your best to refrain from attending to the behaviors.

A) If you can tolerate the disco effect in your living when the lights are going off and on repeatedly, simply sit on the sofa and continue watching TV or reading or cooking (or whatever you may have been doing). If you have migraines and the disco lights send you over the edge, simply walk over to the light switch (without looking at your child) and cover the light switch with your hand. Do not say anything and do not look. If possible, continue the activity you were doing when the disco started (e.g., keep reading your book). As soon as your child begins an appropriate activity, count to 10 and then join her in the activity. You can tell her how happy you are to see her reading, playing, or whatever she is doing that is appropriate.

B) For the toy throwing, create a box and label it timeout. Sit your daughter down and show her the box. Explain to her that if she chooses to throw her toys, each thrown toy will be placed in timeout for the rest of the day. Every time she throws the toy, simply walk over to the toy, pick it up, and place it in timeout. Do not look at your daughter, do not say anything to her, and then return to your previous activity as if nothing happened. Repeat as often as necessary.When she is playing with toys appropriately, take a couple of minutes to sit down and play with her and tell her how you like the way she is taking care of her toys.

If your child asks to have one of the toys from timeout, simply remind her that it is in timeout for the day because she threw it. Tell her she can have it back tomorrow.

Running in to the Street

While this behavior may also be attention-seeking, a two-year-old lacks the understanding of the dangers associated with street crossing and various forms of vehicles. So, separate from an incident, be sure to begin teaching your child about street-crossing rules (e.g., always hold Mommy’s hand, always cross in a cross walk, look for the walk signal, look both ways). There are some great children’s books that can help you with this. Road Safety, Policeman’s Safety Hints, and Be Careful and Stay Safe.

If your daughter runs in to the street, get her as fast as you can without over-reacting. Bring her back to a safe place and remind her of the rules (e.g., always hold Mommy’s hand, always cross in a cross walk, look for the walk signal, look both ways).

When your daughter follows one of the rules, tell her how happy you are to see her use her rules or how smart she is for remembering her street safety.

Thanks for contacting us Dawn. Please let us know how it goes with these behaviors!

If you have questions about behavior, email Missy at askmissy at appliedbehavioralstrategies dot com.

Why is PJ Tantrumming?

Take a look at our picture below. (Thanks go out to Bil Keane for this wonderful cartoon (c) 1976.) See if you can guess why PJ is tantrumming. When there is a reason for a behavior, behavior analysts called it a function or a purpose. This is the first time we have tried a poll so please participate! We will post the answer tomorrow! Thanks for playing.

State Laws for Behavior Plans

Here at Applied Behavioral Strategies, our mission is to improve the quality of life through effective intervention. One way we hope to do that is by reviewing research articles for our readers. The title of today’s article is State Special Education Laws for Functional Behavioral Assessment and Behavior Intervention Plans. Perry Zirkel authored the article and Behavioral Disorders published it in August, 2011 (Volume 36, number 4).

Purpose

The author set out to analyze state laws regarding Functional Behavioral Assessments (FBA) and Behavior Intervention Plans (BIP). For background information related to federal requirements for FBAs and BIPs, read Dr. Zirkel’s introduction. He provides information regarding the law, regulations, and federal interpretations of the law.

Method

The author searched  for state laws regarding FBAs and BIPs. Keep in mind, states may only add to federal legislation, not take away from requirements. Then he tabulated the information adding a “when”, “who”, “what”, and “how” column. Specifically, the “when” column identified if a state identified when the FBA and BIP were required. The “who” column indicated when a state identified the parties responsible for completing the FBA and developing the BIP. The “what” column indicated when a state defined the FBA and BIP. Finally, the “how” column identified when a state included information about how to complete an FBA and BIP.

Results

Key finding #1. Thirty-one of the states have requirements regarding FBAs and BIPs.

Key finding #2. Twelve of the 31 states fail to identify both the “who” and the “when”.

Key finding #3. Zero of the 31 states require both an FBA and a BIP when a child’s behavior interferes with the child’s learning or that of others. May we note that this seems absurd to us? How can a BIP be developed without an FBA? And how could an FBA not result in a BIP? We are terribly saddened by this finding.

Key finding #4. Only 2 states provided information about how to complete both an FBA and BIP. Meanwhile 12 states provided some information about how to complete a BIP.

Key finding #5. Seventeen states define FBAs and BIPs with only 14 of the 17 mentioning “function” with regards to FBA.

Conclusions

As parents, teachers, behavior analysts, and/or advocates for children with behavioral challenges, we have a duty to make changes at the state level to ensure that students are protected with policies that will result in appropriate assessment and intervention. Protective policies regarding FBAs and BIPs will most likely prevent the use of scream rooms and other inappropriate behavior reduction techniques.

Feeding Therapy Works!

Hi and welcome to What Works Wednesdays where we share a success story from one of our clinical cases. All names have been changed to preserve the privacy of the child and family. Our intent is to show readers how successful ABA can be.

Today’s post is a follow-up for a case we have described previously. You should read the original post first to gain a full understanding of how far this child and his family have come.

Many blogs do Wordless Wednesdays where they simply post a picture with no words. Yes, we realize we have already written words, but you need them to fully understand the photo. February marks one year since Nathan had behavioral feeding therapy. This is a picture from his meal from last week. As you can see, he is going strong! This meal consists of  artichoke hearts, roasted red peppers, Brussels sprouts, olives, brown rice, chicken, sausage, and garlic. What you cannot see is the side of broccoli steamed with lemon juice. Bravo Nathan! You are doing great and your mom and dad are an invaluable support team.