Have Mental Health Questions? Ask a Psychiatrist Online
Welcome to JA.com. Do you mind if I ask a few questions to get a clearer picture of your situation and what you are dealing with?
Hello yes I'm open to questions
Sorry for the delay. When I saw you weren't available I started working with another customer. With a case like yours, I'd really like to have a short chat session. When are you next available for chat?
I've worked as behavior consultant for a major school board and as a psychotherapist to high emotional and behavioral needs kids. I think I can provide a helpful answer to your question. I'll check back frequently for your response.
Hello, I'll stay on line now for a time in case you are available to chat, otherwise it will be this evening around 1930 when I finish work.
Hello thank you for waiting for me...
Would you mind providing me with some "snap-shot" behavioral descriptions of 1) the disruptive behaviors at school; 2) the self harm behaviors; and, 2) the specific problems in large groups?
Hello. By snap-shot I mean descriptions that put me right there when it's happening.
Please take your time. It's better to have a really clear behavioral description. I can work with you until I have a good sense of what's really going on there.
1) He is described to me as being disruptive in class by the lack of work produced and he is described as being switched off. He gets easily involved in class with anyone else who is not doing as they should be. He can say hurtful things to other children out of the blue and shows no remorse.
2) He has always been reluctant to take part in any activities even down to attending birthday parties. We had a lunch booked some weeks ago that we had to attend along with family he locked himself in his bedroom and complained bitterly that I know he doesn't like eating in public. I had to promise him we would sit away from other people and leave straight afterwards. he was very agitated throughout .
3) Following a detention at school he cut his arm with a pen knife when i asked him why he said he had felt angry. Just this week he was left outside the classroom to sit for an hour following an altercation with a group of girls the teacher described him as very upset when he came home he had been sat outside the class and had scratched one of the girls initials deep into his forearm.
Excellent thank you, XXXXX XXXXX
When did you start to see these behaviors at school? What is your son's current and historical level of academic performance - grades etc?
I ask about academic performance because it tells a lot about learned vs unlearned behaviors, which in turn speaks to potential therapeutic intervention and biological vs environmental contributors to his problems.
Has there ever been any psycho-educational assessment or identification through his school?
He is behind at school level 3 in most subjects as opposed to level 5 where he should be. He has historically had speech delay attending soeech therpy to the age of 7, he has been under a nutrionalist some years ago but she took him off her books as she thought he used his cintrol with food to control me. He had problems settling at school right from the beginning to the extent thta he climbed under a desk every morning until he was ready to come out. he struggles at school yet won't ask for help, he deosn't answer questions in class nor put up his hand which i guess is because he doesn't want to attrack attention to himself. He has had some friendships at school but I feel he tends to befriend other children who are classed as disruptive like him
Sorry lots of typos
No problem I make them also, it's part of chat I've learned.
In the large school board I once worked with as behavioral consultant there were "behaviorists" on staff to provide additional specialized supports. Any such service at your son's school? Do they provide formal psycho-educational assessments?
I contacted the school this week following Fridays incident with his arm and they have told me they are going to arrange for me to go into school next week for a meeting to discuss all this behaviour. There is a SENCO there but my son doesn't see him as a rule. He was receiving extra help prior to him starting this school 2 years ago due to his speech delay his reading was very poor. I was told on his entry to this school that he didn't fall below the line for help and he'd been spoiled at his previous school.
I feel things are now taking a downwards spiral
What is an SENCO?
Special Educational Needs Co-Ordinator
Got it thank you...
One thing I'd add as an aside having worked with a number of school boards over the years. is that end-of year, they are usually low on budgetary funds so they really look for ways to avoid spending on support services. In addition to asking for every available behavioral support and a formal psycho-educational assessment in your up coming school meeting, I would plan to aggressively, be the squeaky wheel at the beginning of the next school year if they don't act this time.
Just re-reading your points above....
You mentioned social avoidance type behaviors like the attending birthday parties, does he eventually go in most instances and if so how does he do once there?
He's never stayed long enough to get involved I've always made the attempt and got him there but he's refused to let go of me when he was younger, other activities have always panned out the same; such as rugby traing I took him for about 3 months every weekend and he just stood on the sidelines and wouldn't get involved. I feel he is missing out on life experiences?I wonder whether I should seek help from the CAMHS unit here (Children's and Adolescent Mental Health Services) We come under the MOD umbrella so I know all about the c
sorry pressed too early... I know all about the cuts its affecting the schools here too
I think that's a very good Idea. Do you know what formal assessment and behavioral intervention services they offer?
Sound's to me that there is a spectrum component to his behavior, but that with highly targeted behavior analytic supports most of these problem behaviors can be replaced with more pro-social and school normalizing targets.
I have no idea..I've been reluctant to go down the line of mental health services as I feel the stigma might follow him into adulthood but I realise things can't go on like this.
I agree. My preference has always been for systematic evidence-based behavioral intervention.
If it's done properly the results can be phenomenal.
I hope so I will definately be that squeaky wheel if nothing comes of next weeks meeting;
Most behavioral parenting and school interventions fail because they lack the precision needed to effect real change
Have you considered working with a Board Certified Behavior Analyst?
No, I haven't heard of one before, will I need a referral?
I'm just brain storming but BCBAs are the hidden gold mind for systematic behavioral intervention. They do everything from ABA which academically and normalizes most autistic children, to clinical behavior therapy for depression (see "activation therapy" an ACT therapy) and performance management in organizations...Let me get some links...back in a few moments
...You may even be able to work online and by phone if you need and possibly for free if you connect with an BCBA certificant who is being supervised for board certification. You then get a highly trained Doctoral supervisor and a master's level behavior specialist for free or low cost...
Thank you I'll take a look at those
You could set up an integrated home and school behavior change program. The specific behavioral strategies will depend on direct observation and perhaps basic data collection. The tools and strategies these guys have are amazing. They know how to target increased teacher participation. A point and level system and daily home-school report chart are just a few evidence-based intervention strategies that get results....
You can call the listed German BCBA's and they will talk to you for free. They generally provide a free consult. I advise asking if there are any BCBA certificants who are being supervised for clinical hours you can work with. Make sure you work with a BCBA certificant and not one of the lesser qualifications. They are specially trained to identify and distinguish non-environmental variables that maintain behavior. They also use least intrusive methods first and follow the strictest confidentiality guidelines. The will specially design charts and tools for you and your son to use based on his individual needs and presentation.
He's been on school report before for producing so little work in class but it had no real function as far as I could see it just led to lunch time detentions if he didn't comply which wasn't getting to the root of the initial problem. I think some of the teachers focussed too much on the bad and not the good. My son however liked it because he felt like he was the one in control and not them weirdly
"Off task" "acting-out" and non-compliance to adult direction behaviors are classic BCBA targets. There is a vast data base of research they utilize in the tailoring of their interventions. BCBA's focus on the good, literally through positive behavioral supports and positive reinforcement..
They know how to use simple data collection tools on your son's behavior to simultaneously monitor and influence the teacher's desired behavior changes also...
Social control is usually secondary to avoiding unmanageable tasks or being over stimulated for example. When these are assessed and addressed systematically, the "coercive-control" process usually diminishes big time.
....this also true for teachers..
Having a formal BCBA tailored, evidence-based intervention is also good postive "amo" for influencing the school for supports
Finally, the Applied Verbal Behavior training they all get is proven more effective than any form of non-behavioral speech therapy.
I'm showing you as "typing" on my screen, so I'll wait for your reply...
Sorry I'm in work was dealing with a customer.
Ok, no problem.
This all sounds great I'm going to go onto the links and check them out, make notes and make sure I have all the suggestions to hand should I need to bring them up at the meeting. I'm keen to look into a BCBA any assistance at this stage would be brilliant especially if it would avoid going down the mental health street.
Alright. I'm really glad this was a helpful suggestion. Is there anything else I can help you with today?
No thank you; I'll go on with this. Thank you for your advice.
Great. You're very welcome. Please don't forget to press the "Accept" button if you feel I've satisfactorily answered your question. I'd also really appreciate a short positive summary comment for my other customers to see in the feedback window you'll see at sign out.