It was 1999 and Danielle was a ten year old with cerebral palsy who was non-speaking and non-ambulatory. Although she would soon have a defined yes/no we weren't there yet. She lay on a mat in my classroom in the city and cried. We tried music, favorite toys, hand lotion and massage and even scolding her to stop. She didn't. Finally I verbally listed body parts to her from the toes up touching each one and she stopped crying when I said "do your thighs hurt?" Two days later we have confirmation of a femur fracture from previously undiagnosed brittle bones. I filed away the memory of connection between the unusual behavior and the student being in pain.In 2004 in a classroom for high school students in rural New England a young man, Chuck, with multiple disabilities including spastic quadriplegia, communication impairment and hearing impairment refused to transfer from his manual wheelchair into his power chair. We argued, I insisted and he went off to his job in the community. The next day the refusal to transfer chairs happened again. Danielle came to mind and I asked if he was in pain. He nodded. It turned out his seat cushion had popped, all the gel had leaked out and he was sitting on a metal plate. I again filed away the memory of the connection between unusual behavior and pain.
Recently, in a classroom nearly 60 miles from that classroom in rural New England another young woman with profound, multiple disabilities was crying every day, during every transfer and every slight shift in positioning. She was unable to indicate in any way what the tears were about. A few days passed and some people questioned if the behavior was manipulation. Danielle and Chuck entered my mind and I asked the nurse if we could try giving her some Tylenol just to rule out pain. The next morning we did just that and to our thrill not a tear was shed all day and for the first time in weeks the student was able to participate in active PT exercises!
I wish there was some way I could thank Danielle and Chuck (and all my other students) for teaching me that all behavior is communication and that sometimes that communication is simply, "that hurts!"
Oh, Kate! I wish all educators were as observant and diligent as you were in these cases. It bothers me tremendously that so many people want to attribute my son's adverse behaviors as possible manipulation or his seemingly-perseverative use of some words on his vantage lite as meaningless chatter. I know for a fact that the only times my son really acts up is when something is very wrong. Recently, it's been a behavioral aura preceding seizure activity. That "chatter" is his way of trying to communicate that he doesn't feel "right" and someone needs to investigate.
ReplyDeleteYou are so wonderful, your students are so blessed to have you. Thank you for always looking out for these wonderful kiddos!!
ReplyDeleteforwarding to my daughter- soon to be an ESE teacher. (and making note to self for future reference.)
ReplyDeleteThose are great stories... my daughter was able to do something similar this week and I blogged about it. I was thrilled to learn she could tell me something's wrong then select " something hurts". I was a very happy mommy to know what was up and she got some benadryl which helped her feel better. I don't know what we do if not for her ipad and proloquo2go. It took quite a bit of time to customize and lots of daily practise but she is getting iT!! Well worth the time and money.
ReplyDeleteI need to add those students are very lucky to have you .. your a very patient and caring teacher.
ReplyDeleteSuperb! Generally I never go through whole articles but how you wrote this information is simply amazing – thanks
ReplyDeleteGreat post as always Kate! Passing this on at a staff training of MDS teachers tomorrow - just as a gentle reminder! LOL
ReplyDeleteEmpathy...what a great concept!!
ReplyDelete1987, working as an aid in a center-based respite program, I met the busses that were bring the kids from their school programs to ours. The bus driver told me 5 year old "Natalie" (spastic quadriplegia) had cried the whole way, and he was annoyed. I knew it wasn't like her. When I got to her seat, she wasn't crying, she was FRANTIC. It seems like she was overheated. I unbuckled her, and lifted her like an infant (behind her back and under her knees) Her crying didn't change, but she didn't feel right in my arms. I got her into the building, grabbing two staff along the way to come help me because I was afraid to move her to set her down. While holding her, I got her to take some deep breaths and try to relax. I told her we were going to lay her on the floor (we had a large mat that she liked to play on) and she started screaming again. Ok then, not laying down! My arms were killing me at this point. We didn't have a chair for her, so finally I had another staff person call her mom while I sat down on a chair and just kept holding her. Mom came very quickly, and better than us decided to call an ambulance. Turned out she had a dislocated hip. For years I felt sick every time I thought of picking her up out of that car seat. 24 years later, and I have two kids with Down syndrome. My daughter, 15, has chronic UTI's, but never indicates pain. Instead her behavior goes off kilter. I bring her in for a urine test and VIOLA!
ReplyDeleteIt was great to find this web-site. Thanks for your time and efforts for this wonderful read!! I have you bookmarked… Thanks
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