Managing Challenging behaviour

University Degree Education and Teaching

Heidi Watts

FDLS 1016

Managing Challenging Behaviour

Anne Perkins

In approximately 2,500 words:

Critically reflect on possible explanations for the incident;

Critically reflect on positive future management

I felt that there were a number of factors that contributed to the child’s behaviour. The child had spent long periods of time in hospital from the age of eighteen months trying to find ways to control her seizures. This meant that she was confined to a hospital bed, wired up to monitors twenty four hours day with very little social contact with other children. She spent most of her time sleeping; recovering from a cluster of seizures. When I first spoke to her mum about the cluster, I was assuming that she meant three or four seizures a day but unfortunately that is not the case. Mum went on to tell me that a cluster could be thirty or forty seizures in a couple of hours, only stopping when she was administered a drug that gave her respite for an hour or so before the clusters started again and this could go on for days! This made me realise how difficult life had been so far for this child and how isolated she had been. I feel that this resulted in the child’s development being delayed, which in my opinion has only made the problem of her behaviour more pronounced. She is a tall child and stood out from the rest of her peers. This was then accentuated when she was a year older and was showing no or very little progression with her development.

Johnson and Parkinson (2002) outline some association between epilepsy and behaviour problems;

The frequency and/or severity of the child’s seizures;
The area of the brain from which the excessive activity originates;
The way in which the ‘activity’ may then spread;
Actual structural differences, damages or abnormality to a part of the brain which rise to both the epilepsy, behaviour problems and also possible associated learning difficulties;
The type of seizure, e.g. a complex partial or simple partial seizure may evolve a series of odd, repetitive behaviours or movements over which the person has no real control; a prolonged absence or series of absences may result in someone completely missing out on an instruction, or misinterpreting it because the crucial words have not been heard, leading to what can appear to the onlooker to be bizarre or insubordinate behaviour. (pg 72 paragraph 1)

Behavioural and emotional difficulties are recognised as more prevalent in children with epilepsy than the general population. Research indicates that this could be as a result of: some anti-epileptic medicines; unpredictable seizures; low self-esteem and feelings of isolation. Bullying and stigma is also a significant problem for children with epilepsy.

For the rest of the class I think I always felt sorry for them in a small way, they were being asked to witness this behaviour and but to also ignore it. The child’s condition was explained to them but I do not think that enough detail was put into the explanation, which resulted in the rest of the children in her class starting to resent her being there because they did not have enough understanding of why she was behaving like she was. This escalated into some of the children showing signs of bullying her. Epilepsy Action talks about ...

This is a preview of the whole essay

Some children with epilepsy are picked on at school. This may be because the other children do not understand epilepsy and/or the child with epilepsy doesn't feel able to assert themselves. Signs can include temper tantrums, violence, or sudden misbehaviour like playing truant, or nervousness. Talk to your child's teacher if you are worried and make sure your child knows they have your support and encouragement to stand up for themselves.

At the time we had what I have heard termed many times as an “old school” teacher who blatantly showed her own personal feelings towards the child in front of her peers which resulted in the children constantly saying “but Mrs X says that about her.”

It got so bad that I felt that the teacher was verbally abusing the child and spoke to the head teacher about it. It was decided that I would write a daily diary of everything that was said and done in the classroom. This diary was eventually used as evidence when the head teacher and the chair of Governors made the decision to suspend the member of staff.

Porter (2007) refers to a valid point to where a child’s social skills are concerned,

Classroom groups organised so that students feel liked and respected are more likely to have youngsters acting in ways that warrant the liking and respect of others. (Schmuck & Schmuck, pg 234)

Porter goes on to talk about how a child’s social relationship has an impact in their academic progress as well as the psychological wellbeing. But I am not sure this is the case for this child. As she always seemed completely unaware that there were any other children in the room. I am sure this is due to her having no prior experience with other children in social setting, she only had contact with children like herself, too ill to do things the everyday children take for granted. But what do does socialising mean for a child? Lindon, (2005), tells us that it is a process where children learn how to behave and form attitudes that fit in with the society, or social and cultural group they are involved in.

For this child she had never had the experience of other children to play with, something most children just take for granted. Intervention for individual children with social difficulties is not enough for these children. By the time an programme is put in place it is often the case that the child has been labelled by children, parents and staff members. I think that we need to work with the group as whole to enable the child to become socially accepted by their peers. Especially when an adult has already planted the seed in their minds as to how they should think of the child, I do not think that some adults realise the immense power they have of their children’s thoughts.

I feel that the government initiative ‘Removing the barriers to achievement’ has some good ideas on we as professionals can support the children we are working with to enable them to achieve, not matter how small the achievement (Fig.1).

In the county that I am employed in, the Disabilities, Inclusion, Sensory and Communication Service (DISCS) have people who come out to schools at assess the child in her surroundings at home and at school. They offer support for both the pupil, Staff and Parents. They provide support for pupils with physical disabilities, sensory impairments, communication difficulties (which include pupils with autistic spectrum disorders and specific language disorders) and children with complex learning difficulties. Their support I feel kept me sane and remaining in my job. The Inclusion service personal that came out to see the child every week gave us lots of resources and ideas how to handle the child when her behaviour is not appropriate.

They also helped set the targets for her Individual Education Plan (IEP).

The main idea was that the class teacher, another Teaching assistant and I would learn to sign in Makaton. The reasons for this were to be able to communicate with her when she was unable to communicate verbally. With the signing came symbols but unfortunately the symbols that Makaton created are a bit out dated, so we used a programme with similar pictures but more colourful and also more up to date called communicate in print. The idea was that we would show her the picture and then sign to her after always saying the word while you are signing. This was fine if you could get good eye contact with her but this was very rare and extremely difficult to achieve. She liked the pictures and with them we created a visual timetable that enabled her to be able to see what she was doing and in what order. When she had achieved the task, she was allowed to take the picture of the timetable and put it in the finished box. Again this worked well, as long as it was something she wanted to do. If not then the inappropriate behaviour started.

The next idea was to build a Low Arousal Room for her. It was suspected that she also Autistic and so DISCS had the room built in a corridor, so that if she was being disruptive then I would be able to take her out of the classroom and into the low arousal room to calm down and to finish the set task.

The National Autistic Society gives a good description of why a low arousal room is suitable for these children;

Many people with an ASD have higher or lower sensitivities to noise, light, heat or smell. Therefore it is important that lessons are held in a calm environment, free from disruption or noise which may cause them to become anxious (strategies for dealing with this will be discussed in more detail later).

Even the tone of voice or body language can be a factor. Being too harsh may cause anxiety amongst some individuals so a low tone of voice and slow body movements should be used.

Epilepsy is treated by Anti-Epileptic Drugs (AEDs), of which there were nineteen that I looked at. The most common or important side effects that were presented by children when they were taking the drugs were

Headaches
dizziness
drowsiness

(Fig.2)

Although the side effects are relatively mild, after prolonged use of these drugs surely they must do more damage?

One drug I did find Acetazolamide, left 32 patients out of 37 were complicated with mental retardation, when scientist were testing it mixed with some of the drugs in mentioned . (sciencedirect.com, fig.3)

It was thought this child had a type of epilepsy, which every time the child had a seizure her speech and language skills worsened. It was thought that it was killing off part of the temporal lobe where our hearing, learning, language, emotions and memory are. If this is being damaged every time the child has a seizure then to my understanding it is going to severely affect the child’s behaviour. I am also of the opinion that if her memory is affected by her seizures then she will not always remember the behaviour that was not suitable in the classroom.

If this is what happens when a child’s drugs are mixed to achieve a relatively seizure free lifestyle then I would presume that this would impact on a child’s behaviour. Knowing that the child in my care was taking at least three different drugs a day and still she was no where near having her seizures controlled, what could possibly have been happening to her brain? Epilepsy action, describe what they think the link is between Epilepsy and Learning difficulties. (fig.4)

Learning disabilities can be caused by damage to the brain. This damaged part of the brain can then become irritable and provide a focus for epileptic seizures. The resulting seizures, however, may not appear until many years after the damage occurred. Usually epilepsy does not cause learning disabilities. However, having many and/or severe seizures over a length of time can cause damage to the brain. This in turn can lead to learning disabilities.

In some cases epilepsy and learning disabilities can both be a part of a . (A syndrome is a group of signs and symptoms that, added together, indicate a particular medical condition.) Examples of syndromes where epilepsy and learning disabilities are both present are , , , and syndromes. People with Down’s syndrome are at an increased risk of developing epilepsy in later life.

I also feel that because her behaviour was so erratic and unpredictable it made the other children in the class stay away from her. There was only one child that talked to her and strangely she was also diagnosed with epilepsy. I am assuming that this was purely coincidence,

Reflecting on this I am sure if we knew more before she started school, then things would probably have been different. There so many different types of epilepsy and they all have different issues attached to them. This I feel was something that would have helped; the school were told that she had epilepsy and needed somebody to be with her at all times in case she had a seizure. This was not really a very helpful description. There was certainly more than just epilepsy wrong with the child and although her mother could see that things weren’t working as well as we had all hoped she was reluctant to move her to a local special school where they had more resources and better qualified staff to deal with her. I think that with regards to future positive management, I would most certainly get as much information regarding a child’s medical condition as possible as this would certainly made a difference to her education, but I think that in some ways we have gone too far with inclusive education, making it difficult for head teachers to say that they don’t think this is the right place for the child, whether it be a behaviour issue or a special education need.

This child did eventually go to the local special school and as far as I am aware is very happy there and is well looked after and now stays a whole day at school, even if she has a seizure because they have the facilities for looking after her, this also gives mum a few hours respite.