Case Study: Veata, a child with separation anxiety and NVLD

  “I would like to stop spitting.”

                                    Veata

Background:  

Veata was adopted from an orphanage in Cambodia at the age of nine months by a white couple that lived in the West Village.  Her parents sought educational therapy because Veata had so much trouble writing, doing math, and behaving in school.  Writing frustrated her; sometimes she’d refuse to do it.   She was evaluated in second grade, but the evaluator wrote that she might outgrow the symptoms though he suspected NVLD.   Therefore, the parents did not share the evaluation with the school.  Her testing showed high abstract verbal reasoning, but her visual spatial scores were below average. 

 Veata’s behavior in school was the presenting issue.  She seemed to look right at her teachers when they told her not to do something, and do it anyway.  She spit on her classmates; she got into tussles at recess.  Transitions were very difficult for her.  Her classmates shunned her and her parents were exhausted.  They had leave work from time to time and bring Veata home if she disrupted class too persistently.  Veata’s school was a local regular education public school and her teachers were at a loss.  Sometimes Veata could behave and attend to her work in class, especially in music class.  She could be extremely dependent on her teachers, but often incited mischief among the more distractible children.  

During our first interview I asked Veata what she would like to have happen if we decided to get together.  “I want to stop spitting,” she told me.  She did some writing for me and her handwriting was extremely neat, but the production of it was very slow.  She meant this story to be special, and when she gave it to me, she also gave me a little envelope with a quarter in it, as a gift.  During the intake interview she alternately clung to her mother, or ran about the room.

 Veata’s parents were in crisis.  The father had lost his job, and the mother had to travel frequently. Money was an issue.  Their friends had advised them that Veata was just bored by her class because she was so bright, and that she’d grow out of it.  This advice had created a false hope in her parents and they delayed getting help for Veata by two years.  Yet they were kind and gentle with their daughter, and in their presence, Veata could calm down and control herself.  Her behavior at home was variable, so the demand that she write or do math were taken up with minimal pressure to finish. 

Her teachers wanted management strategies for Veata’s behavior in the classroom.  Recognizing that she was bright, they tried to engage her in class work. Nothing worked for long.  She could become bored, anxious or defiant, especially during math and writing.  Putting Veata in a time out for negative behavior she exhibited on the playground or during class transitions was difficult to accomplish because the consequence could not follow poor behavior immediately. In fact, time out, when offered to Veata as a choice, was something she used to soothe herself, and was a great clue to cognitive and emotional underpinnings of her behavior. Using a token system for rewarding target behavior didn’t help for long, as she couldn’t adhere to a reward program that took all day to fulfill.  The principal resorted to calling the parents in to take Veata home at least once a week.   She told me privately that she wished Veata’s parents would move her to another school, but as this was a public school, there was no way she could counsel the family to more suitable placement.  Her wish was that I provide classroom management strategies, and help to counsel the family to a new school placement for Veata.

 Though it took another year, Veata’s parents applied to a special education private school in NYC that was suitable for her needs.  She was accepted and is now doing better behaviorally and academically.

 

Non-academic interventions:

·       Steer Veata to occupational therapy to relieve some of the stress that handwriting was causing her.  Veata liked this; she wanted to be able to do all her homework.

·       Create a safe zone at school where Veata could go when she felt overwhelmed by transitions, noises, or the physical pell-mell of her classmate’s bodies near hers. This was done. 

·       Request a Functional Behavior Analysis from all teachers and from Veata’s parents through the Department of Education with a trained behavior specialist.  Meanwhile: Do the ABC’s of behavior modification.  Observe the antecedent; note the behavior; create a consequence.  Rework the token system so that Veata had tokens she could earn a reward each hour rather than at the end of the day. The behavior target had to be expressed as a limited positive behavior, had to be taught, had to be simple, and had to be consistently applied.  Veata’s use of negative behavior to get attention or to avoid stressful transitions had to be reduced by lowering the teachers’ reactions to disruptive behavior and building relationships through positive behavior.  The target behaviors had to be limited to one or two to be realistic.   Veata’s teaches would be overwhelmed otherwise. Recommended teacher training from a school behavior specialist, who could also do a functional behavior analysis, and help with school placement.  Giving teachers positive actions to focus on helped relieve their stress, and helped them reduce the number of times their buttons were pushed.  Teachers needed steady praise and strategies.

 ·       Explain Veata’s perceptual, social, math and writing issues to the teachers, and help them communicate their needs to her parents.  The teachers needed help to see past Veata’s defiant behavior to the non-verbal learning difficulties and the emotional factors that lead to it.  For example, separation anxiety in adopted children combined with inconsistent rules at home or at school can lead to manipulation and oppositional behavior.

·       Invite Veata’s father to spend a day observing her in class.  He saw and understood the extent of Veata’s disorganization and oppositional behavior. 

 ·       Begin to convince the parents that Veata needed a different kind of school so that her behavior issues would not subsume her academic life.  We attended a lecture together on special schools.

 ·       Meet at the school to help the teachers and parents communicate and begin to plan together for Veata’s well being.  Over time, when the school and Veata’s parents agreed that a new placement was important for her well being, everyone could relax a little more.

·       Invite Veata’s parents to visit schools with me.  Veata got into a school for children with learning disabilities that had an excellent record with emotionally fragile children.

·       Urge the Department of Education to apply Carter funding to this case.  They got funding, but have to reapply every year.

Some academic interventions:

 ·       Record Veata’s dictation of stories and homework assignments.  Bypass handwriting except in small doses. 

 ·       Read along with Veata so that she had multimodal feedback to help her attend for longer periods of time.  This was comforting and is always a great way to engage a child in good reading strategies. 

 ·       Practice math facts using computer games, manipulatives, songs, rhymes, and flash fact quizzes in which she could point to the answer from among several choices.

 ·       Take Veata outside during planned breaks so that she could get used to routine transitions when she was tired.  This worked when her father took her out.

 ·       Allow her to stop a task when her attention flagged, and switch to another, but to keep working for a full hour, with a large red timer on the table.  Didn’t always work. Some days were challenging.

Some resources for behavior management of special needs children:        

 Center for Social and Emotional Foundations for Early Learning   http://www.vanderbilt.edu/csefel/

Challenging Kids, Challenged Teachers, by Leslie E. Packer, Ph.D., and Sheryl Pruitt, M.Ed., ET/P, from Woodbine House http://www.woodbinehouse.com/

 The Technical Assistance Center for Social and Emotional Intervention

www.challengingbehaviors.org/ Provide recommendations of behavior consultants for teacher/parent/child.