RE: [VerbalBehavior] Quiz -- Is it behavioral or medical?

[Guest guest]

First, I want to thank everybody for their responses.

I realized after I began getting emails that I had neglected to say that we

WERE giving Kenny LOTS of praise for using the potty appropriately during

the day. The other thing I didn't mention is that, at age 15, he likes his

privacy in the bathroom. He insists that the door be closed and that we

are on the other side of it when he goes in to do his business.

Having said all of that, it appears that the problem was medical. Our GI

doctor prescribed Sporanox and Prednisone for him, and after the second day

on the medication, his behavior stopped.

I think the key lesson for me is that there is not always a " right " way to

approach problems like these. We are told to " Rule out medical first, then

treat behaviorally " . Many people suggested other behavioral procedures to

try, based on the fact that his lab tests had come back clear. And that

makes sense.

Yet the behavioral procedures WEREN'T working, and no matter how many

different approaches I might have tried, I doubt that they would have

corrected the problem.

I wanted to share this experience because it has really pointed out to me

the importance of the fact that it is hard to " rule out " medical issues.

Just because we can't find them with the traditional methods, doesn't mean

they aren't there. As I think back to earlier times, a lot of " behaviors "

that Kenny had, actually turned out to be related to undiagnosed Crohn's

disease. We went to 4 gastroenterologists, all of whom had great

reputations, and all of whom told me there was nothing wrong, before the 5th

doctor decided to use a PillCam to check the small bowel. Sure enough, it

appeared that he had been suffering for years! And once we got him on the

proper meds, life became MUCH calmer and happier for everybody.

s

persistentC@...

_____

From: VerbalBehavior [mailto:VerbalBehavior ]

On Behalf Of persistentC

Sent: Tuesday, June 17, 2008 10:10 AM

' '; VerbalBehavior

Subject: [VerbalBehavior] Quiz -- Is it behavioral or medical?

Hi Gang,

I'm curious to hear your feedback about this...

My son, Kenny, is 15 years old. He has been potty trained since he was 3.

A couple of months ago, instead of urinating into the toilet, he began

urinating next to it. At first, I ignored the behavior, and just cleaned it

up, thinking it was just an accident. But as the incidents increased, I

began to suspect there was something more going on. My first thought was

that perhaps he had a UTI. I took a urine sample in to be tested (twice)

and the results came back clear.

After getting the test results, I decided to approach this behaviorally. I

started by just having him clean up his mess, but not making a big deal

about it. As this made no difference, I began making the cleaning up

process a little more aversive to him by increasing the amount I expected

him to do. This, too, made no difference. So then I began using over

correction. At this point he was clearly unhappy about the whole process.

However, it made no difference, and in fact, he began urinating on the

carpet of his room in the middle of the night. I began making him shampoo

the carpet, empty the water tank etc. Still, the behavior continued. After

a week or so of this, he began defecating on the carpet as well. Since the

stool was very loose and liquidy (a REAL mess to clean up) I thought I

should check to see if he was actually having a GI issue. (He has chronic

GI problems, including Crohn's Disease and Barrett's Esophagus.) I took

stool samples in to be tested, but these results, too, came back with no

problems detected. I also took him into the pediatrician's office for an

exam twice. Two different doctors saw him, a couple of weeks apart, and

neither had any idea about what to do.

A week or so ago, I even caught him going into his room during the day,

pulling his pants down, and eliminating on the floor.

We started looking at foods that he was eating. In an attempt to expand his

diet, we had recently introduced some new items. I removed those foods, but

it made no difference.

So, for those who want to " bite " , what would your next step be? Do you

think it's behavioral or medical?

s

persistentC@ <mailto:persistentC%40gmail.com> gmail.com

[Guest guest]

Thanks for update and glad things are shaping up. Our kids are such a

challenge and I agree there are many behavioral problems that have a medical

cause or contribution.....and it is impossible to truly ever rule out a

medical cause with our kids. Kenny is lucky to have a wonderful mother like

you!

Take care,

______________________

Lynch Barbera, RN, MSN, BCBA

_www.vbapproach.com_ (http://www.vbapproach.com/)

In a message dated 6/21/2008 10:31:02 P.M. Eastern Daylight Time,

persistentC@... writes:

First, I want to thank everybody for their responses.

I realized after I began getting emails that I had neglected to say that we

WERE giving Kenny LOTS of praise for using the potty appropriately during

the day. The other thing I didn't mention is that, at age 15, he likes his

privacy in the bathroom. He insists that the door be closed and that we

are on the other side of it when he goes in to do his business.

Having said all of that, it appears that the problem was medical. Our GI

doctor prescribed Sporanox and Prednisone for him, and after the second day

on the medication, his behavior stopped.

I think the key lesson for me is that there is not always a " right " way to

approach problems like these. We are told to " Rule out medical first, then

treat behaviorally " treat behaviorally " <WBR>. Many people suggested other beha

try, based on the fact that his lab tests had come back clear. And that

makes sense.

Yet the behavioral procedures WEREN'T working, and no matter how many

different approaches I might have tried, I doubt that they would have

corrected the problem.

I wanted to share this experience because it has really pointed out to me

the importance of the fact that it is hard to " rule out " medical issues.

Just because we can't find them with the traditional methods, doesn't mean

they aren't there. As I think back to earlier times, a lot of " behaviors "

that Kenny had, actually turned out to be related to undiagnosed Crohn's

disease. We went to 4 gastroenterologistsdisease. We went to

reputations, and all of whom told me there was nothing wrong, before the 5th

doctor decided to use a PillCam to check the small bowel. Sure enough, it

appeared that he had been suffering for years! And once we got him on the

proper meds, life became MUCH calmer and happier for everybody.

s

_persistentC@persisten_ (mailto:persistentC@...)

_____

From: _VerbalBehavior@VerbalBehaviVer_

(mailto:VerbalBehavior )

[mailto:_VerbalBehavior@VerbalBehaviVer_

(mailto:VerbalBehavior ) ]

On Behalf Of persistentC

Sent: Tuesday, June 17, 2008 10:10 AM

' '; _VerbalBehavior@VerbalBehaviVer_

(mailto:VerbalBehavior )

Subject: [VerbalBehavior] Quiz -- Is it behavioral or medical?

Hi Gang,

I'm curious to hear your feedback about this...

My son, Kenny, is 15 years old. He has been potty trained since he was 3.

A couple of months ago, instead of urinating into the toilet, he began

urinating next to it. At first, I ignored the behavior, and just cleaned it

up, thinking it was just an accident. But as the incidents increased, I

began to suspect there was something more going on. My first thought was

that perhaps he had a UTI. I took a urine sample in to be tested (twice)

and the results came back clear.

After getting the test results, I decided to approach this behaviorally. I

started by just having him clean up his mess, but not making a big deal

about it. As this made no difference, I began making the cleaning up

process a little more aversive to him by increasing the amount I expected

him to do. This, too, made no difference. So then I began using over

correction. At this point he was clearly unhappy about the whole process.

However, it made no difference, and in fact, he began urinating on the

carpet of his room in the middle of the night. I began making him shampoo

the carpet, empty the water tank etc. Still, the behavior continued. After

a week or so of this, he began defecating on the carpet as well. Since the

stool was very loose and liquidy (a REAL mess to clean up) I thought I

should check to see if he was actually having a GI issue. (He has chronic

GI problems, including Crohn's Disease and Barrett's Esophagus.) I took

stool samples in to be tested, but these results, too, came back with no

problems detected. I also took him into the pediatrician'problems detect

exam twice. Two different doctors saw him, a couple of weeks apart, and

neither had any idea about what to do.

A week or so ago, I even caught him going into his room during the day,

pulling his pants down, and eliminating on the floor.

We started looking at foods that he was eating. In an attempt to expand his

diet, we had recently introduced some new items. I removed those foods, but

it made no difference.

So, for those who want to " bite " , what would your next step be? Do you

think it's behavioral or medical?

s

persistentC@ <mailto:persistentCmailto:pemai> gmail.com

[Non-text portions of this message have been removed]

[Non-text portions of this message have been removed]

**************Gas prices getting you down? Search AOL Autos for

fuel-efficient used cars.

(http://autos.aol.com/used?ncid=aolaut00050000000007)