Published on 12, July, 2020
I would just like to thank everyone who has read and commented on our last posts. I have only one more question. SIB... Some of our students engage in SIB from time to time and in times of distress and overwhelm.
We have figured what's causing it for most, needs not getting met, over stimulated, under stimulated, bored and communication. For most of the students we know what can help and do our best. But, for Riley, I know it seems pike we are picking her but we are just baffled and confused, we don't know what to do.
Today, she has gone home with bite marks on her hands. She didn't come to school with them, so it happened at school. She was very overwhelmed today and was close to exploding but she kept it in and under control. Staff had an eye on her at all times, but somehow she manged to bite herself. We aren't sure when yet but we will do our best to figure things out and what triggered it.
SIB is very common for Riley, more than the other students, so our responses change. She will headbang, bite, pull her hair nearly ripping it out, punch things and herself, and eat inedible objects. We will say stop or redirect her, if she's headbanging, we will use our hand to block or a cushion or mat. If she's biting, we will get her chew and hold her hands to block this, if she doesn't manage to bite, we have no choice but the pinch her nose so she stops, but that's last case scenario which we've only had to do once. We do everything to keep her safe, but the more people there is or if we try stopping her, the worse the SIB and she gets even more agitated so it's difficult. What else could we do to help, new tactics and support to put in place.
Update: Today Riley told staff that she wants to die and kill herself. We have taken this seriously because she has had suicidal tendencies in the past and it happens especially in the summer. Her parents are aware of this. We know the triggers and are trying to sort this quickly. We have realised a slight change in her mood and behaviour, including more agitation and tiredness and severe mood swings. She's starting to isolate herself away from the students and most staff and doesn't tend to engage in conversation and if she does it is extremely limited. She has also been wearing her ear defenders a lot recently, like nearly all day everyday. She's not eating or drinking either. She's just not herself. And to top it off, her mother explained, TW, that she is starting to self harm which she hasn't done in a year, maybe two. How can we help her? We have people in tomorrow to talk to her, if she would like to and staff are always there for her aswell. It's just upsetting to see any of our students going through a difficult time and we want them to be happy and have the best outcome to life.
I am very sorry to hear that ideation level behaviours are manifesting such asymmetry from the central learning & living experience. It seems from the text that these immediate thoughts accompany a history of such thought, curiously during the warmer months, with a self harm TW ? Foremost in school minds may be several profound ones i'd imagine when it comes to what becomes of the meaning of DOC concerning the service user. Do the circumstances still define a state where the school can facilitate a way through the dilemma ? If so what are the clinical boundary conditions from which you can source the delineation are the sort of questions that need to be asked. I feel i might understand school continues to walk the path of empathy. The desire is for meaningful special based balance within the school setting.
Perhaps so be it that there could be a requirement for a specialist chartered psychologist or not as matters develop or not. In that sense it feels like the school is aware of the paraconsistent nature that takes place when a care plan escalates into what is best described as a multi agency suicide watch. We are facing a fact that the support would be meaningless in most other ways, though some could disagree there. Nonetheless it is true that the state of evolution in qualitative & particularly quantitative research concerning 3-9 suicide ideation stressors is underdeveloped. This strongly indicates there is little hope that support would mean much else in the Uk at this time, it is reasonable to say that. Specifically the lack of knowledge linked to psychological drivers for S<I>B in this age range.
Thus while in effect there is the DOC requirement to follow procedures that are appropriate, in opposition a known archetypal sense of this place. Itself arguably DOC, with respect to the way involvement with mental health services could take over & pervade the service users life. While should matters continue to develop in this fashion, then a criticality effect, with regard to how the sea beneath the ice will shift matters to be realigned in a potential multi agency topology where service users special learning energy would indubitably be expended should the service user replicate in that setting. A course in life to the detriment of meaningful special education is a profound loss. On the other hand a psychopathological interest which urgently requires a categorisation for this self destruction narrative.
Whilst there would be a yet to be experienced nature to either course. We can see the dilemma, in all probability, brings with it these types of threshold potential. Hence if correct the DOC faces a known bifurcation, though the school prefers a path to fulfilling emotional regulation via means obstensibly in house it seems fair to say ?
There are two main research theories that study an area called Diathesis :
With good reason assuming there is a worth in establishing a logical starting point perhaps. If so what is learned to prove mostly useful in the long run, there is far too much short term determinism around, and sometimes what is needed in the future has a harmonic balance with that required in the now - do not fear counter intuitions. it remains fortuitous that a school mindfulness directed toward the SU's concept of death, and the differential towards susceptibility. For example Trajectory and predispositional vulnerability data, should we have it ( just for instance ) could be influential. Should such data not be harvested, the worth of rational starting point created shall remain intact & be vital on that level as a minimum.
Simply as an ultra tentative remark not to be considered compatible with DOC :
In an ideal world one could suggest that a critical factor rests with lack of symmetry so as to speak, or heuristic markers concerning the service users ability to understand what death means on a perceptual level. If there is an incumbent heuristically triviality within service users psychopathological reasoning, then hypothetically one might argue that the suicidal narrative seems bereft of a imaginative scale conducive with physical self destruction. Thus one can reasonably gather a reassuring doubt, but this would require someone chartered to investigate it so that matters fall correctly within someones remit. If school had arrived at that engagement, one would request they also compile the mundane strategy for your staff during the session(s) for the purpose of bespoke guidance with emotional regulation furthermore within specific context, not simply a general meaning.
One disadvantage in that way concerns how many independent chartered psychologists were local authority trained. LA's have value for money responsibilities, thus sensibly and compassionately streamline what they require from such psychologsts for a form of efficiency. This still does entail the need for those operative to gain accreditation. Therefore we end up with a somewhat accidental grey area. Often they are not experienced in key areas that are vital to special needs children. This is only a top down effect that is reasonably applied, since for many service users it is appropriate, and LA's must deliver value for money. It does mean that in instances where there is a shortfall, then a bottom up scenario is created. There is a limit with repect to how quickly the school can put a relevant strategy in place. Andralogical inclinations will be required when taking notes from this free service = Aspergermins.
'' How can we help the student ?''
How many dimensions has your question got ?
When a school contracts a CP & instructs they might they specific specialised data, a school will not know they actually shall. Regardless of clear agreement, specialist recommendation may be missing from the report. They may agree to look at your carefully elucidated X, but hand in a box ticked Y, which any SU receives anytime. I'm speaking from DOC dimensions made in ideal worlds on a board since i can that is true. The fact remains - the ability to gather personally phenomenological & existential data specific to service user is DOC. There is nothing about 'being unspecific' in the legislation = DOC. Thus this isn't a missive, this merely illustrates the challenges in sourcing professionals with the relevant skills on behalf of SU's as promised in any special school statement. I can quote a recent remark ( by phone ) be a former federated principle, who is now a regional director for the same special school trust :
''We cannot find a chartered psychologist who can do what we want them to do''
Therefore for schools encounter unhelpful obstacles in front of them, in the process of doing the right thing. Ironically the difficult quest to engage a relevant chartered person is another of the service users woes in itself. In fact shall we all bang our heads against the wall in a show of solidarity might be the question. I ad hoc trained a chartered psyche the same school mentioned. The principle had contracted a professional could understand how to interpret a WISC 4. In that sense the matters around your service users et al face angst of many separate dimensions. You'd also need to be sceptical if interviewing and probing CP on specific areas. They may indicate experience in the natural science with theory of mind, = have tackled its more challenging concepts, and yet just tick boxes as per the streamlined purposes they had been trained in. Far be it, but it sounds like your service user, and others in complex predicaments listed, can have certain forms of need which shall not confluence with expertise lite, & many that could.
Should you not had time to search the web. I can link to this study as it is free source in the domain. I'd imagine that at least the odd passage could be helpful for building up the beginning of a robust architecture :
On noticing a sense of urgency. SU needs a short / long tern parallel. Will continue with a post containing further hypothesis that could suit your service user ( or not ) shortly.
Regards from M of the research base Aspergermins.
In this post Aspergermins's can collate what could be best described as ongoing samples, or perhaps it shall be a pile of logs, parts of which school might put to use fo purpose of constructing the SU's scaffold. So be it whatever school to decides it is, the samples will almost always consist of some kind of citation from a study, along with a rational interpretation, and often A's own hypothesis for the purpose that school might discover something relevant. School might begin to sense if it can obtain sound reason to scaffold around a plan, and perhaps a practical, less intense way to work with such aspect(s) within the architecture school can form - or may not who knows.
Items will be listed one by one and the post updated regularly with new rationale. School might post back whenever on any topic be it daily as so far, or make other remarks as school deems relevant. This is a flow of rationale upon which school may gain the opportunity to form a relevant hypothesis linking to a strategy on SU behalf or not. Some items will arguably tend towards the potential to show an short term regulation, others long term. A's would say there is an inextricable relationship when it comes to long and short term motivational couplings.
First Impressions concerning SU. :
School could be dealing with psychological phenomena(s) which are showing explicit social emotional manifestation in cause and effect terms only. School does not appear to have sufficient data, in order to know if there is implicit phenomena at this point. The SU's relationship with those two states form a crucial demarcation in clinical terms. An explicit experience might be a psychological disturbance exclusively manifested by the conscious mind & therefore reasonably far less profound. The several paradigms that surround this area are compelling well established, and tend to consider that conscious mind stores in short term memory. Thus as of now it is still unknown if there is a greater deeper devastating unconscious nature behind this phenomena, hence any long term harbour of painful emotion ( an implicit nature to the disturbance) is something entirely different. If that was so matters default to a higher level of apprehension with relation to affect with respect to the death wish expressions, by school.
School only knows there is self destructive narrative, with regular SIB outbursts. None of that means much except perhaps that a painful emotion isn't being understood by SU or anyone.
In the respect so far experienced by school and detailed, so far A's opinion, in accordance to the information shown, as a reasonable probability, would inclined toward a dilemma related to personal disorientation or the explicit. This would mean SU in challenge with a complex sociological difficulty measure on the information for far in such early days. This could be manifold in decription, though perhaps this SU could be experiencing an existential versus societal form of crisis. Thus If possible school needs to know something concerning Driver(s), so that the expressions might alter course under school support. If such a existential type predictor were to be accurate ( only for example ), then an event(s) which drove such causation is likely to be unfathomable unless the SU reveals and evidences as such. Though it could be true to say that unless something is active, thus is a matter that should be curtailed, or at lesst detailed historically, such an event is unlikely in most cases to be useful or relevant. Therefore strategy and intervention might merely concentrate of fresh experience in order to begin ways to facilitation emotional regulation and thus recovery. In many ways this can be understood by a restart of another preoccupation, whence negative frecall is in opposition with positive School might experiment with influx of new stimulus, in order to monitor changes in mood. Going from this basis, it would not matter to much if the positions were voluntarily ( as it were ) conflated with crossover points in any existing diagnosis. An interpretation could be that the clinician trace forth through that diagnosis, and look for bifurcation. It is possible there are key points in SU's experience where shock has damaged their spirit & hurt them deeply. That could be classed as a partial probability. As such the existing diagnostic path onto the convolution would be the interesting area of the trauma.
School might also note that in A's opinion SU's who manifest explicit signs of this type, could also be losing alertness during the days to the degree that :
Transitions from microsleep jogged into poor wakefulness are not impossible. The SU conscious mind could be receiving preconscious artefacts = could be experiencing actual sleep type conditions in small inteludes. If so SU might be wandering in and out of hypnagogic episodes, with beadies open, right before the schools large collection of retinal membranes.
Thus this sentence could be relevant :
''Mental phenomena that may occur during this "threshold consciousness" phase include hypnagogic hallucinations''
Naturally we do not take this as a cue to entertain a schizotypal form of hallucination, in the endeavour forth, in the slightest. that would be backward unless we had serious data! Such is not even close anyway, we are discussing segments of preconscious mind leaking into conscious. This can happen to anyone, is often experienced daily by many early in the morning, and it is a transition between sleep and wake. Less common is bouts of the same effect due to losing wakefulness when at school or work, though plenty know this in/out state. For example one of the ideas linked to the moorgate tube disaster, an incident where a colleague saw the drivers eyes wide open & hand on handle seconds before the crash - this is the same hypothesis. Except the young the brain organ, the greater certain types of agility. For instance the average person over 18 even, still young, but will have completely lost touch with the nimbleness of the brain, in certain ways, aged around 8 by then. Under duress and suffering from heavy stressors, an 8 year old brain could nip in and out of conscious and preconscious within 100ths of a second. An adult cannot match anything like that & it gets worse with age. Thus adults cannot take direct personal adult experience as a comparison. Older folks on average can interlude @ intervals od a second, but will have trouble coming in/out in terms of 2 to 3 seconds the majority of times. Very young people cam maintain consistent intervals in the 100ths of.
Without such comparison we'd not understand the entry / exit proposal in the case of young people at all.
If we a collective are behind with this discussion that is incredible, but there we are. Possibly the aspect that fools us easily, is the way that elements of hypnagogia can linger even when we are convinced we are fully awake - it is surprising. If we then look at a learning difficulty challenged young person, with stressors, who dips into microsleep often. The implications may become clearer ? When true this state can create the conditions where a death wish is powered partially by the dream mind = not authentic ? Though great care is needed with that notion, as the proper way to view suicide ideation is take it seriously ofc. Furthermore hypnagogia lurking unnoticed, can transport many other perplexing behaviours. In that sense Aspergermins supports the strain of thought which is against SSRi's. They could impact negatively by contact with neurons which link to unconscious fight or flight where the preconscious is firing up. If so thus invigorate any hypnagogic phenomena itself. For example ( this is not a recommendation ) but even the caustic & ballistic Pro Plus would be better that SSRI's in such instances.
If as a parent on exams day an Aspergermins staffies young person is having preconscious episodes & likely to fail. The choice is a prescribed SSRI or PP in the hope alertness boots up.Q which would A's parent choose ? A PP immediately. A massively lesser of two evils.
Could SU trigger & melt when strings of wakefulness versus hypnagogia happen back to back ?
This SU seems HF to A's. There will be SU disgust if that is going on, & SS cannot decode that. It could be noted also that the Retina is linked to the CNS. So certain preconditions for nerves and hypnagogia are wired right in here. In other words disturbance to sleep at sudden points, is even more relevant than sudden noise in its own way, because the retina can communicate directly with the central nervous system.
It is not imposible that there is a relationship between motivation in immediacy and in the mind concept of a futuristic sense. In that way the quest to scaffold short term motivation might be impaired if a suitable coupling that transports long term motivation is not implemented. Thus a nature or nurture based theory debatable. Working along the lines that the fight or flight mind needs certain forms of parallel influx in order to be content and suitably preoccupied due to a natural selection process. if new information is arriving in the conscious mind, the unconscious samples it. This type of theory can only be logical should it be so, that we have a mind management trait that hungers for short term and long term enrichment based on concepts of safeguarding the fture and present. Therefore the mind wants to now things will be good (and how) in the long term * seems very obvious diesn't it ) - or F&F will exert uncomfortable phenomena if rationale for the future is lacking for too long. - explicit nervous conditions basically. It should be added here that a God can be the agency that intelligently designed it. The point isn't to remove or inpugn religion by speaking of natural selection - this post author holds no view of that type except consider this a God or nature so be it.Whatever the truth of design & neuroscience is not close at all to any empirical evidence of that type, it actually makes no difference since school only has the choice to work with psychology & phenomenology But the point is ..
If SU entirely lacks sense of direction like that, then even NT sense of direction encouragements are triggers. SU et al - could be any - may have no concept of the significance of an education relative to the future. If that were the case, it is an obstruction to any SU's understanding concerning the point of education itself - just for instance.
School may also gain something by a small study, with relation to what linguistic adaptations could be implemented. As if to make notes. Maybe recalling words used leading up to previous meltdowns & any in future as if the SU is in the thought police. This is darn hard work for school, but a breakthrough, with a scaffold in place, and respite, could make all the difference. By any chance will school be asking everyone what words they like anytime soon ? And what delicious home made goodies will there be for the students?