I am in the process of implementing my recommendations for my PDD son who will be entering the high school this fall. He has within the last few months been getting in trouble at school for not being able to control his anger. He has had detention for being overheard swearing with talking to his classmates and also talking back to teachers when reprimanded. Most of his behavior is due to being on growth hormones in conjunction with puberty. A lot of testosterone. He is getting detentions for this behavior that he finds difficult to control and partially medical per his neurologist.

My question is that I want a safe place for my son to cool down so as to not get in trouble with outbursts. How do I word this into an IEP to get my point across. It is affecting his self esteem and I think if he had a place to just cool down when he feels overwhelmed it would help.

Thanks so much for your help.

Answer:

Your question is complex from a medical standpoint. I do not understand the reasoning behind his being on growth hormone. I would need to know more about that aspect of his history prior to addressing your question.

Behavioral interventions for individuals with Autistic Spectrum Disorder(ASD) are more complicated than those for other students with behavioral disorders. ASD children often need specialized “rewards” since they often do not value the rewards used by more typically developing children.

Usually our staff at the Diagnostic Center recommend individual behavior intervention plans that take into consideration cognitive abilities, motivators for the particular individual (i.e. computer time or time alone) and a careful look at the antecedents of the worrisome behaviors. The principle is that if the antecedent situation can be avoided then the behavior will probably not occur.

While a safe place to cool off might well be what your son needs, allowing him this may not help him avoid the behavior in the future. Can your son recognize feelings related to his behavior. Can he talk about what might help avoid or deescalate his behavior? He is getting to the age when including him in the IEP process might be helpful, assuming that he is able to understand the process and participate appropriately for his age.

I caution you that decisions about hormone therapy (you mention too much testosterone and growth hormone) have to be weighed against your son’s quality of life and ability to control his impulses. Again, I am not sure why growth hormone is being used, but if it is adversely affecting his behavior, then that needs to be considered in the medical decision involved. The positive reasons for treatment with growth hormone need to be weighed against the negative self esteem that comes from poor impulse control in a youngster already burdened by PDD and possible tenuous self regard.

I am sorry not to be more medically specific but I would need a great deal more information to adequately answer your question. I would be happy to discuss this more if you provide me with your son’s more complete medical and psychological history.

Hoping to hear more from you,

Kay S. Browne MD
Behavioral Pediatrician