[ShortyLPN]

Hello-
I didn't know whether to post this here or the HH Nursing..so I'll just see how it goes. I just started Home Health Nursing and I love it. My main case is a 9 year old boy with Down Syndrome and Autism. I love him to death but there is a little bit of a problem...behavior. He'svery mentally handicapped but still able to use sign language so I know he somewhat knows what's going on. He's constantly biting, scratching and pinching. He is INCREDIBLY strong for his size. I've left there with bruises that cover the width of my arm and scratches everywhere. We've tried putting him in "time out" but that's becoming ineffective. It all seems to be a big game to him. Another thing...he's his mother's baby...she babies him all the time. Time out is basically the only punishment he has...and then she tells him "good boy" whenever he gets out, which totally defeats the purpose. I will be honest..one time when he pinched me I smacked his hand..not hard or anything, I wasn't abusing him but more like self-defense. His eyes got big and he stopped for a while. So I questioned the mom asking if that was a technique that we could try and she said "Oh no, I don't like that...some people might not know what a light smack is." So basically all the nurses are between a rock and a hard place. He KNOWS what's going on...he laughs everytime he does it and laughs even more when I sign "that hurts!" I know I sound mean, but he honestly knows enough to know the difference between right and wrong. Discipline is the major part..so anyone have any similar experiences or have any suggestions? Any will do...I'm so frustrated...I look like I've been beaten. Some of the nurses have demanded raises for taking care of him, myself included. Any help...please?

[DelightRN]

Does he ever try to injure himself, or just others that work with him? Its difficult to say how you should handle the situation without knowing more about him and his other behaviors. Generally the way we would handle this is with a "block and ignore"... i.e. block him from hitting you and then do not attend to the behavior. This is assuming the negative attention is what is driving this kind of behavior.

As I said previously, I could offer much more insight if you weren't so vague. I definitely would not advocate slapping this child as a behavioral modification technique.

[Nurse20481]

Originally Posted by ShortyLPN

Hello-
I didn't know whether to post this here or the HH Nursing..so I'll just see how it goes. I just started Home Health Nursing and I love it. My main case is a 9 year old boy with Down Syndrome and Autism. I love him to death but there is a little bit of a problem...behavior. He'svery mentally handicapped but still able to use sign language so I know he somewhat knows what's going on. He's constantly biting, scratching and pinching. He is INCREDIBLY strong for his size. I've left there with bruises that cover the width of my arm and scratches everywhere. We've tried putting him in "time out" but that's becoming ineffective. It all seems to be a big game to him. Another thing...he's his mother's baby...she babies him all the time. Time out is basically the only punishment he has...and then she tells him "good boy" whenever he gets out, which totally defeats the purpose. I will be honest..one time when he pinched me I smacked his hand..not hard or anything, I wasn't abusing him but more like self-defense. His eyes got big and he stopped for a while. So I questioned the mom asking if that was a technique that we could try and she said "Oh no, I don't like that...some people might not know what a light smack is." So basically all the nurses are between a rock and a hard place. He KNOWS what's going on...he laughs everytime he does it and laughs even more when I sign "that hurts!" I know I sound mean, but he honestly knows enough to know the difference between right and wrong. Discipline is the major part..so anyone have any similar experiences or have any suggestions? Any will do...I'm so frustrated...I look like I've been beaten. Some of the nurses have demanded raises for taking care of him, myself included. Any help...please?

i have a cousin that autistic and can't sign or anything. I notice she goes through different stages. Before she used to hurt us too, but when she got out of that phase she starts hurting herself. I suggest that you just walk away from him when he's about to strike at you, that's what I do with my cousin.

[ShortyLPN]

First of all..let me explain a little further. I didn't smack him or slap him hard like it may have seemed. Secondly, I did it immediately after without thinking..if you only knew how hard he pinches. It's almost impossible to block him. He doesn't hurt himself. I'll be sitting there doing paperwork and he'll be watching his Sesame Street DVD and then he'll just come over and pinch me and laugh. Then I thought it was an attention thing so I started to play with him and then he scratched and bit me. What I wrote made me sound like a child abuser and a bad nurse. I will most definately tell you that I am neither. Smacking his hand was just an instant reaction. If you saw my arms, and he was doing it to you, you'd probrably have the same reaction. He may be mentally handicapped...but he knows the difference between right and wrong. He doesn't pinch his mom.

[nesher]

I'm afraid I don't have any answers for you, but your question made me curious and I did a bit of searching on the internet.
I found a site which is like allnurses in it's design, but it is a place where you can post your question in a specific forum such as the Down Syndrome one - perhaps you can find help there. It was:
www.healthboards.com
I also found another site which did an great job in explaining the combined issues of DS and autism.
http://www.altonweb.com/cs/downsyndr...ge=capone.html

Good luck, it is hard to find solutions if you are fighting against a mom who doesn't see the problem...

[DelightRN]

Originally Posted by ShortyLPN

If you saw my arms, and he was doing it to you, you'd probrably have the same reaction.

Actually I'm quite sure I wouldn't have the same reaction, but that's because I work with these kids all the time. You need to be alert. Maybe it would be a good idea for you to wear some arm guards or something else to protect yourself. He needs a behavioral therapist.

Incidentally, if he pinches you and you attend to the behavior negatively or positively (by playing with him, as you state in your post above), he has received reinforcement for this behavior and will continue.

[ShortyLPN]

Originally Posted by nesher

I'm afraid I don't have any answers for you, but your question made me curious and I did a bit of searching on the internet.
I found a site which is like allnurses in it's design, but it is a place where you can post your question in a specific forum such as the Down Syndrome one - perhaps you can find help there. It was:
www.healthboards.com
I also found another site which did an great job in explaining the combined issues of DS and autism.
http://www.altonweb.com/cs/downsyndr...ge=capone.html

Good luck, it is hard to find solutions if you are fighting against a mom who doesn't see the problem...

Thank you so much for your supportiveness. Finally, someone who doesn't see me as a child abuser or just a horrible person. Oh, and I tried the walking away thing, and it just got worse. He pinched and scratched even more and pulled out his trach 3 times. It's so frustrating that everyone can't understand exactly what's going on. His mom goes to Riley Hospital all the time at the Down Syndrome Clinic...and the main person there said..."You can search nationwide and you will never find another one like *****." I think everyone on here has the absolute wrong impression of me. I'm sorry that happened that way. Thank you again for your help, I'll most definately look at the information.

[kharing]

How about giving his mother some alternatives. I would suggest "Mandt"ing this child - as well as ignoring him when he's inappropriate - kind of like a reverse time out. Unfortunately, alot of these behaviors are created by the parents/caregivers - and can become quite a problem as the child grows up. Things he's doing as a child seem cute, but will get him in serious trouble as he gets larger and stronger - just not a good situation. I used to work with a child with similar behaviors years ago - he was so cute - but I had to end my contract because his mother thought his little episodes (taking his clothes off in public, hitting/biting/screaming) weren't a problem. I've since heard that she's placed him in a group home.......

On another note, watch yourself - you don't want to be accused of child abuse.....if you feel that you can't control your instincts, (I know it's hard to keep your guard up when someone's attacking you!!) find another placement. Don't have an abuse neglect charge filed against you by his mother or other team members - you'll never be able to work in this field again. Hitting of any kind isn't the way to teach this child how to behave. Redirect him.

Good Luck and here's the Mandt website!

http://www.mandtsystem.com/

Originally Posted by ShortyLPN

Thank you so much for your supportiveness. Finally, someone who doesn't see me as a child abuser or just a horrible person. Oh, and I tried the walking away thing, and it just got worse. He pinched and scratched even more and pulled out his trach 3 times. It's so frustrating that everyone can't understand exactly what's going on. His mom goes to Riley Hospital all the time at the Down Syndrome Clinic...and the main person there said..."You can search nationwide and you will never find another one like *****." I think everyone on here has the absolute wrong impression of me. I'm sorry that happened that way. Thank you again for your help, I'll most definately look at the information.

[traumaRUs]

I gather you live in Indianapolis since you refer to Riley (Riley CHildren's Hosp?). If that is true, I would suggest he get more of a referral to a child psychiatrist who deals with these issues. I'm unsure why there is home health? Is he manageable in the home? I know parents certainly wouldn't want to consider it, but there is a nursing home for kids in Shelbyville, IN a few miles outside of Indy. I did my ADN at Marian College and did some clinicals there. Good luck...personally, I would never tolerate being hurt at work, but that is just me. I think you are a saint to tolerate it.

[nurse educate]

It's very easy for me to say this, but if he is 9, autistic AND has Downs, how are you so sure he knows what he's doing? And even if he seems to know by his laughing and his persistence), CAN he control himself? I've dealt with Downs, but not really with autism. By form what I know, both have very regimented and anal personalities. I've dealt with them when they are out of their element (ie, in the hospital), and it is almost always a very difficult situation.