Awareness of Medical Issues in Relation to Changes in Behavior
By: California Deaf-Blind Services
Individuals with dual sensory impairments may demonstrate behaviors which are frequently viewed as inappropriate. These behaviors can be interpreted as strange head movements, odd body postures, unexplained emotional reactions, self-stimulatory movements, noncompliance, tantrums, etc. Individuals with dual sensory impairments may be attempting to compensate for the loss of vision, hearing and/or the physical impairments which may be related to their specific disability. Many of these behaviors are caused by reactions to medical issues and/or the effects of medications needed to manage the medical issues.
These behaviors are more important if there is a change from the individual's usual behavior. The change in behavior may indicate a change in the medical condition of the individual with dual sensory impairments. Prompt medical attention should be considered to rule out medical issues as a cause in behavior.
The following charts give an overview of some medical conditions frequently associated with deaf-blindness. The behavior should be thoroughly discussed with the personal physician to determine diagnosis and resulting medical treatment.
| Components | Behavioral Signs | Questions for Physician | Evaluation | Home/Classroom Management | Emotional Reactions |
|---|---|---|---|---|---|
| Cerebral palsy | Inattention | Ways to inhibit reflexes | Exam by therapist | Positioning Therapy | Excitement, Fear |
| Hypotonia | Fatigue | Limitations | Exam by therapist | Positioning | *Left Blank |
| Dislocated hips | Pain, Crying, Resisting, movement | Treatment, Handling, Limitations | Exam by physician | Braces, Surgery, Positioning | Fear, Discomfort |
| Scoliosis | Curvature of spine, Pain, Crying | Treatment and therapy advisement | Exam by physician | Braces, Surgery, Positioning | Discomfort |
| Components | Behavioral Signs | Questions for Physician | Evaluation | Home/Classroom Management | Emotional Reactions |
|---|---|---|---|---|---|
| Conductive Loss | Congestion, Fingers in ears,"Not Listening," Pulling on ears,Talking too loud | Exam, Allergies | Exam by eye physician | Medication, Tubes, Surgery, Hearing aids | Frustration, Paranoia, Withdrawal |
| Sensorineural loss | "Not listening." Not responding to particular/all sounds | Exam | Exam by ear-nose-throat specialist and audiologist | Hearing aids, Auditory training, Surgery, Augmentative communication systems | Frustration, Confusion, Social isolation, Difficulty with self-concept |
| Allergies | Fluctuation inattention, Congestion, Pain, Respiratory difficulties, Rashes, Sleepiness | Sensitivities | Exam by allergist or ear-nose-throat specialist | Medication, Allergy shots, Environmental modification | Frustration, Confusion |
| Components | Behavioral Signs | Questions for Physician | Evaluation | Home/Classroom Management | Emotional Reactions |
|---|---|---|---|---|---|
| Near & Distance Vision | Holding close to face, Inattention, Squinting, Responding to near or far objects, not both | Cause and Exam | Exam by eye specialist | Classes, Seating, Positioning of objects & people | Withdrawal, Social isolation, Fear |
| Field Loss | Head turning/tilting, Task avoidance, Clumsiness, Impaired mobility | Areas of field loss | Exam by eye specialist | Positioning of people and objects | Fear, Frustration, Withdrawal, Refusal of specific activities requiring use of impaired field |
| Glaucoma | Tantrums, Eye-poking, Head-hitting, Pain | Exam | Exam by ophthalmologist | Eye drops, Surgery | Anger, Confusion |
| Cataracts | Cloudy lens, Eye-poking, Lack of visual focus, Seeking light | Treatment | Exam by ophthalmologist | Surgery | Adjustment to blindness |
| Nystagmus | Small, rapid eye movements (horizontal or vertical) |
Cause, Treatment Effect on visual field and focus | Exam by ophthalmologist | Positioning of people & objects, Allow time for processing visual information |
Frustration |
| Light Sensitivity | Avoiding light, Head down, Eyes Closed, Crying, Pain | Cause | Exam by ophthalmologist | Visor, hat, Sunglasses, Classroom lighting, Support for student as light changes in moving from one environment to another | Fear, Discomfort, Anger |
| Components | Behavioral Signs | Questions for Physician |
Evaluation | Home/Classroom Management |
Emotional Reactions |
|---|---|---|---|---|---|
| Heart/endurance | Fatigue, Shortness of breath, Change in skin color/temp. | Limitations | Exam by physician | Medication, Surgery | Frustration, Fear |
| Asthma | Wheezing, Tightness in chest, Fatigue, Pain | Limitations, Cause | Exam by physician | Medications, Relaxation training, Environmental modification, Positioning | Fear, Frustration, Embarrassment |
| Diabetes | Frequent urination, Volume of urination | Limitations | Exam by physician and ophthalmologist | Medication, Diet | Frustration, Embarrassment |
| PMS | Emotional ability, Irritability, Food cravings, Monthly behavior change | Diet, Vitamins, Exercise, Medications | Exam by physician and dietician | Diet, Vitamins, Exercise, Medications | Withdrawal, Depression |
| Nutrition | Fatigue, Difficulty attending, Crying | Diet, Vitamins, Food allergies | Exam by physician and/or dietician | Diet, Vitamins, Gastro-intestinal tube | Withdrawal, Depression |
| Psychomotor seizures | Pattern of “tantrum,” Sleeping after “tantrum,” Lack of responsiveness during “tantrum” | Exam | Exam by neurologist | Medication | Confusion, Anger |
| Medications: Behavior or Seizure | Small tremor-like movements, Sleepiness | Weighing side effects vs. benefits | Exam by physician; re-evaluate during puberty | Close communication with physician | Confusion, Frustration |
| Puberty | Change in behavior, Change in vision, Clumsiness, Weight change, Growth pain, Odd sensations, Skin and body sensitivity | Normal development and effects on medications | Exam by physician | Laugh a lot, Counseling, Education, Peer support groups | Confusion, Embarrassment, Withdrawal, Anxiety, Egocentrism |