PDD-NOS: Questions for anyone who has knowledge of this

[khaoskat]

Ok, I am an attorney and I have been appointed to represent a child who has at some point in time been diagnosed with this. Child also has been diagnosed with
Tourettes Syndrome.

The child has been removed from the home and placed in Child Protective Services Custody (Temporarily). Since I have been appointed, the child has been in about 7 different placements, with most of those since the beginning of 2010. Most recent placement is in a Residential Treatment Program.

My concerns are that by placing the child in this environment, that this particular placement is not appropriate. I believe the child is about 12 years of age....

Reading the website of where the child has been placed, the child is in one of these two programs....

a dual (substance abuse/dependency and/or mental health) diagnosis and treatment program for <gender>.

or

a concentrated mental health program for <gender> with a strong emphasis on behavior modification

What kinds of treatment are needed for a child with PDD-NOS, and is residential treatment like this good for a younger child with this diagnosis? Also, the child has now telling parents they have learned about same sex relationships and has been kissed by another person of the child's sex; furthermore, the child has been telling parents about the kids who are self harming (cutting, etc). As the child's attorney I am gravely concerned that these is going to cause significant harm to the child, as we have already been told by the Court Psychologist that this child is not competent for criminal charges purposes. You are exposing this child to something the child has absolutely no understanding of and is now beginning to think might be normal social behavior. (Not saying there is anything wrong with those that choose the same sex lifestyle, but I don't believe this child is competent enough at this stage to make an informed decision on such topics.)

[joensally]

Does the child have a diagnosed mental health issue?

Are you saying that the child has been kissed by an adult while in the residential facility or in a former placement? Or was the kissing by another child?

Are you saying that the child is reporting witnessing self-harming behaviour in the residential facility or in a former placement?

[OdinsMommy0409]

As someone who has worked in a residential treatment center for youth, I would highly recommend removing the child from that environment. A child with a PDD-NOS diagnosis does not fit the criteria for that type of environment nor therapy module as those facilities are intended to treat children with defiant issues not developmental issues. Personally, I witnessed a child with an MR and Asperger's diagnosis develop new and violent behaviors due to placement in that type of residential setting. She was in a similar situation as your client. Your client would best be suited in a foster home that understands a diagnosis of PDD, ASD, or other delayed developmental disorder.

[OdinsMommy0409]

Originally Posted by khaoskat

You are exposing this child to something the child has absolutely no understanding of and is now beginning to think might be normal social behavior.

This aspect is what I witnessed (as mentioned in my previous post), and her newly developed violent tendencies became profoundly difficult to manage as she did think those behaviors were normative.

We had another patient who had significant mental retardation and also became a victim of the environment. She became very attached to another resident (normal functioning) with extremely violent tendencies, and th MR resident wanting to be more like the other resident became extremely violent. The severity of her mental retardation made changing the violent behavior extremely difficult. Ultimately, we believed she would need to remain institutionalized for many years due to her behavior.

[khaoskat]

Originally Posted by OdinsMommy0409

This aspect is what I witnessed (as mentioned in my previous post), and her newly developed violent tendencies became profoundly difficult to manage as she did think those behaviors were normative.

We had another patient who had significant mental retardation and also became a victim of the environment. She became very attached to another resident (normal functioning) with extremely violent tendencies, and th MR resident wanting to be more like the other resident became extremely violent. The severity of her mental retardation made changing the violent behavior extremely difficult. Ultimately, we believed she would need to remain institutionalized for many years due to her behavior.

The child just meets the minimum age requirements of this facility, and I believe may be just slightly above the minimum IQ requirements.

The problem is, the child wants to go home, and child is not being allowed to. Child's behavior has escalated and gotten worse the longer child has been away from home.

[khaoskat]

Originally Posted by joensally

Does the child have a diagnosed mental health issue?

Are you saying that the child has been kissed by an adult while in the residential facility or in a former placement? Or was the kissing by another child?

Are you saying that the child is reporting witnessing self-harming behaviour in the residential facility or in a former placement?

The child has several diagnosed issues, but cannot remember them all off the top of my head, but the one I believe is most recent is PDD-NOS.

Kissing - my understanding is that it was by another resident in the facility.

Self-harming behavior - Not sure if child is actually witnessing it or just witnessing the results and hearing the stories from those who do it in therapy sessions. It would be while child has been in residential.


Due to the constant disruption in placements of child, I have had minimal contact, and right now I am not up to the almost 3 hours of driving to get to the facility with myself having an EDD of 5/13. A lot of what I am getting comes from parent reports to me.

[veganone]

You're his lawyer right? I think you owe it to the kid to drive to actually MEET him. If you are incapable of providing adequate representation because of your pregnancy I think you should find someone else to replace you or go out on disability now (I know my OB wanted to put me on disability at 36 weeks).

Also, you're relying on information from his parents, who lost custody?

Finally, I'm not an attorney, but it seems like you might be violating his confidentiality by posting about his case on a very public message board.

I wish the child all the best - poor kiddo.

[MeepyCat]

I don't have information, but I have to question the appropriateness of discussing your client in this level of detail in a public forum. Your posts read to me like you're trying to leave out identifying details, but it seems like a violation of client privilege, and of professional ethics. If I was this child's parent, I would be extremely upset to see this post.

I appreciate that you need information, but I think that private contacts with pediatricians, therapists or social workers would be a better way to get it.

[stik]

RTCs work with lawyers a lot. As you are the child's lawyer, you should be able to contact the RTC and ask to review the child's records.

[PikkuMyy]

As a teacher who posts publicly about my students without any identifying details, I agree with the PP who said that said residential facility is in no way appropriate for a child on the spectrum.

Behavioral therapy and behavior mod are two very different things, and behavior mod is geared towards children who have much more understanding of their behavior, social norms, and consequences, than kids on the spectrum. Furthermore, the social skills, language development and sensory needs of kids on the spectrum require a very different approach from "troubled teens".

I agree that it's important for you to meet the child ASAP but could see how 6 hours in a car in one day would be extremely difficult for a pregnant woman due in 10 days. So do your best from a distance and visit as soon as you can. HOwever, can't you get more info from the facility and the people in direct care of the child?

[WatermelonSnow]

How are you going to manage this case once you have the baby? This child might be better off being represented by someone who can comfortably make the drive to meet with them and possibly their care team.

[kavamamakava]

This child is on the Autism Spectrum which is a DEVELOPMENTAL disability and not a behavioral one or a mental disorder. Yes it's in the DSM IV, but it's a developmental issue that has specific ways to address it. The Tourrettes diagnosis is a common one as is anxiety. His needs must be addressed on a developmental level. My heart goes out to him. He needs consistency, familiarity, and predictability in his life as part of his treatment. Shuttling him from home to home to facility is only heightening his anxiety. And heightened anxiety in children on the Spectrum often increases the undesirable behavior to the point where behavior programs completely backfire and the child regresses.
I encourage you to contact someone at AutismSpeaks or even ARC and do you best to get AUTISM therapy for your client - Occupational Therapy, Social Cognitive Therapy, actual therapy that is evidence based to treat his specific diagnosis.
In the best case scenario, he would be able to be placed back in the home with intensive in-home therapy and supports so that he could successfully reintegrate and have his familiar and predictable surroundings.

[khaoskat]

Originally Posted by veganone

You're his lawyer right? I think you owe it to the kid to drive to actually MEET him.

Also, you're relying on information from his parents, who lost custody?

Finally, I'm not an attorney, but it seems like you might be violating his confidentiality by posting about his case on a very public message board.

I have met the child previously, but due to the constant disruptions lately in the child's environment/placement, I have not been able to meet with child lately. Other than not traveling, I have been working (not just this case, but my other cases). I do not plan on taking a maternity leave per se, I just do not excessively schedule myself for the first 4-6 weeks after my EDD, and generally nothing more than a short 30-60 minute appearance.

Ethically I cannot give out identifying details that would identify my client or the case, and I have not and am being careful not to and trying to keep things general (I will go back through and re-read and edit posts if needed after this post to double check).

The problem with going to care providers is that there has been no continuity for many months due to constant changes in placements, which have caused disruptions in services and in some cases finding new service providers each time there is a change/disruption.

I posted, because there are so many parents here who have children or work with children with this diagnosis (and yes, I am a parent of a SN child myself and have posted in this forum numerous times) in hopes of finding out how to best help a child with this diagnosis and if where the child is placed is actually beneficial or harmful to the child.

[khaoskat]

Originally Posted by WatermelonSnow

How are you going to manage this case once you have the baby? This child might be better off being represented by someone who can comfortably make the drive to meet with them and possibly their care team.

As the attorney, I do not have access to medical records or providers, without parental consent or Court Order. A Guardian Ad Litem has the ability to do this w/o getting consent or Court Order.

I am not part of any treatment teams/meetings/etc. I am not even involved, in general, in the development of children's services case plan objectives for children I only am an attorney for. I can review their file at Children's Services, but often times those records are not complete and lack a lot of information and files from providers.

For instance I have seen case files where a child is being seen by 5 or 6 physicians/psychologists/etc, and they only have the records of one or two and have no desire to request or obtain the others.

[khaoskat]

Originally Posted by kavamamakava

I encourage you to contact someone at AutismSpeaks or even ARC and do you best to get AUTISM therapy for your client - Occupational Therapy, Social Cognitive Therapy, actual therapy that is evidence based to treat his specific diagnosis.

Thank you, I will see what I can find on AutismSpeaks. I am not sure what ARC is.

I am truly just trying to get the best information, so that I can formulate a plan of action at this point. I have felt that the child's behavior and not getting what the child wants now for so long are interconnected.

[kavamamakava]

Originally Posted by khaoskat

Thank you, I will see what I can find on AutismSpeaks. I am not sure what ARC is.

I am truly just trying to get the best information, so that I can formulate a plan of action at this point. I have felt that the child's behavior and not getting what the child wants now for so long are interconnected.

The ARC is the Association for Retarded Children www.thearc.org also, how are this boy's academic needs being met? http://wrightslaw.com/ is a resource you may already know about. He needs support for his cognitive deficits and that's not the same as behavior re-education or redirection or even therapy. There is ABA therapy which is a type of behavior for those on the Spectrum but I think he's too old for that.

This could have been the road my son went down But I became unemployed and homeless in my desire to advocate for my son and make sure his needs as a child on the Autism Spectrum were not ignored. He has these wild outbursts and breaks things and kicks and hits people and his siblings as well. I wrote letters to my senator and representatives, went to my state capital, filed complaints with the state department of public instruction, went to countless meetings, filed numerous letters and petitions, attended mediation and did everything. CPS was brought in at some point but they were so impressed with how much I've done that they thought I didn't need their help. I begged and pleaded for them to find me more support and they did. They sent an Autism Specialist to my home who pinpointed his developmental delays and cognitive deficits and worked specifically on them. For the first time in his entire life, he began to make measurable progress and learn new skills. It was just amazing. We used the SuperFlex program from Michelle Garcia Winner but every kid is different and finding the right type of therapist is the key to finding what will work for this child. So I really feel for this boy and hope he can receive the proper type of support and therapy that he is asking for. If his home isn't the right environment, it doesn't sound like anywhere else is either

[khaoskat]

Thanks for reminding me. My State has an Autism Scholarship, where parents can use the funds to send their children to special schools/service providers that will work on the skills needed.

I totally forgot about it until I just read your post. I will have to go look up more information on it, to see if this child might qualify, as the parents can apply for it, and maybe get additional help.

I just don't think people get the child is not being deviant to be deviant, but because of the medical diagnosis.

[joensally]

Well, I think what the court has to answer is what is in the best interests of the child. If the child has a dev. disability such as PDD, then no, the complicated and often traumatizing group enviroments for severely impaired individuals is not suitable for a child unable to process the information. If the child has trauma-induced mental health issues, placing him/her in setting where other traumas can occur (ie being kissed where it was presumably non-consensual, witnessing either the occurence or after-math of self-injury) is not suitable either. If the child with PDD also has sensory issues, my bet is an institutional environment would be in absolute conflict with meeting their sensory needs, thus potentially leading to more problematic behaviour (lashing out due to over-stimulation etc), which continues the cycle of the child looking like they're the problem rather than the environment. If the child's PDD also leads to difficulty with transitions, problematic behaviours are also going to increase due to the multiple placement changes. All the things wrong with this scenario for a typical child are exponentially more problematic for a child with PDD.

[APToddlerMama]

Originally Posted by khaoskat

What kinds of treatment are needed for a child with PDD-NOS, and is residential treatment like this good for a younger child with this diagnosis? )

I think there are way too many variables for this to be the only question. There are so many other factors that could play into this child's need for mental health or residential treatment that would have little to do with a diagnosis of PDD-NOS. Having worked in child welfare as a social worker I cannot believe 7 placements in just a few months?!? There has to be way more going on than PDD... Residential is a last resort, or at least it should be for ANY kid...PDD or not. But if he/she has run through that many placements, perhaps it is the only option left. Are there any TFC homes available and equipped to handle a child like this? If there were I would say I'd fight to have this child placed there, but it sounds like there probably isn't or nobody would have even considered residential. Has this kid been sexually abused, physically abused, neglected? There is clearly way more going on. You probably can't just look at it from a PDD standpoint. Are there safety issues? Mental health issues?

I mean this in the nicest way possible, but I really feel strongly that the attorney working with the child should be taking the advice of the therapist working with the child. They are the ones with the most experience in determining the most appropriate placement for a child. What is the therapist saying? What is the social worker saying? Are you the GAL?

[khaoskat]

Originally Posted by APToddlerMama

I mean this in the nicest way possible, but I really feel strongly that the attorney working with the child should be taking the advice of the therapist working with the child. They are the ones with the most experience in determining the most appropriate placement for a child. What is the therapist saying? What is the social worker saying? Are you the GAL?

Unfortunately, I do not believe there is currently a treating therapist, or if there is, it is more medication management type of situation, as the child has not been in one area (ie city/county) for a long enough period of time to get established in services. Unfortunately, where I live, it can often times take up to 4-6 weeks, even with CPS involvement, to get services started.

As the attorney, my job is to get what the child wants....so for instance if the child wants to go live with Captain Kangaroo, that is what I have to fight for. (Ok, I am using a far fetched example on who a person may want to live with.) My job is not to look out for the child's best interests, that is the GAL's job.