Monthly Archives: January 2012

Naturalistic Observation.

Today, Kari was unable to make it to the Center because of her fellowship. So instead, I assisted another graduate student named Karen. Karen had me do my first naturalistic observation of a resident while he was at work. Karen is working on changing a target behavior, in this case, non-compliance. This particular resident had a lot of non-compliance complaints from his social worker while at work. Karen thought the resident was potentially bored, but was unsure. Karen had done one observation on him, but needed the assistance of someone else he didn’t know to watch him so that he would “act normal”. The observation took place on a Friday when the residents were not assigned to do any contract work. The observation lasted an hour and I noted five or so instances of the resident leaving his work space and wandering to talk to someone else. There was one instance of not listening to his social worker tell him to sit down, however, I noted, that the social worker had been across the room when she informed the resident to sit. The workshop is a rather large space and very noisy, even when there is no work to be done. I believe the resident did not hear the social worker the first time due to the noise and distance between the social worker and the resident. I also noted one period of extended absence where I was unsure of where he went to. This particular resident is known for wondering off and not coming back unless fetched by his social worker. I informed Karen of this, but also said it was my belief that he had gone to the restroom as it was a period of about five to ten minutes that he was gone. Karen agreed with this. The most important information I gathered from the observation was almost at the end of the hour when the resident stated “I’m bored” to his friends, thus affirming Karen’s belief that the resident’s non-compliance was solely out of boredom, which unfortunately is not a behavior we can change.

After the observation and discussion of results, Karen and I discussed the lack of mental health care for contract workers (who develop PTSD symptoms) in Iraq and Afghanistan during the war. The reason this was brought up was because my dad was a contract worker during the war in Baghdad and in Afghanistan and now complains about flash backs and lack of sleep among other things. We found a clinic in California who stated they provided mental health care specifically for contract workers. We also read up on some court cases in various states. One judge actually stated it was not the responsibility of the health insurance provider to provide services for contract workers as “they were never in any real danger, actual or perceived”. Although comments like this infuriate me, I did find the entire research process very informative.

Walking Program Data and TXABA.

Today Kari discussed TXABA with us. Originally, we were supposed to present a poster at TXABA, however, it won’t be ready by then so unfortunately that won’t be happening. I will most likely not be attending TXABA as I have to work. I look forward to hopefully being able to attend next year.

After this, we talked about the walking program. We’ve been having HUGE issues with the pedometers, one resident was reporting she took 15,000 steps in one day. We were very confused as to how this happened as this particular resident did not go off campus and The Center is fairly small. We think she is trying to make Kari happy by reporting large numbers, especially after Kari questioned why the numbers were so high. The numbers then went down. We also established that the pedometers are very inaccurate. One had a 40% accuracy one day and then on another day reported a 90% accuracy. Kari asked her professor about it and was then told she could purchase new pedometers. Kari researched a pedometer and found one online that reports only a 5% inaccuracy when worn around the neck. Fairly impressive.

After that Kari discussed her clinic visit with two year old’s with autism. One child had some speech, mostly labeling (“This is piglet.”) Some interest in play and people, however she mostly stuck to the prompts she was taught. She was also open to being social (some smiles). Another child has hypertonia and seizures. Her seizures only showed on EEG, she showed no physical signs. Had no language skills, although this could possibly be from a seizure she had as an infant, on one knows for sure. The most interesting case was one with three siblings, all three had autism. Their ages were 6, 5, and 2.It was thought that  the mom had a borderline IQ. All four had little to no interaction with each other. The two year old was nick named mama cat and would not respond to her name, however she did respond to mama cat. The mother was taking parenting classes at a location in Houston.

PMR.

PMR stands for Psychotropic Medication Review. PMR happens every 90 days. Dr. Lewis will see different residents each time, though occasionally a resident will have PMR twice in a row if something was updated in their BIP or medication changes.

Dr. Lewis fills out internal review paperwork and fills out prescriptions for medications. The whole process takes about five minutes or so with each resident. Residents guardians can attend, though most at this particular PMR session did not.

At this particular PMR session, two new residents were in attendance. One, a female in her 30’s was eventually placed at the farm due to noise she made. Concern was that she would agitate other residents and so it was decided that the farm was the best placement for her. One intern made the comment, and Dr. Grossett and Kari agreed, that she appeared to have autism. The resident was only diagnosed with schizophrenia.

PMR lasted from roughly 9am-2:30pm. PMR was abnormally long as we took a break in the middle of it to hear from two pharmaceutical rep’s. Their presentation was over the drug Nudexta, which is marketed for the treatment of PBA (Pseudobulbar afffect). “PBA is a medical condition that can occur in patients with certain underlying neurologic conditions and causes involuntary, sudden, and frequent episodes of laughing and/or crying” (http://www.nuedexta.com/).

Some brief notes on Nudexta (all claims made by the reps):

  • Not a psychotropic medication
  • Glutamate regulator
  • Works quickly (knew within week one if the medication worked)
  • If the medication doesn’t work, it won’t cause any damage
  • Side effects include cough, diarrhea, dizziness (in most cases were gone within one week)
  • Free with medicaid
  • Reimbursement with part D
  • Low co-pay $30 or less with private pay

The presentation came with several handouts including “Center for Neurologic Study-Liability Scale for Pseudobulbar Affect”. An electronic copy can be found here.

Autism Workshop (Speaker Series at UHCL).

On January 14th I attended Teaching Communication Skills to the Early Learner, presented by Adrian Rodrigue. This was part of the Speaker Series for the Center of Autism and Developmental Disabilities at the University of Houston-Clear Lake, Houston, Texas. Adrian showed videos of one of her clients and how she taught him affective language skills. The boy was able to speak when she first met him, but he had a hard time getting across his wants/needs. Adrian started out with basic words, like firetruck (his preferred toy). She eventually started to teach him more complex sentences such as “I want my red firetruck” or “please open [the box containing the firetruck]”. Adrian also showed other videos of a little girl learning how to ask for her juice. Each child received prompts, either verbal or physical to signify that they needed to ask, eventually the children no longer needed prompting to ask what they wanted.

This was a very informative experience in regards to learning about communication with a person with autism. (I’ll include a few more notes on this subject later).

Afterwards, I then introduced myself to Adrian (as she is a classmate of Kari’s) and asked her what she did as an undergrad to get to where she is no and what I could do myself. Of course, she told me I should do anything involving applied or clinical experience. She also gave me some advice to look up cognitive behavioral therapy (as I’m interested in neuroscience and behavioral interventions).

Future Plans And Preference Assessments.

Today Kari and I plus two other interns went over how we were going to complete a multiple stimuli preference assessment. We determined which resident would benefit from the assessment and then used an old preference assessment to see items she previously had preferred. We then made a list of about seven items including nail polish, bubbles, Michael Jackson, and a few others. Pictures were then printed out so that cards could be made for the resident to see the items without size being an  issue. The concern was, a large item would stand out more and thus the resident might prefer it, so by putting all the items on cards first, they would appear to be equal in size. They were also in black and white so preference couldn’t be determined based on color alone. When we do the assessment we will show all seven cards together explaining what each one means (example, “this card means you get to listen to Michael Jackson for 30 seconds”) and then ask her to choose her favorite, she will then get 30 seconds of access to the item. The process is repeated. At the end, to build report with the resident we will then give her the item she first selected for two minutes.

After that we discussed an article on bizarre vocalizations and why this study isn’t particularly good in Kari’s opinion. Decreasing bizarre vocalizations doesn’t mean the patient no longer suffers from schizophrenia as the disorder is generally a life long disorder.

We then discussed Kai’s past experiences with bipolar disorder, schizophrenia, and brain injuries.

After that potential careers, the GRE, and graduate school were discussed briefly based on a few of our likes and ideas.

Data Sheets And Assessments.

The end of December means data sheets! Again, I collected data sheets, this time for the month of December. I also pulled out all extra behavioral data sheets and the accompanied addendum’s. Kari then re-typed up directions to the addendum and printed out new data sheets for residents who were missing data sheets for January, February, or March. All were returned to the binders on their respected floors. Kari also went over another assessment, the COMQL-i5,  that she is using for her thesis.

We also made plans on when to meet the next week. I will be attending two events related to the internship, the first is a speaker series at the University of Clear Lake and the second is a PMR, which is one of my goals. More information to come once the events have taken place.