Suspect with little evidence: The action of psych meds on injured brains is unpredictable

Another in a series of things I suspect but cannot prove ...

I suspect that the actions of psychiatric meds on injured brains cannot be predicted.

If this were true, it would not be surprising. It's hard to predict how psych meds affect even intact brains. In the injured brains of autism, mental retardation, and (presumably) schizophrenia we expect to find unusual neurotransmitter distributions, injured connections with recovery bypass routes, and areas of atypically high and low activity corresponding to injury and compensation.

If this were true, it would not mean we should avoid these meds. It would mean that we should look for unexpected side-effects, and perhaps be cautious about how we interpret response and failure. It would also mean that medications might be unexpectedly effective in atypical contexts.

Anyone know of any research on this? I doubt any research exists, there's unlikely to be funding for it.

iPad for accessibility – and special needs?

Josh de Lioncourt has written a review of iPad use for visually impaired persons. He’s pretty positive, though reading between the lines I’m guessing version iPadOS 4.1 will be much better (4.0 is due out this fall, I expect 4.1 @ Feb). It does seem like Apple turned a corner with the 3GS iPhone; previously they’d taken a big step backwards with the Classic to OS X transition.

An essential feature for visually impaired persons is VoiceOver, Apple’s robust screen reader. These same technologies are also very helpful for people who struggle to read. Voice commands help those who struggle to write, and predictive text entry helps students who have trouble typing.

The same features that make the iPad accessible to a large number of Americans who don’t use computers well also make it interesting to the special needs community. It is relatively simple to use, very easy to maintain, and much more resistant to virus infection than traditional computing devices.

The next generation iPad will almost certainly support video conferencing (that’s far more likely than adding a camera). There are many uses of that kind of technology in providing support to special needs teens and adults.

It’s a new world indeed.

Fortune

My daughter leaves Zen Shorts out each night for her dolls to read.

One of the parables retold is about fortune. This moment's fortune may be the future's misfortune; this moment's misfortune may be tomorrow's gift.

Yesterday we came within an inch of life shattering tragedy. There was an unlucky accident born of special needs adolescence.

Unlucky?

The cost was small compared to what might have been. Lives have changed, judgments have been revised. Yesterday's future is gone, today's future is new.

Lucky?

You never know.

Persuasion, adolescence, and the joys of prison life

Low IQ special needs adolescence does not come as a "thief in the night". It comes as a ton of bricks.

Behavioral management, which was never terribly effective, has become even less effective. We may still have a "paradoxical permission" effect, whereby when we give permission for an annoying behavior it becomes less attractive. I'm not sure we have even that however.

Medications are still available, but of course side-effects may be less tolerated.

Which is why I'm turning, with a measure of desperation, to my favorite sales book: Three Steps to Yes: The Gentle Art of Getting Your Way by Gene Bidell. I hope I can use some of Bidell's techniques to change my son's choices.

Bidell emphasizes understanding your Prospect's recognized and unrecognized needs and aversions, then figuring ways to meet them to get the sale. The Prospect "needs to win", for example, so find a way they can win and you can lose -- while still getting the Sale.

Understanding my son's world is a real challenge. He combines the limited knowledge of an early teen with a limited capability to understand and assimilate new knowledge.

I think, for example, that I erred by describing prison as the outcome of particularly poor choices. In my son's mind, I now realize, prison means no school, association with the police and K9 dogs he loves, comforting concrete instead of disturbing nature, agreeable routines, few challenges, plain meals, lots of television, regular exercise, no frightening choices, no concerns about employment, and congenial like minded peers.

In his mind, prison is not a bad thing, it's a bit heavenly. The worst bit is that in some ways he's quite right. He might actually find a well run low security prison more congenial than the alternatives.

So I need to persuade him that there are better options than prison (even if I'm not entirely sure there are - but that's a different story). Juvenile detention, for example, does include math class. It doesn't provide much police contact, and there are no K9 dogs. Most of all, there are no girls and his companions may not be very friendly.

At the same time I need to come up with a better future alternative for him to work towards - and I need to come up with it very quickly.

Any ideas?

Update: In our community the local police are happy to enter a special needs person into their database with a special "tag" including disability and contact information.

Update 6/26/2010: UK study on low IQ prison population.

A new behavioral intervention: adding calendaring

It's easy to persuade someone who can reason about past and future, and who can connect actions and consequences.

It's much harder to influence someone when reward or consequences must instantly follow action, where the past is forgotten and the future is inconceivable.

So we would like to make the future more real, more tangible. Something that he can interact with. We need to do it in a way that leverages his skills.

How do we do that?

We know that despite a quite low IQ he has a relative talent for devices and computers. They are natural to him, more comfortable and familiar than forest or water or rock. He struggles with many things, but not with software. Plan iMac has been successful. He's done well with his mobile phone, and texting seems to have advanced his writing skills.

So I've added a Google Calendar to his Gmail account - both on our family (free) Google Apps domain. He can view his parent's free/busy time and subscribe to other calendars of interest to him. I've populated his calendar with school events, and "invited" him from our calendars for events of interest. By necessity we have to plan a long way out, so he can see major events coming from many months away. He's awaiting the arrival of a Wii game -- I've put the estimated arrival time on his calendar.

My goal is that he interact with time through the calendar, that he begin to have a sense of future and past. I expect he will add his own events. Calendar items send SMS reminders to his phone (default 30 minute warning).

If he can develop a sense of time, then maybe we can return to teaching about deferred rewards, and then have more ways to change his behavior.


Update 5/26/10: We ran into a calendaring problem. We can't give my son unlimited Google access since his Google Image searches are not necessarily family friendly. We can't, however, using OS X parental controls, block Google Image search without also blocking calendar access. So this plan is on hold for the moment.

Not recommended: special needs spelunking

This actually worked, but I wouldn't try it the same way again.

We took two "spectrum" kids on the regular guided tour of Wind Cave National Park.

One of them was on the verge of bolting for the half the 60 minute tour, then he settled down. The other was tearful, anxious and had his ears covered and eyes largely closed for about 50 minutes, though after 30 minutes he was doing better. By the last 10 minutes he was almost ready to start.

It's very hard to exit one of these tours. You need a guided escort to take the elevator hundreds of feet to the surface. Yes, it was a bit much for our guys. They need a more gradual introduction. We should have started with the small-time gaudy tourist-trap type caves that are easy to enter and exit. Then we could have worked up the to the real thing.

It can be done though. Not saying it should be done ... this way.

A prosthetic conscience for special needs persons

Some special needs teens and adults may wish to do well, but have a great deal of difficulty modeling the impact of their actions. Impulse disorders, limited abilities to abstract, and autism-associated disabilities may all make a prosthetic conscience useful ...

Gordon's Notes: A conscience for robots - and for humans too

... Some humans too would benefit from a prosthetic conscience. It might allow persons with disorders of conscience to function more effectively in the modern world. Our prisons are full of low IQ individuals with a limited capacity to model the impacts of their actions on other persons. A prosthetic conscience might allow them to avoid prison, or to have great success after prison life...