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.

Topic: Positioning Issues
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

Topic: Hearing Issues
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

Topic: Vision Issues
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

Topic: Physical Issues
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