Couch 204: The Refactorable Couch

I was complaining about all the verbiage I had to put on my syllabi a month ago--now I am glad because my "Classroom Conduct" clause can be used against my problem student (and I make them agree to abide by the syllabus, which he has).

Hurrah for academic over verbiage

Comes in handy every 10000 students or so.

I am really surprised this student doesn't have an accommodation plan filed with the college. From what you describe, there is no way this kid got through high school without special services of some kind . . . unless he was homeschooled (which might be). Clearly there is something going on with him; this is more than just poor behavior. This is odd behavior -- rather out of the ordinary behavior which would have gotten the attention of teachers all along the way. He doesn't sound violent; he absolutely does sound impulsive and completely lacking in social skills.

I would definitely be writing a report and requesting removal from my course if he behaviors are impeding your ability to teach and/or the ability of your other students to learn.

I don't know his background, since he isn't registered with the disability center. The center's director was speculating he had an IEP in high school where someone was with him at all times to redirect his behaviors, but home schooling makes even more sense (and would explain why he doesn't seem interested in accommodations).

Definitely social skills problems. Doesn't talk to the other students or make eye contact. Before class, glued to his phone with earbuds in, ignoring everyone around him, while the other kids are usually chatting with each other.

I should be sending the report to him outlining behaviors and explaining changes tomorrow after checking in with a woman I know in the dean's office.

That is my gut assessment. Students with these kinds of behaviors either have a special education teacher or para with them all the time, or they are in a self-contained classroom situation with pretty constant supervision. If he was homeschooled, there is no paper trail of accommodations; thus, he won't receive accommodations in college. The sad part is someone, at least his parents, is perfectly aware of his issues and apparently chose not to take any steps to help him find success in the college environment. It can be done, but it generally takes people working and advocating for that student. Sounds like his parents totally dropped the ball here since they are the ones that would have provided documentation to the college.

Personally, if I were one of your other students @@, seeing campus security (I assume you mean campus police?) would have no effect on me beyond wondering if there had been some incident with you. It would not worry me. If I even registered it at all, I'd probably assume someone had broken into your vehicle or something. I think the same would apply to this problem student if he notices, unless his issues include having bizarre or paranoid thoughts in which case who knows. Alternatively, if he is violent and is actually plotting something, he could momentarily fear he is under suspicion for something concrete. I doubt simply seeing campus police would forestall any action on his part, especially since it seems like he might have an issue with impulse control and making decisions based on taking responsibility for himself and having an eye to the consequences of his behavior.

Still, I doubt it would hurt - that is, unless he is paranoid and/or delusional and also violent, is plotting something and thinks he should act sooner rather than later because people may be growing suspicious, or something like that. But in those cases, he would certainly become violent at some point anyway.

Oh, myth? Ithn't thith backwardth?

I have to do an online course about healthcare improvement as a requirement of my residency program and it is sooooooooo dry.

Artie, I don't know how you do it!

I am a security officer for a hospital. You wouldn't believe the number of times we are called to just "stand by" for problem patients (usually intoxicated patients in the ER). It usually goes one of two ways 1) the patient straightens up and starts cooperating or 2) the patient goes off the rails in which case it's good we are right there to handle/restrain them. I don't think your other students will be upset by having the campus security there and I think it's a really good idea.

I did some brief research into ADHD, because what keeps striking me and others, including some of you, is that it seems to be more than ADHD.

Turns out there are a couple behavior disorders in the DSM that more than half of kids diagnosed with ADHD also exhibit (conduct disorder, oppositional-defiant disorder). I’ve no idea if he’s diagnosed with either, but they both fit him—e.g., persistent refusal to follow rules, persistent resistance to authority figures.

Doesn’t bode well for changing his behaviors.

If he shows up in class after I send him my report today, I think I will talk to campus security and see if they’d be willing to do a “walk by.”

I'd also wonder about ASD, particularly what used to be known as Asperger's. ASD is often comorbid with ADHD (we're pretty certain my D has ADHD as well). I think you mentioned how he doesn't make eye contact. And he doesn't seem to understand social norms. Just a thought...Also, another subtype of ADHD involves impulsivity, so it could partly be that as well.

Or it lacks parallelism.

I wonder if he will even look at the report. I know you have to send it but I’m not sure I would count on him looking at it.

Doesn’t matter, fortunately. The clock begins as soon as I send it, whether he reads it or not.

Of course that might lead to a fun scenario down the road where he’s been removed from the class but doesn’t know it because he doesn’t read his email, so he still shows up. In which case I guess I tell him to leave and if he refuses, I call security.

I would call security first - once they have arrived then tell him to leave

This.

(More characters)

I’m off work today. (Thursday’s are off due to the long Wednesday’s)
That means I get to go visit my twin friends at 12:30.

Yes, even though I’m off work, I’m still working in some form. But I miss them so I’m excited to see the tots.

I'm here waiting at the pdoc appointment and I saw that both psychiatrists are here like last time. I can't do this.

I'm supposed to see my T in an hour and half so at least that's good. But my anxiety is off the charts this morning now.

That seems a bit high to me. I suspect there may be some misdiagnosis due to misattributions about behavior of kids with ADHD. For example, chalking up a failure to follow rules to defiance and resistance to authority instead of the rather prominent ADHD symptom of difficulty regulating impulses. I had a good friend with really quite severe ADHD as a kid. She definitely didn't have a pathological disrespect for authority and actually I would say she yearned for approval. But she also had a lot of trouble following rules. For example, she was the type of kid the teacher constantly would have to tell to stop talking in class. Also, from the point of view of a kid with ADHD, constantly trying to keep a lid on the urge to let loose (just to do schoolwork, no less) is no fun. What kid wouldn't feel a bit resentful of being micromanaged and having to tamp down their hyperactivity? I hardly think that's pathological.

I guess I just think ADHD symptoms can sometimes be so incredibly frustrating to deal with for parents and other caretakers that there is a danger of misdiagnosis of additional disorders such as ODD. Another way to look at it is that there are other disorders, such as BPD, that can manifest in ways that are oppositional or defiant, but that doesn't mean the person with BPD has a separate disorder - the behaviors are symptoms of the BPD.

All that said, I don't think this student's issues accepting redirection, advice, and the specific ways he has been disrespectful sound like ADHD issues. If that were the case, he would probably be agreeing to whatever the suggestions were then failing to follow through.

Got through the appointment. They asked how my wrist was doing and I told them I messed with it but thankfully they didn't ask to see. Just told me to go to an urgent care to get it looked at today. Not sure if I'll do that
Now I'm waiting at Ts office. Really wish I could see him tomorrow too.

So sorry to hear, SheHulk. Would your T be willing to offer an extra session? This would seem to me to be exceptional circumstances.

By taking things like this Belly Dancing class, to keep me from being too much up in my head! Class was a lot of fun last night, we did this dance thing as a group in a big circle to music, the steps weren't too hard and I caught on pretty quickly. There are like 9 people I think in the class. Our instructor made CD's for each of us so we'll have the music she's using in class at home to practice to. I am getting better at watching myself in the wall mirror and smiling instead of looking down at my feet and frowning. Letting myself have fun with it.

Sending gentle hugs and head nods as appropriate.

LT...I lost track of the consultations. Was there someone today?