CASE SUMMARIES

OVERVIEW: NEUROBEHAVIORAL PROGRAM

Meridell Achievement Centerís neurobehavioral residential treatment programs offer a composite of therapeutic approaches specific for children (5-11) and adolescents (12-18) with neurobehavioral disorders.† Neurobehavioral refers to behavioral problems that are associated with brain disorders.† Neurobehavioral problems can include:

Explosive rage behavior

• Impulse control problems
• Mood swings
• Poor judgment

These problems can occur developmentally as a result of fetal exposure to drugs or alcohol (fetal alcohol syndrome, crack babies), anoxia or other complications at birth, shaken child syndrome (secondary to physical abuse), or may be a result of traumatic brain injury (falls, concussions, accidents, etc.).

At Meridell our treatment approach is based on a thorough assessment of brain function and psychosocial issues.† Many children with neurobehavioral disorders have language or memory disorders that prevent other psychotherapeutic approaches (verbal psychotherapy) from being effective.† Some of these children have partial complex seizure disorders and other treatable brain conditions.† With accurate assessment of correctable brain disorders, appropriate medication interventions and modified methods of therapy, it is possible to effectively manage neurobehavioral problems.† Re-socialization and integration back into the family and school can then occur because the patient is more manageable.

The treatment focus of a neurobehavioral unit is positive.† Emphasis is placed on successes, and behavioral changes are made gradually through multiple modalities.

6-YEAR OLD MALE

ìBenî is a 6-year old boy referred after two acute care hospitalizations for rage behavior.† ìBenî had a history of temper tantrums, previous diagnosis of attention deficit disorder, and also a history of suspected but not confirmed sexual abuse.† ìBenísî rages included hitting, kicking, and biting along with cursing and yelling.† They would last for hours at a time and he would scream things like ìIím stupidî.† Birth and developmental history were remarkable for a maternal infection at the time of delivery.† At 2 days of age, ìBenî developed a high fever and required hospitalization in the intensive care unit for four days.† Gross developmental milestones were delayed speech was also delayed.† ìBenî had an early history of playing alone and poor social skills.† Assessments at Meridell confirmed diagnoses of complex partial seizure disorder and IQ testing showed low average intelligence with a strength in visual learning.† ìBenî also had evidence of a developmental coordination disorder and had symptoms consistent with a diagnosis of pervasive developmental disorder (atypical autism).† Over an 18-20 week period, ìBenísî symptoms improved with a complex pharmacological regimen and coordination of therapies including play therapy, occupational therapy, and group therapies focused on socialization skills and modeling of appropriate behaviors.† ìBenî was able to return home with his mother and be re-integrated into his previous school.

8-YEAR OLD MALE

ìWilsonî is an 8-year old male referred to Meridell after multiple episodes of aggression both at home and school.† He had threatened to kill his mother and sister with a knife and had been disruptive and violent at school, throwing a desk and physically attacking a teacher.† ìWilsonísî birth history was remarkable for motherís crack cocaine use during pregnancy.† His assessments at Meridell confirmed the presence of a complex partial seizure disorder and IQ testing showed low average functioning with significant memory impairment.† Medication interventions to treat his seizure disorder and attention deficit disorder reduced the intensity and frequency of his aggressive outbursts.† His discharge disposition was difficult in that his mother relapsed in her own recovery and required inpatient psychiatric hospitalization.† Interventions in family therapy identified another family relative who was able to assume a temporary parenting role.

12-YEAR OLD FEMALE

ìAriannaî is a 12-year old female admitted to Meridell after a worsening of physical and verbal aggression.† Since the age of 6 years, ìAriannaî has had approximately 14 acute care inpatient psychiatric hospitalizations.† She has attempted suicide on multiple occasions and threatened to kill her brother with a knife.† ìAriannaísî developmental history is significant for motherís active drinking during the pregnancy and an emergency delivery secondary to fetal distress.† ìAriannaísî assessments revealed the presence of a complex partial seizure disorder and IQ testing showed her to be functioning in the mild mental retardation range.† With medication management and appropriate therapies, ìAriannaî was able to return home to her parents and return to school with a modified educational curriculum.† Her episodes of physical and verbal aggression were dramatically reduced and she was able to function without self- injurious behaviors.

14-YEAR OLD MALE

ìZackî is a 14 year old boy who had a long history of hyperactive and impulsive behaviors, was easily agitated, and would become verbally and physically aggressive, both at home and at school.† He had very poor social interactions and few friends. While at Meridell Achievement Center he was diagnosed with cerebral dysrhythmia based on the computerized EEG with auditory and visual evoked responses.† It was felt that the cerebral dysrhythmia was contributing to his mood swings and aggressive behaviors.† He was also diagnosed with ADHD, which manifested itself in hyperactive and impulsive behaviors and a nonverbal learning disorder, which contributed to his difficulty with social interactions. He was stabilized on Trileptal and Concerta and treated on the neuropsychiatric milieu.† Particular attention focused on his nonverbal learning disorder.† He was placed on a highly structured individual behavioral program with minimal stimuli. With individual work and very small groups he progressively tolerated more activity.† At the time of discharge, he showed no aggressive behaviors.† An ARD conference was held to facilitate his schoolís continuation of proven strategies.

16-YEAR OLD MALE

ìDonî is a bright 16 year old boy who had a two-year history of episodes of becoming ìglassy-eyedî, not responding to verbal commands, saying things that were not well-connected, and lying down and having rhythmic movements of his arms and legs.† These episodes were often followed by several hours of sleep.† ìDonî consistently denied that he had any problems despite the fact that his parents had videotaped some of the episodes; with their permission they were played for him.† ìDonî was stabilized on Trileptal after a computerized EEG with auditory and visual evoked responses showed a Complex Partial Seizure Disorder of Limbic Origin.† He is now functioning extremely well at home and at school.