If
you wish to return to the 'Ask Dr. Dunc.' mainpage, please click
here
If
you wish to visit the 'Ask Dr. Dunc.' question archives, please
click here
Question 50: I work with Developmentally
Disabled Adults between the ages of 18 and 29 as a facilitator assisting
them in making the transition from school to adult life. One of the
individuals I serve is a young woman age 21 who also has Downs Syndrome.
Her tics are in the form of spitting. Her cognitive level of understanding
seems to be at about a 5 year old level in most areas. She understands
only concrete simply concepts. Those of us who spend time with her
are noticing the spitting increases when she is out in public or in
situations which are new to her [and] I am not sure if she is capable
of understanding what is happening when she is spitting. Right now
she is getting all kinds of negative messages from the world at large
and I am seeing her self esteem being eroded and her family also feeling
discouraged. Do you have any suggestions of how I/we might help her?
Blessings, B.H., ON, Canada.
Good evening
B.H.!
Given
that you feel she is very concrete and may not be able to understand
the complexities of social interpretation, cause-and-effect, etc. I
would suggest sticking with a purely solution-focused, equally concrete
approach. Let her know that spitting openly IS not and WILL not be condoned
while at the same time teaching her acceptable "compromises".
Spitting into a handkerchief might be one example. Other children with
TS I know will "wipe" their mouths on their sleeves and release
the saliva then. For still others, making the "noise" of spitting
(without actually engaging in the action) satiates the tic urge -- these
individuals may learn to make the noise quietly, or into their hand.
The important
thing to get across is that scratching an itch ONE way may not be allowed,
but scratching it a slightly different way is just fine. When it is
clear to her that the options are to either spit in a slightly different
way or not spit at all, compromises suddenly look more appealing. While
eventually most individuals with TS can learn to problem-solve in this
way on their own, given the limitations you say your client has she
may always need support in finding and practicing appropriate compromises.
I hope some of the suggestions above, whether they work or not, at least
give you a starting point for thinking about ways to resolve this issue
in a way that will suit YOUR client best.........take care.
