Tuesday, September 15, 2015

Panics in Public

Lyn's been having increasing difficulty in handling day hab outings.

We've known she's not able to process plexiglass at  the mall.  Day hab has been advised that she should not be taken to the mall.  Going even to the first floor causes her anxiety.  The mall was redecorated and a primary decorating element is plexiglass.  Even the stairs are plexiglass.  She cannot see it and her brain cannot process it.  It induces full-blown panic attacks with tears, shakings and an inability or lack of desire to stand.  A recent outing was scheduled to be to a doughnut shop.  At the last minute, a trip to the mall was added.  The staff took her to the second floor and she melted down.  She asked for help and at some point, someone stated that she needed to stop her games.

In a another incident which happened just last week, Lyn started to panic getting out of the day hab van.  She called to the day hab staff three times for assistance and received none and a another full panic attack ensued.  We do not know if the staff did not hear her or chose to not respond.

What is happening to cause these panic attacks?  They don't happen when she's with Mom or her respite care provider.  An email from Lyn's behavior therapist provides good insight.  She writes:

There could multiple issues going on: 
*  transition from on activity to another, and having difficulty with remembering what is next
* the change in lighting leaving the bus into bright lights could not be registering the depth of the stairs
* the commotion of the transition with everyone talking, getting stuff, standing in line waiting to get off the bus, etc.
* difficulty problem solving visual illusion effects (for example, when going downstairs – determining how many steps there are, and where the next one is; going upstairs is not usually a problem) 
The real extent of Lyn's visual difficulties will not be apparent until she experiences a change in environment, like going out shopping, on an outing, or on the van. Visual difficulties and ‘perceived obstacles’ will make Lyn more anxious and fearful. It would be helpful to anticipate situations where Lyn will likely have perceptual difficulties, help explain what is being encountered, offer encouragement and support, and slow down their own movements around Lyn.  When there is a lot of commotion, talking, other people moving around, her brain is not processing this information and she is over whelmed.   
The size of the vehicle (she can't put her foot out and touch the ground while still seated) and the number of people add to the processing confusion which leads to panic.  A hand out and a staff member standing right there would allow Lyn to focus on the staff and see where their feet are in relation to hers.  The staff to client ratio is only 3 clients to 1 staff.  This is not a high ratio and should be adequate to cover Lyn's transition and movement needs.

Mom is actively working with Lyn's team and the supervisors at day hab to address the situation.  

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