Scenario

I have been working with a child that is diagnosed with ASD. She engages in severe self-injurious behavior (head banging). She has been hospitalized 2 times for cuts to her forehead and concussions. Behaviors have decreased at school after staff training from our team but stay consistent in the home. The family is struggling with staying in close proximity to her, being proactive and implementing strategies when staff is not around. Their insurance company is suggesting a helmet to keep her safe, but the parents don’t want their child to walk around with a helmet on all the time even if it means keeping her safe when staff is not around. I am not sure what approach to take with this family since behaviors are still very high and dangerous when staff is not around. To keep the child safe, a helmet is the next best choice…thoughts?

Response

• Review record of parent training and approach to parent training

• Increased frequency of parent training, assess where the function lies with the parent not implementing with procedural fidelity

• Reassess to ensure proper function is identified in the home setting

• Ethical obligation to communicate with family that adaptive equipment could increase behaviors and should be handled carefully with risk/benefit assessment and appropriate protocols in place

• 2.09 right to effective treatment