Monday, 10 June 2013

Chocolate anyone?


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Britain and the USA have, in the past few years, acknowledged that there is a huge rise in the number of obese children.

"Obese kids, blame it on overweight moms" -Daily News and Analysis, June 2013

"10 percent of children are obese by the time they start school" -Daily Express, Feb 2013

"42 percent of American adults will be obese by 2030" -Los Angeles Times, May 2012

Society argues that it's parents fault, some argue that it's more prevalent among working class families, other scientists blame genetics and poor environment.

It's not an unknown fact that many children with autism have strict food preferences as well, from only eating things that are a certain colour to only eating certain textures, and everything in between. I don't tend to deal a whole lot with eating issues, mainly because I haven't had much experience in the area so would rather consult with a professional who does first. Unfortunately, this is where I hit my brick wall.

I recently met a family who had asked me to come and help them with their child's behaviour.  During the parent interview, the parents also informed me that their child was a "picky eater". They told me that they had been to dietitians and nutritionists and that the last doctor they saw said "....it doesn't matter if he eats chocolate all day, as long as he's eating". It took me about 30 full seconds for me to close my mouth and utter a word when the parents told me this. And we wonder why there is an increase in childhood obesity?

As a behaviourist, I have to ask myself, why is obesity on the rise? How are we dealing with it?
I am NO expert in this area, as I don't often treat kids with eating disorders, but it has struck me that at least in the UK, the dietitians and nutritionists (that I have come across) do not seem to either 1) care as long as the child is eating something and/or 2) definitely don't look at environmental aspects when treating problems with eating.

I remember years ago watching a programme on TV that featured children with eating disorders. One of the children had a diet that consisted of chocolate and crisps. That's it. No bread, no fruit, no veg. She ate the same for all meals. For seven years until someone finally decided to do something.  The approach that was used was systematic desensitisation and a differential reinforcement procedure. By the end of the show, the girl went from not being able to look at toast to taking small bites. See the power behaviour analysis can have on any problem? You identify the environmental variables (in the above case, parents giving in to the child's requests until she restricted her diet down to two different foods) controlling the behaviour, manipulate them (in the above case by no longer honouring this, while at the same time slowly introducing new foods and providing rewards for each step), and viola! problem gets better and eventually goes away.

I'm by no means saying the above procedure is necessary or even appropriate in every situation, however I do think that dietitians and nutritionists, who are often given referrals for children with eating problems, could probably do with some training in behaviour analysis. Maybe then we can really tackle our childhood obesity problems.

Monday, 3 June 2013

Just Listen!! And other ethical thoughts...

So today marked Day 13 of an episode of 8 migranes. Of course the first thought that comes into one's head is "Oh my god, do I have a brain tumor?". So, like normal people do, I called my dr. I was lucky enough to get an appointment relatively quickly (something that really isn't guaranteed on the NHS) and was soon sat in front of a dr I trust. After attempting to explain that I thought I might have a sinus infection, that I've been exposed to mouldy conditions, that I find taking an allergy med before bed helps prevent migraines...."Well," he said "I think this is just a change in frequency for whatever reason, we don't know, so let's start you on some beta-blockers to try and break it and then go from there. Your blood pressure ok?". I had no time to answer. "Yes. It is. Ok then, I'll give you some propanalol and sumatriptan.".

What's wrong with that statement?
Lots of things. For one, he didn't listen to me.
He never checked my blood pressure.
On my way out, knowing I am prone to low blood pressure, I checked it on the machine in the lobby.
"102/64".
A quick google search indicates that anything under 100/70 is considered low. Not a bad thing, but low.
 So then I looked up propanalol: "Propranolol hydrochloride blocks the effects of certain chemicals in the body. It can be used to reduce heart rate, to help the heart beat more regularly, to reduce the heart's work and to lower blood pressure. It can also reduce the frequency and severity of angina attacks." -Nhs.uk 
So the med he gave me works to LOWER blood pressure. Wait a minute. My blood pressure is already low. Then I wondered what if I already have low blood pressure? Should I still take it? I read on under "people who should not take this drug" and low and behold, "people who suffer from low blood pressure". Bang! 

Luckily, I have the sense not to take the med. For one thing, I know it won't prevent attacks. We never determined the cause. The cause was "I don't know". Not good enough. How can you prevent something when you don't know what's causing it? 

My next stop was to the chiropractor. He told me (after doing an exam) that my neck had a severe subluxation which is causing the migranes. He adjusted me and I go back for another appointment Wednesday. Because he determined the cause, he knows what to do to PREVENT my next attack. And it's worked without fail in the past. Without drugs that will probably cause my blood pressure to reach dangerously low levels. Brilliant!

Right now I am taking a course on Ethics to finish my BCBA exam course sequence. So of course, in addition to questioning all of the above, I began to question the ethical implications of my oh-so-trusted doctor. Doctor's are scientists, just like Behaviour Analysts. They treat symptoms based on scientific evidence, they use the least restrictive treatments necessary, and they use a patient-centered approach just as we use a client-centered approach. By not finding the cause (i.e. requesting further investigations or tests), this doctor acted unethically. By not taking my blood pressure before prescribing me a blood pressure medication was also unethical, and potentially life-threatening. As behaviour analysts, we know that the cause of behaviour cannot always be determined by looking at it once. Sometimes we need collect baseline data, interview the client, staff, parents, etc, and do a functional analysis before implementing a behavioural intervention. Why isn't it the same for medical interventions? Surely we all have similar ethical guidelines?

Just a thought....and back to the ethics book I go...