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January 27, 2003

Behavior

Question from Washington, DC, USA:

I am an advocate for a child in an administrative law proceeding as to special education benefits. The child has type 1 diabetes, and exhibits a number of problematic behaviors in school that I believe may be symptoms of hypoglycemia and poor control of blood sugar. In what published medical sources can I find basic information on the relationship between hypoglycemia and childhood behavior disorders?

Answer:

I suggest you do a PubMed search which is free to the general public. You can try searching “hypoglycemia and behavior”, “hypoglycemia and neurologic symptoms”, “hypoglycemia and learning disabilities”, “hypoglycemia and psychiatric disorders” or “hypoglycemia and whatever psychiatric diagnosis” your client has been given. You can read the abstracts of all the articles for free on line to see which if any of the articles apply to your particular case. You can then either pay to request reprints, or go to a medical library to photostat the articles if the library will let you in.

TGL
Additional comments from Dr. Donough O’Brien:

It would have been helpful to have had a fuller understanding of the nuances of the case which I assume to be under the Americans with Disabilities Act and with a local Board of Education. In very general terms, you can find some information by searching PubMed under a variety of terms such as ‘hypoglycemia and cognitive development’. It is time consuming though as you would really have to visit a medical library to explore the additional references in any key publications. The issue would seem to fall under two categories.

The first is perhaps to do with the availability of special education on account of the behaviour. In this instance, the cause of the behaviour is surely irrelevant. What is needed is a psychiatric opinion that, after examining the child, the problem is one that is disruptive to others or severe enough to justify special care.

If, on the other hand, the plea is for special help for hypoglycemia (i.e., for a nurse to interpret or measure blood sugars or to give glucagon) because of the concern over hypoglycemia during school hours, then it will be important not only to document the hypoglycemia but also why it has not been effectively treated. In this case, the search should be for transient behaviour problems associated with a low blood sugar rather than for cognitive problems resulting from hypoglycemia in the past.

A more practical approach would be for you to call the ADA at 1-800-342-2383 and ask for their ‘Education Discrimination’ package and also for the nearest contact for their ‘Advocacy’ staff.

DOB
Additional comments from Dr. Jill Weissberg-Benchell:

As far as I can tell, there is no research that suggests there’s a relationship between on-going behavior disorders and hypoglycemic episodes. The only behavior problems are at the moments during the low. However, there’s a whole body of literature (you would need to do a med-line search and a psychlit search) that shows that kids with diabetes who have lots of lows or a few severe episodes are at increased risk for learning disabilities.

JWB