January 25, 2011
Behavior, School and Daycare
Question from Langhorne, Pennsylvania, USA:
My daughter was diagnosed with type 1 diabetes at age four and a half. My husband and I are currently working with school officials developing an IEP and behavior plan. Recently, a functional behavior assessment (FBA) was performed because my daughter has had repeating behavior difficulties. Our endocrinologist states that they would consider her diabetes to be out of control with fluctuating blood glucose readings, sometimes low, many times high. I have always been told that these fluctuations in blood glucose can be related to behavior difficulties. I am not excusing my daughter’s behavior but did inform school personnel that, at times, she could have difficulties if her sugars were high or low. The FBA stated that there was no correlation between glucose levels and behavior. The data collected supports that out of eight random testings when some behavior was exhibited, there were five testings that revealed either a blood glucose reading in the low 70s (70, 74 mg/dl [3.9, 4.1 mmol/L]) or over 200 mg/dl [11.1 mmol/L]. Since her diagnosis, my daughter has had a great amount of social difficulty and anger issues. We have sought counseling to help her deal with her feelings of anger, defiance and low self esteem. Both my husband and I feel that behavior is affected by changes in blood glucose. We are not placing blame on the diabetes but it certainly can contribute physically and mentally to her difficulties. What do you think? We would really appreciate your input.
Answer:
I’m really glad that you are working with a mental health professional to help your daughter feel less angry and sad, and instead feel more competent and in control of her behaviors. Although it is possible that the fluctuation in blood sugars plays a role in her difficulties, varying from 70 to 200 mg/dl [3.9 to 11.1 mmol/L] is not unusual for children, and most children do not struggle with severe behavioral outbursts in that range of numbers. The lows, numbers under 80 mg/dl [4.5 mmol/L], are associated with behavioral changes (but not necessarily aggression or outbursts). Numbers under 250 or 300 mg/dl [13.9 or 16.7 mmol/L] are not typically associated with behavioral difficulties (although children feel awful and be grumpy, but they are still in control of what they do). If your daughter�s endocrinologist states that her blood sugars are “out of control,” then working closely with that team to improve her fluctuations would be a very important goal. In addition, diabetes may also be a piece of this puzzle if your daughter has strong opinions and feelings about life with diabetes. Working closely with your diabetes team, your school and your mental health professional are great strategies to help your daughter gain control over her behavior and her mood.
JWB
