Girl, 5, chews off all her fingers

The BBQ Pit
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So you know that the child wouldn’t feel the ‘punishment’; you’d have no way of knowing if you injured her; and you understand that she may also be lacking the mental facilities to appreciate such punishment, yet you like the idea anyway? Please, Dr. Brazelton, share more of your wisdom.

So I assume your have expertise in this field and can convince us that the child can be taught self control. Why don’t you share some of you knowledge with us? I’d be happy with just one or two primary source cites – I don’t want to take up too much of your valuable time.

So yelling would have the same end result, yet you prefer beating a physically and mentally handicapped child? If I may speak for those of us you lack your skill in caring for special needs children: what the fuck are you on about? I also assume you’ve chatted with the grandparents and know they didn’t think of the ‘yelling thing.’

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My point, cletus, is that all that negative conditioning (your physical and/or emotional infliction of discomfort on her) will not work. Let me repeat. It will not work. Let’s try it again and see if you get it this time. It will not work. The literature shows quite nicely that in cases of self-mutilation on a neurologic basis, stress makes the self-mutilation behavior worse.

I suspect this kid is one of those very, very rare female Lesch Nyhan syndrome kids, or has some other basal ganglia dysfunction syndrome.

So let me say again, cletus. Your proposed therapy regimen will make her worse. If you have some special knowledge in treatment programs for patients with hyperuricemia and basal ganglion defects, now is the time to present it to us, complete with relevant cites. If not, I suggest that now is the time to back away from your proposed treatment method, because your proposed therapy regimen will make her worse.

http://ericec.org/faq/lesch-ny.html

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But beating the shit out of her will make cletus feel better. When people stare at horror his poor child as she nibbles away at her palm, cletus could just backslap her and return the stare knowing deep in his heart that he’s doing it for her own good.

And when her disorder continues and her self-mutilation becomes even more severe perhaps cletus will instruct her to get a switch so that he can whip her real good directly on her freshly made wounds so that she can make the connection in her brain-damaged mind that Daddy is a cruel idiot with no clue and a sadistic streak.

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Because she’s so likely to forget having her fingers chewed off?

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Say you catch the child chewing at herself, cletus, and “beat the shit out of her”. What do you have then?

You have a child with broken ribs, maybe a concussion, bruises everywhere, a black eye or two … and she’s going to go back to chewing on herself the instant you turn your back.

What will you do then? Beat the shit out of her again? How much shit will you beat out of her? Will you beat her to death? Will you permanently damage her, or kill her, to keep her from … permanently damaging herself? Except, oh yeah that’s right you can’t keep her from damaging herself by beating her up.

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Maybe there’re some, like me, who thought, “What an ineffective and violent reaction to a serious incident.”

:smack:

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There have been instances of children being born insensitive to pain.

They break bones. They cut themselves. They burn themselves. And yes, some of them chew on their fingers. Normal children chew on themselves, too, but stop when the grow teeth and feel pain from biting themselves. Children unable to feel pain have nothing to stop them from using their hands as teething rings.

Such people, even in the West, even with constant attention, even with the best medical care, almost never survive childhood. Not even when they have normal intelligence. In other words, even if you can keep a person like this relatively intact until they are old enough to reason and think they still severely injure themselves.

Unlike a person suffering from, say, leperosy who at least has the memory of pain and knows that certain injuries are serious from past experience these kids have no comprehension of pain.

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People, people, some of you have obviously never heard of ‘argument ad hominem’ or ‘false dichotomy’. Jeez

Perhaps I didn’t make myself clear in my last post so let me reiterate. Once i understood this to mean she couldn’t feel pain I realized physical, negative reinforcement would have no effect. Many of you are so preoccupied with my first post you can’t see anything else. Looks like I’m not the one that needs to practice my reading comprehension skills.

If she could have felt pain in the rest of her body then yes, I would still consider it a viable option. If I determined that it was not helping then I would have tried something else. Don’t just assume the worse of someone because they have a idea contrary to yours.

After rereading my first 5 post I was amazed at how worked up I got over this article. Still, it seems to me to be obvious exaggeration. Perhaps you should learn to take what you read with a grain of salt (Marley23). Or is it because you still cannot fathom how my initial reaction would be to actually strike a girl?
Qadgop, Lesch-Nyhan Disease is a genetic disorder. While one of the symptoms (self mutilation) is similar, the cause is completely different. The article states it is believed she had some form of cerebral palsy, NOT she had a abnormal level of serotonin, dopamine, or uric acid. If you have a cite that says cerebral palsy is a direct precursor to these three, then by all means, please share. But then again, a fever wouldn’t cause genetic diseases. :rolleyes:

Furthermore, it is stated (they don’t know everything yet about this genetic disorder) that LND causes a form of behavioral aggressiveness and tendency to inflict self injury, therefore making it a shaky comparison to the little girl at best. She didn’t know her actions were bad, much less wanting to cause self injury. Your link may say negative conditioning wouldn’t work with LND but it doesn’t apply here. How do you know the little girl didn’t have perfectly cognitive mental abilities other then the lack of pain nerves? Once again, I understand that the lack of pain receptors means hitting her would not work. There are alternatives to drugs or surgery.

And yet, even with this disease there is still hope that the patient can learn to control himself. Restraints might be needed at first but the point is they can be taught to control themselves.

I’ll also like to emphasize that the treatment options they recommend and you endorse is exactly what disgusted me so much in the first place. They suggest you pull out all of the person’s teeth(!) and casually note that this disease means doctors are exempt from JCAHO regulations (they can legally bind her wrist or tie her to a table for the rest of her life if deemed necessary). You don’t realize just how bad a lifetime of restraint would be. Perhaps you should check your cites more closely before posting them. Your argument already requires many assumptions which you arbitrarily define as true.

ratty, I tried to be nice even after you called me a fucking CHILD ABUSER. Now you resort to name calling because I would dare to respond. I had originally written a long post flaming you but I’ve decided it would be more prudent just to ignore you.

biggirl I believe no matter how much it tears me up inside, if it was the right thing to do I would do it
After reading some of the above posts I’m beginning to agree death would be a far more attractive alternative. Life for this little girl would have been hell. No one deserves to experience that.

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I might’ve taken it with a grain of salt - or at least let the argument go - if you hadn’t come back to it over and over again. You continued to reiterate it as a viable option long after common sense would’ve discounted it, and then insisted on attacking everybody else. Don’t blame me for that one. And what’s with the “hitting a girl” thing? Are you trying to imply something? Your comment was gross because you talked about abusing a kid, it has nothing to do with the kid’s sex. I’d love to know how you lept to that conclusion…

I’m really sorry I assumed the worst about you because you said you’d beat the shit out of a brain-damaged five-year-old. Repeatedly.

Shit, man, you didn’t even say you’d take her to a doctor or a hospital. You said right in your first post that you’d have “warned her once” and then started with the beatings. I can’t believe you have the nerve to blame everybody else for overreacting to your comment.

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cletus, thanks for taking the time to look over my links and do your homework, and raising the tone of the discourse. You make some good points.

You’re right, we don’t know what this kid really has. We have too little data to figure it out. So we cannot know what she has. But we can probably narrow it down to a number of disease.

She’s pre-adolescent, and she is reported to have had a high fever when she was younger (the latter is a bit of a red herring; few children make it thru childhood without having a fever of 105 or so, and do ok). She’s also said to have cerebral palsy. As for CP, I’d not place a lot of reliance on a precise diagnosis, given the lack of testing. But it tells us some things at least.

So what disorders cause such severe self-mutilation in a young child? This is not the pattern one sees in adolescents, neither from frank psychosis nor depression.

1)Mental retardation is big on the list. This could fit in with a cerebral palsy picture too. It’s common for MR sufferers for do autophagia (eating of oneself).

2)Lesch Nyhan is still on my list, despite the kid’s gender. We don’t know how she acts towards others, but the commonest inappropriate behavior with Lesch Nyhan remains self-mutilation.

3)Encephalitis can acutely cause this behavior, but since she’s chronic, this wouldn’t apply. She could have experienced brain damage in the past from her encephalitis, however.

4)Tourette’s Syndrome. Less common here, at least with the finger mutilation. Many tourette’s sufferers chew their lips to the point where damage is severe. But still it possibly could be her underlying problem.

5)Autism. Autophagia has been described not infrequently with autistics.

6)De Lange Syndrome. Possible, they self-mutilate a lot. Another genetic disorder, which occurs equally in males and females.

7)Obsessive-compulsive disorder. Unusual to manifest so strongly and severely at such a young age, but certainly possible. OCD types have chewed off lips, fingers, and even toes before.

I’m sure I’ve left out a few, but we’ve covered the possibilities pretty well with the above, IMHO.

Now if one investigates the above disease entities (which I have) and focuses on suggested therapies for curbing the self-mutilating behavior, one sees a common thread. All the self-mutilating behavior is a mechanism for reducing stress for the individual. The sufferers, when stressed, engage in more self-mutilation. When not stressed, less such behavior is observed.

In terms of therapies, a variety of methods have also been studied. And they are nearly universal in demonstrating that negative reinforcement either has no effect on reducing the undesired behavior, or (the more common finding) it increases the undesired behavior.

So employing negative reinforcement schemes (whether physical or other punishment) should be avoided, as it does not contribute to the goal of reducing the behavior.

What does work? Frankly, and quite unfortunately, not a lot. But positive reinforcement and protective measures demonstrably have the best track record for changing behavior. Unfortunately, many children who engage in this sort of behavior are too cognitively damaged to get as much benefit as we’d like.

Sadly, most of these kids are not responsive to the milder anti-anxiety medications or anti-OCD drugs. If they can engage with a therapist in a behavioral modification program (learn to ask for help, or do distractive techniques when the urge to self-mutilate comes on) along with medications, there is a higher success rate. But frankly the behavior, even in high-functioning kids, can be so automatic that the child will not even notice what they’re doing until they’re well into it.

So in the hard cases, heavy-duty drugs and restraints end up being used. And don’t presume my ignorance on the horrors of the use of restraints. I worked in a chronic psychiatric “hospital” (D building, Baltimore City Hospital) before they were emptied out! They housed both kids and adults.

In short, I continue to assert that negative reinforcement will not be effective in these types of situations. You continue to assert that it will be effective. In higher functioning children, they are already appalled at what they’re doing to themselves, they’re ashamed and frightened and angry to begin with. Punishing them increases the shame and anger, which then causes more self-mutilatory behavior. In lower functioning children, they have trouble making the association between the mutilation and the punishment, which increases their stress, so they do more mutilation. And in OCD, the DSM-IV considers negative reinforcement to be the driving mechanism behind the compulsive behavior.

If you still hold that negative reinforcement is an appropriate approach for these cases, I would like to hear what sort of treatment plan you propose which would help, rather than hurt the situation.

QtM

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I’ve sent a email to Snopes concerning the validity of this article. Hopefully he will be able to find more information.

Qadgop, thank you for responding with a post that doesn’t involve name calling or blind anger. You seemed to be the only one that was refuting me with anything of value anyway.

The article didn’t provide much in the way of details but I can at least hazard a guess as to what was wrong. Fevers in infants lower then about 107 degrees F are relatively common but cases of extremely high fevers have been documented. The cause is often heat stroke or severe bacterial infection. Both are likely occurrences in a ‘village’ on the outskirts of town and it would explain why this particular fever was so much more damaging then usual. I would hate to think the grandparents left the 2 year old in the sun and forgot about her, though that is a distinct possibility. More likely, IMO, would be a bacterial infection caused by a lack of cleanliness in her environment. In either case, the primary end result would be brain damage with, apparently, the side effect of damaged pain nerves.

Still, Mental retardation is too broad a medical term to be any type of concise conclusion. It also wouldn’t explain the question of why she would chew her own fingers constantly. Again, I can only guess, but perhaps the sudden absence of sensation after the month long fever caused her mind to generate pain to compensate, similar in theory to phantom pains. If that was the case then it would be wise to explore the treatment options available to amputees. That would also explain why it took 3 years for this to happen. The ‘feeling’ might have been recurring as opposed to constant.

I still stand by my initial belief that it isn’t LND. Compare the severity of this case (or rather, her hands) to the average person with LND. However, your right in that there likely wasn’t adequate testing equipment available at any point in her life. Therefore this possibility can’t be completely ruled out.

Do you have any cites stating negative reinforcement either has no effect or encourages self mutilation? Studies aren’t always as reliable as they appear to be. Please don’t interpret this as a blanket dismissal of all studies. I am merely saying observational selection is a unfortunately common fault among them. Without the actual details to look over, I would be reluctant to put much weight in their findings. I find it is usually best to fall upon personal experiences to determine what’s right or wrong.

I did some searching on google and seemed to find as many studies for my stance as against it. Some even stated that a comprehensive body of applied research does not exist at this time. In other words, we don’t really know that much about the way the mind works. Drugs and physical restraints are better understood but the effects they pose on the mind is not. I AM glad you aren’t the type to automatically think drugs are the right solution like I had originally assumed. I already know far to many people IRL that regard drugs as a magical care-all for their kids.

I haven’t had much experience with people of low mental capacity IRL. I am willing to agree that negative reinforcement would not work for this child or for people of lower mental functionality assuming they lacked the mental prowess to be taught. I am not willing to disregard it completely as useless. Increasing the amount of shame and anger would not necessary increase the level of self mutilation. The two subsets of negative reinforcement, escape and avoidance, should be factored into consideration. No reinforcement after a period of negative reinforcement (extinction) should be considered as well.

Your example of OCD may be true but would hardly encompass all mental disorders. I am reluctant to lump all mental disorders together and state a particular facet of one would apply to all.

Do you honestly believe it would be possible to raise a child from birth to adulthood limited to only positive reinforcement? And what type of child would result from this method of parenting?

What would I do in this situation? Perhaps I could teach her through senses that still worked, similar to what Derleth purposed. Perhaps some type of negative psychological association (yelling and screaming at her) along with teaching her how to escape it (avoidance would be tougher to teach). There is still the question of how much she can be taught. If I determined she lacked the cognitive awareness to recognize what’s happening, I would seek some form of professional help. Therapist or even pharmacist if necessary. Not to get to esoteric but alternatives such as hypnosis or biofeedback are at least worth considering. Physical restrictions would definitely be out of the question because of the long term ineffectiveness. Let’s be realistic here, would 24/7 supervision be possible or even best?

Marley23, I’ve already stated that I realized the error in my thinking, why are you still so obsessed with it? Looks like I’m not the one overreacting here. Judging from your above post, I don’t think you’re even reading what I write. Either that or you selective remember what you want and forget the rest. Let me try again, my OP was a kneejerk exaggeration in response to the shock of the article.

When I said “the girl” it was my shorthand for referring to the 5 year old in the article. What is it YOUR trying to imply?

If you go back and reread the posts, you’ll see I never initiated a attack. I was merely responding to the attack of others.

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Well, after much looking, the bottom line is that not a lot of controlled research has been done on kids who self-mutilate to this extreme. Not real surprising. Not many kids like this. I found one study with exactly two kids in it. One had positive reinforcement, which reduced the behavior, and this persisted after the trial ended, one had negative reinforcement, and this reduced the behavior, but it returned after the study was over.

But I did consult a friend of mine, a behavioral pediatrician, who’s been working in the field for 30 years, albeit mainly with ADD kids, and mainly normal or near normal IQ kids.

He basically says in his experience, more than 90% of the autophagia kids are profoundly retarded, and non-verbal. That stacks the deck against success in and of itself. Also the self mutilation behavior is related to stress, in that it’s a stress reduction behavior. Negative feedback raises their stress levels, and thus actually prolongs or increases the self-mutilation behavior.

His recommendation is to avoid negative feedback, concentrate on positive feedback, and protective (not necessarily restraining) devices. Sadly, he predicts bad outcomes whatever one does, but that avoiding punitive responses does generally result in a less-stressed child, and less of the unwanted behavior.

And no, I do not advocate avoiding all negative reinforcement. But I strongly advise avoiding it in these syndromes where it appears to do far more harm in good.

I can also strongly say that getting the caregiver of these unfortunate kids (and any parent of kids with chronic conditions) out of the ‘punishment’ mode makes for a happier family situation.

Negative reinforcement as a very episodic correction mechanism is one thing, but to use it multiple times in a day, day after day, eats at people’s souls. Not very scientific, I know. But as a parent of a child with multiple severe chronic illnesses, I have firsthand experience in the anger and fear and resentment that builds up with time, even with ‘verbal’ discipline’ on everyone’s part. One can end up thinking one is living in hell.

Basically, I’m pragmatic. If it works, use it. But all my training, and clinical experience, and personal experience and investigations tell me that for this type of kid, negative reinforcement is not the way to go. Not for moral reasons, or on philosophical grounds, but because I strongly believe it will make things worse, not better.

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After watching a great deal of storm and thunder in this thread, I think some of the kneejerk reactions and yelling come from the horror of someone chewing their own fingers off. I mean, it combines cannabalism, self-mutilation, and pain. That’s a really nasty combination.

And I understand that most folks would react to horror at the idea of yanking healthy teeth to keep a LND kid from chewing off his lips, or tying his hands down every morning, but we aren’t talking about choosing between abuse and treatment here. I can’t imagine anyone being happy about that “solution” - it’s an option only because no one has come up with anything better. It would be fantastic to have a pill with minimal side effects you could give a person like that to still this compulsion but we don’t have that. So… the “choice” is between a child who self-mutilates (and maybe hurts others, too) or a child whose physical mobility is limited but can be kept healthy, whole, and alive in the hope that a true, effective treatment can set him (or her) free of both restraints and compulsion.

I mean, it’s equally horrific to see a 5 year old quadraplegic in a wheelchair being kept alive by a respirator. It’s a horrible thing, but that’s what required to keep the person alive. Until we can fix a damaged spinal column or brain, though it’s either that or death. Likewise, a child with this sort of self-mutilation or lack-of-pain disorder poses a nasty dilemna

1 - you can ignore the problem - and wind up with a mutilated kid who will probably die very young from some horrific infection or traumatic accident.

2 - you can have someone watching and guarding the child 24 hours a day (including sleep - kids can chew on themselves in their sleep), 7 days a week, 365 days a year for life. Not practical, even in the wealthy West

3 - use a mix of restraints, medication, supervision, and so forth to minimize the behavior or the results of it.

IF the child have enough intellgence to be reasoned with (and there are lack-of-pain disorders that are not associated with mental retardation, the people have normal intelligence) when they grow older that intelligence can be harnessed to take over some of the burden from the caregivers, but until that point you have to keep the child alive and as intact as possible.

I’m sure, with the child in the story, there was considerable disbelief on the part of her guardians - this sort of self-mutilation is very hard for the average person to wrap their heads around, and I would expect knowledge of these disorders is not common, particularly in third-world peasent villages.

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Qadgop, I’m in complete agreement with most of your above post (especially the part about “eats at people’s souls”). I believe if a person can not be taught to mentally connect A with B then it would be pointless to continue with A. I suppose much of the flak I caught in this thread was from not stating what I thought clearly enough.

Normally, the mental limits of the person is not something I consider upon the first examination of a situation. I didn’t even think about possible mental retardation of that little girl until someone mentioned it here. Like I said earlier, I’ve not had much interaction with people IRL who suffer from a mental disorder or disease. It does play a major part in teaching a person, it’s just not something I’ve had much experience with. Therefore, I didn’t always factor it into preliminary considerations. That, of course, will be different from now on.

I still believe in the effectiveness of physical punishment in children capable of learning. However, I think that would be an altogether different debate. At least it seems we have similar thoughts regarding this matter. I hope I didn’t give you the wrong impression of me with my OP and my nickname (I’m fairly sure I did :)).