"Sorry, the bathroom is for employees only," the Domino's employee told me. I stared back at him and then looked over at my student Ryan. A stream of drool was running down the corner of his mouth, as usual, and he raised his eyebrows at me.
"Okay, Ryan, we're going to find a bathroom at another store," I told him. I made sure to say it with authority. With limited verbal skills and a diagnosis of pervasive developmental disorder (related to autism), Ryan had trouble understanding any but the clearest directions. Usually he trusted me to take care of him, but I knew I was pushing my luck.
In the time since Ryan had used a combination of speech and sign language to request the bathroom, Domino's was the second venue to turn us away.
This was exactly the kind of situation I strived to avoid. Ryan was clearly getting confused — he didn't understand why I hadn't taken him to a bathroom yet — and he did not handle confusion well.
We were walking back out across the parking lot, heading toward a nearby gas station, when he started to attack me, swinging his hands and arms aggressively at my face. I ran backward, keeping my eyes on him, shielding my face with my forearms.
He dropped his arms and thrust his head forward, nearly connecting with my jaw. I reached out, managed put my hands on his shoulders, and forced him to keep a safe distance. Urgently, I commanded, "Ryan, take a seat!"
He sat. I stood in front of him and caught my breath. He began showing his typical sign of calming down: an exasperated and indecipherable mumbling under his breath.
It was my fault. If I had remembered to send him to the bathroom before we left the residence, as I almost always did, this wouldn't have happened.
I looked around the small parking lot and the busy nearby street, then back up at the Domino's where the staff had denied our request for a bathroom. I had just been violently attacked in public, and in broad daylight, no less. But no one seemed to notice. No one came over to ask if I needed help or to see if we were all right. No one was even staring.
I took Ryan to the gas station nearby. They let us use the bathroom.
When I first started working at a residential school for students with complex disabilities, I had very little idea of what to expect. I was fresh out of college. I was living at home. I needed a job. I never had any particular interest in special education, and my degree in philosophy was hardly a road map to the pitfalls and challenges faced in a school specializing in students with violent behaviors. I told myself I would start the job, and if I found I wasn't cut out for it, I could always quit.
It turns out the head of human resources agreed. On the first day of training, she told me and my fellow new hires the same thing: "If you can't handle the work we do, that's fine; we'd rather you not stick around."
But I took to the job much more readily than I expected.
Here are seven things I learned about caring for students with developmental disabilities.
1) We know you notice us in public. But you don't always know what's going on.
When I would take my students into the community, to parks or stores or restaurants, people would sometimes stare. I understand why.
Many students draw attention to themselves, usually without meaning to. Carlos is constantly singing and dancing, even while he walks. Paula wears braces on her legs that alter her gait. Ryan always has saliva running down his chin. (I would frequently prompt him to clean it with a napkin, though it was Sisyphean task.)
When taking the students out, it never bothered me if they drew a little extra attention. If they were doing something I thought was silly, like making a funny voice, or rocking enthusiastically, or dancing, I would just smile or laugh, partially as a signal to other people that everything was fine.
If you do find yourself staring, don't beat yourself up about it. Watching people can be great fun, and while excessive staring is rude, it's often only natural to look over. But if you do, try to remember to smile. There's nothing less welcoming than a stone-faced glare.
But sometimes things do go wrong. Students draw attention to themselves even when they are being completely well-behaved, but other times, despite the meticulous planning that goes into any outing, they draw attention to themselves while acting out — like Ryan did in front of the Domino's.
Once, while walking out of a restaurant with a younger student named Molly, I got distracted. Molly bolted away from me, straight toward a stranger enjoying his pizza in peace. Just as he was raising a slice to his mouth, she ripped it out of his hands and began devouring it herself. I apologized, left some cash on his table to reimburse him, and hurried her out of the restaurant.
That was my fault. I should have known what Molly might do, and I should have been paying closer attention. But the poor man who had his pizza stolen was kind and understanding, and I deeply appreciated that.
Sometimes bystanders aren't so understanding. Sometimes they try to take matters into their own hands.
If you suspect someone might be in danger, or that a caretaker is losing control of the situation in public, don't panic. Certain behaviors are often less intense than they may appear, and the staff or family member with the individual who's acting out is likely very familiar with the behaviors. When Ryan attacked me in front of the Domino's, I was taken aback, but I was also able to manage the situation.
If possible, try to make eye contact with the family member or staffer accompanying the individual. If they need help, they will ask for it. Unless it is specifically requested, or someone is clearly injured, do not call 911. Police, by and large, are not well trained to deal with mental health crises. Calling 911 is very likely to make things worse.
2) Sometimes we physically restrain students — and yes, it's for their own good
Some people believe physical restraint is never really necessary. I used to be one of them. In my first interview, I was asked if I would be comfortable physically restraining students. I said yes — "You always say yes in a job interview," my mom always tells me — but in truth I had no idea if I would be okay with it, or even if it was morally right. Media didn't help: When restraint incidents reach the news, they're typically appalling, like the horrifying video of restraint combined with electric shock from the Judge Rotenberg Center, or this video of a cop handcuffing an 8-year-old with ADHD as a form of punishment.
Isn't this just a cruel, outdated form of control?some people ask. Can't we just do away with it entirely?
I wish we could, but we can't. In many cases, restraining a student is the kindest thing you can do for her.
For example: Restraint is often used when students are self-injurious. Students try to hurt themselves in all sorts of ways. Head banging is a stereotypical example, and it was common with many of the students I worked with. I once restrained a student who was trying to swallow screws. Sometimes these behaviors are purely attention-seeking, but many students may seriously injure themselves if they aren't physically blocked from doing so.
Other times they will hurt others. I ended up in the hospital several times due to student behavior, twice because of back injuries that rendered me unable to work for a week each time. A good friend took a head-butt to the face, forcing her to wear braces on her teeth for nearly a year. Even young students can be surprisingly strong and dangerous, and restraints are an effective method of ensuring safety under some circumstances.
And to be clear, that's the only justification for physical restraint: to keep everyone involved safe. Restraint should not be used as a form of punishment; consequently, any restraints should be the least restrictive possible, and the student should be released at the earliest sign that he will behave safely.
The alternatives, by the way, are worse. Beyond physical restraint — which may be uncomfortable but isn't life-altering — the only other realistic option for ensuring safety is chemical restraint, drugging up students so much that they are unable to aggress or hurt themselves. Many of our students were admitted to the school after being hospitalized for their conditions, and students coming from the hospital were often on such heavy doses of medication that they basically slept all day.
It's understandable why chemical restraints might be used in a hospital setting, but they are largely inappropriate for an educational environment. For those of us who have an interest in actually educating students, chemical restraints are not much help. You can't learn much on such high doses of medication, and it's hard to see the value in living that kind of life.
3) These students are capable of impressive progress, but they need professional help
Many of my students had considerable intellectual disabilities, and some tasks seemed to be completely beyond their grasp. But I never met one student who didn't end up surprising me in some way or another with a skill or interest.
More immediately, many of them can learn to overcome their most frightening and worrisome behaviors. Some days, the process is excruciatingly slow, like when after months of treatment, a student's decline in head banging from 90 instances a day to 75 is considered progress. But other times, the progress can be remarkable. One student I taught, Gideon, came to the residence where I worked as the most intimidating student I had ever met. My supervisor quit shortly after his arrival. When Gideon kicked me in the groin and then in the chest while trying to steal television sets from his peers, I thought about quitting, too.
But I stuck it out, and over time he improved.
When Gideon had an overnight visit with his parents after many months at our program, I went with three other members of the education staff to pick him up. When he saw us, he started crying, screaming, kicking, and banging his head. He tried to throw a picture frame at my face.
But we tried again, a few weeks later. This time it was bad — but it wasn't as bad. The time after that, only three staffers went. After that, it was just my boss and me who would pick him up.
Eventually I felt comfortable enough to pick him up on my own. When I would tell him it was time to go, he would pout, get dressed, pack up his things, kiss his mom, and walk with me to the car. Without even a single kick to my shins.
The "secret" to such improvement, in a lot of cases, is fairly old-fashioned behavioral therapy. Its modern form is known as Applied Behavior Analysis (ABA). ABA involves shaping a student's environment and social interactions such that positive behaviors are reinforced while negative behaviors are not.
As simple as this is to say, it can be much more difficult to actually implement. I firmly believe, despite much of the opprobrium surrounding institutional settings for those with mental illness, that often students like the ones I cared for are worse off at home with their families.
This is not because their families are abusive or neglectful. While unfortunately some are, many parents are clearly trying to provide the best lives for their children. Many of my students' parents have my undying admiration for the care they have given to their children, even when it is still not enough.
Parents lack the skills and resources to treat and respond to the most challenging behaviors. So when their son bangs his head against the wall because he doesn't want to go to school, the parents relent. This essentially guarantees that the behavior will reemerge the next day, or the next time he wants to avoid an activity.
When my student Lisa broke her toothbrush to avoid her daily brushing routine at one of our residences, we happened to have a closet full of extra toothbrushes. I told her that it was time to brush her teeth, and we were going to wait as long as it took. Additional staff was on hand, in case she became aggressive.
At one point, she picked up the plastic box containing her toiletries and threw it across the room. It shattered. (I suspect, had she liked me less, she would have thrown it at my head.)
I waited with her for an hour. Eventually, she wanted to get to school and see her friends. So she went to the bathroom and brushed her teeth, and we went to school. When it was time to brush her teeth the next day, she did it right away.
Parents and families are ill-equipped to have these standoffs over tiny, but vital, everyday activities, especially when they have other children to care for, or jobs to get to. I don't know if Lisa's parents ever made her brush her teeth at home. Who could blame them if they didn't?
Ideally, of course, all the students would live with and be taken care of by their families. But in the world we live in, some children need more care than their parents can provide.
4) Sometimes medication is necessary
Behavioral therapy boasts impressive results and frequently succeeds beyond expectations. But it can only do so much. While some behaviors are very difficult to treat for practical reasons, others are challenging for more fundamental, psychiatric reasons.
Medication can grease the gears of behavioral therapy, particularly when it comes to behaviors that appear to have no rational basis, such as compulsions or psychotic behavior. Some people are very resistant to the idea of medicating children with mental illnesses, but in my experience it can be a godsend.
Some mood disorders are so severe that they make pure behavior therapy nearly impossible. Had Lisa been so depressed that she didn't want to leave the house, waiting an hour for her to brush her teeth would have been ineffective. If Gideon's anger and anxiety weren't modulated by medication, he might never have been able to calmly leave his parents' house.
As I mentioned earlier, it's not desirable to chemically restrain these students. But the right meds, at moderate or low doses, can give them the ability to learn and the capacity to control their behaviors.
Unfortunately, psychiatric medication is still very much a guessing game. It's never a sure bet what combination of medications will do the trick, especially when you're also treating a student's nonbehavioral conditions like seizure disorders. And there are legitimate worries about the lifelong side effects of some medications, especially in younger students.
But there are also long-term effects from continually banging your head, or picking your skin, or having chronic mood swings.
I saw many students before and after changes to their medication regimens. Some of the meds helped, some did nothing, and some made things worse. But the capacity for improvement is clear, and good doctors know how to achieve and sustain progress.
5) People with mental disabilities are an important part of the police brutality conversation
It's been a year since I left the school, but I still worry about my students. I worry about them for all the obvious reasons — they're not on the right meds, a new maladaptive behavior may arise, they could develop health conditions that are difficult to treat, or they might hurt themselves or someone else before the staffers are able to prevent it.
But many of the students I worked most closely with have limited cognitive skills, and they will always be in programs that provide the necessary care. The students I worry most about are those with high IQs, for whom assistance throughout adulthood is less certain.
I've heard stories about students I've known who, despite the best efforts of the staff, have ended up living on the streets. And I've met homeless people on the streets of New York City that I know are not very different from some of the students I used to serve.
Students of mine have also tangled with the police. Thankfully, none of these incidents came to a tragic result, but they could have, and they might in the future.
When I saw video of police officers killing Kajieme Powell as he was wielding a knife but not clearly posing an immediate threat to the cops, I could imagine that happening to students I know. Many students I've known wouldn't know what was going on if a police officer aimed a firearm at them; others might know what was happening but not have the discipline or emotional stability to make a prudent choice in the moment.
When there's the chance that someone isn't of sound mind, pointing a gun at him is the last thing you should do. I say this because I've been physically attacked literally hundreds of times, sometimes by individuals significantly bigger and stronger than I am. In these cases, my goal has always been to defuse the situation, to reduce stress and tension as much as possible. Pulling out a firearm is the opposite approach — it escalates the situation.
Anyone who has ever had an argument with a child, or even a spouse or colleague, will know this. If you raise your voice, she'll raise her voice. You call him names, he'll call you names. Physical violence often works the same way.
Police seem to think that when they are armed and others are not, their superior force will produce submission. But when you are dealing with a mental health crisis, there's no reason to think rational forces will compel the individual to submit.
Educators trained and experienced in crisis prevention and behavioral therapy know how to deescalate these situations. But many people with mental illnesses, especially adults, don't have these support structures around them. It frightens me that outside of mental health centers and special education programs, police are most likely to be the first responders. We need to be giving them the training to effectively handle these individuals.
6) We don't pay mental health-care workers enough. The turnover hurts patients more than you think.
Turnover greatly impacts the quality of care. Many students with autism, in particular, are very resistant to and uncomfortable with change, and losing preferred staff members can be devastating.
But workers in the field of mental health care aren't paid enough, and combined with the difficulties of the job — in any given day, I might have been expected to act as manager, teacher, therapist, nurse, counselor, orderly, janitor, bus driver, advocate, tour guide, cook, and barber, with the care and attention of a parent or sibling — high turnover is virtually guaranteed, even among committed staff members.
As a result, places like where I used to work are frequently understaffed. That hurts the quality of care. Most of my co-workers wanted to do a great job for our students by helping them learn and have a high quality of life. But many still wind up moving on to another school or occupation, often because the pay simply cannot justify sticking around. They leave, and their positions, unable to offer compensation commensurate with the talent required, often remain open for a while, increasing the likelihood that less than ideal candidates will be hired.
Even excellent new staffers must figure out the best way to interact with each student. Every student has her own idiosyncrasies, quirks, and triggers, and responds best to only certain kinds of interactions. Those take time to learn, regardless of ability. I once had a student who always walked too far ahead of the group during nature walks; when asked to wait up, he would bang his head. I eventually found that if I directed the instruction to another student, or to the group, he would comply with the direction without getting upset. This knowledge greatly improved his quality of care, but it was also hyper-specific, the kind of thing that takes a long time to learn about any given student. A constant stream of new teachers, even a stream of talented ones, usually won't stick around long enough to undergo the trial and error required to learn something like that about more than a handful of students.
If we want good people to work in this field, and if we want them to stick around, we have to pay them more for the work they do. And believe me, they earn it.
7) You don't have to be a saint to do this job. You just have to be willing to adapt.
I worked at the school for three years, and I eventually left to go to graduate school. I stuck around as long as I did because, for all the challenges, I loved the work more than I ever would have guessed.
It breaks my heart to know that most of the students I was closest to do not understand where I've gone or why I've left. (One of them who does understand asked, when I told him I was leaving to go to school, said, "But we're at a school right now!" Apparently he forgot why I said I was leaving, because when I returned for a visit after several months, he exclaimed, "How long was your vacation?!")
Some people are really surprised when I say that I miss it, or that I stayed so long when I didn't have to. These people often claim, perhaps thinking they're giving me a compliment, that it "takes a saint" to work at that kind of school.
I resent the implication that working with "those kids" is such a burden. In truth, they are often great students, and you develop a fondness for them very quickly. And I guarantee that any student you might think is the toughest or most challenging to work with is somebody's favorite pupil.
And while I have discussed many of the things that make the job hard, we are often able to cope and adapt to much more than we think we're able to. Physically restraining violent students sounds very difficult, I'll grant. And for some people, the prospect of assisting others with their hygiene is nearly unthinkable. But you adapt.
Any profession presents its challenges, and you ease your way into figuring out how to handle them. If I had known the kinds of students I would end up working with on a daily basis when I first applied for the job, I probably wouldn't have accepted the offer. But just as a skier doesn't start with a black diamond, you work your way up to dealing with the biggest challenges. And you learn from those around you.
There's a lot to love about working in special education. There's something very rewarding about clear, important goals and the success that can be achieved. Any day, week, or year will have its ups and downs, but it's very nice to know that you share a purpose of educating and improving the lives of students who face significant challenges. Additionally, many of the challenges are complex and multifaceted, which keeps the work consistently interesting and engaging.
I feel privileged to know the students I worked with and to have developed relationships with them. Helping them learn and succeed was a huge part of this. But so too were the moments when we would play games, or enjoy a meal, or watch a movie together.
There were many days when I was lucky enough to take some of my favorite people in the world on a beautiful walk around a sunny park. Those days didn't feel much like work.
Cody Fenwick is a writer and graduate student in New York City. His work has previously appeared in Cognoscenti.
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