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Behavior Characteristics of Prader-Willi Syndrome Cindy Stolp. Prader-Willi syndrome (PWS). PWS is a chromosomal disorder from a deletion or disruption of genes in the proximal arm of chromosome 15. Deletion 70%. Chromosome 15. Imprinting defect – 5% (pwsausa.org). Maternal Disomy – 25%.
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Prader-Willi syndrome (PWS) PWS is a chromosomal disorder from a deletion or disruption of genes in the proximal arm of chromosome 15 Deletion 70%
Chromosome 15 Imprinting defect – 5% (pwsausa.org) Maternal Disomy – 25%
1 in 12-15,ooo Rare disorder But PWS is the most common genetic cause of obesity All races Both sexes (pwsausa.org) Prader-Willi Syndrome
Diagnosis often delayed until early childhood. Genetic testing detects nearly 100% of Prader-Willi Syndrome Diagnosis
Difficulty feeding Poor sucking reflex Failure to thrive Hypotonia Early developmental milestones are delayed Newborns
Difficulty with feeding transitions into hyperphagia After the 1st year Victor 9 months Victor 24 months
What doesn’t work Appetite suppressants What has worked Extremely low-calorie diet (their entire life) Limited access to food Treatment
Prader-Willi Food Pyramid • Typical person – 1600 – 2800 calories per day • Person with PWS – 800 – 1200 calories per day • Vegetables make up the bulk of the recommended diet
Almond Shaped Eyes Eye Abnormalities (Esotropia & myopia) Thin upper lip Narrowing of the temples Common Facial Characteristics
Short stature Relatively small hands Relatively small feet Between 1-6 progress into development of morbid obesity Common Characteristics
Primary care physician Ophthalmologist Pediatric endocrinologist OT PT Speech Therapist ECSE & Special Education Recommended Team Members
Temper tantrums Stubbornness High pain threshold Sleep disturbances Obsessive compulsive behaviors Repetitive thoughts Verbalizations Collecting & hoarding possessions Picking at skin Behavior Problems
Garbage Leftovers from cafeteria trays Scraps off the floor Frozen food Stealing to obtain food Dangerous High threshold for pain Decreased ability to vomit Need to Seek Food
Need for Routine & Consistency Strategies • Visual schedules or lists • Discuss changes in schedules or staff • Provide praise for flexibility • Breakdown procedures into concise steps
Obsessive Thinking Strategies • Less is best – give smaller amount of work at one time • Don’t give more info than necessary • Use”strategic timing” – schedule an activity they have difficulty ending right before snack or lunch
Emotional Control • Strategies • Over stimulation in crowded hallways – enter & exit school in a less populated area • At the beginning of the day, review the daily schedule to help decrease anxiety • Encourage communication • Listen carefully • Teach, reteach & practice frustration coping strategies • Don’t try to reason with them when out of control
Food Cravings • Educate all people working with the student • They will lie to get food, “I didn’t have breakfast this morning” – check with parents • Avoid letting them have money – • money buys food • Don’t delay snacks • Limit the visibility of food • Be aware of smells – popcorn • Avoid using food as a reward or incentive
Poor Stamina • Strategies • Send them on an errand – take a walk • Schedule high energy activity after lunch • Deep breathing activities – balloons • Schedule rest times or quiet activities
Scratching & Picking Skin • Strategies • Keep hands busy – playdoh, hand held games • Keep nails short • Apply lotion liberally – keeps the skin moist and slippery
Baby monitors Security system with alarms Motion detectors 160 degree mirrors (see what’s going on behind you) Security
Recent research • The brain’s pleasure center • 3x as much neurotransmitter gammaaminobutyric acid in their blood • Neurotransmitters inhibit dopamine
1999 U.S. Supreme Court • “Developmentally disabled people must be given the choice to live in the community if they can be supported there.” • www.pwsaa.org
Learning disabilities are always present Ranging from Low normal intelligence To mental retardation Global Delays
Mainstreamed into classroom Need additional physical activity periods
Appear to be Lazy & lack motivation Manipulative, Lying & stealing Lack of empathy & Lack of conscience Stubborn Temperamental Controlling Perspective on Behaviors(Teresa Kellerman)