Transcript Ain`t Just Misbeaving

Addressing Challenging
Behaviors Using the
Neurobehavioral Approach
February 10, 2016
Explanation and introduction to the neurobehavioral approach
 Discuss the importance of a good fit between the child and her/his
environment
 Demonstrate application of the NB approach to 1-2 specific situations
OBJECTIVES
Diane Malbin
Trying Differently
Rather than Harder
www.fascets.org
Teratogens
Over 50,000 tetragons and pre/ and/or
postnatal events that can cause brain damage
↓
50,000 different factors that can contribute to
similar symptoms to those of FASDs
NB framework is relevant
regardless of cause
NB Approach
Brain is source of behaviors
and this
Gives us a different lens with which to
think about behavior
• Looking at etiology, not surface symptoms
• Gives us different understanding of
– the individual
– her/his behaviors
• Working from research on alcohol exposed
brains to inform interventions
• Not one size fits all
Physical Changes
Cause structure and functioning of brain to be
different
invisible physical disabilities
underlying this approach
is that the brain is damaged
“CONCEPTUAL GLUE”
This means that
Providing accommodations for such invisible
physical differences is as appropriate and
essential as providing accommodations to
those whose physical disabilities can be seen
***achieve change through accommodations
not through changing the person***
Diagnosis alone insufficient
need this conceptual piece
to inform recommendations
Neurodiversity
produces a variety of
characteristics
(primary, secondary, tertiary)
Primary Characteristics
Behavioral symptoms based on
differences in brain structure and function,
including strengths
Primary Characteristics
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Developmental dysmaturity
Easily distracted by extraneous stimuli
Lack of follow through on instructions
Lack of understanding/consideration of
consequences
• Difficulty organizing tasks & activities
• Lack of impulse control
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Often interrupts/intrudes
Sensory systems challenges
Communication differences
Difficulty initiating & following through
Lack of comprehension of time
Uneven Development
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Chronological Age
Developmental Age
Strength (i.e.,art)
Expressive Language
Receptive Language
Reading
Comprehension
18
9
24
12
9
12
8
Processing difficulties
receptive and expressive
language
Strengths (exceptional abilities)
Identification is important
in considering ways of interaction: How can these
be utilized in learning, as well as in avocations and
in job settings?
(Examples: artistic, mechanical, hard working,
willingness to try new things, musical, athletic,
affability, loves animals)
Learning styles
also important considerations
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Kinesthetic----see, touch, or move
Experiential----hands on---learns by doing
Visual
Auditory
Multimodal----uses all senses
Relational (1:1)
Executive functions
So much of day to day life is based
on executive functions
What did you have to think about to add this
workshop to your schedule tonight???
Traditional therapies are based on these same
executive functions
 Cause and effect
 Generalization
 Working memory
 Problem solving
 Flexible thinking
 Self-monitoring
Secondary
Characteristics
Problems that are not part of
neurodiversity per se
rather a result of
expectations
that child is neurotypical
POOR FIT
normal defensive reactions
What are your reactions to being
forced to “fit?”
Typical Reactions
to unrealistic expectations
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Anxiety
Frustration
Anger
Fatigue
Isolation
Withdrawal
Fear
Depression
Poor fit 
problems
AND
Accumulation of Diagnoses
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ADHD
Mood Disorder
RAD
OCD
ODD
Anxiety Disorder
Conduct Disorder
Oppositional Disorder
Common Secondary Realities*
(tertiary results) for those with FASDs
• Mental health problems (90%)
• Problems with employment
(80%)
• Dependent living (80%)
• Victims of physical/sexual abuse
or domestic violence (72%)
• Disrupted school experience
(60%)
• Inappropriate sexual behaviors
(50%)
• Confinement (50%)
• Alcohol & drug problems (30%)
*The Streissguth Study
TRADITIONAL INTERVENTIONS IN HOME AND
THERAPIES OFTEN INEFFECTIVE WITH THOSE
WITH NEURODIVERSE INDIVIDUALS
because of brain differences, which are not
taken into account
Standard Interventions include
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Time out
Sticker charts
Rewards of food
Grounding, suspension
Threats, bribes
Lecturing
BUT
to have these practices work,
the brain has to do exactly
what it may not be able to do
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Think fast
Think sequentially
Multi-task
Learn, remember, apply
Regulate emotions
Manage sensory input
Problem solve
instead the
Atypical Brain
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Slow processing
Difficulty predicting
Does one task at a time
Problems w/memory
Dysregulation
Easily overstimulated
Difficulty problem
solving
So must take the brain
differences into account in our
approaches with these
individuals
Differences in Approaches
Standard Approach
• Behaviors are intentional or
from psychopathology
• Person is problem
• Behaviors are problems and
must be changed
• Multiple dx, meds, tx
• Behavioral issue
NB Approach
• Behaviors are symptoms of
brain differences
• Person has problem
• Alter environment for
success
• Etiology
• Physical disability with
behavioral symptoms
Good fit
Appropriate accommodations will
alleviate chronic frustration, failure,
isolation
Strategies and Accommodations
Come from understanding
the nature of the disability:
Brain Damage
Identify & build on strengths
to help prevent frustration
and
to support positive outcomes
Not WON’T, but
CAN’T
Kathy Hotelling, Ph.D.
Navigating Life with FASD
919-265-3390
www.kathyhotelling.com
www.facebook.com/navigatinglifewithfasd