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

NB framework is relevant 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

“Conceptual Glue” 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 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

Often interrupts/intrudes Sensory systems challenges Communication differences Difficulty initiating & following through Lack of comprehension of time

Uneven Development Chronological Age 18 Developmental Age 9 Strength (i.e.,art) 24 Expressive Language 12 Receptive Language 9 Reading 12 Comprehension 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)

also important considerations Learning styles also important considerations 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 Secondary Disabilities/Realities 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 Anxiety Frustration Anger Fatigue Isolation Withdrawal Fear Depression

Poor fit  problems

AND Accumulation of Diagnoses 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

because of brain differences, which are not taken into account 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 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

Think fast Think sequentially Multi-task Learn, remember, apply Regulate emotions Manage sensory input Problem solve

instead the Atypical Brain 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 NB Approach Behaviors are intentional or from psychopathology Person is problem Behaviors are problems and must be changed Multiple dx, meds, tx Behavioral issue 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