© FASCETS, Inc. PPC Teleconference February 24, 2015 Fetal Alcohol / neurobehavioral conditions: FA/NB Trying Differently Rather than Harder Understanding and application of a brain-based approach Diane V. Malbin, MSW

© FASCETS, Inc. Session 1: Thoughts, observations? 1.One important or new point? 2.One thing you learned about your child? 3.Observation logs 1.One thing you’ve observed 2.One example of seeing things differently 4.Feelings

© FASCETS, Inc. Session 2 1.Feelings and emotions: They’re normal 2.Now what? Trying differently rather than harder

© FASCETS, Inc. EMOTIONS Where do those strong feelings about behaviors come from?

© FASCETS, Inc. Values and values clashes Primary characteristic Values, expectations Interpretation / Feelings InterventionSecondary symptom Accommodation: Build on strengths

© FASCETS, Inc. Values and values clashes Primary characteristic Values, expectations Interpretation / Feelings InterventionSecondary symptom Accommodation: Build on strengths DysmaturityAct your age Being a baby, Lazy, not trying Frustrated PunishAnxiety, anger Think younger Adjust expectations Confabulation Honesty Lying, manipulative, “At me” Fear, angry sad Punish, groundAnger, denial Recognize brain dysfunction, alter communication Memory problems Remember “Should” know!! Angry frustratedRemove privileges Anger, frustration Accept need to reteach, based on learning strengths Slow processing pace Value speed – think fast Not trying, withholding, on purpose Angry, frustrated Speed up, yell, embarrass Shut down, fear, avoidance, withdrawal SLOW DOWN! Use fewer words Difficulty generalizing, gets the piece, not the picture Know and apply concepts in different settings Breaking the rules, Should understand concepts in all settings Angry, frustrated ConsequenceConfusion, anxiety, frustration anger Show rather than tell, reteach in different settings

© FASCETS, Inc. Poor fit FA/NB Characteristic Visual learner……… Processes slower………. Needs external support.. Difficulty organizing……. Concrete…………… Strategy / expectation Verbal instruction Fast paced Work independently Organize, prioritize Abstract

© FASCETS, Inc. Good fit: Accommodations FA/NB Characteristic Visual learner……… Processes slower………. Needs external support.. Difficulty organizing……. Concrete…………… Strategy Provide visual cues Allow adequate time Provide supports Provide structure Teach experientially, build on strengths

© FASCETS, Inc. Fit and behaviors Poor fit = challenging secondary behaviors Good fit = prevent or reduce challenging behaviors Build on strengths: Round peg, round hole

© FASCETS, Inc. Application: Functional Neurobehavioral Assessment A systematic approach to developing person-specific accommodations in all settings and managing the complexity of FA/NB

© FASCETS, Inc. Application: Functional Neurobehavioral Assessment Setting:____________________ Age: ___ Developmental age: ___ 1 Task or Expectation 2 Brain has to 3 Primary symptoms FA/NB 4 Devel. Age (estimate) 5 Secondary behaviors 5 Strengths 6 Accommodations

© FASCETS, Inc. Application: Functional Neurobehavioral Assessment Setting: ___School___________ Age: _6_ Developmental age: _3_ 1 Task or Expectation 2 Brain has to 3 Primary symptoms FA/NB 4 Devel. Age (estimate) 5 Secondary behaviors 5 Strengths 6 Accommodations Listen, learn

© FASCETS, Inc. Application: Functional Neurobehavioral Assessment Setting: ___School___________ Age: _6_ Developmental age: _3_ 1 Task or Expectation 2 Brain has to 3 Primary symptoms FA/NB 4 Devel. Age (estimate) 5 Secondary behaviors 5 Strengths 6 Accommodations Listen, learnProcess fast

© FASCETS, Inc. Application: Functional Neurobehavioral Assessment Setting: ___School___________ Age: _6_ Developmental age: _3_ 1 Task or Expectation 2 Brain has to 3 Primary symptoms FA/NB 4 Devel. Age (estimate) 5 Secondary behaviors 5 Strengths 6 Accommodations Listen, learnProcess fast Slow processing pace

© FASCETS, Inc. Application: Functional Neurobehavioral Assessment Setting: ___School___________ Age: _6_ Developmental age: _3_ 1 Task or Expectation 2 Brain has to 3 Primary symptoms FA/NB 4 Devel. Age (estimate) 5 Secondary behaviors 5 Strengths 6 Accommodations Listen, learnProcess fast Slow processing pace 3

© FASCETS, Inc. Application: Functional Neurobehavioral Assessment Setting: ___School___________ Age: _6_ Developmental age: _3_ 1 Task or Expectation 2 Brain has to 3 Primary symptoms FA/NB 4 Devel. Age (estimate) 5 Secondary behaviors 5 Strengths 6 Accommodations Listen, learnProcess fast Slow processing pace 3Frustration

© FASCETS, Inc. Application: Functional Neurobehavioral Assessment Setting: ___School___________ Age: _6_ Developmental age: _3_ 1 Task or Expectation 2 Brain has to 3 Primary symptoms FA/NB 4 Devel. Age (estimate) 5 Secondary behaviors 5 Strengths 6 Accommodations Listen, learnProcess fast Slow processing pace 3FrustrationVisual learner

© FASCETS, Inc. Application: Functional Neurobehavioral Assessment Setting: ___School___________ Age: _6_ Developmental age: _3_ 1 Task or Expectation 2 Brain has to 3 Primary symptoms FA/NB 4 Devel. Age (estimate) 5 Secondary behaviors 5 Strengths 6 Accommodations Listen, learnProcess fast Slow processing pace 3FrustrationVisual learner Provide visual cues, use fewer words

© FASCETS, Inc. Application: Functional Neurobehavioral Assessment Setting: ___School___________ Age: _6_ Developmental age: _3_ 1 Task or Expectation 2 Brain has to 3 Primary symptoms FA/NB 4 Devel. Age (estimate) 5 Secondary behaviors 5 Strengths 6 Accommodations Listen, learnProcess fast Slow processing pace 3FrustrationVisual learner Provide visual cues, use fewer words Be age- appropriate Develop “on time” Dysmaturity 3Isolation depression Willing, relational Adjust expectations: “stretch toddler”

© FASCETS, Inc. Application: Functional Neurobehavioral Assessment Setting: ___School___________ Age: _6_ Developmental age: _3_ 1 Task or Expectation 2 Brain has to 3 Primary symptoms FA/NB 4 Devel. Age (estimate) 5 Secondary behaviors 5 Strengths 6 Accommodations Listen, learnProcess fast Slow processing pace 3FrustrationVisual learner Provide visual cues, use fewer words Be age- appropriate Develop “on time” Dysmaturity 3Isolation Depression Willing, relational Adjust expectations, “Stretch toddler” Sit and learn, paper and pencil Ability to abstract Concrete, difficulty with abstraction 2Anger, frustration, avoidance Learns by doing Hands-on Kinesthetic

© FASCETS, Inc. Application: Functional Neurobehavioral Assessment Setting: __Mental Health__ Age: _32_ Developmental age: _15_ 1 Task or Expectation 2 Brain has to 3 Primary symptoms FA/NB 4 Devel. Age (estimate) 5 Secondary behaviors 5 Strengths 6 Accommodations Cognitive behavioral techniques Abstract, analyze Concrete, literal 14May not finish assignments Artistic, experiential Art, drama, music, relationship, role modeling CommunicateProcess language Slow processing pace 12Anger, frustration Determined creative Art, drama, music, poetry Apply new knowledge Store, retrieve and generalize Memory problems, difficulty generalizing 16DefensiveRelationalTeach in different settings, use mentor

© FASCETS, Inc. Brain = behaviors Brain changes = behavioral changes

© FASCETS, Inc. General starter strategies Stop fighting Ask: What if? Think younger Give time Recognize strengths Breathe Be kind to yourself

© FASCETS, Inc. Advocacy: Success 1.Trust yourself 2.Accept that you have to teach others 3.Don’t settle for “good enough.” Is it? 4.Never, never, never, never give up Churchill

© FASCETS, Inc. Review 1.FA/NB is a brain-based physical disability 2.Reframe behaviors: Neurobehavioral Screen -- primary, secondary and tertiary symptoms 3.Application: Observation. Fit and accommodations Functional neurobehavioral assessment

© FASCETS, Inc. Diane V. Malbin, M.S.W. FASCETS PO Box Portland, OR