1. Addressing Challenging Behaviors Using the Neurobehavioral Approach
February 10, 2016

2. 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

3. Diane Malbin
Trying Differently
Rather than Harder

4. 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

5. NB Approach
Brain is source of behaviors and this Gives us a different lens with which to think about behavior

6. 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

7. Physical Changes
Cause structure and functioning of brain to be different
invisible physical disabilities

8. “Conceptual Glue” underlying this approach
is that the brain is damaged
“Conceptual Glue”

9. 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***

10. Diagnosis alone insufficient
need this conceptual piece
to inform recommendations

11. Neurodiversity produces a variety of characteristics (primary, secondary, tertiary)

12. Primary Characteristics
Behavioral symptoms based on
differences in brain structure and function,
including strengths

13. 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

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

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

16. Processing difficulties
receptive and expressive language

17. 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)

18. 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)

19. 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???

20. Traditional therapies are based on these same executive functions
Cause and effect
Generalization
Working memory
Problem solving
Flexible thinking
Self-monitoring

21. 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

22. What are your reactions to being forced to “fit?”

23. Typical Reactions to unrealistic expectations
Anxiety
Frustration
Anger
Fatigue
Isolation
Withdrawal
Fear
Depression

24. Poor fit 
problems

25. AND Accumulation of Diagnoses
ADHD
Mood Disorder
RAD
OCD
ODD
Anxiety Disorder
Conduct Disorder
Oppositional Disorder

26. 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

27. 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

28. Standard Interventions include
Time out
Sticker charts
Rewards of food
Grounding, suspension
Threats, bribes
Lecturing

29. BUT
to have these practices work, the brain has to do exactly what it may not be able to do

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

31. instead the Atypical Brain
Slow processing
Difficulty predicting
Does one task at a time
Problems w/memory
Dysregulation
Easily overstimulated
Difficulty problem solving

32. So must take the brain differences into account in our approaches with these individuals

33. 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

34. Good fit
Appropriate accommodations will alleviate chronic frustration, failure, isolation

35. Strategies and Accommodations
Come from understanding the nature of the disability: Brain Damage

36. Identify & build on strengths
to help prevent frustration and to support positive outcomes

37. Not WON’T, but
CAN’t

38. Kathy Hotelling, Ph.D. Navigating Life with FASD 919-265-3390