© fascets, inc. ppc teleconference january 27, 2015 fetal alcohol / neurobehavioral conditions:...

© FASCETS, Inc.

PPC TeleconferenceJanuary 27, 2015

Fetal Alcohol / Neurobehavioral Conditions: FA/NBTrying Differently Rather than Harder

Understanding and Application of a Brain-based Approach

Diane V. Malbin, MSW

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Neurobehavioral Foundation

What if brain function has something to do with behaviors? It’s just a question…

What’s the brain got to do with it?

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Logic model:Is FA/NB a physical condition?

1. Alcohol, drugs, other teratogens and trauma kill cells and cause physical changes in the brain

2. Physical changes affect the structure and function of the brain

3. Behaviors are usually the only symptoms

4. FA/NB is an invisible physical disability with behavioral symptoms

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Conceptual framework:If FA/NB is an invisible physical

disability

Then Providing accommodations for people with FA/NB is as appropriate and effective as providing accommodations for people with other physical disabilities

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Examples of success

• Artist, musician• Lecturer on FASD• Electrician• Boat builder• Mechanic• Child care worker• Animal rescue worker• Drummer, dancer• BA, MA, MSW, PhD

• Office worker• Special ed. teacher• Counselor• Massage therapist• Truck driver• Husband, wife• Delivery person• Parent• Adult care worker

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Examples of birth parents

Teacher

Physician

Therapist

Office worker

PhD

Attorney

Famous peoples’ children

Administrator

Friend

Neighbor

Supervisor

Supervisee

Relative

Spouse

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Paternal Use: Findings of effects on pregnancy outcome

1. Low birth weight

2. Impaired cognitive skills, increased hyperactivity in sons of alcoholic fathers

3. Changes in behaviors of sons of alcoholic fathers

4. Low count and altered structure of sperm

5. Lower rates of pregnancies; sons were less fertile

6. Decreased activity of sperm and lower testosterone levels

7. Effects on epigenetics, or expression of genes on cognitive functioning

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Comparison: Effects of drugs on prenatal development

Effects: Alcohol Cocaine Marijuana

Low birthweight

X X

Intellect,Development X

Organdamage X

Hyperactivity X XSource: US Department of Health and Human Services

X

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Keith L. Moore

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Myelin sheath

Dendrites

Nuclei

• Axons

Processes quickly

Many interconnections

Demyelination, processes slowly

Fewer interconnections

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Neurobehavioral screening tool

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Definition:Primary characteristics

Behavioral symptoms associated with differences in brain structure and function

Strengths are also primary characteristics

Source: Ann Streissguth, 1996

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Primary characteristics

1. Developmental level of functioning

2. Sensory systems

3. Nutrition

4. Language and communication

5. Processing pace: How fast the brain works

6. Learning and memory

7. Abstract thinking

8. Executive functioning

9. Strengths

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Uneven development 6-year-old

Actual age of person:____6

Developmental age---3

Strengths (art, sports)----------------10

Expressive language------------8

Receptive language-2

Reading ------------------4

Comprehension ----3

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Uneven development adolescent

Actual age of person: 18

Developmental age--------9

Strengths (art, sports)----------------------------24

Expressive language---------------------20

Receptive language----8

Reading ---------------------------14

Comprehension ------7

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Learning strengths

• Relational: 1:1

• Visual

• Auditory

• Hands-on

• Kinesthetic -- see, touch, move

• Experiential -- learns by doing

• Multimodal -- uses all senses

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Definition:Secondary characteristics

Secondary defensive behaviors develop over time when there is a “poor fit”

Defensive behaviors are normal reactions to pain and are preventable

Adapted from: Ann Streissguth, 1996

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Anonymous, with permission

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Secondary behavioral symptoms

• Easily tired, fatigued

• Anxious

• Lonely, isolated

• Shut down; flat affect

• Fearful, withdrawn

• Depressed

• Frustrated, short fuse, angry

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Are the net result of a chronic poor fit, failure, isolation and alienation: As an extension of secondary behaviors, these are also preventable.

•Trouble in school•Social services involvement•Involvement with justice•Homelessness•Addictions/ mental health issues, suicide

Tertiary symptoms

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Accumulation of DSM diagnoses:Short list

Primary characteristics

Attention Deficit DisorderIntellectual Disability (Intellectual Dev. Disorder ICD 11)Language DisorderAutism Spectrum Disorder

Secondary characteristics

Reactive Attachment DisorderOppositional Defiant DisorderPost-traumatic Stress Disorder / TraumaGeneralized Anxiety DisorderPersonality Disorder

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Following diagnosis, then what?

What is seen as the problem?

What do we do to try to change behaviors?

Note: Sometimes a person has FA/NB and other diagnoses. Brain function trumps behaviors. Start there.

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Fit between technique and abilityStrategy example: Talking

Assumptions about Brain function: Store information……………….Retrieve information……………Form associations………………Abstract………………………….Generalize……………………….Predict……………………………Conceptualize…………………..Process quickly………………….

Research on FA/NB hasFound brain differences:

Difficulty with memoryDifficulty retrieving informationDifficulty forming links Concrete Difficulty generalizingDifficulty predictingGets piece, not pictureProcesses slowly

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Behavioral techniques based on learning theory are used in all

systems:

ParentingEducation

JusticeMental health

Addictions treatmentSocial services

Others

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What if?

What if behaviors are symptoms of brain function?

Would strategies to help a child see work for a child who is blind?

What is more appropriate and effective?

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Between sessions activities

Next month’s teleconference will focus on shifting thinking and

developing strategies. It will be based on observations

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The importance of observation

• To observe without interpreting or assigning meaning

• To factor in brain function

• To move from crises to identifying patterns

• To depersonalize behaviors

• To clarify points of intervention and problem prevention

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Interpret or Observe?

Nice

Inappropriate

Mean, did it on purpose

On purpose

Doesn’t care

Based on what behavior?

Describe action!

Exactly what happened?

How do you know?

Describe affect. Flat?

The goal is to observe without assigning values-laden meaning to the person or situation

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Observation log

1. Complete screening tool

2. Note if behaviors are primary or secondary

3. Observe what happened1. Who, what, where when?

2. Were there any unexpected changes?

4. Note personal feelings

5. Accommodation?

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Application: Functional Neurobehavioral Assessment

A systematic approach to developing person-specific accommodations in all

settings and managing the complexity of FA/NB

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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

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Setting: ___School___________ Age: _6_ Developmental age: _3_

1

Task or Expectation

2

Brain has to

3


4

Devel. Age

(estimate)

5

Secondary

behaviors

5

Strengths

6

Accommodations

Listen, learn

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1

Task or Expectation

2

Brain has to

3


4

Devel. Age

(estimate)

5

Secondary

behaviors

5

Strengths

6

Accommodations

Listen, learn Process fast

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1

Task or Expectation

2

Brain has to

3


4

Devel. Age

(estimate)

5

Secondary

behaviors

5

Strengths

6

Accommodations


Slow processing pace

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1

Task or Expectation

2

Brain has to

3


4

Devel. Age

(estimate)

5

Secondary

behaviors

5

Strengths

6

Accommodations



3

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1

Task or Expectation

2

Brain has to

3


4

Devel. Age

(estimate)

5

Secondary

behaviors

5

Strengths

6

Accommodations



3 Frustration

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1

Task or Expectation

2

Brain has to

3


4

Devel. Age

(estimate)

5

Secondary

behaviors

5

Strengths

6

Accommodations



3 Frustration Visual learner

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1

Task or Expectation

2

Brain has to

3


4

Devel. Age

(estimate)

5

Secondary

behaviors

5

Strengths

6

Accommodations




Provide visual cues, use fewer words

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1

Task or Expectation

2

Brain has to

3


4

Devel. Age

(estimate)

5

Secondary

behaviors

5

Strengths

6

Accommodations





Be age-appropriate

Develop “on time”

Dysmaturity 3 Isolation depression

Willing, relational

Adjust expectations: “stretch toddler”

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1

Task or Expectation

2

Brain has to

3


4

Devel. Age

(estimate)

5

Secondary

behaviors

5

Strengths

6

Accommodations





Be age-appropriate

Develop “on time”

Dysmaturity 3 Isolation

Depression

Willing, relational

Adjust expectations,

“Stretch toddler”

Sit and learn, paper and pencil

Ability to abstract

Concrete, difficulty with abstraction

2 Anger, frustration,

avoidance

Learns by doing

Hands-on

Kinesthetic

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Setting: __Mental Health__ Age: _32_ Developmental age: _15_

1

Task or Expectation

2

Brain has to

3


4

Devel. Age

(estimate)

5

Secondary

behaviors

5

Strengths

6

Accommodations

Cognitive behavioral techniques

Abstract, analyze

Concrete, literal

14 May not finish assignments

Artistic, experiential

Art, drama, music, relationship, role modeling

Communicate Process language


12 Anger, frustration

Determinedcreative

Art, drama, music, poetry

Apply new knowledge

Store, retrieve and generalize

Memory problems, difficulty generalizing

16 Defensive Relational Teach in different settings, use mentor

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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

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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

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General starter strategies

Stop fighting

Ask: What if?

Think younger

Give time

Recognize strengths

Breathe

Be kind to yourself

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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. ppc teleconference january 27, 2015 fetal alcohol / neurobehavioral conditions:...

Documents

strengths slide

msw slide

moore slide

physical disabilities

cognitive functioning

human services x slide

brain structure

brain function