biology vs behavior - ip day powerpt

8/14/2019 Biology vs Behavior - IP Day powerpt

1/31

Biology vs. Behavior:an interactive seminar

IEP Day April 11, 2008

Joshua D. Feder, MD

Faculty, Interdisciplinary Council on Developmental and LearningDisorders


2/31

The Problem:

How do we tell the difference if a

behavior is due to the diagnosis,and therefore harder or perhapsimpossible to treat, or is a learnedbehavior that might be more easilyremoved?


3/31

The Problem:

Attitudes

Supratentorial

Mind vs. Body

Its a Behavior


4/31

Attitude is Everything

We tend to externalize the problem instead of the-buck-stops-here.

We tend to take it personally when

we do not have the answer We tend to blame instead of thinking

productively


5/31

The Blame Game

Blame the person

Blame the family

Blame the illness All of these tend to be reductionistic

and unhelpful


6/31

Getting Past it

A better response? Pull it apart and sort it out

Accept that it will be complicated

Solutions will be imperfect, but, wehope, helpful


7/31

The range of symptoms:

Hard-wired: e.g., pure mania, pure

tics Grey area: e.g., the early part

before many a wild-eyed tantrum

Totally learned: whining, look & hit YOUR IDEAS HERE:


8/31

Deconstructing the

symptom:

Biological factors

Psychological functioning

Social/ environmental


9/31

mm n Bi l i l F t r I:

Sensory processing and integration

disorders Motor tone, function and planning

disorders

Central auditory processingdisorders; receptive and expressivelanguage disorders

-


10/31


11/31

Common Psychological

Factors I:Square peg, round hole

Discouraged kids

Anxious kids Frustrated kids


12/31


13/31

Triggers and Responses:ll tin D t

Date and time

Place What happened?

What happened before that?

What happened after that?

What else is going on?


14/31

ABCs

Antecedants

Behaviors

Consequences


15/31

But its more than ABCs

Hydra 5000 neurons in a net?

Clams? Fish in schools?

Octopus swipes fish?

Packs of hyenas hunting? People on cell phones driving on the

freewa


16/31

Common Social DynamicsIa:

Square peg, round hole situation

leads to frustration or anxiety

Child balks at demands, expectingmore emotional pain

Adults react, usually in a punishingmanner

Child balks, again expecting more


17/31

Common Social DynamicsIb:

Over time the childs reaction becomes more

automatic

The pattern becomes predictable for the childand the adults Predictable is better than unpredictable,

psychologically speaking, so there is littlereason for the child to change his reaction

Child may become a control junkie, sensingthat he can control what happens next, and soreduce the anxiety of not knowing whathappens next, by taking the easy way andfailin to control his im ulse to react a ainst


18/31

Common Social Dynamics II:Support vs. Expectations

-

Low Support/Low Expectation e.g.,unengaged, alone in room, playingvideogames (can be neglectful)

Low Support/High Expectation e.g.,He needs to just be normal and he WILLbe! (can become abusive)

High Support/Low Expectation e.g.,accommodations and excuses with littleprogress (often very frustrating)

High Support/ High Expectation e.g.,


19/31

Intervening:

Sort out and prioritize where in the bio-psycho-social system you can interveneand make a difference

Usually need to intervene at severallevels

Cant do much if a person is notregulated

But medication never makes up forproblems in the environment

And meaningful progress does not


20/31

Intervening I:Bi l i l M liti

Occupational therapy sensory and motor Speech and language therapy communication

is the better, broader term, to encompass

critical gestural/ non-verbal aspects Many, many others All work toward neuro-biological change, and

all, at their best, are also by their very naturesocial and psychological

Medications, supplements, etc. a talk foranother time...but if there is a clear underlyingdisorder, e.g. seizures, or a target symptomthan can be ameliorated, such as


21/31

Intervening II:A Few examples of

Psychological Modalities

Classic behavioral approaches addressing any

surface symptom to eliminate it, offeralternatives, achieve compliance CBT cognitive behavioral therapies - for mood,

anxiety, compulsions, anticipatory guidance(incl. Carol Grays work)

Family based CBT Barkley especially fordefiant and oppositional behavior

DIR/Floortime BPS/Relationship baseddevelopmental model, looking at regulation,


22/31

Intervening III:Examples at the

Social/ Environmental Level

Home-School Communication Wraparound: Home-School

Collaboration

DIR/Floortime wraparoundfocused on engagement, withcoaching and reflective processingbuilt in


23/31

An Easy Example:

ACTING OUT Slow Talker:Possible symptoms..

Withdrawn

Hits

Doesnt do work

Not getting along with peers


24/31

ACTING OUT Slow Talker:

Whats going on?

Biologic cant process and / orexpress himself fast enough to keepup

Psychological frustrated,

discouraged, etc. Social left in the dust by adults


25/31

ACTING OUT Slow Talker:

Things to try.

Wait for the person to talk Teaching the person delaying tactics

Quick Guide for teachers and

others The intervention is so simple and the

difference in function is remarkable!


26/31

A tougher example:

Stimming

Its always different for each person

but Neurobiological aspects: trouble

communicating, overactive basal

ganglia? Psychological: anxiety, stress

Social dynamic: left unengaged, and


27/31

Stimming

There is probably a biologicaltendency to stim

There is probably a trigger in theenvironment

There is probably a psychologicalneed that stimming helps the person


28/31

Still Stimming..

Turn B-P-S to S-P-B Social/ Environmental: Try engaging the

person work on regulation,engagement and creating a continuousflow of back and forth reciprocalinteraction make yourself a part of hisworld

Psychological - Work toward affective

communication, whether verbal or non-verbal, so the interaction with youbecomes more interesting than the

-


29/31

Your Examples.


30/31

Conclusion:

Its usually not either/or, its usuallyand/and; these things can often beunderstood, and a BPS/bottom-updevelopmental approach is often

helpful.


31/31

Resources:

www.circlestretch.blogspot.com

www.icdl.com

www.Floortime.org Barkley, R. Defiant Children
http://www.circlestretch.blogspot.com/http://www.icdl.com/http://www.floortime.org/http://www.floortime.org/http://www.icdl.com/http://www.circlestretch.blogspot.com/

biology vs behavior - ip day powerpt

Documents