David D Nowell PhDwww.DrNowell.com

Understanding the Top-Down and Bottom-Up of Executive and Sensory Functioning

www.DrNowell.com

DavidNowell

DavidNowellSeminars

Overview

• Top-down and bottom-up

• Points of impairment

• Curious compassionate nonjudgmental evaluation

• HËDŸDT?

• Joie de vivre and “magic moments”

• Living in the gap

• Q&A&D

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TOP DOWN AND BOTTOM UP

What’s wrong with this brain model?

What’s wrong with this brain model?

What’s wrong with this brain model?

POINTS OF IMPAIRMENT

Points of impairment

• Intellectual development

• Autistic spectrum

• ADHD / executive dysfunction

• Attachment disorders

• Trauma-related disorders

• Cerebral palsy

CURIOUS COMPASSIONATE NONJUDGMENTAL EVALUATION

Skillfully eliciting the chief complaint

• Too much of what? Or too little of what?

• Invoking the Pediatric Fairy (or the Psychiatric Genie)

HËDŸDT?

• How exactly did you do that?

– Everybody’s doing the best he/she can

– Every behavior problem is either

• Skills deficit

• Contingency problem

Forming a diagnostic impression

• Where do you see it the most? And where do you see it the least?

• Two disorders = two stories

Documenting and communicating your conclusions

• The footprints in the butter

• Defend your diagnosis

STRATEGIC BEHAVIORAL INQUIRY

Objectives of SBI

• Specific behavioral strategy

• What was the feeling-goal?

• Motivational level on a scale from 1-10

Benefits of SBI

• Affirms the value of clients’ unique internal experience

• Emphasizes the culture of self-regulation

• Encourages metacognition

Assumptions of SBI

• Everybody’s doing the best they can

• Behavior is not incomprehensible or random

• Behavior follows patterns which reveal themselves to the curious observer free of prejudice or blame or theory

How to do SBI

“How exactly did you do that?”

“How did you know it was time to _____?”

“How long had you been thinking about ____?”

JOIE DE VIVRE AND MAGIC MOMENTS

The end goal of treatment: joie de vivre

Dr. Lucy Jane Miller

“Magic moments”

LIVING IN THE GAP

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@davidnowell David Nowell Seminars

Q & A & D