Primary Disabilities, Secondary Challenges

 

The Neurobehavioral Model

The neurobehavioral model is supported by over 50 years of neuroscience research, and is considered best practice for working with kids who have neurobehavioral challenges including FASD. Research has found this framework increases understanding, lowers frustration, expands options, and reduces and prevents problems.

Parenting through a neurobehavioural lens can decrease the frequency and intensity of secondary behaviours and, at times, prevent them altogether.

 

"The gift of the neurobehavioral model is in redefining behavioural symptoms in a manner consistent with research. A profound shift is created in moving from anger to compassion, from blaming to acceptance, lessening frustration on all sides, and improving outcomes." - FASCETS.org

 

Primary Behaviours

Diane Malbin (who developed 'The Neurobehavioral Model') states that "FASD is an invisible, brain-based, physical condition" and lists these as the areas of primary disabilities in those with FASD:

  • Dysmaturity: socially or developmentally younger than their chronological age
  • Sensory system integration (over and under sensitivity to stimuli)
  • Nutrition
  • Language and Communication
  • Processing pace (how fast the brain works)
  • Learning and Memory (and inconsistent performance)
  • Abstract thinking (including difficulty predicting outcomes)
  • Executive functioning (including difficulty generalising, forming links & making associations)
  • Strengths – there are many strengths in all individuals

 

Secondary Challenges

Secondary Behaviours are what the neurobehavioral model describes as 'defensive behaviours'. They are normal reactions to pain and discomfort, and often develop over time due to 'poor fit' within the environments through which the children move. When a child's primary characteristic differences (see list above) are not recognised, and the child is then deprived of appropriate supports or accommodations, we see these secondary challenging behaviours emerge as a result. Where there is a poor fit, there are problems. Examples of these problems might be aggression, meltdowns, shutting down, anxiety, becoming easily tired, depression (along with many more).

Diane Malbin lists these as secondary behaviours:

  • Fatigue, frustration
  • Anxious, fearful
  • Rigid, resistant, argumentative
  • Poor self-esteem
  • Self-aggrandisement, attempts to look good
  • Isolated, few friends, often picked on
  • Acts out, aggression
  • Interrupted school experience – stand downs, suspensions, expulsion
  • Sexual problems
  • Truancy, run away and other forms of avoidance.
  • Trouble with the law
  • Depression, self-destructive or suicidal (most common in adolescents and adults)

When behaviours (both primary and secondary) are understood differently, the shift is made from judging and reacting to understanding and exploring. There is less anger and frustration. The same old behavioural symptoms now mean something different, because they are understood differently. That is the paradigm shift.

 

“Children exhibit challenging behaviour when the demands being placed upon them outstrip the skills they have to respond adaptively to those demands. The same can be said of all human beings.”

- Dr. Ross Greene

 

The possibilities for accommodations are endless, however it does take practice to really be able to focus in on what might work for your unique child. Accommodations are successful when developed with each individual child’s brain function in mind.

Because individuals with neurobehavioral challenges have a brain-based, physical disability, they need (and deserve) accommodations for their condition. When we see that they cannot meet an expectation due to their primary characteristics (lagging cognitive skills), we need to adjust those expectations to be in-line with their skills. For example, if we know they process information slowly (primary characteristic), we need to give them more time and/or provide them with visual cues. If we know they can only hold on to one direction at a time (vs two- or three-step directions), we need to provide one direction at a time. If we know that they are younger socially and emotionally, we need to teach and explain things to them at developmental age level.

(Reference - Eileen Devine: The Neurobehavioral Model