Primary Disabilities

These are defined as those which exist from birth in the individual with FASD. Diane Malbin (who developed 'The Neurobehavioral Model' see below) states that "FASD is an invisible, brain-based, physical condition" and lists these as the areas of primary characteristics in those with FASD:

• Dysmaturity: socially or developmentally younger than their chronological age
• Sensory system integration (over and under sensitivity to stimuli)
• 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)

Secondary Characteristics

These are not present at birth but occur as a result of the challenges of the primary symptoms. They can be better mitigated by the presence of FASD protective factors. These are:

• early diagnosis and interventions
• brain- and trauma-based supports and interventions
• FASD training for caregivers and professionals
• stable home environment
• formation of loving, nurturing connections with caregivers / whānau
• the absence of violence, trauma and adverse childhood experiences (ACEs)
• a positive and stable education experience

Secondary characteristics often develop over time due to 'poor fit' within the environments through which the children move. When a child's primary disabilities are not recognised and the child is deprived of appropriate supports or accommodations, we see these often challenging secondary characteristics 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 characteristics:

• Fatigue, frustration
• Anxiety, fear
• Rigid thinking, being argumentative
• Poor self-esteem
• Self-aggrandisement, attempts to look good
• Isolated, few friends, being bullied
• Acting out, being aggressive
• Interrupted school experience – stand downs, suspensions, expulsion
• Inappropriate sexual behaviour
• Drug and alcohol use
• Truancy, running away and other forms of avoidance
• Mental health issues
• Homelessness and social isolation
• Parenting, relationship and employment issues
• Depression, self-harm or suicide 

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 be able to focus on what might work for your unique child. Accommodations are successful when developed with each individual'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.

The Neurobehavioral Model

The neurobehavioral model is a brain-based approach to responding to those with FASD. Once we understand how their brain function has been injured by alcohol (a form of trauma) we can then begin to understand and react differently to the behaviours that are symptomatic of the brain functioning differently.

If we can keep the fact that we are dealing with a person who has a brain injury at the front of our own minds when dealing with difficult behaviour, it can change our own responses significantly, and this can contribute to an ongoing positive impact on our interactions.

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

Parenting through a neurobehavioural lens can decrease the frequency and intensity of secondary behaviours (see below) 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

Reference - The Neurobehavioral Model