Biology vs Behavior - IP Day powerpt
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Transcript of Biology vs Behavior - IP Day powerpt
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Biology vs. Behavior:an interactive seminar
IEP Day April 11, 2008
Joshua D. Feder, MD
Faculty, Interdisciplinary Council on Developmental and LearningDisorders
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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?
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The Problem:
Attitudes
Supratentorial
Mind vs. Body
Its a Behavior
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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
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The Blame Game
Blame the person
Blame the family
Blame the illness All of these tend to be reductionistic
and unhelpful
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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
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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:
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Deconstructing the
symptom:
Biological factors
Psychological functioning
Social/ environmental
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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
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Common Psychological
Factors I:Square peg, round hole
Discouraged kids
Anxious kids Frustrated kids
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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?
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ABCs
Antecedants
Behaviors
Consequences
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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
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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
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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
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Common Social Dynamics II:Support vs. Expectations
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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.,
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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
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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
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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,
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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
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An Easy Example:
ACTING OUT Slow Talker:Possible symptoms..
Withdrawn
Hits
Doesnt do work
Not getting along with peers
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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
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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!
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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
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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
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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
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Your Examples.
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Conclusion:
Its usually not either/or, its usuallyand/and; these things can often beunderstood, and a BPS/bottom-updevelopmental approach is often
helpful.
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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/