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The Neurobehavioral Model


A brain-based approach to parenting kids with brain-based differences

I vividly remember a time in my life that I now refer to as the “Dark Ages.” While it certainly wasn’t constant “darkness” in the way you might imagine, it was a time of frequent and intense waves of stress, anxiety, concern, sadness, grief, and confusion for me as a parent. As I look back now, the most critical piece to recognize about those Dark Ages, and the impetus to label it as such, was the information I was missing on how to parent our daughter who has significant neurobehavioral challenges.

Because I did not know that what she needed from us was different than what our “neurotypical” son needed, I tried harder and harder, implementing the “very good, tried-and-true” parenting techniques I was raised by, with little success. Not only did those approaches fail to help our daughter control her behavior or regain a sense of calm, they often made things worse. As my concern for our daughter grew, my confidence in what we could do about it was rapidly diminishing because, it seemed, nothing worked.

And yet — because we still didn’t know any differently — we held on to this fantasy that with enough love, patience, and understanding, she would learn to behave appropriately and respectfully. We believed that if we provided her with the most supportive home environment imaginable, she would catch up enough socially and emotionally to fit in with her peers. My belief was that if we, as her parents, continued to give her enough unconditional love, attention, and patience, she would get there. Her childhood (and then later, her adulthood) would be “normal.” We were missing key information that would lead us to believe anything different.

This line of thinking led to feelings of hopelessness, the distinct feeling that we were failing as parents.

This period of groping for answers, and drifting toward hopelessness, is the first of several developmental stages of “getting it” (as described in Diane Malbin’s work), with “it” being an understanding of neurobehavioral conditions as brain-based disabilities, and achieving the paradigm shift from thinking “brain” instead of “behavior.” During the first stage of this journey, appropriately termed “The Dark Ages,” parents and caregivers have little to no information about the neurobehavioral approach. They are chronically frustrated as they do their best to parent through a behavioral lens, meaning: Targeting the behavior for intervention and hoping that each new behavioral intervention they try will be successful. During this stage, numerous parenting techniques have been attempted, and fail, and the behaviors they’re trying to calm or extinguish altogether continue to get worse. Parents find themselves yelling more often, breaking down in tears more frequently, and feeling increasingly hopeless.

It wasn’t until I learned of the neurobehavioral model, and then later was trained and mentored by Diane Malbin (author of the neurobehavioral model), that I was able to emerge from my earlier darkness. I was able, over time, to achieve the paradigm shift required to parent my daughter given her unique brain function, so she could settle in her environment and experience much less frustration in her day-to-day life.

The Model

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

It starts with recognizing that the brain is the source of behaviors. The two can never be separated. Every behavior we perform each day, big or small, is connected to our brain function.

Giving equal weight to the idea that the brain has something to do with behaviors is not diagnostic. Asking about brain function does not excuse inappropriate behaviors or enable them. It reframes behaviors, giving an alternative explanation for what is happening, which opens up a new set of possibilities in terms of how to parent our child more successfully. This is the basis for trying differently, rather than harder.

We know, based on neuroscience research, that there are over 50,000 different reasons why someone can experience changes in their brain structure and function. Pre-natal events (trauma endured by birth mom, drug/alcohol exposure), birthing events (loss of oxygen), and post-natal events (trauma, neuroimmune illnesses, traumatic brain injury) can all cause significant physical changes in the brain. These are just a few examples.

Yet, many individuals with these physical changes to their brain appear outwardly "neurotypical," and behaviors are usually the only symptoms to manifest (remember the brain and behavior connection!).

This leads us to the fact that neurobehavioral conditions are invisible physical disabilities with behavioral symptoms.

If neurobehavioral conditions are invisible physical disabilities

Then providing accommodations for people with these disabilities is as appropriate and effective as providing accommodations for people with other physical disabilities.

This shifts the target for interventions from the person (behavioral lens) to the person-in-environments (neurobehavioral lens). Recognizing and implementing this shift is when challenging behaviors begin to resolve and outcomes improve.

No matter what diagnosis or label the child’s cluster of challenging behaviors is given (ADHD, FASD, autism, ODD, PANS/PANDAS, and more), the behavioral symptoms often look the same: executive functioning challenges, learning and memory issues, slow processing pace, dysmaturity, and many more. These behaviors are symptoms of the brain-based differences. While there are valid reasons for obtaining diagnosis for our child, when we're working on parenting from a neurobehavioral lens, the brain is the organizing principle. This means that the brain is the brain, and no matter what may have caused the changes in structure and function, the behaviors are the symptoms of these brain-differences. This again encourages us to move away from behavior modification and instead focus in on developing appropriate accommodations with our child's unique brain function in mind.

The neurobehavioral model divides behavioral symptoms into two categories: primary and secondary characteristics.

Primary characteristics are behavioral symptoms associated with differences in brain structure and function. They basically give us information on how our child's brain works differently than say, their sibling or peers. It gives us information on where their lagging cognitive skills may be, which then leads to a poor fit for them in many environments. Primary characteristics include: dysmaturity, sensory system integration, nutrition, language and communication, processing pace, learning and memory, abstract thinking, and executive functioning. These are broad “brain task” categories, with many details fitting underneath each, but can be a helpful starting place for parents in understanding where their child may be experiencing lagging cognitive skills that, if not viewed through this lens, are either misinterpreted as willful misbehavior or remain all together unrecognized.

Secondary behaviors are what the neurobehavioral model describes as defensive behaviors. They are normal reactions to pain and discomfort, and often develop over time due to “poor fit” within the environments through which children move. When a child's primary characteristic differences (ie: lagging cognitive skills) are not recognized, and the child is then deprived of appropriate accommodations, we see these secondary challenging behaviors 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). Parenting through a neurobehavioral lens can decrease the frequency and intensity of secondary behaviors and, at times, prevent them all together.

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

“Children exhibit challenging behavior 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

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 to them and explain things to them at developmental age level.

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 and their development are NOT about a provider giving you a list of ideas you might try that are not based on your child. Often, this only leads to greater frustration on the parent’s part and further evidence that “nothing works.” Accommodations are successful when developed with each individual child’s brain function in mind.

In brainstorming accommodations, here are some key questions to ask yourself:

  • What is the task or expectation the child is expected to do (and failing at/"refusing" to do)?

  • What does the brain— anyone’s brain— have to be able to do in order to successfully complete that task or meet that expectation?

  • What do you know about how your child’s brain functions in those areas? Do they have those skills?

  • How old is your child developmentally (which might be different than their chronological age)?

  • What are the secondary behaviors you see in this environment or with this specific situation?

  • What are your child’s strengths and interests?

  • Based on all the information gathered from the above questions, what accommodations need to be implemented to help this child be successful?

The neurobehavioral parenting model is just that— a different approach to parenting our child with brain-based differences based on their unique brain. It is a lifelong practice that is made easier with the support of individuals who understand the model and your lived experience, who can walk alongside you to help climb the steep learning curve of implementing this model in your day-to-day interactions with your child.

Want to learn more about the model and/or access the support of an expert in the model who is also a fellow parent of a child with neurobehavioral challenges? Visit my website at eileendevine.com.

Interested in learning more about how to identify the brain tasks your child has difficulty with or about the work Eileen does with parents and parenting with a neurobehavioral approach? Visit eileendevine.com and reach out to her directly. She’d love to hear from you.

Eileen Devine, LCSW is parent coach and consultant for families impacted by FASD, PANS/PANDAS and other neurobehavioral conditions. She is also the founder of The Resilience Room, a close-knit membership community for parents of kids with neurobehavioral challenges. She lives with her husband and two amazing kids, one of whom happens to live with FASD. For more information, visit eileendevine.com.

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Neurobehavioral Support Coach for Parents

500 Terry Francois Street

San Francisco, CA 94158

info@mysite.com

Eileen Devine, LCSW

Therapist & Neurobehavioral Consultant

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