Behavior: A Neurodevelopmental Perspective A video presentation from - - PDF document

ASK THE ADVOCATE WORKSHOP: Down syndrome January 26, 2016

Behavior: A Neurodevelopmental Perspective

A video presentation from the Duncan Seminar on Down syndrome by David S. Stein, PsyD

• Dr. Stein is the Co-Director, The Down Syndrome Program; Pediatric Psychologist, Boston Children’s Hospital;

Instructor, Harvard Medical School Watch Dr. Stein’s video presentation: http://www.seattlechildrens.org/For-Healthcare-Professionals/Provider-and-Nursing-Grand-Rounds-Online- Videos/2015/Duncan-Seminar--Behavior-and-Down-Syndrome--A-Neurodevelopmental-Perspective/ Background

• Big Need for Services
• Education and Background
• Low Success Rate - Hard Work
• Progress not Perfection: This is hard work

and nobody has 100% Success. Our goal is NOT perfection, it is improvement. Self-Care

• Long-Term Goals
• Take Breaks: As parents and providers, we

have to keep our keys on the long-term prize and remember to take care of

• urselves.
• Spend Time on Yourself

Epidemiology

• 30% of kids with Down syndrome have

diagnosable behavior condition vs. 10% of typically developing peers (3x more likely)

• More minor behavior problems
• Behavior problems in children are

predictors for behavior problems in adults

• Intervention is critical

ASK THE ADVOCATE WORKSHOP: Down syndrome January 26, 2016

Behavior: A Neurodevelopmental Perspective

A video presentation from the Duncan Seminar on Down syndrome by David S. Stein, PsyD Etiology: Why do children with Ds have behavior problems?

• Brain Differences
• Reduced Growth in Frontal Lobe
• Smaller Brain Stem & Cerebellum
• Problems in Temporal Lobe &

Hippocampus Brain Differences Consequences of Brain Differences in Ds

• Social
• Hyper-aware & hyper-engaged
• Hyper-aware can also mean

hypersensitive

• Language
• Receptive vs. Expressive
• Resulting Frustration
• Information Processing & Memory
• Strong Visual Learning
• Storing and Understanding

Information

• The world has expectations about

understanding/comprehension = scary!

• Motivation
• Lower Desire for Mastery
• Gas in the Tank model
• Great frustration can lead to avoidance
• Executive Functioning
• Impulsivity: may not see the stop signs
• May struggle with planning behavior

and considering consequences Big Picture

• Complex world = Perfect Storm for

Frustration and Behavior

• If not well supported and understood

ASK THE ADVOCATE WORKSHOP: Down syndrome January 26, 2016

Behavior: A Neurodevelopmental Perspective

A video presentation from the Duncan Seminar on Down syndrome by David S. Stein, PsyD What can we do about behavior problems? Relationship is key: When you don’t know what to do, consider what is best for your relationship Behavior Basics

• Reinforce what you want to see more
• Don’t reinforce what you want to go away.

Reinforcing Good Behavior

• Use Attention
• Notice Good Behavior and React
• Praise Good Behavior
• Simple Token Economy
• Visuals, Repetition, Motivators,

Attention for Positive Behavior Functions of Behavior Purpose

• ABCs of Behavior
• Antecedent: What’s the situation?
• Behavior: What are they doing?
• Consequences: What happens

afterwards?

• 2 Most Common Functions are Attention

and Avoidance/Escape

• Lower Intrinsic Motivation = Escape
• Hyper-Social + Reduced Impulse

Control = Attention Positive Behavior Support Strategies

• Choices = control
• Redirection
• Providing positive feedback
• Incentives or Providing the Carrot
• First ____, then _____
• Boost motivation throughout the day

ASK THE ADVOCATE WORKSHOP: Down syndrome January 26, 2016

Behavior: A Neurodevelopmental Perspective

A video presentation from the Duncan Seminar on Down syndrome by David S. Stein, PsyD Attention Seeking Example

• What is the Situation?
• What is the Function of this behavior?
• What is reinforcing this behavior?
• What could be done differently?

Have you experienced a similar example? Planned Ignoring

• 3 Basket Model
• Basket 1 is safety concerns, something

must change

• Basket 2 is frustrating for everyone,

something should change

• Basket 3 is minor frustrations,

something could change, mostly ignore the behavior How do we remember these principles?

• Mindfulness in stressful situations
• Shut down your reactions
• Reverting to old habits can be easy;

remember reaction influence immediate and future path

ASK THE ADVOCATE WORKSHOP: Down syndrome January 26, 2016

Behavior: A Neurodevelopmental Perspective

A video presentation from the Duncan Seminar on Down syndrome by David S. Stein, PsyD Environment Strengths and Weaknesses Visual vs. Verbal Social vs. Impulse Control Routine and predictability vs. inconsistency

• Routines, especially visual, promote

repetition and predictability

• Visual takes pressure off of relationship
• Visual Timers
• Social Motivators
• Social Stories
• What to do in a given situation

Negatives include wordiness, inconsistency, and responses to negative behavior Discipline

• Positive Behavior Supports > Punishment
• Positive strategies are more effective!
• Discipline may be Reinforcing negative

behavior

• Reinforcement = adding
• Discipline = taking things away

Adjust Situation by Removing Reinforcers

• Vocal Communication (i.e. yelling)
• Reasoning/language
• Eye Contact
• Facial Expression
• “Social-Emotional Radar”

Respond but don’t react

• Look at the Whole Picture (condition,

environment, etc.)

• What can you remove?
• Seek Help when Needed
• Is there another condition that needs

treatment?

• Is the environment causing problems?

ASK THE ADVOCATE WORKSHOP: Down syndrome January 26, 2016

Behavior: A Neurodevelopmental Perspective

A video presentation from the Duncan Seminar on Down syndrome by David S. Stein, PsyD Support/Resources

• Professionals
• Schools
• Community
• Books

Review/Closing Thoughts

• Think about Situation from Child’s point of

view

• Focus on positives - and their strengths!
• The goal is not perfection, it is

improvement: Remember Where you Started “The “endpoint” is not tomorrow or next

• month. It is the individual with Ds having a

fulfilling adulthood and not being limited by behavior problems.” Q&A

• Extinction Burst
• Ignoring and Siblings
• Peer Modeling/Influence
• Insurance Coverage
• Toddlers
• Dual Diagnosis