The communication log comes home with yet another note about a child’s behavior during the school day. Phone calls from the teacher and guidance counselor report the child’s behavior at school. The parent is asked to report to the principal’s office to discuss the child’s aggression or defiance.
In these situations, a parent can quickly feel the child is being portrayed as a “bad kid.” Knowing the child’s behaviors are complex and associated with intellectual or developmental delays, the parent wonders, “What is going on in my child’s head?”
Neuropsychology explores this very question. By understanding the structural and functional differences in children with various intellectual and developmental disorders, doctors and researchers are helping unlock the brain-science of behavior.
This spring, Dr. David Stein, founder and proprietor of New England Neurodevelopment, gave a presentation at the Massachusetts Down Syndrome Congress conference on behavior and Down syndrome. Stein is a pediatric psychologist specializing in neurodevelopment. He began his career as a child behavior specialist, served as an instructor at Harvard Medical School, and was co-director of the Down Syndrome Program at Boston Children’s Hospital.
He opened his presentation stating his goal: helping the parents, grandparents, and educators in the audience understand the concepts of neurology as they relate to behavior in Down syndrome so caregivers can help children do their best.
According to Stein, 30% of children in the Down syndrome population have a diagnosable behavioral condition, in comparison to 10% of neuro-typically developing children. He added there might be even more who have behavior challenges but no diagnosis. Stein traces the increase in behaviors in children with Down syndrome to certain factors, including neurological features of the brain. For example, people with Down syndrome exhibit differences in the frontal lobe, brain stem and cerebellum, and the temporal lobe. These structural and neurodevelopment differences in the brain contribute to behavior challenges due to differences in language and social skill development, information processing and memory, motivation, and executive functioning such as impulse control, he said.
Stein’s clinical work is not limited to children and adolescents with Down syndrome. In his Concord-based practice, he conducts neuropsychological assessments and develops treatment strategies for children and adolescents with various challenges and diagnoses.
Bridging the gap between clinicians and the classroom are specialists such as Jane Crecco, a training and support specialist at the Recruitment Training and Support Center for the Federation for Children with Special Needs, who presents professional development training to teachers, administrators, and clinicians throughout Massachusetts. A certified special education teacher, she is also a parent of two children with behavioral and emotional impairments related to their early childhood experiences through the child welfare system.
“I have training in Applied Behavior Analysis; my master’s degree was on that approach. But, when working with kids with ABA, I often felt like something was missing,” she said.
Crecco bases much of her philosophy around behavior on a quote by Dr. Ross Greene: “Kids do well if they can.”
“If they can’t do something, we need to figure out why,” she noted.
People are beginning to realize that every child communicates and learns differently — either they haven’t learned the skills or do not have a brain that developed the ability to do that skill. She believes children learn skills best through engagement with a safe and supportive adult in school and home environments that are nurturing and safe without an emphasis on punitive and disciplinary practices.
An advocate of team collaboration, Crecco recommends parents request the child’s IEP team meet to discuss the behavior challenges.
“There is knowledge on both sides of the table that must come together to look at the problem from a social and emotional learning perspective,” she said.
The “bad kid” perception needs to go away, said Crecco, who recognizes that teachers can burn out from trying to manage ongoing behavioral challenges.
“Before it gets to that point, it needs to go to the team. It is essential to determine why behaviors are happening and formulate a treatment plan,” she said, adding that parents should learn about the Massachusetts Guidelines on Implementing Social and Emotional Learning (SEL) Curricula put into effect with the 2010 law, An Act Relative to Bullying in Schools.
Crecco cautions against the standard ABA approach of a functional behavior assessment and behavior plan, which is a single assessment around a single behavior.
“Nobody has one behavior,” she noted. “We need a more holistic approach and to look at the whole neurology, the neuroscience, so we can modify the curriculum, supports, and environment effectively.”
The strategy must be implemented throughout the child’s whole day across environments. Social emotional learning goals should be contained within every academic area of an IEP. For example, a social emotional goal in the mathematics section of an IEP allows the math teacher to help carry out the goal, she said.
“Teachers are often OK with this, they are excited,” Crecco said, acknowledging that teachers may need some training around implementing the goals.
There may be many specialists on a student’s IEP team. Each specialist wants to help a child resolve his or her behavioral challenges, but they may view it only through the lens of their specialty, she added.
“We need to put it all together and accept that perhaps the child is reacting differently because the child’s brain is different,” she said.
Education is the key to changing the “bad kid” mindset, Crecco said. She recommends parents and teachers visit websites such as:
* livesinthebalance.org: Dr. Ross Greene’s website.* casel.org: This Collaborative for Academic, Social, and Emotional Learning site is a clearinghouse of materials and tools for social emotional learning.* childtrauma.org: This Houston-based program is making tremendous strides in social emotional research. The website has a variety of tools, including videos, for parents and educators.
Stein also supports the need for parents to educate themselves. There is high demand for appointments with neurological specialists, and parents may have to wait a month to several months for an appointment depending upon the provider they choose. This is part of his reason for writing his book, Supporting Positive Behavior in Children and Teens with Down Syndrome.
Massachusetts is home to many experts in the field of pediatric neuropsychology, including Stein. Hospital-based programs exist at Boston Children’s Hospital, Massachusetts General Hospital, and Tufts Medical Center, and there are many private practitioner offices throughout the state. Parents should research providers carefully prior to scheduling an appointment. Also, neurological assessments are often not covered by health insurance, so parents should consult with their insurance company, primary care physician, and the billing department at the selected provider to understand the financial costs to the family.
Crecco admits that every child who needs one is not going to get the functional MRI to support a neuropsychology treatment plan because of cost. However, she is excited that there are doctors and neuroscientists looking to simplify the approach.
According to Crecco, Dr. Bruce Perry, a senior fellow of the ChildTrauma Academy in Houston, and his team are charting behaviors with teachers to create a neurosequential therapeutic approach for educators. He has mapped the brain, allowing teachers to look at the mapping as it correlates to a child’s behavior to identify what skills are needed for the child to manage the behavior, she said.