Treatment

 
Neuro-biological disorders cover a wide spectrum. While many are diagnosed, mis-diagnosis often occurs as mental health practitioners may be unaware of the full range of these disorders and their inter-relatedness. Traditional intervention and treatment tends to focus on physical/behavioral manifestations (e.g. inattentiveness in AD/HD or impulsive actions). A strict behavioral approach to treatment is often assumed or even demanded by managed care personnel as they seek to implement "evidence based practices" that can produce "measurable outcomes." Stopping an objectionable behavior is considered a success. If I could teach you to fly you would surely think it miraculous because it is not within the physical ability of humans to fly. No modality of treatment can succeed in giving anyone voluntary control over involuntary behaviors. These people's brains are in charge and no amount of will power can overcome that control center. It's the natural biological order of things. Birds fly, Touretters tic.  
 
The goals of treatment vary greatly depending on the person's presenting symptoms and/or diagnosis. Psychotherapeutic treatment, traditionally, is "talk therapy" that takes place in an office, usually for a "50 Minute Hour." Many individuals, couples and families avail themselves of this form of treatment with or without accompanying medical intervention in the form of psychotropic medication. Such classical therapy relies on clients developing a trusting, meaningful relationship with the therapist. It is through the therapeutic relationship that insight into particular difficulties occurs which then, hopefully, lead to an avenue(s) for change. How long the therapy goes on is really an open-ended question. A mentor/therapist once said to me that it usually continues until the client realizes that they have better things to be doing! In my experience the therapeutic relationship takes on a completely different (i.e. non-traditional) flavor when working with children and adolescents struggling with neuro-biological disorders. It becomes quite multi-faceted. This section discusses the BTC treatment approach to working with this particular population. 
 
I've never met a kid with a neuro-bio disorder that didn't know, at some level, and whether or not they could express it in adult language, that they were "different." Kids see that they have a different cadence than their peers and playmates. They see that they have emotional responses out of proportion to events. They see kids that can handle stress better and ones that don't take everything so personally. They also see kids that are engaged and enjoying their life experiences whether at school, during recess, on walks or bus rides home and during after school playtime. They often wonder, albeit silently, why they can't get along, why they argue, why they can't listen or behave or why they feel the way they do which is, oftentimes, out of synch. They just know an awful lot about what's going on without being able to conceptualize it, let alone verbalize it.  
 
I've met countless mental health professionals, teachers and parents who persist in trying to make these types of kids behave, implying that it is only the behavior that is out of kilter. They often believe the behaviors are willful and insist that the kid override biological manifestations (e.g. hyperactivity, defiance, temper tantrums), assuming they even acknowledge that it IS the biology. They are willing to do this at all costs (or, with managed health care, with as little cost as possible). Despite repeated indications and the resultant failures with behavioral approaches (time outs that are countless and endless, a never ending supply of adhesive tape residue on the refrigerator from sticker charts that were stuck up, tried, torn down and replaced again, or from frustration at an inability to get Magic 1-2-3 to work its magic), there is an insistence to continue to "do it" the same old way, when it's so obvious to everyone that those ways (insistence on solely behavioral changes) just aren't working.

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All material on this website ©2009 by Bridging the Chasm and Garry L. Earles, L.I.C.S.W.