The Brain as Organizing Principle

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It’s a list—punctuated, it’s worth noting, with the word “disorder”— that will be familiar to parents and caregivers of children struggling with difficult-to-diagnose neurobehavioral challenges:

  • Oppositional Defiant Disorder

  • Attention Deficit Disorder

  • Reactive Attachment Disorder

  • Post-Traumatic Stress Disorder

  • Autism Spectrum Disorder

  • Conduct Disorder

  • Fetal Alcohol Spectrum Disorder

These are just a few of the diagnoses that children who have behavioral challenges might accumulate over a lifetime. Parents understandably have difficulty sorting out what all of these diagnoses mean for their child, and the specific ways they should parent in light of each different label their child might have received. There is a frequent hope that with the right diagnosis, the way forward will become illuminated, and the confusion a parent has experienced over how to best support their child will dissipate.

But instead of bringing clarity, a diagnosis—or several diagnoses— can sometimes further cloud the picture.

In my experience as a therapist who works with families experiencing this dilemma, the multiple diagnoses suggest that there has been confusion amongst providers as to what exactly is going on for this child, and that no one has taken a step back to consider the role of brain function. I believe that if we can move away from the specific diagnosis, seeing the brain as the organizing principle and the source of all behaviors, we can begin to view behaviors as symptoms of brain dysfunction. When this happens, parents and providers can shift from reacting to reframing in ways that are consistent with the latest neuroscience research.

For parents, teachers, and other caregivers, viewing the brain as the organizing principle not only helps with understanding the source of the challenging behavior (often, it’s lagging cognitive skills coming up against poorness of environmental fit), it also opens a new path for supporting and intervening with the struggling child. Shifting the perspective of the presenting problem almost always unveils a new set of possibilities in terms of how to understand, care and support.

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