It's always everything, not just one thing.
by Nathan E. Ory, M.A.

Why is a supportive environment, positive modelling and "behavior management" with reinforcement for appropriate behavior, and negative consequences for inappropriate behavior sometimes just not good enough?

Behavior management isn't "good enough" for someone whose developmental disability is such that they are unable to learn from their own experience.

The nature of some very handicapping brain dysfunctions is that some individuals "live in the moment". Often, their attention and consciousness goes through wide fluctuations and is variable within the moment, hour, or day.

Living in the moment, when they have an "old" memory, it is reacted to as though it is happening right now. They have no sense of "before" and "after." Later doesn't exist for them. There is only now.

Waking up in the morning is like a Post?Traumatic Stress experience. They often display "conditioned" emotional reactions to "old", negative, triggering events, or anything that reminds them of these.

Living in the moment, they don't have a sense of continuity, or connectedness to their own past and future. Thus, they can not generalize their experience.

Living in the moment, they can not shift their immediate thought. Whatever is on their mind dominates their actions. They can not see alternatives, or the "other" person's point of view. There is only what is on their own mind right now. They can not "share" their attention, or easily shift their attention.

Living in the moment, they can not resolve their own feelings of conflict. Having a conflict means having two different, opposite feelings, at the same time. Living in the moment, they can only deal with one thing at a time.

They may not be able to resolve conflict, but they know what they do not like. They can tell what is wrong right now. They often are "smarter" than they can act. Being unable to organize themselves towards their own positive goals, they often become overfocused on reacting against what is going on around them that they sense is "wrong", in the moment.

Often they become very emotionally fragile. Living In the moment, they are reactive and absorb the emotions displayed around them. Often they magnify the emotions displayed around them. Often they become "stuck" in an emotion and escalate out of control. They have little ability to "take a step back" to attenuate or modulate their emotional reactions.

They depend on you to rescue them. This is why some people "don't get better."

Nathan Ory is a psychologist with the Island Mental Health Support Team
Copyright 2001 challengingbehavior@shaw.ca