How can we address the behavior problems that can result from the asynchronous development of the brain? It takes parents and teachers working together, and it may require the help of these types of professionals as well:

• Psychologist
• Physician
• Physical or occupational therapist
• Speech/language therapist
• Reading specialist.

The solution lies in a multimodal approach that may involve some or all of the following:

Assessment. It’s important for the child to have a comprehensive pediatric neuropsychological evaluation that assesses the functioning of the whole brain. Also important is assessing a child’s hearing and vision.

Education. Parents and teachers need to learn about the brain as well as work at understanding the gifted child’s behavior. It’s important to keep track of what does and does not work with a child.

Medication. In some situations, medications such as stimulants or anti-anxiety medications are appropriate. However, they should never be used alone. Children need help in learning new behaviors. Stimulants may put a child at the doorway of inhibition, but they still need to be taught proper behavior.

Cognitive Rehabilitation Therapy. This type of therapy takes a brain-injury approach to addressing behavior problems. It helps a child learn new ways of doing things – ways to compensate for or work around weaknesses. It also is a means of evaluating the child’s environment and accommodating that environment for structure, routine, and consistency.

Psychotherapy. A psychotherapist won’t be able to fix a brain-based disorder. However, this type of professional can work on healing the emotional damage that these types of problems can do to a child’s self-esteem.

Behavior Management. It’s possible to structure a child’s environment to minimize problem behavior. When an environment is chaotic, inconsistent, and unpredictable, children respond in kind with similar behaviors. When an environment is structured, children know what to expect and tend to adjust and comply appropriately. A structured environment, which can function like an external set of frontal lobes for the child, requires parents and other adults to:

·Plan ahead. Establish daily routines and be consistent about following them. Routines reduce the opportunity for failure.

·Anticipate. As you enter new environments, be a step ahead of the child in regard to transitions, disruptions of routine, and explaining your expectations for behavior.

·Develop a bag of tricks. Offer soothing techniques, distraction, etc. Give alternatives to undesirable behavior.

·Preview events. Anticipate the next developmental milestone and provide appropriate space in which to achieve the milestone, without the opportunity for catastrophic failure.

·Make pre-emptive strikes Interrupt behavior before it passes the “point of no return.” The trick is to catch the child before he/she is in trouble, which requires knowing what situations trigger problematic behavior (for example, “meltdowns”).

·Intervention.When problematic behavior occurs, interventions should be short and frequent. They should take place without anger, and they should be soothing to the child. Remember the idea is to soothe the back of the brain in order to allow the front of the brain to regain control. Here’s a five-step intervention process to follow:

1.Prime. Prepare the child for how you will discipline by explaining that it’s a way to help him/her get back into control. Spend days discussing the disciplinary process and get the child to buy into it. If he/she knows what’s coming, it won’t over stimulate the child’s back of the brain and thereby flood the frontal system with undue stimulus.

2.Preview. Be in sync with the child so that you can better anticipate what his/her next logical move or behavior will be and know what situations trigger unwanted behavior. This knowledge helps you avoid pitfalls and plan for disruptions to routine.

3.Pre-empt. Interrupt behavior before it passes the point of no return. Identify when the child is “perking” (over stimulated) and on the verge of losing control.

4.Disengage. Remove the child from a situation and engage him/her in an intervention aimed at helping the child calm down or self-soothe.

5.Rectify. Once the child is soothed, return him/her to the situation from which the child was removed in order to rectify the behavior that led to the removal. You might ask the child to apologize or clean up after a tantrum.

Some Sample Interventions

A widely used intervention is the “time out.” Despite its popularity, it may not be the best choice. Children often view a time out as a “time to go off.” The time out often ends up being the trigger that causes a tantrum. Because a time out is timed externally, by a parent for example, it does not help the child learn how to self-soothe.

Here are two examples of soothing interventions to try in place of a time out. The first intervention, called Separate the Beans, is appropriate for children from ages 3 through 9. It requires them to spend time separating two types of uncooked beans from an empty coffee can into two small cups. The activity soothes the various senses of touch, hearing, and vision. This activity helps calm children by limiting extraneous environmental stimuli, while not stressing cognition. The result is being once again available for social interaction or learning.

The steps involved in this intervention are:

• Combine uncooked lima and red beans in an empty coffee can.
• Have the child separate the beans by color into two small cups.
• When the cups are full, the discipline is over. The child then amends the behavior that warranted the discipline in the first place and is free to return to his/her activities.

An intervention for older children is Sentences. It involves writing sentences that state: “I will not do this… I will do this…” Rules to follow when using this intervention are:

• Dispense no more than five sentences at the time of a behavioral infraction.
• Instruct the child to write sentences that include what the child is not to do and what appropriate behavior would have been instead.
• Avoid power struggles that may result in adults assigning more sentences.

Keep in mind that discipline teaches without anger and avoids damage to the child’s self-esteem. Remember to suspend privileges until the beans are all separated or the sentences are completed at a proficient level. Remind the child that the discipline “lasts as long as you want it to.” Once it’s completed, it’s time to help the child to re-engage. For example, you might say, “Let’s go apologize…”

In Conclusion

The difficult behaviors that stem from asynchronous development are brain-based problems. As such, they require a brain-based approach to management. Use of the term “management” is intentional here because you cannot “fix” a brain-based problem. You can, however, manage it by following these strategies:

1. Learn to identify the triggers that lead to problem behavior.

2. Be on the lookout for problem situations.

3. Help the child learn self-soothing techniques.

Helping your child face problem situations with greater calm and control is a mentally healthy alternative to the damaging effects of inconsistency, yelling, hitting, or criticizing.


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This article first appeared in the February 2005 issue of 2e: Twice-Exceptional Newsletter.

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Paul Beljan, PsyD,  ABPdN, is the president of the American Board of Pediatric Neuropsychology. Dr. Beljan specializes in the pediatric neuropsychology of learning disorders, gifted intelligence, attention deficit disorder, traumatic brain injury, alcohol/drug related neurodevelopmental disorder, and medically fragile children. He is in private practice and is an adjunct professor of pediatric neuropsychology. He is also a co-author of the book Misdiagnosis and Dual Diagnoses of Gifted Children and Adults: ADHD, Bipolar, OCD, Asperger’s, Depression, and Other Disorders (Great Potential Press, 2005)  and the co-owner of the Learning Enrichment Center in Phoenix, AZ.