The Watson Institute

Children with significant medical and neurological conditions often present with

complex behavioral and psychological needs. These needs can be severe and compromise their medical treatment and their ability to function autonomously in

least restrictive settings. For example, a child with a neurological disease may

suddenly develop aggression, paranoia, apathy, extreme emotional lability, and

socially inappropriate behavior. Effective treatment is possible, but requires

expertise in brain-behavior relationships and behavioral medicine in addition to

more traditional behavioral and cognitive behavioral procedures.

Treatment is uniquely designed to intervene in this synergistic cycle of cognitive, behavioral, and affective

factors to promote optimal adjustment.

In addition to the traditional wraparound model, this program utilizes Ph.D. level Behavioral Specialist Consultants who

incorporate understanding of brain-behavior relationships, behavioral medicine,

empirically validated treatments, and extensive process and outcome evaluation into the case consultation and staff training.

Evidence based treatment methodologies are emphasized for targeting emotional and

behavioral symptoms.

A “culture of evaluation” is created by encouraging use of multiple outcome

measures throughout treatment.

Specialty training provided in brain injury and rehabilitation follows recommendations by

the Brain Injury Foundation.

INTRODUCTION

BACKGROUND

MODEL TREATMENT

CONCLUSIONS

Serving the Needs of Children with Medical and Neurological DisordersChristy Emmons Basista, Psy.D., Sharon Arffa, Ph.D. and Lindsy Yarger, M.A.

This BHRS program is designed to meet the needs of children with physical and neurological disease that have significant co-existing psychiatric morbidity, including, but

not limited to, disorders such as:Disruptive Behavioral Disorder, NOS

Attention Deficit Hyperactivity DisorderMood and Anxiety DisordersAutism Spectrum Disorders

Somatoform DisorderPersonality Change secondary to medical conditions.

Behavioral and cognitive-behavioral treatments that emphasize a neuropsychological and behavioral medicine understanding and clinical approach will be applied in an

individualized treatment program which abides by the CASSP principles. Treatment modalities will include, but not

be limited to, psychoeducation, behavioral management, cognitive behavioral intervention, environmental

management, school and community consultation, pain management, and positive coping strategies.Compared to orthopedic injuries,

children with neurological compromise have three times the rate of new

psychiatric disorder (Brown et al. 1981; Rutter et al. 1983).

Psychiatric issues are more likely as the severity of cognitive, family, and

psychosocial difficulties increase (Sachs, 1991; Taylor et al 2002).

Behavioral disposition may actually worsen over time in severe injury

(Fletcher et al. 1995). Positive environmental and therapeutic

conditions are protective factors in recovery from neurological illness

(Taylor, et al 2002).

Behavioral

Affective

Cognitive

By incorporating knowledge of brain-behavior relationships into the

understanding of the child and family’s strengths and needs, the current program aims to provide more effective services within the least restrictive environment

possible. In doing so, the program aims to decrease the prevalence of persistent

psychiatric disturbances in children with medical and neurological illnesses.