Trying Differently Rather Than Harder: Fetal Alcohol Spectrum Disorders by Diane Malbin

This is a foundational book on supporting an individual with FASD by Diane Malbin. As one of the most suggested parenting guides for caregivers of individuals with FASD there are very few reviews for people who may be new parents or caregivers.

The book was first published in 1999. That was the year after my daughter was born. A second edition was printed in 2002, with revisions in 2011 and 2016. A third edition published in 2017 was a few years after I found out about it during a training I took: 7 things I just learned about FASD

The introduction in third edition states:

FASD is emerging at the end of the behavioral paradigm, a time when behaviors are rarely linked with brain (dys) function, and at the beginning of the neurobehavioral paradigm which recognizes brain function as the source of all behaviors.

The content in Trying Differently Rather Than Harder introduces this neurobehavioral, or brain-based paradigm. It is the platform on which to understand behaviors differently. The brain-based approach is informed by and consistent with research on brain function in general, and with FASD specifically.

A paradigm is a shared understanding–a way of organizing our thinking about the world. Paradigms are rarely recognized as such. They are pre-verbal. We are not aware of their role as foundational to our beliefs.

This book is for anyone who wants to, or needs to, understand what Fetal Alcohol Spectrum Disorder is, how its symptoms manifest, and are misunderstood and/or mistaken for “bad” behaviour (disrespectful, willful, purposeful) – which if not accommodated can turn to adverse outcomes. It also provides a roadmap to how to shift your thinking using examples you will have likely experienced in your parenting journey. Up until this book was published there was little available.

From the book: Thinking about behaviors as symptoms of a physical disability expands options for developing effective parenting and professional techniques. Dr. Sterling Clarren tells the following story that captures what this means for caregivers and professionals. When visiting the library at the Center for Disease Control, he noticed that in each of the sections on physical handicapping conditions, the support literature focused on changing environments to meet the needs of those with physical challenges. Arriving at the section addressing behaviors, he was struck by how all the information in this section focused on changing behaviors. Providing environmental adaptations for people with behavioral symptoms of a physical disability is as appropriate and effective as for people with other, more obvious, physical symptoms.

The book is split into the following five sections:

• Section One: What is Fetal Alcohol Syndrome?
• Section Two: Reframing Perceptions From “Won’t” to “Can’t” (incl. primary, secondary and tertiary characteristics)
• Section Three: Application (incl. traditional behaviour interventions, environmental elements and paradigm shifts)
• Section four: Examples of Behavioral Characteristics and Effective Adaptations
• Section Five: Comments, (examples) Questions and Resources

There really are so many aha moments and points to ponder. Some of my favourites include:

• Learning theory forms the basis for many parenting and professional strategies. This is fine, as far as the theory goes. Unfortunately, learning theory does not include recognition of brain differences.
• Providing developmentally appropriate supports does not mean children are not expected to be accountable. It just means that the level of expectations for accountability is adapted to fit the developmental ability of the child, and that level is increased.
• Primary strengths may erode if they are not recognized and encouraged. For example, if an athlete is prevented from playing sports because of low academic marks, his skill is devalued and the focus instead is on his deficits. This deficit model effectively gives the message that the person’s strengths are not important.
• On secondary characteristics: These secondary symptoms are normal human reactions to pain. Secondary defensive behaviors indicate a poor fit between the person and their environment. They provide useful cues for identifying and resolving problems where the fit is poor. This reframes and normalizes reactions to pain and distress, making their resolution less daunting. They are recognizable, intervenable and preventable.
• It has been said that parenting children with FASD is like trying to find your way around Denver using a roadmap of Portland. The map worked in one city, but not in the other. Using the wrong map is confusing, since some roads have the same name, but in Denver they lead to dead ends. Working with people with FASD is like developing a new map – not a better one, just a different one.

At only 80 pages, you may be able to be read it in one sitting – but I feel it needs to be studied thoroughly to take all the information in. It will likely become a resource that you will refer to as needed.

Understanding the trying differently approach sounds easy but applying it takes effort and practice. Even Diane says:

Our approach is simple, but not simplistic. It starts by asking the question, “What if brain function is the source of behaviors?” The obviousness of the answer is intentional. Even after acknowledging brain function as the source of behaviors, the next step is not obvious: What do we do differently now that we know this?

While there are example provided, there is no way to list every possible situation. This is a guide to understanding. There are some Facebook groups dedicated to implementing the approach. I would suggest if you struggle with applying it, or would benefit from the support of others (and who doesn’t!), to search out a group using the neurobehavioral approach. There are groups with people trained in the approach and others that while not trained practitioners, still follow the general principles.

There have been calls over the years to provide an updated version with more examples but I haven’t heard of one. It’s too bad because for as many people that love this book, there are as many who find it difficult or confusing to implement. If you know of any updates, or other helpful books that support this philosophy, let me know and I will include them in any updates to this review.

Given all this, I still do recommend the book. It is written in a straight forward manner, which while the application takes some work, the book is easy to understand. After reading it, you can apply what might work in your situation and leave the parts that don’t fit. My only issue with the book is some of the language is outdated. A seminal book such as this should be updated to reflect current language.

The key to your success in this approach is shifting your parenting or caregiving paradigm. We simply cannot support individuals with FASD using the same parenting techniques we were raised with. FASD is a disability. As this quote from TMI states: You cannot discipline out a disability. But you can learn to understand its symptoms and the behaviours that manifest as a result of them.

FASCETS, the organization that carries on Diane’s work, has this to say about the NB Approach:

This model is applicable to FASD and any other brain-based conditions, including, but not limited to, autism, ADHD, acquired brain injuries, stroke, dementia, and many others. Our model helps establish the link between the brain function and presenting behaviors.

The gift of the neurobehavioral model is in redefining behavioral symptoms in a manner consistent with research. A profound shift is created in moving from anger to compassion, from blaming to acceptance, lessening frustration on all sides, and improving outcomes.

To learn more:

• The book is available on Amazon in print and as an EBook.
• For some ideas of how to apply the principles, check out: Day 13 of 99 Days to FASDay: Using the Neurobehavioral Approach. Days 13-20 provide different examples of using an NB approach.
• You can watch a 40 minute video uploaded to YouTube of a presentation by Diane Malbin.
• Training is available if you want to dive deeper through Fetal Alcohol Spectrum Consultation, Education and Training Services

One parent summed the book up this way: The book taught me that we need to take a step back and look at what our child CAN successfully do and really focus on those attributes. And to find the supports, tactics, or patterns for the items they CAN’T successfully do.

Final word goes to the author:

Note: I have no received any compensation for this review or for any book purchases. I have provided a review as a means to introduce the book as another tool for your caregiving toolbox.