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The NEATS: A Child and Family Assessment
Category:
Family
This short book provides essential information about neurobiology, executive function, attachment, trauma, and self-regulation. Good informaiton for parents and servic providers who work with children and their families.
he NEATS is a child and family assessment that focuses on five areas that research has established as fundamental to human functioning and development. These areas are neurobiology, executive function, attachment, trauma, and self regulation. The title NEATS draws from the first letter of each of the five areas.
The five elements of the NEATS are inter-related. For example, neurobiology provides a foundation for the development of attachment relationships and executive functions. Secure attachment relationships, in turn, are the basis of optimal brain development and help to build executive skills based on the foundation that neurobiology provides. Executive functions include judgment, planning, and capacities for the management of emotions and the effects of trauma.
What's more, negative experiences such as trauma, loss, and neglect, can affect brain development as well as capacities for attachment, self-regulation, and executive function.
Read this book and you will learn a lot about children and their families. Helpful to parents of children with special needs and to direct service providers who work with children and their families.
Excerpt
Executive Function
Executive function (EF) is a term that covers a broad range of capacities related to judgment, problem-solving, organization of self, anticipation of consequences, working memory, and following rules and directions. Regulation of emotions, thoughts, and behaviors is part of executive func-tion as well, but in the NEATS assessment, self-regulation is a separate category because of its significance in social work and other applied settings.
The neurological basis of executive function is located primarily in the neocortex, which is in the front of the brain and is the seat of reasoning. The term “executive” fits these sets of capacities because an executive is someone who is in charge. The neocortex, however, is connected to many other areas of the brain, such as emotion and motor centers.
Like brain functioning in general, executive functions or skills arise from a combination of genetics and experience. Adequate nutrition and good prenatal care as well as genet-ics lead to good executive functions at birth. Subsequent experience contributes further to executive function development. With sensitive, responsive care, children build upon existing skills to continue their optimal development.
Stress, trauma, abuse, and neglect may undermine the development of executive skills in children with a good genetic makeup. These children can recover or develop new executive skills if their circumstances change for the better, where parenting is sensitive and responsive, except if the damage to neural circuits cannot be reversed.
Conversely, many children are born with brain functions that predispose them to executive function issues, but their quality of care is so high that they develop new neural circuits that appear to compensate for what might have been executive function deficits. How much neural growth is pos-sible is related to genetic makeup and whether or not any brain damage has ceiling effects. For example, there appear to be ceiling effects for some of the executive functions of children with fetal alcohol effects.
Parents of children with executive function challenges may require emotional support and psychoeducation and the children’s development of executive skills could take longer than with other children. Once again, however, there are lim-its to the brain’s plasticity and some individuals may have life-long issues with executive functions.
Conditions Associated with Executive Function
Executive function issues include difficulties with attention, following directions and rules, organizing the self, self-soothing when stressed, and self-regulation, and impulse control. Impulse control and following involves capacities for holding information in working memory and in considering alternatives and consequences, as well as resistance to distractions.
Childhood issues connected to problems in executive function issues are those listed under “neurobiology,” including fetal alcohol spectrum disorders, autism spectrum disorders, conduct disorders, oppositional disorders, and at-tention deficit/hyperactivity disorders (ADHD). In general, children may have good executive skills in some situations and not in others.
Children with executive function issues require structure in their daily lives, clear and simple directions in how to accomplish tasks, clear expectations, and heaps of praise when they show the smallest executive skill. They benefit when others show them how to do things and when the adults around them also have good executive skills.
As with other challenging child behaviors, parents of children with executive function issues benefit from psycho-education, parent support groups, and professionals who themselves have good executive skills. Parents’ executive functions are compromised if they have chemical depend-ency issues and untreated mental illness.
Practice Note
Once practitioners have reason to believe that chil-dren have executive function issues, it is advisable to assess parents’ executive functions. Children learn good executive skills from their everyday experiences of care that parents and others provide.
The case of six year-old Jack who has a diagnosis of ADHD will illustrate this point. Almost by defini-tion, executive function issues are part of ADHD. To develop an effective treatment plan for Jack, practitioners would assess parents for executive function skills as well and then recommend a course of action for them if they have executive function issues. Typical referrals are parenting classes, parent support groups, and psychotherapy, which can be a combination of individual, family, and couple treatment.
Another important application of the concept of ex-ecutive function is to assess who is in charge of the family; in other words, who has the executive functions for the family. In traditional families, where fathers and husbands are in charge of household finances and child discipline, women may struggle with executive function issues if their husbands die or leave the family. An older child may assume executive roles, but not have the skills to fulfill them.
For example, Pang, a Hmong refugee, a widow, and the mother of six children ages sixteen to six, depended upon her sixteen year-old daughter Moa to use the cash card that county social services agency provided every month. Pang did not know how to use the card and asked Moa to do it. Moa spent the money on clothes and entertainment for her-self and her friends, leaving the family in serious financial difficulties, and showing her poor executive functions in this situation. An effective treatment plan would assist Pang in taking on executive functions.
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