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David D Nowell PhD 
www.DrNowell.com 
Understanding the Top- 
Down and Bottom-Up of 
Executive and Sensory 
Functioning
www.DrNowell.com 
DavidNowellSeminars 
DavidNowell
Overview 
• Top-down and bottom-up 
• Points of impairment 
• Curious compassionate nonjudgmental 
evaluation 
• HËDŸDT? 
• Joie de vivre and “magic moments” 
• Living in the gap 
• Q&A&D
www.slideshare.net/dnowell
TOP DOWN AND BOTTOM UP
What’s wrong with this brain model?
What’s wrong with this brain model?
What’s wrong with this brain model?
POINTS OF IMPAIRMENT
Points of impairment 
• Intellectual development 
• Autistic spectrum 
• ADHD / executive dysfunction 
• Attachment disorders 
• Trauma-related disorders 
• Cerebral palsy
CURIOUS COMPASSIONATE 
NONJUDGMENTAL EVALUATION
Skillfully eliciting the chief complaint 
• Too much of what? Or too little of what? 
• Invoking the Pediatric Fairy (or the Psychiatric 
Genie)
HËDŸDT? 
• How exactly did you do that? 
– Everybody’s doing the best he/she can 
– Every behavior problem is either 
• Skills deficit 
• Contingency problem
Forming a diagnostic impression 
• Where do you see it the most? And where do 
you see it the least? 
• Two disorders = two stories
Documenting and communicating your 
conclusions 
• The footprints in the butter 
• Defend your diagnosis
STRATEGIC BEHAVIORAL INQUIRY
Objectives of SBI 
• Specific behavioral strategy 
• What was the feeling-goal? 
• Motivational level on a scale from 1-10
Benefits of SBI 
• Affirms the value of clients’ unique internal 
experience 
• Emphasizes the culture of self-regulation 
• Encourages metacognition
Assumptions of SBI 
• Everybody’s doing the best they can 
• Behavior is not incomprehensible or random 
• Behavior follows patterns which reveal 
themselves to the curious observer free of 
prejudice or blame or theory
How to do SBI 
“How exactly did you do that?” 
“How did you know it was time to _____?” 
“How long had you been thinking about ____?”
JOIE DE VIVRE AND MAGIC 
MOMENTS
The end goal of treatment: 
joie de vivre 
Dr. Lucy Jane Miller
“Magic moments”
LIVING IN THE GAP
Let’s stay in touch! 
 Join my e-newsletter list: 
 Fill out a card today and drop it in the box. 
 Sign up on my web site or Facebook page 
 Visit us on the web: www.DrNowell.com 
@davidnowell David Nowell Seminars
Q & A & D

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Understanding the top down and bottom up of executive and sensory functioning