by Krista Shaul, JD, Deputy County Attorney, Cheyenne County
Chances are, at some point during a juvenile case, a child under the Nebraska Juvenile Court jurisdiction will participate in some kind of therapy or treatment. Some therapy addresses trauma the child has been subjected to soon after the trauma has occurred. Other therapy works on behavioral actions of the juvenile, which in all likelihood are precipitated by and are also a result of trauma. Traditional therapy, the kind thought of when the words “counseling” or “therapist” are mentioned, can be helpful to a child, but only with the right child at the right time. There are numerous success stories based on therapy a child has participated in; however, with Neurosequential Model of Therapeutics (NMT), the success of the treatment and care of Nebraska’s children will vastly improve.
The Science Behind the Method
The brain, along with the experiences a person has and is subjected to makes a person who they are. The brain rapidly develops prior to being born and up to age four. The brain is responsible for every action and thought we do and have. Synaptic connections are the physical connections between neurons, and with continued, repetitive use, the synaptic connections increase and strengthen. If synaptic connections are not used, they will decrease or even disappear. The development of the brain is a sequential process. The lower, more regulatory part of the brain develops first. The brainstem which controls the heart rate, body temperature and other survival-related functions is the first to develop, followed by the diencephalons, limbic, and neocortex portions of the brain. The higher parts of the brain control the complex functions of language and abstract thinking. The brain also organizes from the inside out.
Under normal circumstances, normal stressors will help the brain develop the capability to respond to stress. Children who experience abuse, neglect, unstable homes or other trauma will have negative effects on their brain when they experience the same normal stressors. The more extreme and tragic traumatic events will result in more severe and chronic damage to a brain, as well as cause a greater resistance to improvement and treatment. Neural systems formed while under trauma or abnormal stress develop in such a way that traditional therapies alone cannot provide a meaningful and sustained change in the child’s behavior and affect the child’s emotional, behavioral, cognitive, social, and physical behaviors.
If portions of the brain are underdeveloped or not developed at all, subsequently developing parts cannot be developed until the initial portions are developed. In other words, when a traumatic event prevents a lower part of the brain from developing appropriately, the upper parts of the brain will not develop until the lower part has been remedied.
There are ways to repair a brain that has been exposed repeatedly to trauma and stress in the early developmental stages. Exposing the child repeatedly to positive influences and appropriate therapeutic techniques will assist in repairing the brain and will help the underdeveloped parts of the brain develop.
Human beings are innately social creatures and crave social interaction. The brain depends on relationships with other people. Spending time with positive loving friends or family will mimic and stimulate the reward systems in a brain.
The Method
Dr. Bruce Perry, MD, Ph.D., presented at the NACC Conference on the Impact of Trauma on Brain Development and the Neurosequential Model of Therapeutics (NMT) technique. NMT maps the neurobiological development of maltreated children. NMT is not actually a therapy technique, but rather gives additional information and guidance to determine which specific therapeutic techniques would be most beneficial to a child. NMT assesses a child, identifies the child’s problems and strengths, and suggests appropriate treatment that will best meet the needs and goals of the child. The basis behind NMT is that a child’s behaviors can be changed by changing the actual makeup and development of the brain.
NMT starts with an in-depth review of any stressors or traumatic events in a child’s life during the early development stages, especially prior to age four. The stressors are rated based on the severity and timing of their impact on the child. NMT then looks into how attached or vulnerable the child was during the early developmental times. Lastly, NMT provides a specific recommendation for how to approach the treatment of the child. Developmentally appropriate treatment techniques are recommended which will help address and cure any deficits in the brain. The goal of NMT is to mimic the normal, natural, sequential development of the brain. NMT also looks at the current relationships between the child and individuals in the child’s life, as the more stable and positive the relationships a child has, the more a successful outcome can be predicted.
An actual map of the child’s brain is printed out, looking somewhat like a reverse or upside-down pyramid. The brain map not only indicates which portions of the brain are developed, but also how functional or developed each portion is. The map is a visual depiction that is used to plan for treatment and also helps track the progress the child makes through their therapies and treatment.
Implementing the Method
One therapeutic contact per week is not sufficient to give the child the opportunity to repair or grow the years worth of damage done by trauma and stress at the pivotal time the brain was developing. Merely increasing the hours or times of traditional therapy will not be sufficient. Rather, it is necessary to focus on the kind and timing of therapy offered to the child. It will be necessary for more ‘repair’ or therapeutic work to be done the younger the child at the time of the trauma or stress.
Dr. Perry lays out four keys to successful treatment. First of all, the therapeutic treatment provided to the child must match the child’s developmental abilities in each of the following domains of function: social, emotional, cognitive, and physical. Second, the therapeutic treatment must be provided in a safe and predictable situation and location for the child. Third, there must be repetition of the activities in order for a change to actually occur, and the repetition must be over an extended period of time. Fourth, there must be some ‘element of reward’ contained in the therapeutic treatment for the treatment to be effective.
One of the most important kinds of therapies used in these situations is a mentoring type relationship. Increasing the amount of positive interaction a child has with an adult is vital to building the brain and improving behaviors. Even one hour a week of mentoring can provide the relational stability necessary to help mitigate the effects of trauma.
Why the Method works
When NMT is implemented, individuals involved in the treatment of a child can better understand the development of the child’s brain. When the development of a particular child’s brain is understood, a treatment plan can be specifically and individually created and implemented for the child. The child will receive treatment and therapies that will be effective and developmentally appropriate and will remedy the underdeveloped or non-developed portions of the child’s brain which will in turn change the child’s behaviors. Traditional behavioral therapies do work, however they only work on the right child at the right time.
Traditional treatment plans focus on the current actions of the child or why they are behaving the way the are. NMT focuses on what happened in the past and what is missing because of the past occurrences. In other words, the best therapy with the best therapist will have no effect on the child if the child is not developmentally at a stage to be receptive to the therapy. The child must be brought through the proper treatments to properly and fully develop the brain before the next level or stage of treatment and development is initiated.
The key behind NMT is that there is no specific therapeutic technique that works with a child. Rather, with the additional information provided during the NMT assessment, the proper person working with the child on the proper treatments can have a high rate of success. Implementing NMT for children under the jurisdiction of the Nebraska Juvenile Courts will allow the children a better chance at fully remedying the negative effect trauma and stressors had on the child’s brain development. The appropriate treatments will be used at the appropriate time, preventing the system from needlessly getting nowhere in the actual treatment of the child, wasting precious time, or excessively spending the dollars we all know are so limited. Ultimately, the child can hope for a full treatment, which results in a lifetime of success, and that is most certainly in the best interest of the child!
Krista Shaul is a Deputy County Attorney in Cheyenne County. She can be reached at 308-254-6060 or krista@39cty.com.
Additional Resources regarding NMT:
www.childtrauma.org
Hambrick, Erin P., & Perry, Bruce D. (2008) The Neurosequential Model of Therapeutics. Reclaiming children and youth, Volume 17, number 3.
Perry, Bruce D. (2004) Maltreatment and the Developing Child: How Early Childhood Experience Shapes Child and Culture. The Margaret McCain Lecture Series.
Perry, Bruce D. (2006) The Neurosequential Model of Therapeutics: Applying Principles of Neurodevelopment to Clinical Work with maltreated and Traumatized Children. In N. B. Webb (Ed.) Working with traumatized youth in child welfare (pp. 27-52). New York: The Guilford Press.
Perry, Bruce D. (2009) Examining Child Maltreatment Through a Neurodevelopmental Lens: Clinical Applications of the Neurosequential Model of Therapeutics. Journal of loss and trauma, 14:240-255.
Perry, Bruce D. (2010) The ChildTrauma Academy. Introduction to the Neurosequential Model of Therapeutics (NMT).
