‘The Neurosequential Model of Therapeutics’ – recognising developmental rather than chronological age in maltreated / traumatised children
I recently had the opportunity to attend a day of presentations by Dr Bruce Perry of the Child Trauma Academy  , author of “The Boy Who Was Raised as a Dog”
.The effects of maltreatment on the developing brain – intrauterine, perinatal attachment and post natal trauma are well documented.  So Dr Perry’s focus is on what can be done about this, attempting to directly target neuronal networks.
He reminded us we are all “neurobiologically connected” i.e. we are built with brains that want and need to interact, and that the best way to heal is through relationships. “Presence, patience and persistence” in a relationship with a child, he said, will have far more impact than programmes of interventions services may provide.
He describes the core elements of a positive developmental, educational and therapeutic experience as:
- Relational (safe, stable)
- Relevant (geared to child’s developmental stage, not chronological age)
- Repetitive (creating patterns)
- Rewarding (pleasurable)
- Rhythmic (resonant with rhythmic patterns)
- Respectful (of the child, family and culture)
Functional Brain Map
So this is where ‘The Neurosequential Model of Therapeutics’ (NMT) comes into play for the assessment and treatment of traumatised and neglected children. It claims to differ from a traditional medical model approach to more developmentally sensitive, neurobiology guided practices.
The clinical implication is that in order to most efficiently influence a higher function such as socioemotional communication, the lower innervating neural networks (e.g., locus coeruleus norepinephrine systems) must be intact and well regulated.
A twelve point scale assigns values to the child’s current level of functioning at each developmental stage of the four regions of the brain. This produces a visual representation known as the ‘Functional Brain Map’ used for treatment planning and measuring outcomes.
The map helps to identify key strengths, and recommend the sequence of appropriate activities (educational, enrichment and therapeutic) to replicate the normal sequence of brain development, in a way that will help family, teachers, therapists, and other professionals best meet the needs of the child.
The field of restorative neurology highlights the positive impact of repetitive motor activity in cognitive recovery from stroke. Perry states “this suggests that therapeutic massage, yoga, balancing exercises, and music and movement, as well as similar somatosensory interventions that provide patterned, repetitive neural input to the brainstem and diencephalon monoamine neural networks, would be organizing and regulating input that would likely diminish anxiety, impulsivity, and other trauma-related symptoms that have their origins in dysregulation of these systems.” 
Not rocket science
And so you start at the lowest level, and provide interventions that meet the 6 “R”s. As an adoptive parent of a maltreated child, who exhibits developmental delay, regressive behaviour and dysregulation, it is reassuring that these, on the whole are not rocket science!
Rhythmic, patterned sensory input. Massage, drumming, music and movement. Building on these over time to broaden their social experiences.
Contact with animals, play therapy, performing and creative arts, and as their functioning improves at higher levels, moving on to story telling, drama, engaging in more traditional cognitive behavioural approaches.
I have written elsewhere about encouraging regressive behaviour in order to readdress early unmet needs . Whether the NMT approach and the mapping ever become widely practised within the UK remains to be seen.
But the research behind it should give more credence to providing and engaging in activities for traumatised children at what is perceived to be their developmental age and not chronological age.
 Perry, B.D and Szalavitz, M. 2008. The Boy Who Was Raised As a Dog: And Other Stories from a Child Psychiatrist’s Notebook – What Traumatized Children Can Teach Us About Loss, Love, and Healing. New York: Basic Books
 Perry, B.D. 2008. Child maltreatment: The role of abuse and neglect in developmental psychopathology In: Beauchaine T. P. and Hinshaw S. P. eds. 2008. Textbook of child and adolescent psychopathology. New York: Wiley. pp93-128.
 Perry, B.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
 Watt, C. 2012. Fostering Regressive Behaviour. In: Phagan-Hansel, K. ed. Foster Parenting Toolbox: A Practical, Hands-On Approach to Parenting Children in Foster Care. 2012. New Jersey: EMK Press. pp158-161
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