“The Neurosequential Model of Therapeutics is not a specific therapeutic technique or intervention; it is a developmentally sensitive, neurobiologically informed approach to clinical work. The NMT integrates several core principles of neurodevelopment and traumatology into a comprehensive approach to the child, family, and their broader community. The NMT process helps match the nature and timing of specific therapeutic techniques to the developmental stage and brain region and neural networks mediating the neuropsychiatric problems. The goal of this approach is to structure the assessment of the child, articulation of the primary problems, identification of key strengths, and application of interventions (educational, enrichment and therapeutic) in a way that will help family, educators, therapists, and related professionals best meet the needs of the child.”
Recently I had the privilege of joining a meeting in which two organizations that have been certified as flagships in the Child Trauma Academy’s NMT (Neurosequential Model of Therapeutics) came together to share stories and discuss ways to enhance what they are doing with their NMT training.
NMT is the brainchild (pardon the pun) of Dr. Bruce Perry, who is a neuroscientist, child psychiatrist and founder of the Child Trauma Academy. I first met Dr Perry over 10 years ago and was immediately deeply impressed with his knowledge of trauma and his heart for helping children. His now best-selling book, The Boy Who Was Raised as a Dog, was soon to be published. We began working together and at some point he invited me to become a Fellow with the Child Trauma Academy (CTA), an honor I continue to appreciate to this day.
Flagship organizations are those that have met the rigorous requirements of CTA to demonstrate that a large number of their staff have completed NMT training. Some are qualified to train others in NMT. Lakeside Global Institute, where I am Program Director and Warwick House, a residential treatment center for traumatized children located in Warrington, PA have each achieved this status of becoming a flagship organization with CTA. Currently there are over 50 people from these combined organizations who are either certified or on their way to being certified by CTA. These organizations have experienced huge shifts in their awareness and understanding of trauma. They have acquired very specific skills and strategies via NMT teaching including how to generate maps of a child’s brain to allow staff and parents to better understand the very specific developmental needs of a child.
Basically, NMT is an assessment tool that provides insights into which specific parts of the brain (there are 32 parts identified on each map) are underdeveloped. Under development is most likely the result of neglect or abuse. In order to mediate this underdevelopment, the child needs specific interventions to allow him or her to fully develop each affected area.
Because each of these 32 brain parts requires very specific strategies to allow this development to occur, the NMT approach provides clear processes that staff and parents can use to guide children through steps to allow them to catch up developmentally in that particular part of their brain. What works for one child may not be developmentally appropriate for another.
The one critical component of all of these strategies is what Dr. Perry calls patterned, repetitive, somatosensory interventions, meaning whatever somatosensory protocol is recommended must be repeated multiple times every day in order to have real impact. These processes need time for them to have impact on the developmental changes that need to take place. Once adults know the specific strategies, they can help children move through processes so that, over time, development that was interrupted by trauma can be converted into complete development.
Being in the company of so many clinicians who are using the NMT approach, I was overwhelmed with the hope that children with unresolved trauma can eventually experience healing and can claim a life in which their whole brain is fully developed. Under the guidance and encouragement of CTA, these clinicians were able to facilitate amazing growth in the children with whom they interact.
All were in awe of Dr. Perry’s brilliance and deep desire to help children and families. Seeing two organizations who share in that passion for helping children discuss their processes, describe their successes, celebrate what has happened, changes their motivation and commitment to continuing to use NMT. We can indeed change the world with strategies like this that can make all the difference in helping a child address and resolve childhood trauma.
Invitation to Reflect
- What are some of your first reactions to learning about NMT?
- Now that you know something about it what do you envision or wish could happen to all systems who work with traumatized children? How might this change the world? (I encourage you to do your own online research as well as read Dr. Perry’s The Boy Who Was Raised as a Dog).
The following information about NMT maps comes from The Village Network in which they share what a map for a normally developing child looks like compared to a child with unresolved trauma. You can see from the boxes where that child with unresolved trauma needs specific assistance to help their brain become developmentally healed.
In the Assessment phase, the NMT process examines both the past and current experience and functioning, including a review of the history of adverse experiences and relational health factors to help create an estimate of the timing and severity of developmental risks that may have influenced brain development. Once determined, the information collected is plotted on maps to generate an overall risk assessment and then are compared to a “normal”/stable individual, to determine areas of focus. Based on the findings, and treatment plan, specific therapies and behaviors are modified in order to more closely align the child within clinical norms.
Above is an example of a functional brain “map” produced by the web-based NMT Clinical Practice Application. The top image (with the red squares) corresponds to a client (each box corresponds to brain functions mediated by a region/system in the brain. The map is color coded with red indicating significant problems; yellow indicates moderate compromise and green, fully organized and functionally capable). The bottom image is a comparative map for a “typical” same-aged child. The graphic representations allow a clinician, teacher, or parent to quickly visualize important aspects of a child’s history and current status. The information is key in designing developmentally appropriate educational, enrichment and therapeutic experiences to help the child. This clinical approach helps professionals determine the strengths and vulnerabilities of the child and create an individualized intervention, enrichment and educational plan matched to his/her unique needs. The goal is to find a set of therapeutic activities that meet the child’s current needs in various domains of functioning (i.e., social, emotional, cognitive and physical).
Diane Wagenhals, Program Director, Lakeside Global Institute