Child abuse and neglect create enormous problems for the victims. Among these are fundamental changes in brain development. The brains of severely neglected infants and children can be so damaged that the brain simply fails to grow in size at a normal rate, resulting in a brain size and a head size that are much smaller than is appropriate for a child’s age.
In addition, certain critical governing neural networks that extend throughout the brain in a healthy individual must begin their development in the brainstem, and then gradually grow upward to progressively more complex regions of the brain. If, as a result of child abuse or neglect, this does not happen, as an older child, teenager or adult a survivor of child abuse will have great difficulty with self regulation, impulse control, physiological calming, and attention. The result? Erratic behavior, including anger outbursts, inability to focus, mood swings, anxiety, depression, reckless or dangerous behavior, failure to follow through on goals or tasks, and hyperactivity.
Typically children with these problems have been variously diagnosed and misdiagnosed as having attention deficit disorder, conduct disorder, oppositional defiant disorder, mood disorders, anxiety disorders, and “childhood” bipolar disorder. All of these labels do nothing to identify the child abuse and neglect that are the root cause of the problem and do not lead to interventions that repair the brain’s regulation systems.
Unfortunately, the brain stops increasing in size before age 5, so the small brain size resulting from neglect becomes permanent unless therapeutic interventions are done very early. Other problems, however, are more responsive to change than was previously believed.
Some of the nation’s top child abuse and trauma therapists, led by international experts including Dr. Bruce Perry and Dr. Bessel Van Der Kolk (both psychiatrists) have been working for the last thirty years to discover what is damaged in the traumatized brain, and how to fix it.
Their research, along with a wealth of new information from brain imaging, has created a therapy approach that stimulates the gradually development of the appropriate neural networks, from the brainstem up, even in older children and adult survivors of child abuse and neglect.
One such therapy, developed by Dr. Perry, is called “Neurosequential Model of Therapeutics” or NMT. This therapy approach requires much more than one hour a week of intervention; however much of the work is simple and does not require a therapist. Many of the therapeutic exercises can be done at home, as long as they are overseen and guided by a clinician who understands the sequencing of tasks needed at each stage.
For example, at the brainstem level, the essential neural networks need to be stimulated by touch and by physical activities involving balance, posture, rhythm, breathing and motion. Appropriate activities thus include yoga, tai chi, rhythmic dance, music, drumming, breathing exercises, horseback riding, and massage.
As the networks of self-regulation begin to improve, the therapist can then add activities that focus more on hand to eye coordination, social interactions, understanding and experiencing emotions, learning trust and teamwork, and watching social cues and body language.
The last stage of this developmentally-sequenced therapy is to learn cognitive skills such as mindfullness, positive thought patterns, self-worth, goals, motivation, and attention. These skills cannot be effectively mastered at the first stage, but they can be very helpful in the final stages of therapy.
Dr. Perry has developed a sophisticated system of brain mapping of various aptiudes and developmental skills. This brain mapping enables the therapist to evaluate the level of brain development in a survivor of child abuse or neglect, and to then choose the level of intervention that is most likely to be helpful.
Using this system, Dr. Perry and others have achieved a level of emotional and functional repair in survivors of child abuse and neglect that was not previously believed possible.
Unfortunately, this therapy approach is not yet widespread, partly because of entrenched conventions and insurance protocols that pay only for older traditional therapies and medications. This is unfortunate, as in many cases the medications that are being prescribed do not help, mask the problem, tranquilize the child, and may in some cases actually prevent the brain of a child abuse survivor from building the essential neural networks of healing.
Dr. Perry and staff at the Child Trauma Academy offer distance training to therapists who want to learn the Neurosequential Model of Therapeutics. Clinicians attend ten 90 minute seminars, one a week, to complete the training, and can do this via phone or skype. For more information go to childtrauma.org. To support research at the Child Trauma Academy through tax-deductible donations, go to http://store.ctaproducts.org/donations.html
Dr. Bessel Van Der Kolk has been actively raising research funds to create a new diagnostic category, “developmental trauma disorder” and to establish a diagnostic system that will recognize the trauma core of symptoms, and will allow clinicians to use and be paid for appropriate therapies that actually repair the brain. To donate to his research, please go to http://traumacenter.org/about/donate.php
Your assistance in this project can help make the difference: childhood trauma is by far the biggest health problem in our nation. More than half of US adults have experienced childhood trauma, and this trauma doubles and triples the risk of most major health problems. In addition, childhood trauma multiplies the rate of addiction, depression, anxiety and suicide attempts, in some cases as much as thirty or forty-fold.
If you would like to be involved, please consider contributing to these pioneers in healing.
To go to the website of Dr. Bruce Perry’s Child Trauma Academy, go to http://childtrauma.org.
To read Dr. Bruce Perry’s recent article on NMT, published in the Journal of Loss and Trauma, go to http://michfed.org/wp-content/uploads/2009/11/TraumaLoss_BDP_Final_7_09.pdf
To view Bruce Perry’s powerpoint slides showing brain mapping, go to https://childtrauma.org/images/stories/docs/nmt_core_slides_2011.pdf
To go to Bessel Van Der Kolk’s Trauma Center, go to http://traumacenter.org.
Neurofeedback and its role in regulating and repairing the brain was also a significant portion of this broadcast. For information on Neurofeedback and to find a practitioner, go to eeginfo.com. This site also has links to a great deal of excellent research.
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