(This insight was written based on Lon's notes after attending a two-day training seminar conducted by Dr. Bruce Perry, MD, PhD, on March 5-6, 2008, at Sandhill Child Development Center, Linda Zimmerman - Founder, Los Lunas, NM, 505-866-9271, lzimmerman@sandhillcenter.org, www.sandhillcenter.org.)

Dr. Bruce Perry is an entertaining lecturer who can present complex concepts in a way that can be easily understood. About 70 professionals attended, and Dr. Perry rapidly gained the attention of everybody present and maintained their interest throughout the whole seminar.

His purpose at the seminar was to explain the model he has been developing for several years of understanding and treating children with problems. He calls his approach Neurosequential Model of Therapeutics (NMT), which simply is stating that the brain is the source of all that we do and think. The brain develops in a precise sequence and most problems occur because of some developmental delays in brain development.

Dr. Perry started with the observation that the brain is responsible for everything we do, and the brain for the most part reflects our experience through life. When a child or an adult has problems, the cause is usually some kind of developmental delay in some area of the brain. The trick is to identify what part of the brain has not developed appropriately and focus interventions to impact that area.

NMT is a departure from the assumptions and techniques of mainstream psychological assessment and therapy. The heart of this therapy is the Diagnostic and Statistical Manual of Mental Disorders (DSM) developed by the American Psychiatric Association. Dr. Perry describes the DSM as an early attempt to categorize complex behavior by checklists of symptoms. He points out that this makes diagnosis a very tentative matter since categorization is based on results (or symptoms) instead of causes, which means diagnoses and drug interventions are more a trial and error process relating to observations of symptoms rather than based on isolating and treating the root cause of the problematic behavior which is the brain.

NMT postulates that the brain is constantly changing and develops in the growing child in sequence, roughly from the lower part, the brain stem, to the upper part such as the cortex. The brain develops through the life experience of the child, through a sequence where vulnerability differs with age, that is, different areas of the brain are developing at different times. For proper development the brain must be exposed to the proper stimulation at the time the brain is ready to develop that area. How well each area develops depends on the life experience of the child at that time.

For example, Dr. Perry explained that cortical function of the brain is highly developed through the child learning to speak and read. In addition to those basic useful skills, this also teaches the all-important ability of self-control. He pointed out experience has shown that one of the best anti-recidivism techniques in prison is teaching the inmates to read or to improve their reading and speaking skills.

As an example of how important it is to teach these brain developing skills when the brain is ready to develop in that area, he reported studies of people who grew up without any verbal stimulation as children, and as adults they were unable to learn to speak except in a very limited way. The window of opportunity for the brain ever learning that particular skill had closed permanently.

Dr. Perry also asserts that the best biological intervention for problematical behaviors and brain organization or re-organization is human interaction. He attributes this to the way humans evolved. He points out that humans are not designed for the world in which we now live. Humans evolved in small groups called tribes, competing with other small groups. In this culture, especially, the key to survival was building and maintaining strong relationships. Consequently, relational health is vital to proper brain development throughout life and vital to a successful life. One of the most destructive aspects to proper development is a poverty of relationships. Dr. Perry used this poverty of consistent relationships as a major reason our foster system of child care has such problems.

Dr. Perry explains that poverty of relationships creates stress, which creates a hunger for the reward that should have come from positive relationships. As a result, substitutes are selected for that craving such as drinking, drugs or other unhealthy behaviors. Treatment is based on developing an environment for the child of healthy relationships, where the child has enough moderate stress to feel safe enough to explore without being overwhelmed with unpredictable events creating harmful stress. A safe environment with moderate novelty for the brain to learn and develop will allow the brain to heal and reorganize from the unhealthy development from earlier life experiences.

As NMT has evolved, Dr. Perry has developed assessment tools that are designed to determine what areas of the brain have been developmentally delayed, and interventions have been developed to heal those specific areas. Healthy relationships, of course, form a major part of treatment, but a wide and creative variety of other interventions can be used. For example, since the brain is a rhythmic organ, music and movement are often exactly what the brain needs in order to heal and overcome problematical behaviors.

The key thing in NMT is a change in focus. Instead of looking at symptoms and a checklist as a guide, the clinician looks beyond symptoms, to the brain as the root cause of the problematic behaviors. Treatment is then focused on healing the brain, which will take care of the problematical behaviors.

About the Presenter:
Dr. Bruce Perry is Senior Fellow at the Child Trauma Academy in Houston Texas www.childtrauma.org. He is one of the leading authorities in the country on brain trauma and child development. This seminar was a staff training session for the staff of Sandhill Center and other invited professionals.)