In a presentation at the third annual Northwest Get Together sponsored by Woodbury Reports, Inc., Jonathan Mack and Joel Smith showed how a neurodevelopmentally-sensitive perspective could be tremendously helpful in effectively treating troubled children.

Speaking in Naples, ID, to more than 60 professionals from around the country in the private parent-choice network of therapeutic/emotional growth schools, Mack began with a quote from Dr. Bruce Perry about the goal of the Neurosequential Model of Therapeutics. "The goal is to find the appropriate set of therapeutic activities that match a child's current need in various domains of functioning (i.e., social, emotional, cognitive and physical)."

This process begins, Mack stated, with a thorough assessment of the child, which considers the child's history, as well as emotional, behavioral and physiological symptoms. Mack then identified three of Dr. Perry's key principles of neurodevelopment and neurobiology.

The first principle is that the brain develops in a sequential fashion. Certain parts of the brain develop primarily in utero, while other parts develop primarily in infancy, early or later childhood and adolescence. If exposed to stressors at these various points of development, the developing brain is impacted in ways that can have potentially massive impacts on brain development and functioning. Mr. Mack showed a slide of a precarious stack of blocks from the popular game "Jenga" to illustrate the point that problems in these early parts of the brain can have tremendous impacts on other areas and functions of the brain.

The second of Dr. Perry's key principles presented by Mack was that "incoming sensory input enters the lower parts of the brain first." Mack explained that sensory data, whether from the outside world or from one's own body, goes through the brainstem, the most primitive part of the brain, first. If problems exist in that part of the brain, then incoming data can trigger "false alarms." One result of this can be an individual who lives in a near-constant state of alarm. The development of a child's attachment template further determines one's neurobiological relational and stress-response system. Later trauma can also contribute to problematic patterns of response to stress. These difficulties are often layered.

The third of Dr. Perry's key principles stated, "Neurons and neural pathways are use-dependent." Mack explained that this suggests, simply put, that the brain becomes better at what it practices. If a child "practices" being in a state of fear and hyper-arousal, these neural pathways are reinforced. This also suggests that the brain can make changes. The way this may be the most effectively done is through interventions that specifically target particular areas of the brain where problems exist. If a problem exists in a more primitive part of the brain, Mack explained, doing insight-oriented therapy, which tends to target the cortex and pre-frontal cortex, may not be helping the brainstem "practice" functioning in a more regulated, organized manner.

Again referencing the work of Dr. Perry, Mack stated that activities that tend to impact areas of the brain that are more primitive (i.e. the brainstem, diencephalon, limbic system) are likely to differ from traditional therapeutic approaches. Activities that meet Perry's criteria of being rhythmic, repetitive, relational, rewarding, respectful and relevant include therapeutic massage, rhythm/drumming, animal interactions, music and movement, treadmill/hiking, swimming, performing arts and play therapy. When effectively used in conjunction with assessments identifying areas of the brain requiring remediation, they can effectively help calm and organize areas of the brain that cannot typically be reached by insight-oriented or cognitive-behavioral therapies.

Mack and Smith discussed the use of neurofeedback as an effective method of calming and organizing the brain. "What we found is that neurofeedback can be remarkably effective for calming the brains of kids who have lived with a great deal of fear," said Mack, whose children's residential treatment center incorporates cutting-edge neurological research into treating children with emotional difficulties. "Our clients are telling us that neurofeedback sessions make them feel incredibly calm and relaxed, as though they're in a beanbag chair. It gives them a sense of control over their level of arousal, often for the first time. To be able to do that is monumental."

One child with severe anger issues whom Smith treated with neurofeedback has had close to 25 sessions. Drawings the boy made five months ago, before treatment, show faces with rigid, fearful expressions, while pictures of people were small with their arms close to their bodies. After the sessions, however, the drawings were looser, with smiling faces, arms open and a clear sense of humor.

"These approaches have helped this child make a shift towards a less fearful, less labile, more emotionally and cognitively available state of functioning," Mack explained. "The social learning model we use in our milieu is an essential component of our treatment model. Adding neurodevelopmentally-informed approaches such as neurofeedback have helped many children become more available to the relationships in the milieu and to the other types of therapeutic, relational work we offer."

About the Authors:
Jonathan Mack, jmack@sandhillcenter.org, is the Clinical Director and co-founder of the Sandhill Child Development Center, www.sandhillcenter.org, in Los Lunas, NM. Joel Smith is the Neurofeedback Supervisor. They co-presented "Shake, Shimmy, and Dance: Neurodevelopmental Considerations in the Assessment and Treatment of Troubled Children" at the third annual Northwest Get Together hosted by Woodbury Reports. They previously co-presented, "Technology and Neurobiology; Practical Applications in the Treatment of Children with Regulation Difficulties" and demonstrated "Dance, Dance Revolution!" at the second annual Northwest Get Together.