Neurosequential
Model
Understanding the brain's sequential development is
necessary to understanding and effectively treating traumatized children. The
brain is the system through which all information is gathered, regulated,
interpreted and reacted to, and develops in a predictable, sequential fashion
from basic to complex functioning. Key to meeting an abused child’s needs is
understanding that the brain requires appropriately timed stimulation, and
neglect or negative experiences alter the brain development of a child,
delaying or denying the chance for the brain to develop its complex
functioning. Traumatized children's brains are developmentally different; often
they have developed an altered baseline in which an elevated sense of arousal
and/or alarm is persistently experienced and their brain function is controlled
by basic rather than complex brain areas. Under-socialized children are also at a
greater risk for general emotional, behavioral, social, cognitive, and physical
health problems.
Understanding
the brain is key to helping traumatized children, because the neurosequential
model understands that the brain is the central regulatory area for emotional,
behavioral, social, motor, and neurophysiologial functioning; so if a behavior
change is desired, the brain must be changed. Neurons are designed to change in
response to activity; dendrites and neural patterns are trained by use. Healthy
organization of brain development areas and capabilities depend of the presence
of sufficient and appropriately timed stimulation and exposure to signals. Patterned,
repetitive activity changes the brain, for better or for worse. Interventions
to retrain children's brains need to be predictable, frequent and consistent. Stress
response systems originate in brainstem and basic systems. If brain system is
poorly regulated, if basic stress response and arousal cannot be governed, the
lower brain system will override and deregulate higher parts of the brain. Therapeutic
activities need to reflect a sequence of normal development; from the brainstem
up.
There are several new promising treatment modalities and
ideas for helping traumatized children. A conventional approach to helping
traumatized children is the use of psychotropic medication to constrain the brainstem’s
neural response to stress and threats. The effects tend to be nonspecific, the
efficacy is not clear, but after reading this article I understand why
medication may not be the most helpful intervention. Because the brain changes
through repetitive use, suppressing negative learned patterns through
medication doesn’t actually re-train the brain to develop more healthy and
normal reactions. Medications cannot organize and/or reorganize dysfunctional
neural networks. Behavior by regulating emotional dysfunction with medications
may work short-term, but they do not and cannot create new, healthy neural
networks. Medication use alone cannot have an enduring positive impact on
maltreated children. Alternative brainstem modulating interventions are
beginning to be rediscovered, and their basic, repetitive, patterned rhythmic
stimulation of the brainstem have tentatively proven helpful. Such activities,
such as music and movement therapies, may have great benefit for traumatized
children. I would want a trained individual to provide music or movement
therapy, however, because I do not currently feel qualified.
EMDR,
also another newer treatment modality, helps short circuit the chain of
traumatic memory by tapping into a more powerful part of the brainstem; diencephalic
memory. Because most brain development happens very early in life, early
childhood trauma or maltreatment has disproportionate capacity to cause
significant dysfunction in comparison with similar trauma/maltreatment later in
life. The younger a child is, more likely the child is to have enduring and
pervasive problems following said trauma. Usually assistance is not provided to
children until they obviously need services. It would be easier to implement or
offer proactive therapeutic services through enriched educational and therapeutic
services earlier in life. Neural systems can be changed, but some systems are
easier to change than others, and because the brain develops sequentially,
earlier interventions with children in need of services will be more effective.
The degree of brain plasticity is related to two main factors; stage of
development and area/system of brain. Once organized, an area becomes less
responsive to change. Other areas, such as in the cortex, plasticity remains
throughout life.
Neurobiologically
we need each other to develop successful interactions and emotions; and today’s
children are more relationally deprived than previous generations due to lifestyle
choices relating to caregiving and entertainment that provides overstimulation
through artificial light, TV, sounds, and images. Working with the child’s
family and caregivers will be necessary to help “rewire” a child’s brain
because repetition, predictability, and reliability are extremely important for
re-training the brain. Using family members and caregivers to help the child is
important, as is explaining the situation fully. An abused child’s age may not
match up with their developmental age, and people around the child often become
frustrated that the child doesn’t live up to the expectations of their physical
age. This frustration among those around them decreases the likelihood of
enough appropriate, nurturing relationships to provide development and
relational security. A child’s family must understand how important creating
new experiences and positive brain connections is to that child’s continuing
recovery and development. Often dogs or
other animals help, as they can provide unconditional love to a child even when
everyone around them is frustrated.
I
would consider using any of these methods in practice with abused children, the
most important factor would be the individual assessment of the child’s needs.
Each child will be at a different state of neurobiological, emotional, and
physical development. Meeting individual needs of each child may require a
combination of therapeutic interventions appropriate for their individual
circumstances. Before I personally implemented any of the treatment modalities,
however, I would want to research more thoroughly each method and try to find a
colleague or co-worker with personal experience. I would need to be trained in
each intervention or find a professional to work with whom I felt comfortable
referring my clients to. I would also have to analyze the client’s resources.
Knowing how cooperative caregivers will be and identifying enough emotional and
physical support resources for the child is very important. The brain is
altered when a child experiences abuse or neglect. Although the brain can be re-trained,
it is a long, difficult and repetitive process that must be customized for each
child’s needs.
