The Neurosequential Model: Understanding and Healing Trauma Through Education

Trauma, neglect, and abuse can profoundly impact a child's developing brain, manifesting in various behavioral challenges as they grow. Dr. Bruce Perry's Neurosequential Model (NM) offers a comprehensive approach to understanding and addressing these challenges, not as a specific treatment technique, but as a method for organizing a child’s history of trauma, neglect, or abuse, and assessing how they are currently functioning. This article explores the principles of the Neurosequential Model, its applications in education, and its potential for fostering healing and resilience in traumatized children.

Dr. Bruce Perry and the Genesis of the Neurosequential Model

Dr. Bruce Perry, a Senior Fellow at The Meadows, brings over 30 years of experience in children's mental health to the development and application of the Neurosequential Model. His expertise has made him a sought-after consultant in high-profile cases involving traumatized children and youth. The 2021 book by Oprah and Dr. Bruce Perry, What Happened to You?: Conversations on Trauma, Resilience, and Healing examines this problem. The Neurosequential Model of Therapeutics creates a structure for assessing the needs of children based on their history and how they are currently adapting to the world around them. Treating the whole person has significant implications for long-term recovery. If only one condition is treated, other untreated conditions may continue to flare up and cause problems.

Core Principles of the Neurosequential Model

The Neurosequential Model of Therapeutics (NMT) is rooted in neuroscience and emphasizes the importance of understanding how trauma and relationships impact a child's developing brain and body. It provides a framework for selecting developmentally appropriate therapies. Several key principles underpin the Neurosequential Model:

The Impact of Early Experiences

The brain's core neural networks develop in early childhood. The brain develops from the bottom up. This means that prenatal experiences and the earliest weeks, months, and years of life have lasting effects on brain development. As Dr. Perry notes, "Because the majority of brain growth and development takes place during these first years, early developmental trauma and neglect have a 'disproportionate influence on brain organization and later brain functioning'."

Bottom-Up Brain Development

The brain develops from the bottom up. The lower areas of the brain mediate the more primitive body-based functions such as heart rate, blood pressure, and respiration, while the higher levels of the brain are responsible for more intricate functions like logic, insight, and reason. Interventions must also occur from the bottom up. Perry’s Sequence of Engagement is guided by the understanding that when the lower brain is not regulated, well-organized, and efficient the higher brain regions such as the cortex cannot function optimally. When kids are dysregulated or upset, they have little access to the cortex's logic, insight, and reason.

The Importance of Relational Health

One of the key pieces of the Neurosequential Model is that it takes into consideration the full context of a child’s history to inform opportunities and interventions. In What Happened to You?, Dr. Perry emphasizes the critical role of relational health: "Our major finding is that your history of relational health - your connectedness to family, community, and culture - is more predictive of your mental health than your history of adversity." Quality of relationships and support can drastically improve a child’s chances of healing and healthy adaptation.

The NMT Metric: Assessing Brain Function

Assessment of the functional strengths and deficits of the child is accomplished through the NMT Metric, or Brain Map. Using information about the child’s history of adversity, their current and past relational supports, and measures of development in 32 areas of the brain, the Brain Map provides a snapshot of the child’s current brain-based functioning, their relational health, and their Cortical Modulation Ratio (CRM), an approximate measure of the child’s developmental age. Four critical areas of brain functioning are also scored on the NMT metric: sensory integration, self-regulation, relational function, and cognition. Scores in these areas allow NMT practitioners to select therapies that address the child’s neuro-developmental needs. For example, kids with highly dysregulated sensory integration systems need treatments that create rich sensory experiences and will not receive maximum benefit from interventions such as traditional talk therapies that target the brain's cognitive regions.

From NMT to NME: Applying the Model in Education

Perry and his colleagues have expanded this innovative way of thinking into schools, creating the Neurosequential Model in Education (NME), parenting through the development of the Neurosequential Model of Caregiving (NMC), and coaching with the Neurosequential Model in Sport (NMS).

The Neurosequential Model in Education (NME) applies the principles of the NMT to create trauma-informed learning environments. It recognizes that traumatized children may exhibit behaviors that are often misinterpreted as defiance or learning disabilities. The NME seeks to understand the underlying neurobiological reasons for these behaviors and to develop interventions that support regulation, relationship building, and cognitive development.

Recognizing Low-Brain Dysregulation

Youth with complex trauma histories often struggle with poor behaviors related to low-brain dysregulation, particularly in the areas of sensory integration and self-regulation. In traumatized kids, over-reactions to sounds and touch, hyperactivity, or an inability to smoothly change activities and make transitions are all common behaviors. The NMT helps us recognize these behaviors for what they are: the result of the child’s low-brain dysregulation and sensitized stress response system.

Read also: Impact of the Prussian Model

Regulation, Relationship, and Reason

Perry’s Sequence of Engagement prioritizes regulation through the body and the senses. First, we regulate, then we relate. Relationships are vital in creating a sense of safety and security in children with trauma histories. Adult regulation in the face of the child’s distress and misbehavior is critical. It is easy to become frustrated, irritated, and angry with youth who appear defiant and non-compliant. Yet, it is imperative for adults to maintain a calm, regulated presence in these moments. It is only after regulation and relationship that we can begin to reason. This means kids (and adults) must be calm, regulated, and feel safe before they can start the process of learning from or reflecting on their behavior. Only when the child is in this state can they think about what they did, attempt to understand why they did it, repair the mistakes, and reflect on how to avoid these situations in the future. In the reason state, the child can think and talk about what happened, noticing-like my son at the arcade-how emotions, sensations, or the environment may have played a role in their behavior.

Creating Trauma-Informed Classrooms

Implementing the NME in schools involves several key strategies:

Creating a Safe and Predictable Environment: Establishing routines, providing clear expectations, and minimizing sensory overload can help regulate the lower brain and create a sense of safety for traumatized children.
Building Strong Relationships: Nurturing positive relationships between students and teachers is essential for fostering trust and promoting healing.
Integrating Sensory Activities: Incorporating movement, music, and other sensory activities into the classroom can help regulate the nervous system and improve focus and attention.
Addressing Lagging Skills: Recognizing that trauma can lead to developmental delays, educators should focus on identifying and addressing lagging skills in areas such as self-regulation, social skills, and academic performance.
Promoting Self-Awareness: Encouraging students to understand their own triggers and develop coping strategies can empower them to manage their emotions and behaviors.

The 6 R's: A Framework for Healing Trauma

The 6 R’s are a framework for creating the rich developmental experiences needed to heal trauma.

Relational: The importance of relationships in healing early trauma and broken attachments cannot be overstated. It is only in the context of relationships that a child’s most critical developmental skills are learned. Children with histories of maltreatment, neglect, chaotic caregiving, or broken attachments often struggle to feel safe, trust others, or participate in healthy relationships. Adults who care for and work with traumatized children must prioritize relationships. We all long to be seen, heard, and understood. Approach challenging behavior with curiosity, not judgment. Asking a child how you can help or what they need gives us valuable insight into their behavior. Be aware of your facial expressions and tone of voice. While traumatized kids crave relationships, the intensity of emotional closeness can often be overwhelming or triggering, causing them to shut down or even lash out. When seeking relational opportunities with youth, adults should allow them to have as much control as possible. While we often think connection means looking each other in the eye and sharing our most profound truths, this kind of interaction can be incredibly overwhelming for children with attachment challenges or trust issues.
Relevant: Adversity and trauma cause children to have lagging skills in multiple developmental realms; for this reason, we must meet kids where they are. While it sounds simple, this is often incredibly frustrating for parents and professionals who feel children should perform at their chronological age level rather than their developmental age. Carefully observing, reflecting on, and recognizing a child's strengths and weaknesses helps adults have reasonable expectations and know the right times to challenge a child and stretch their skills. In his book What Happened to You? Conversations on Trauma, Resilience, and Healing, co-written with Oprah Winfrey, Dr. Perry states, "It really is never too late. Healing is possible. The key is knowing where to start the process. Invest in a new way of thinking. When adults see misbehaviors as lagging skills, they are more apt to respond with kindness and support rather than anger and punishment. Have flexible expectations. Remember that stress makes it more challenging to learn and perform. Take note of your child’s lagging skills and strategize about what they might need for support.
Repetitive: Repetition is essential for creating changes in the brain. This neuroscientific principle is often expressed by the phrase, “neurons that fire together, wire together.” Patterned, repetitive experiences are the basis of all therapeutic and educational growth. Caring adults must provide many opportunities for kids to strengthen their skills and experience safe and healthy relationships. Make the child’s life predictable. Routines and consistency create safety and regulation. Repeat expectations often, even in situations that are common or familiar. Create multiple opportunities for youth to engage in positive relational interactions. Promoting healthy connections with teachers, coaches, community, and family members allows kids to create new beliefs about themselves, others, and the world.
Rewarding: The human brain is highly motivated by pleasure. We all understand that if an activity or relationship feels good, we want to do it. If it does not feel good, we are not likely to seek it out or may even actively avoid it. When children receive an intrinsic reward, they will typically return to the activity or relationship over and over, without the adult even prompting them. Set aside time for play. Play performs multiple essential roles in child development. It strengthens the imagination; allows children to explore relationships and learn social skills; and helps with problem-solving and physical development. For kids recovering from maltreatment, play can be a way to express big emotions and fears and a safe means to connect with adults. Think of play-time as a way to build your child's skills, form or deepen relationships, and stimulate growth after trauma.
Rhythmic: In a 2018 interview, Dr. Perry said, “One of the most destructive effects of trauma is when the stress response systems of the brain become dysregulated…patterned, rhythmic, repetitive activity can restore regulatory balance." Patterned, repetitive activities get the body ready to learn by balancing and organizing the low brain. One of the most common rhythmic regulation techniques is rocking and singing to an infant. While you may not rock an 11-year-old, you can listen to or make music with him. Do not wait until kids are dysregulated. Be proactive.
Respectful: All trauma-sensitive interactions must be based on a deep respect for the child, family, and culture. Perry writes, "Marginalization is a fundamental trauma." Dismissing or invalidating the experiences of an individual or group creates dysregulation and a lack of safety. Remember that children’s emotions are real and valid. It’s easy to dismiss children’s feelings as silly or inconsequential, particularly if they are communicated in ways that feel irritating or over-the-top to adults. Be aware of the impact of race and culture on adopted children’s identities.

tags: #neurosequential #model #of #education #explained