the Neurosequential Model of Therapeutics
Updated: Feb 11, 2019
The Neurosequential Model of Therapeutics,created by Bruce Perry, teaches that therapy needs to start at the place in brain development where a child is currently functioning. Only then will it be effective. Brains develop from the bottom up- from the brainstem,outwards to the cortical brain. The brainstem, which develops first, controls motor and sensory input. Then the limbic brain develops,which controls attachment, emotions,and behavior.The thinking,planning, impulse control and higher learning cortical brain develops last.
If a child has an underdeveloped or hyperactive brain stem- if they are operating in survival mode, with quick transitions into flight,flight, or freeze, which often happens after trauma or early childhood stressful events, therapy needs to start there. The child can’t form proper relationships,can’t control their emotions and behavior, can’t learn or control their impulses if they are still operating in a primarily primitive brain state.
With this in mind, after we make sure a child’s basic needs are met and they are in a safe, nurturing environment, Occupational Therapy is a good place to start. Occupational Therapy from a sensory lens can help to regulate the brain stem response through body based strategies, allowing the child to feel safe in their own bodies and environments and allowing them to engage in their worlds and possibly other therapies without quickly swinging into fight or flight. Body based strategies include patterned, repetitive activities as well as grounding activities such as using the body against resistance, breathing exercises,or other calming movements to help regulate the brainstem. Ideally these activities would take place with a caring adult to help develop co-regulation and foster attachment and relationship.
Other important places to start in calming a stressed child are a healthy diet, exercise, free play, and mindfulness. An OT can help with the practical aspects of creating a healthy routine for a child.
Check out beaconhouse.org, specifically their repair of early trauma document, 'the Body Keeps Score' book, thetraumatherapistproject, and neursequential.com for more information. *Images from beaconhouse.org*