Brain Basics for the Classroom Alexis Myers LPC

Brain Basics for the Classroom Alexis Myers LPC, RPT Michelle Hamilton LPC, ATR, NCC

The Client • • • Nicole, 13 yo female Multiple placements (10 adoptive & residential) Bio mother history of schizophrenia Verbal and physical aggression History of domestic violence Diagnoses history: Anxiety, Reactive Attachment Disorder, Mood DO, ADHD, Oppositional Defiant Disorder, Bipolar DO, Intermittent Explosive Disorder, Post Traumatic Stress Disorder TRUMAN MEDICAL CENTERS 2

• “Going beyond the medical model, The Neurosequential Model of Therapeutics maps the neurobiological development of maltreated children. Assessment identifies developmental challenges and relationships which contribute to risk or resiliency. Formal therapy is combined with rich relationships with trustworthy peers, teachers, and caregivers. ” • Dr. Bruce Perry TRUMAN MEDICAL CENTERS 3

What is NMT • Developed by Dr. Bruce Perry • Developmentally-informed, biologically-respectful approach to working with at-risk children and adults with childhood trauma • Evidence based & trauma informed TRUMAN MEDICAL CENTERS 4

How is NMT Different? • Not a specific therapeutic technique or intervention; it is a way to organize a child’s history and current functioning TRUMAN MEDICAL CENTERS • Structured assessment of a child, the articulation of the primary problems, identification of key strengths and the application of interventions (educational, enrichment and therapeutic) in a way that will help family, educators, therapists and related professionals best meet the needs of the child 5

Functional Brain Maps • Examines past and current experiences and functioning to help generate a visual “map” of the child’s current functioning • Organized in a neurobiological fashion TRUMAN MEDICAL CENTERS • Identification of functional impairment which guides treatment planning • Interventions are designed to replicate the normal sequence of development beginning with the lowest, most abnormally functioning parts of the brain 6

Semi-structured, quantitative assessment process: NMT Metrics • Developmental History • Current Functioning – Genetic – Epigenetic – Adverse Experiences – Individual CNS • Developmental Timing • Nature, Severity, Pattern – Relational Health • • Developmental Timing Bonding and attachment Family supports Community supports TRUMAN MEDICAL CENTERS • • Brainstem Diencephalon/CBL Limbic Cortex/F TCTX – Relational • • Family Peers School Community 7

NMT– Recommendations • Selection and timing of therapeutic activities will depend on assessment • Usually best to start with simple rhythmic and repetitive activities to help the brainstem neural systems to become well organized and regulated • As brainstem is more regulated, activities can target higher, more complex parts of the brain • Over time, more conventional individual therapies become possible, e. g. TFCBT, PCIT (Perry, 2006) TRUMAN MEDICAL CENTERS 8

NMT– Recommendations • Essential = activities crucial to child’s future growth in particular area. (Score below 65% of typical age score). Unless functioning in essential area is increased child will lack foundations for future growth and development in this and other areas. • Therapeutic = activities aimed at building in strength and growth in particular area. (Scores within 65 to 85% of typical age are appropriate for more focused treatment). These activities are important for child’s continued growth and improvement in area. • Enrichment = activities providing positive, valuable experiences that continue to build capacity in given area. (Scores are at or above 85% of age typical functioning). Activities are designed to enhance and reinforce strengths previously built into area. TRUMAN MEDICAL CENTERS 9

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Sensory Integration Client Score: 78 Age Typical: 92 Percentage: 84. 78 Therapeutic: (65% - 85%) – Scores between 65% and 85% suggest that the child has some difficulty in somatosensory functioning. Building in patterned, repetitive somatosensory activities across settings in which child spends time (home, school, etc. ) are required for necessary reorganization to take place. Somatosensory activities such as music, movement, yoga, drumming or massage woven throughout the child’s day will have the greatest impact. TRUMAN MEDICAL CENTERS 14

Sensory Interventions for the Classroom • Work standing up, standing work station, sit on exercise ball • Weighted backpack • Sensory corner: rocking chair, exercise ball, theraputty, fidget tools, arm/ankle weights, resist bands • Sensory breaks for “heavy work”, carry a bag of books to the office, move items from one side of the class to the other • Weighted lap buddy **Consult with your school Occupational Therapist TRUMAN MEDICAL CENTERS 15

Self Regulation Client Score: 45 Age Typical: 85 Percentage: 52. 94 Essential: (below 65%) – Scores below 65% of age typical functioning suggest the child has poor self-regulatory capabilities. These children may have stress response systems that are poorly organized and hyper-reactive. They are likely impulsive, have difficulties transitioning from one activity to another, and may overreact to even minor stressors or challenges. Children in this category require structure and predictability provided consistently by safe, nurturing adults across settings. Examples of essential activities in this category include: developing transitioning activity (using a song, words or other cues to help prepare the child for the change in activity), patterned, repetitive proprioceptive OT activities such as isometric exercises (chair push-ups, bear hugs while child tries to pull the adults arms away, applying deep pressure), using weighted vests, blankets, ankle weights, various deep breathing techniques, building structure into bedtime rituals, music and movement activities, animal assisted therapy and EMDR. TRUMAN MEDICAL CENTERS 16

Self Regulation for the Classroom • Transitioning activity (using a song, words or other cues to help prepare the child for the change in activity) • Patterned, repetitive proprioceptive OT activities such as isometric exercises (chair push-ups, bear hugs while child tries to pull the adults arms away, applying deep pressure) • Use of weighted vests, blankets, ankle weights, various deep breathing techniques, music and movement activities • Incorporate interventions early at first signs of dysregulation TRUMAN MEDICAL CENTERS 17

Relational Client Score: 52 Age Typical: 84 Percentage: 61. 90 Essential: (below 65%) - Scores below 65% of age typical functioning suggest the child has poor relational functioning. Children who have a history of disrupted early caregiving, whose earliest experiences were characterized as chaotic, neglectful, and/or unpredictable often have difficulties forming and maintaining relationships. In order to make sufficient gains in relational functioning, essential activities must include interactions with multiple positive healthy adults who are invested in the child’s life and in their treatment. Examples of essential relational activities include: art therapy, individual play therapy, Parent-Child Interaction Therapy (PCIT), dyadic parallel play with an adult, and when mastered, dyadic parallel play with a peer. Once dyadic relationships have been mastered supervised small group activities may be added. Other examples of essential activities include animal assisted therapy and targeted psychotherapy. TRUMAN MEDICAL CENTERS 18

Relational Interventions for the Classroom • Regulate –> Reason: Therapeutic experiences should begin with a state of regulation (feeling safe) to then build on creating relational enrichment and understanding. • Interactions with multiple positive healthy adults who are invested in the child’s life and in their treatment – Triage with identified support person outside of the classroom • Coordinate with outside providers when possible TRUMAN MEDICAL CENTERS 19

Cognitive Client Score: 64 Age Typical: 77 Percentage: 83. 12 Therapeutic: (65% - 85%) – Scores between 65 and 85 percent suggest that the child has some difficulty with cognitive functioning. Once fundamental dyadic relational skills have improved, therapeutic techniques can focus on more verbal and insight oriented or cortical activities. Examples of therapeutic activities include: insight oriented treatment, cognitive behavioral therapy, reading enhancements, and structured storytelling. TRUMAN MEDICAL CENTERS 20

Cognitive Interventions for the Classroom • Cognitive interventions will NOT be effective until the child is regulated and feels safe (internal state) • Verbal processing • Incorporate sensory based learning, play and art based learning TRUMAN MEDICAL CENTERS 21

Perry, B. D. The Neurosequential Model of Therapeutics: Applying principles of neuroscience to clinical work with traumatized and maltreated children In: Working with Traumatized Youth in Child Welfare (Nancy Boyd Webb, Ed. ), The Guilford Press, New York, NY, pp. 27 -52, 2006 Perry, B. D. Child maltreatment: the role of abuse and neglect in developmental psychopathology in Textbook of Child and Adolescent Psychopathology in (Theodore P. Beauchaine & Stephen P. Hinshaw, Eds) pp. 93 -128 Wiley, New York 2008 Perry, B. D. Examining child maltreatment through a neurodevelopmental lens: clinical application of the Neurosequential Model of Therapeutics. Journal of Loss and Trauma 14: 240 -255, 2009 Ludy-Dobson, C. & Perry, B. D. The role of healthy relational interactions in buffering the impact of childhood trauma in Working with Children to Heal Interpersonal Trauma in (Eliana Gil, Ed. ) pp 26 -44 The Guilford Press, New York, 2010 Barfield, S. , Gaskill, R. , Dobson, C. & Perry, B. D. Neurosequential Model of Therapeutics© in a Therapeutic Preschool: Implications for Work with Children with Complex Neuropsychiatric Problems. International Journal of Play Therapy Online First Publication, October 31, 2011. Doi: 10. 1037/a 0025955 For more information visit The Child Trauma Academy website: childtrauma. org TRUMAN MEDICAL CENTERS 22