Our second day with Dr. Perry gave us an opportunity to delve deeper into the theory underlying the Neurosequential Model of Therapeutics (NMT) and its application as a framework for clinicians to use and apply their own skills or training to. It also gave us a chance to hear from practitioners from around Australia about the application of the NMT in a variety of local settings.
At the start of the day Dr. Perry took questions from the audience. He has a wonderful way of responding to questions that involves the use of case examples to illustrate and support our understanding.
One of the first questions raised the issue of dissociation and how it can present in a way that looks like a seizure. Dr Perry agreed, explaining that children who have a sensitised dissociative response are more commonly sent for medical evaluation. So how do we help the medicos to consider these episodes as dissociative rather than seizures? Dr Perry suggested that our role was to be good documenters, as physicians prefer measurable physical signs to symptoms.
Other questions provided an opportunity to think about memories and how they are encoded. Events that occur when a child is pre-verbal are fragmented as are our memories of trauma. The mind works hard to fill the gaps between these fragments and the result might be a false reconstruction. This might explain why sometimes the children that we work with seem to be lying or confabulating when actually they are just trying to make some sense in a narrative fashion of the memories that they have.
Children who have experienced childhood trauma or intrauterine insults will often present with impulsivity and attention difficulties. Whether these problems arise from a brain that is underdeveloped or a brain that is abnormally organised the treatment is the same: patterned repetitive activities. However, the abnormally organised brain will require more repetitions as you need to build alternative pathways to the ones that have already been created.
Dr Perry described ‘psychological surfing’ as riding the child’s interests and using them to assist the child to self regulate rather than impose our ideas upon them. For example the child that enjoys hip hop music might benefit from having access to an iPod with hip hop music that they can listen to before they are required to pay attention in class or when they are feeling worked up.
Dr Perry pointed us to the work of John Read who has investigated the relationship between trauma and psychosis.
Overview of the Neurosequential Model of Therapeutics
During the second section of the day Dr. Perry gave us an overview of the NMT tool.
The cortical modulation ratio (CMR) represents executive functioning and guides our interventions. A low CMR indicates that the child has little access to their cortex and cognitive therapies wouldn’t be recommended.
Dr. Perry has developed a tool that uses numerical values to calculate a caregiver’s resources and challenges. The ‘Caregiver challenge estimator’ can estimate the size of the deficit, and help predict how well the caregiver will cope with their situation and what level of support they might need.
Dr. Perry pointed out that it is important to start by strengthening the ‘therapeutic web’ around children and families to support their social and emotional wellbeing. ‘Good old-fashioned social work’ to increase the number of healthy relationships in the child’s life still has a very important part to play in treatment.
After lunch we had three case presentations, from Nicole Milburn from Berry Street Take Two, Kerry Gwynne and Gabrielle Duffy from the Dalwood Spilstead Service, and Lesley Whatson from Statewide Behaviour Intervention Service and Gary Raftl from SAL Consulting. These cases demonstrated how the NMT tool has been used to understand the client and guide interventions with infants, young children, adolescents and people with disabilities and illustrated the breadth of knowledge, skill and dedication that we have right here in Australia.
At the conclusion of the day Dr Perry reminded us of the importance of self care – your ability to help a child regulate is connected to how regulated you are, so looking after ourselves is crucial to being able to support our clients effectively.