Symptoms of a child with Developmental Trauma Disorder
Relationships with others
Poor eye contact.
Rejects affection from parents (stiff, rigid, pushes away, squirms).
Acts overly charming to get their way/ Affectionate only on Childs terms.
Indiscriminate affection towards strangers (Disinhibited Type).
Acts incredibly innocent, even when caught in the act.
Demands things instead of asking for them.
Limited ability to accurately read and appropriately respond to social cues.
Gamey; try to get people in their service, make them mad (like they’re feeling).
Difficulty developing emotionally reciprocal relationships.
Difficulty being able to trust adults/parents to meet their needs.
Difficulty respecting authority figures, and adults in general.
Mood & Biological Regulation
Temper tantrums lasting up to 2 hours, can argue for long periods of time.
Difficulty sustaining or regaining (age appropriate) emotional regulation.
Nonstop chattering or asking questions they know the answers for.
Extremely high anxiety, therefore a need to control others & environment.
Impulsive, Hyperactive, Inattentive, but
Can also be hypervigilant/attentive to all sounds & movement around them.
High pain tolerance and/or refuses to let anyone help or comfort.
Daredevil, risk-taking behaviors and/or accident prone.
Food issues: hoards, sneaks, gorges or eats very slowly.
Under high stress default to “Fight, Flight, or Freeze” states, Dissociates.
Deliberately breaks things – then doesn’t’ appear to miss them.
Steals – often things would’ve been given permission for.
False allegations of abuse/maltreatment.
Do “Paybacks” (revenge) for perceived wrongs/ not getting their way.
Sneaks things – even when would’ve received permission had they asked.
Lies – crazy made up stories, to get out of trouble, get others in trouble.
In more severe cases, lack of remorse or lack of capacity to experience victim
empathy: harmful to animals and smaller children, sexual obsession
and/or predatory behavior, preoccupation with fire and gore.
Doesn’t appear to be able to learn from mistakes (poor cause & effect).
Behavior typically good at school, but poor academic effort/progress.
Intellectual, Emotional, and Physical Developmental Delays (often 2-4 years).
Learning Disorders: Receptive & Expressive Language Processing problems.
Mental Health Disorders: Depression, Anxiety, Post Traumatic Stress Disorder.
Fetal Alcohol Syndrome or
Alcohol Related Neurodevelopmental Disorder (without facial features).
Feel alone, sad, worthless, and unlovable.
Filled with shame and a deep sense of “not belonging”.
What happened to make my child the way they are – STILL?
One of the questions I hear the most from Parents at the onset of treatment is “How can my child still be experiencing trauma-triggers, she’s been in our home for 5 years and we have never once hit her!?”
From the child’s perspective, I once told an 8 year old boy who had been adopted at birth that it made total sense to me that he was “still getting used to these parents” and with pause and deep thought responded,
“How come nobody ever told me that?”
Indeed. It IS that hard for some adopted children – even those who were adopted at birth, and it IS our responsibility to acknowledge that. Then it is our responsibility to provide an environment that is allows for a child to feel the way they do, conducive to saying out loud that they feel that way, and asking what it is we can do to help them feel whole and right about how they feel and experience their world. Few would argue that their experience of childhood is different than how we experienced childhood, and we owe them the acknowledgement of knowing the difference. Out loud.
Common causes of Developmental Trauma Disorder
Unwanted pregnancy (fetus’s developing brain bathing in stress hormones).
Substance Abuse by mother while pregnant (alcohol more damaging than drugs)
Traumatic Birth/Premature Birth
Separation from birth mother (lengthy hospitalization for Mother or Infant)
Infant Illness requiring long hospitalization/unresolved pain
Uneducated Parent (young)
Substance Abuse by mother after birth, environmental exposure to drugs
Lack of attunement between mother and child
Physical, Emotional, Sexual Abuse
Frequent moves and/or placements
Harsh & inconsistent parenting
Institutionalized care (particularly 0-2, but more damage the longer in Orphanage)
Early Trauma; witnessing or experiencing physical, emotional, sexual abuse.
Extreme Neglect – Lack of basic needs of emotional, physical and intellectual stimulation for healthy development (0-2)
Experiencing only one of these common causes can literally alter how the brain develops structurally and how well (or not) neuropathways grow. The bad news is that this cannot be healed with traditional therapy; the good news is that it is not your fault. Your child came to you with brain injuries and while this may sound like too strong a term, this is what it is. Yes, it is very different from Traumatic Brain Injury, they are minor in comparison. But the effects are profound, deep, and impact every aspect of a child’s functioning.
Through the integration of the treatment technique called Neurological Reorganization, I have learned just how prolific the damage can be from en-uterine stress and exposure to substances, birth complications, and lack of movement and environmental stimulation in the first year of life. In my experience with families who have participated in Neurological Reorganization, I cannot ignore the fact that many of the drivers for behaviors seem to have been set pre-verbally (before a child can talk). Clearly this would make it impossible for a child to “talk it out” in traditional therapy. My treatment protocol is designed to enhance the emotional and relational aspect of our work together as it is imperative that the work be EXPERIENTIAL for genuine healing to occur. Traditional “talk therapy” is not an effective treatment modality for Reactive Attachment Disorder or Developmental Trauma Disorder, nor is traditional Play Therapy. However, I do utilize Directed Play Therapy with younger children and those who are severely developmentally delayed. But total healing requires more than Therapeutic Parenting and Attachment and Trauma Therapy.
It is true that some children can experience extreme violence and abuse and not seem to be as traumatized as a child who has experienced less. A child’s resiliency to survive the impact of complex trauma varies greatly from one child to the next. While there are many variables that likely contribute to a child’s resiliency, one thing is true: the impact of trauma is not directly correlated to the severity of the event(s). In other words, if someone could will themselves to simply “get over it”, they would. When it comes to trauma-trigger and neurological damage related behaviors, one must think of these in terms of a “can’t”, not a “won’t”.
The impact of en-uterine exposure, birth trauma, and early neglect/abuse in the first year of life effects how well a child will ultimately function on 3 different levels:
Brain Structure & Neuropathway Development
Brain Structure & Neuropathway Development
I first learned about Neurological Reorganization from another practitioner in Iowa City, and frankly it sounded too far outside-the-box, even for me. Less than a year later I and my most skilled parents were presenting at the Attachment & Trauma Network Conference and they attended a day-long presentation on Neurological Reorganization. They came out of this training saying “Denise, we HAVE to look into this, it makes perfect sense.” In the spring of 2008 the Mother and I journeyed to Oregon to attend a 2 day presentation and returned home with a whole different lens with which to view Developmental Trauma Disorder. As a Mental Health Counselor, it was humbling, to say the least. I changed many of my expectations, approaches, and interventions immediately.
For example, just before I left I was working with a child from an eastern Europe Orphanage who had severe trauma and subsequently, behaviors. As the session went on, his head would drop and his upper body would slump down, seemingly disinterested in his own session. So I had him “just practice” sitting up and practicing eye contact while we were talking; he would do as I asked with every prompt, only to slump over again as soon as he started talking. I encouraged him to continue practicing between sessions. At the Neurological Reorganization training, one of the examples provided was delivered this way “You know, especially those kids from eastern European Orphanages, who have such poor core strength that it really is impossible for them to sit up straight for any length of time, these are the kids that are constantly slumped over in their chair – that’s a “can’t”…not a “won’t”. I cannot express how devastated I was when I made this connection. I had set this child up to fail. You can imagine that the parents returned reporting “he didn’t even try”. I did that to him, and I was wrong.
So what was happening here? As long as he could access his cortex (higher order part of his mind: the thinking, organizing, planning part) he was able to override his neurology (how his body functions on its own) and do as I asked, but as soon as I started asking him to explore other things and his cortex got busy with that, he would go back to his basic neurological functioning. At face value it probably could look like a defiant child, or one who wasn’t even trying, but what a colossal error this was on my part.
Another good example explains why children appear to not “learn from their mistakes” or be deterred/modify their behaviors by consequences. When a young child is playing on the playground and another child takes their toy away from them, they may go into ‘fight or flight’ mode (Pons level response) and punch the child. What is going on in the primitive area of their brain is basic survival, and for a young child regaining possession of your toy may seem just that. You must get it back, or you may die. They will likely be escorted into the Guidance Counselor’s office to be talked to, and they will likely even make a plan for the next time. “Next time I will walk away, tell a teacher, or find something else to play with.” Problem solved, or is it just until the next time someone takes his toy away from him, and his traumatized brain reverts back to survival mode? Back in the Guidance Counselor’s office – and now able to access and work out of his cortex, he will be able to precisely regurgitate what he was supposed to do, and with all sincerity and intent, promises to do it next time.
Unless your birth Mother had a perfect pregnancy and delivery with you, and you have not had any trauma or head injuries in your lifetime, you have some neurological damage/deficiencies, too. We all do. However, most are minor enough that we have learned how to compensate – albeit some later in life than others. I had my own NR Evaluation and it explained every one of my deficiencies, so it was sad on one hand that I was pushing 50 before I learned that my eyes do not converge correctly. But I was also relieved to find out why it is impossible for me to read more than a few pages of a book at a time. I have run the gamut of ‘must be lazy, must have attention problems, not trying hard enough’, to feeling like there was something really wrong with me. I’m sharing this for a reason. My compensation for the difficulty I have in forcing my two eyeballs to land on the same point on a page for an extended period of time is obvious. Remember how I said I went on a training mission to some of the top treatment facilities to gain more knowledge? It wasn’t a conscious decision that since I couldn’t force my eyes to read lots of books, I better go everywhere I can to learn first-hand the knowledge I craved. I had intuitively arranged to compensate for my deficiency.
Regardless of whether you choose to have your child (or yourself) participate in Neurological Reorganization, the information about the damage that early neglect and lack of movement and stimulation has on developing neurological and biological systems explains SO much. I am not a Neurological Reorganization Practitioner, but I will explain the basics as I do in my Presentations because it is critical to understanding the “why” of some of the behaviors your child is likely presenting. Please refer to www.developmentalmovement.org for articles on Neurological Reorganization and resources for learning more about it or contacting a Neurological Reorganization Practitioner.
Neurological Reorganization is not a new treatment modality, it was originally used to heal Stroke and Traumatic Brain Injuries in the mid-1950’s. In fact, several times after I have presented a retired Nurse has come up to me and told me that “back in the day” they used to do patterned movements in-home with babies born with complications. Unfortunately there is still no valid research to prove efficacy, and the Practitioners that I know and have worked with are traveling across the U.S. doing just that – providing their services. In 2009 when I had Interns at my Clinic we began doing research on the changes in children doing NR. What I can tell you is that for the children who have consistently participated in Neurological Reorganization that there have been changes that I have never been able to achieve – even with my skilled treatment protocol. It heals things that conventional treatments cannot. Empathy for example, is something that cannot be learned. You either have it, or you don’t, although I have met people who have “taught” themselves to appear they have this capacity. Some might consider them sociopaths or antisocial personality disorders.
I once worked with a boy who was participating in Neurological Reorganization. As he healed, the sibling issues with his younger sibling began to arise. This is more common than not. I have to say that I also had my concerns about the younger sibling because he appeared to be the type of child who was “flying under the radar”. I see this occur when they are truly shut down on the inside, and also have the shelter of another sibling’s acting out. When I attempted to do a session with the siblings, the younger one immediately was triggered and proceeded to trash my treatment room. I advised the parents that I wanted to start doing some work with him, as well. When I got him on Mom’s lap and began exploring his Internal Working Model, it was more dark than I had expected. When I asked him who he felt love for, he said “Well, no one, really.” Mom attempted to salvage the situation by identifying the one person he loved the most as his Grandma. He thought for a moment, then replied “Well, no, I can just get her to do what I want.” This is a very damaging relationship for this child to have, as he perceived himself as much stronger and capable than the adults who were to provide his every need. This in turn creates tremendous anxiety for a child, and in turn, more controlling. So he went home and did his clean slate and repair with Grandma and returned to Therapy the next week.
The Mother, holding her terror at bay that she may have TWO trauma-impacted children on her hands, reported that Grandma was now on the treatment team, he’d done his repair, and that last week’s disclosure was more “shock-talk” than anything else. Being very mindful of the fact that I didn’t want to send this Mom over a cliff, I just nodded. However, once he was on her lap and talking, again more very dark issues emerged. This was a very troubled little boy, much more damaged than his sibling who was acting out his trauma. He shared how he sometimes wants to kill his family, and in fact, kill the whole world, and how he had tried….”but it didn’t work.” Apparently the combination of orange juice, milk and water is not a very explosive combination, but the intention, drive, and effort could be.
I had him return to the lobby while I met with his brother. I could hear a tinkling sound outside the treatment room door, and for the life of me could not figure out what he was doing or with what. When I looked he went scurrying, but nothing was obviously out of place. When we were done I discovered he had pulled the chair railing from the wall to be able to get a finishing nail. This child worked and worked until he was able to get a finishing nail to stand upright outside of my office door (since he was discovered in front of the treatment room door). Keep in mind that the purpose of a finishing nail is to not have a head showing once in place. That took some effort and determination.
Just like I teach in Therapeutic Parenting, I never go after the behavior at face value. I’ve lost a lot of property over this approach, but that’s not what is important, after all. So I simply acknowledged that he had to have worked very hard at that, but was wondering what he wanted to happen? He became very stuck, denying he’d done it, etc. I didn’t go after that by saying “Yes, you did” as this is a lose-lose approach. Instead Mom and I bantered about where they were going to go to dinner, and other unrelated topics. He finally screamed “FINE! I wanted you to step on it!” I acknowledged that that made perfect sense to me, and ask “so what were you wondering would happen next?” He firmly stated “Then you’d have to go to the hospital and you wouldn’t be at this STUPID PLACE!!” I responded that it was hard here sometimes, and very hard to talk about feelings. “I don’t HAVE ANY FEELINGS!!!”
I would like you to take a moment to wonder yourself.
What was this child feeling – what was the need driving this behavior?
What should I do in response to this, give consequences?
This is a child who is absolutely terrified. He has just let us “in” and now we know what it is like for him, how hard he is struggling, and how out-of-control he is. He cannot hide anymore. How scary would that be?
I do not believe there is any type of consequences warranted for this child, other than he should put the nail back where it belonged so he could “repair” what he had done to restore his self-esteem. Giving consequences to such a terrified child whose pathology has just been unearthed would serve no healing purpose whatsoever, and we had bigger problems to deal with than that.
The Mom sent me an email the next day, that could have been hysterical if not so tragic and telling about just how terrified this little boy was. She reported that on the interstate a semi-truck full of chickens went by, and the older boy (now healing with Neurological Reorganization) commented that they were probably on their way to the Chicken Farm. Mom, still holding onto her sense of humor reported “And stupid me, having grown up on a farm said something really dumb – “No, honey, I think they’re on the way to the Chicken Nugget Factory.” He burst into tears and sobbed for 10 minutes….Houston – we have EMPATHY!!
On this same ride home she looked into the rear-view mirror to see the younger boy had a DVD cord wrapped around his neck. She of course asked him what he was doing, and he told her he wanted to kill himself. When she asked him why, he stated “I want to die so I can come back as a ghost and haunt Miss Denise!” He was trying to eliminate the “threat”, which was me – from his perspective. Keep in mind that at no point did I bully, threaten, or even get into a minor power struggle with this boy – and there was no punishment! Yet he was terrified and felt threatened that I was “in” and knew how to get there.
Needless to say, they had him start Neurological Reorganization the next week.
It IS that hard for most of these children. When I present I always confirm with the audience that it is agreed that we are all healing people, here for the right and same reasons, and therefore all “safe”. Then I ask them to think about their deepest, darkest pain for a moment. I advise them that all of us healing people are going to support a volunteer who will come up and lie on a table in our safe hands whilst we dredge up, explore and process this pain. “Can I have a volunteer, please” is a real show-stopper. In fact, there has only been one person who ever managed their way out of freeze-state to say anything out loud. “You’re joking, right?”
But this is what we are expecting of our children? If so, we truly need to be practicing “Therapeutic” everything, because when the pain comes out, it isn’t going to come out in a daintily laced package. And if the big people are standing ready to dole out punishment if it doesn’t come out in an “appropriate” manner, how hard would you try to keep them out?
What is Neurological Reorganization?
The brain develops from the bottom (brain stem) upward, and in a sequential manner. For the brain to go “on-line” the neuropathways must have be Mylenized. Mylenization is the white, fatty substance that coats the nerve endings that allow information (neuronal movement) to flow to other areas of the brain. It is similar to the coating on an electrical cord. If there is no mylenization, there is no ability for signals or messages to be transferred further.
The medulla, pons, and midbrain develop in approximately the first year of life. This is the most important year of life as humans acquire fifty percent of their lifetime skills in this first year. The brain develops sequentially and skills are gained in a cumulative fashion.
When a baby is born they have mylenization to the Medulla, or the brain stem and all functions such as pupil contraction, the startle response and turning their head to reach a nipple when their cheek is stroked are all automatic. The whole medulla level is reflexive movement.
The Pons level develops in an infant between 1 – 7 months old.
From here, mylenization develops from the Medulla to and through the Pons level of the brain, often referred to as the “Primitive Brain” because it is all about survival. Mylenization of the neuropathways happens when a baby naturally does patterns of movements that all babies, across all cultures do. A “pattern” can be described as full body movements done in a sequential pattern. The other type of movement necessary for mylenization of the Pons level is crawling on their tummy. When I see a child with scars on their ankles from being restrained in a crib (common in Chinese orphanages), this causes great concern because not only were they clearly not able to do the (output) of crawling on their tummy, but were also not able to do their patterned movements (input) as they require movement of all four limbs.
The Mid-Brain level develops in an infant between 6 – 14 months old.
Average is 7 – 12 months, but certainly many infants are doing midbrain work as early as 6 months and some well beyond 12 months. But
Typically we say 7 – 12 months is midbrain.
For mylenization of the neuropathways to occur from the Pons to the Mid Brain level, there is another set of patterns that babies all do, but now they are creeping on their hands and knees.
It is really important to note that these parts of the brain develop before a child learns how to communicate, so any trauma that occurs during this time is occurring pre-verbally. You cannot communicate with these levels of the brain with language or reasoning. The functions of these areas of the brain are performed automatically.
Neurological Reorganization focuses on completing any unintegrated stages at the medulla, pons, midbrain and ultimately the cortex. This is accomplished by retracing the developmental sequence and doing the activities that are critical for the development of a healthy brain. When the brain is developmentally whole you then have a capacity to sustain healthy emotional, behavioral, academic and motor function throughout one’s life.
The Neurological Reorganization Practitioner utilizes a model called the Developmental Profile that summarizes and traces the developmental sequence. This profile highlights the neurological soft signs that are to be tested at seven levels of the central nervous system. The tests address visual, auditory, tactile, gross motor, fine motor and language functions at those seven levels. Where there is a gap in the profile, it is the goal of Neurological Reorganization to design a program of activities to fill in that gap. When all functions at a given level have been integrated new skills and behaviors become available to the child. The developmental profile summarizes normal neurological function from birth through age six to eight. It is divided into two primary sections: sensory and motor. The developmental profile allows us to insure an individual met all benchmarks. Where there are deficits, the child will replicate the developmental sequence to trigger new function.
A Neurological Reorganization Evaluation involves evaluating a wide range of skills at seven developmental levels, amongst those, for example they would assess how a person walks, skips, jumps, crawls on their tummy, creeps on their hands and knees, senses pain and light touch, and many other motor activities. I have heard Nina Jonio state that watching a child crawl or creep is like a window into what was going on at that developmental stage as an infant. In one evaluation I heard her state “Well, at least when they weren’t taking care of him they left him on the floor.” She could tell this by how well he did his tummy crawl. I have had the opportunity to observe a healthy tummy crawl (picture an infant mobilizing their body across a smooth surface floor) and I have also watched some of the more severely damaged children do the tummy crawl. One child will always stand out in my mind – he did not use his arms or legs, but rather “wormed” his way across the floor
From the results from the Functional Neurological Profile they are then able to treat the lowest level of dysfunction, with daily programs of neuromotor activities. As that level becomes more organized, the program addresses the next level, then the next, until there is no longer evidence of a central nervous system factor in the child’s profile.
Principles on Which Neurological Reorganization is Based:
1. Sensory input and motor activities are essential for the development of learning as a manifestation of functional neurological organization. Learning is a sensory process that must be reinforced by motor functioning. As stated by Doman and Scott: if input is nonexistent, limited or confused, the sensory pathways will be similarly undeveloped, underdeveloped, or incorrectly developed, and learning will not exist, will be incomplete, or will be incorrect to the same degree.
2. By increasing the duration, frequency, and intensity of sensory and motor activity appropriate for the development of neuro¬logical organization from birth onward, the neurological organization of injured brains can be improved. Treatment programs are therefore based on increased stimulation in six sensory and motor areas: visual competence, auditory competence, tactile competence, mobility, language, and manual skills.
3. To influence the organization or reorganiza¬tion of injured brains, it is necessary to make a fresh start beginning with activities and sensory inputs that have proved beneficial in promoting effective neurological organization from early infancy on. In other words, it is necessary to retrace steps in the normal process of neurological organization going back as far as possible.
What information does a Neurological Reorganization Evaluation provide?
Children who did not adequately complete the developmental sequences, tasks and tummy crawling and hands/knees creeping can have some of the following disruptions in functioning:
Head juts forward, hunched shoulders, Pigeon-toed.
Inadequate hunger-full switch; either hungry all the time or poor appetite.
Bed wetting in older children
Poor horizontal eye tracking; skips letters and words.
Severe anxiety and fearful most of the time.
Fight-Flight-Freeze response to minor stressors; fall apart under stress or not getting their way.
Avoidance of eye contact.
Difficulty bonding and trusting.
Controlling & Manipulative.
Risk-taking behavior (jumping or diving off high structures)
Overly affectionate with strangers; poor personal boundaries.
Rages for long period of time, may include violent rages.
A deep sense of not belonging, feeling unworthy, and alone.
Poor deep pain perception; commonly referred to as ‘high pain tolerance’. This often correlates to a lack of conscience and empathy, harming animals, and risky behaviors (as they truly don’t feel the pain the way others do).
These children are the ones who might laugh after hurting another child, because they do not experience pain the same way as the other child, and may consider it drama. I have heard practioners Bette Lamont and Nina Jonio liken this to feeling the effects of Novocaine all over your body, creating a need/urge to feel – anything. Children with Pons level damage often “stir things up” with others (you can observe them sitting back with a little sense of relief that they are finally able to feel some sense of excitement or interest). They often pick scabs or do self-injurious behaviors. They are also the children who will insist that they do not need a coat because they are not cold; they do not have the capacity (neurology) to appropriately feel deep pain, cold and heat. The same child may have 3 layers of sweats on when it is now afternoon and 80 degrees outside; they require extra supervision to assure that they do not have too few, or too many clothes on for their health. One child would be outside playing hard on a hot day and never sense the need for water, another high-risk situation.
This reminded me of a little girl who was in treatment with me prior to learning about NR; the end of her finger had gotten crushed in a car door. She was able to take fingernail clippers and clip away chunks of raw flesh and fingernail so that it was smooth. Caught off-guard, I foolishly asked if it hurt, and her response was very telling; a calm “Oh, yeah.” Not like it should have, darling.
Another typical example where a Mother just asked the Doctor treating the other sibling if he could just look in her ear or listen to her heart (to even out the attention) only to learn that the child had a burst ear drum and severe infection that required many trips to a specialist and several rounds of antibiotics. She felt so bad, but when a child is unable to feel deep pain appropriately, it is hard, if not impossible to know that a child is experiencing a serious medical condition. There have been many, many stories similar to this.
Note that poor deep pain perception CAN be accompanied with hyper-sensitivity to light pain (paper cut, needing 10 band aids a day).
Mid Brain Dysfunction:
Feet which point outward,
Prehensile grasp: uses whole hand to lift objects (past this developmental stage-shoveling).
Since vertical eye tracking should be developed during this time, a child may skip lines
when reading, subsequently deficits in Reading Comprehension, and Math.
May reverse letters and/or numbers.
Has difficulty differentiating detail within detail (can’t find 1 item in a pile).
Poor Proprioception; knowing where one’s body is in space (touches everything in the
store or at other people’s homes, runs hands along walls when walking).
Muscles which are too loose or too tight; extremely double-jointed and limber.
Disrupted or inconsistent sleep patterns.
Sensory Issues: sensitivity to textures of food, difficulty chewing, tags, seams, etc.
Digestion problems; heartburn, stomachaches
Allergies and Autoimmune Disorders.
Auditory Processing problems.
May have speech issues. Issues with balance and depth perception (skipping a step on a stairway).
Can be easily distracted or hyperactive, with a short attention span.
Can have filtering system problems and have difficulty prioritizing and filtering out
sounds they don’t need to attend to at the time (meaning they are attending
to ALL sounds around them).
Hyper-focusing (have to shake the house to get their attention when watching TV).
Poor impulse control (difficulty applying brakes to stop inappropriate impulses).
Difficulty remembering multiple directives; unable to remember/follow through on tasks.
Difficulty perceiving and appropriately responding to Non-Verbal Social Cues.
Difficulty establishing and maintaining appropriate emotional and physical boundaries.
Mental Health Disorders: Depression, Bipolar Disorder, Schizophrenia, Obsessive
Compulsive Disorder, Autism Spectrum Disorder.
Bladder and/or Bowel issues
Difficulty with temperature regulation, always wanting to bundle up or never wear a coat.
May be characterized as a drama queen, blowing everything out of proportion.
Hypothalamus issues: plays a role in the sleep/wake cycle, internal and external temperature regulation, digestion, bladder and bowel function, and chewing and swallowing food.
Poor Corpus Collosum functioning: The super-highway of communication between the 2 hemispheres of the brain. May have difficulty accessing words, know a task one day – but not the next.
Poor emotional regulation within the Limbic System: limbic rages over minor issues and
difficulty calming down.
The cortex, or the smart, thinking part of the brain from which human intelligence derives, develops from approximately age one to age six to eight. The cortex is the part of the brain most people think of when they say “the brain,” as it is responsible for intelligence, abstract thought, and higher emotional functions.
Visually, a child develops convergence, or both eyes working together at near point. This is a critical skill for depth perception, reading comprehension, and concentration. Studies have linked poor convergence with the diagnosis of attention deficit hyperactivity disorder.
By age six for girls or age eight for boys, the child should be lateralized, or one-sided.
A left-handed child should use left ear, left eye, left hand, left foot in consistently dominant manner.
If not lateralized, it’s like having two vice presidents in the brain: one side of the brain will do a task for a while, tire of it, and hand it off to the other side. When this happens, the way the child takes in, stores, and retrieves information is random and inefficient.
When the child is lateralized, the way she takes in, stores, and retrieves information is effective and well-organized. Laterality most significantly impacts higher abstract thought, sequential reasoning, and advanced academics.
How does Neurological Reorganization heal my child?
I never sugar-coat how challenging completing a Neurological Reorganization program can be for some families. The most difficult part is getting your child to do the patterns, creeping and crawling, vestibular, brushing, etc. every single day for a good 2 or more years (more the level of severity I treat). Re-Evaluations are completed approximately every 3 months, so when progress is being made the child will be given the next level of patterns. It is hard, particularly due to the fact that it is hard to keep the program interesting for your child, and some days they just don’t feel like doing it. This means that some days it can take a couple of hours to get it all completed due to resistance – the child may be tired, being triggered by the patterns (remember, they are doing the very patterns that they missed as an infant, so it is touching on areas with injuries or that are undeveloped), hungry, or simply wants to do something more fun. However, I have also had children who, after doing program long enough for the child themselves to see the changes, WANT to do their program. In these situations program should take about an hour a day, and can be divided into 2 separate times.
In addition, the parents need to be prepared for regressions. A regression may be in the form of raging or increased aggression – and in these cases you are strongly encouraged to call your NR Practitioner as the assigned number of patterns may be too much for your child and need to be temporarily reduced. One regression that I have seen more than others is a true regression in age. These have been intriguing to say the least, and have allowed me to guide the families through some incredibly healing remedial bonding activities. For instance, a child may suddenly start baby-talking and asking for a bottle, or better yet, wanting to “play baby”. The regressions are temporary and always lead to a higher level of functioning for the child.
Total commitment and persistence is necessary to be successful. However, out of the families who have been able to commit to the degree necessary, every single family believed it was worth every ounce of effort. I have had at least three children able to cease the use of Psychotropic Medications, with the knowledge and support of their Psychiatrist
The Unavailable Child: Neurodevelopmental
Barriers to Bonding
By Bette Lamont, Developmental Movement Practitioner
Certified Counselor, Washington State
They take a great deal of our attention, yet sometimes we look at them and feel like there’s “no one home.” They need so much love, but it seems to wash off of them, as off the proverbial duck’s back. Traditional therapy has had to find new ways to deal with these children, who are described as “unbonded” or “attachment disordered.” They can become the bane of teachers and school counselors. As adults, some of them slip into our psychopathic or sociopathic criminal population. The current national sense of crisis about dealing with violent children (violence being one behavioral possibility of the unbonded child) makes it imperative that we take a deeper look at effective treatments for our unbonded children.
Among the effective treatments for this problem – one that is frequently over looked but could be a key to recovery for many children – is the Neurological Reorganization approach. This approach is also used to address head injuries, learning disabilities, and ADHD. Neurological Reorganization Therapy has been effectively used as part of a team treatment plan with children who are in therapy for bonding disorders.
Neurological Reorganization Therapy is a personalized program of neuromotor activities designed to fill in gaps in a child’s neurological development. Used in conjunction with cognitive behavioral, or feelings-based therapies (Denise – can you describe therapies differently. I wasn’t too fond of Attachment therapy at the time I wrote this. You could change what I say you use it ‘in conjunction with’) , it can significantly speed up the recovery process and generally make recovery more complete. What are the behaviors that indicate a bonding/attachment disorder? Frequently the behaviors of the unbonded child appear paradoxical. The unattached child may be remote, or clingy or both. He may at times appear to be impervious to affection, unresponsive or even hostile. At other times, he may be loathe to leave his parent’s side, may insist on sleeping in or near the parent’s bed, or need reassurance throughout the night to sleep in his own bed.
A colleague, Susan Scott, previously of the N.W. Neurodevelopmental Training Center in Oregon, has made the following observation about children with attachment disorder: “This child may appear to lack empathy for others, or he may seem to be overly attentive to the feelings and wishes of others.
“The child’s teacher may comment, ‘he will hurt one of his classmates and then laugh about it.’ He may also go out of his way to appease the people around him. Both of these behaviors result because the child doesn’t have a way to know what others are feeling. In the first case, he cannot compare the hurt that this classmate is feeling to any event in his own experience and, therefore, has no empathy for the classmate. In the second case, it is his inability to know what those around him are feeling that causes him to feel the need to be conciliatory. They may be mad at him or may be pleased, but without a way to know, he must assume the worst and do whatever is in his power to prevent it.”
Paradoxes are common in the attachment disordered child, who can seem to be cruel or merciless, abusing other children or animals without understanding why this wrong. On the other hand, this child may, at the same time, be “socially promiscuous” (a phrase coined by Florence Scott, RN, which refers to a child who tries to win the favor and attention of almost everyone he meets as if he does not have clear idea of who his caretaker is). This child may have to be closely watched in public places, as he can be just as happy to walk off with a stranger as to stay with the family group. He may have no sense of his boundaries and climb into the laps of, or touch inappropriately, people he has just met. Over many years of working with these children, we have come to recognize the specific central nervous system issues that are associated with the behavior of the unattached child or adult.
I propose that the extent to which a child is able to feel pain appropriately is the extent to which that child has a capacity to be empathetic.
Almost universally, these patients have a disturbance in the functions of their pons level brain. This brain area, keenly alert to life-preserving information such as tactile sensations of heat, cold, pain and hunger, alerts us to threats to our life and person. This upper brain stem, pre-cortical, pre-logical, and pre-linguistic, is critical to our survival.
One of the functions of the pons is to alert us to pain, giving us information not only about ourselves, but also about others. I experience pain appropriately, and am fully aware of when I am hurt. It gives me a way to understand the experience of others. When I see someone who is injured, I am immediately able to empathize, because I know the experience of pain and how it affects me.
I propose that the extent to which a child is able to feel pain appropriately is the extent to which that child has a capacity to be empathetic. Is empathy solely a central nervous system function? Certainly not – psychological trauma, family of origin modeling, training in ethics or morality (or lack thereof), all play a part. However, if we do not have the capacity to feel, empathy is something as foreign to our experience as the color red is to the blind.
As a consequence of an inability to feel pain due to and under-active pons, we observe the child seeking out situations that provide needed stimulus to relieve numbness. Without critical information coming into the brain from the pons, a child may engage in high-risk behaviors such as jumping from high places, or perform life-threatening stunts, sometimes injuring themselves in the process, but ignoring the injury until it is “convenient” for them to take a break from their activity and deal with it.
Some children and adults will choose self-mutilation as a means to deal with the numbness they feel, resorting to cutting their skin with knives, razor blades, or broken glass. Others mutilate fingers and toes, cutting or chewing off fingernails or toenails, cuticles, calluses, until they bleed. Some have picked at scabs, creating larger wounds. Other clients, both children and adults, have pounded their heads into walls until they bled. Often adults with these behaviors (being more articulate than children) will report that they just wanted “to feel something…anything.” Clearly these clients feel cut off from the world for a very specific neurological reason. They do not feel, and in their attempt to feel they injure themselves or others. Clearly these children are, in many ways, unavailable. At the same time, a dysfunctional pons that is “working overtime” may cause the child to become hyper alert and anxious, perceiving as a threat stimuli that are not intense enough to be life-threatening. In a state of being constantly on guard, this child may appear paranoid, perceiving everything that is not a direct affirmation of that child as a criticism or a threat to their well-being.
Adults with a dysfunctional pons may feel isolated, alienated, or suicidal, as they tend to believe that there is no place for them in the world. In the extreme, they may become the “quiet loner” who values neither his own life nor the lives of others, who can take a life without remorse.
Because the pons in not a rational brain and does not have the capacity to speak, we often see what appears to be an unreachable substratum of despair that verbal, behavioral or emotion-based therapies do not appear to touch. ________________________________________
Another neurological component that affects bonding also occurs during the first seven months of life while the pons is organizing itself. Visually, at this stage of development, the child does not see in the same detail that adults see. Rather, they see in outline, their favorite outline being the human face: eyes, nose and mouth arranged in the specific pattern of human features.
A child at this stage will stare at another human face, whether family member or stranger, with the same loving intent gaze. This gazing period allows the child to bond with their species, even before they know the specific facial features of their own parents. The child knows that someone with these features is someone who will feed them, protect them from danger, and relieve their distress. In the second half of the first year, the child begins to visually distinguish his parents from strangers, and do more gazing into the face of family members.
For many children diagnosed with attachment disorder, there was little or no gazing into the eyes of another during these early months. Some of these children were in orphanages during this critical bonding period, with one caretaker for each dozen or more children, and no close holding and gazing time available. Children who are born affected by drugs or alcohol may not have the physical ability to go through this gazing phase, and may have a disruption in their bonding because of this unavailability. Both of these factors, the dysfunctional environment and the dysfunctional brain, can be significant barriers to bonding.
A child in neurodevelopmental therapy is screened for the physical ability to gaze, and is given activities to stimulate better visual processing and opportunities to spend time gazing at his caretaker.
When we address the challenges of a child with a pons-level injury, we must always remember that a dysfunction at this level leaves the child feeling abandoned, isolated, and fearful, without a clear way to express these feelings. Because the pons is not a rational brain and does not have the capacity to speak, we often see an unreachable substratum of despair that verbal, behavioral or emotion-based therapies do not appear to touch. Again, we are finding evidence that the unattached child is neurologically unavailable for bonding.
The question then arises, how do children become injured in such a way? The answers are multiple. A child may become injured anytime in the perinatal period from fetal exposure to drugs and alcohol, oxygen deprivation, or trauma in or exiting the birth canal. The brain can also be injured by specific illnesses, particularly those that cause high fevers or injuries such as a fall with a blow to the head, shaken baby syndrome, or drowning.
However, in many of our children, we see this disorder arise as a consequence of a separation from the mother during the first two years of life. Separations such as hospitalization or the child, adoption or foster care placements, time spent in an orphanage (as in the case of many international adoptions), abuse, abandonment, and neglect all interrupt the bonding process.
If, in addition, the child has been restricted in his movements during the first months of life due to hospitalization, surgery, casts or other lack of opportunity to have “floor time,” the resulting dysfunction can appear virtually untreatable. All the love, time, reasoning and reassurance in the world cannot restore this child’s emotional and neurological health until the neurological problems previously described are directly addressed.
In our work at Developmental Movement Consultants, we use a team approach to treating children who are diagnosed with attachment disorder. We perform an extensive evaluation for the child’s neurological organization, observing sensory and motor skills at seven developmental levels. From this Functional Neurological Profile we are then able to treat the lowest level of dysfunction, with daily programs of neuromotor activities. As that level becomes more organized, the program addresses the next level, then the next, until there is no longer evidence of a central nervous system factor in the child’s profile.
Throughout this process, we are in close touch with other therapists. This team approach is essential because feelings that have been previously unavailable often surface. This can be a very beneficial, but also very challenging phase, as the child is now more able to express his grief and anger. The child’s parents and psychotherapist, working in conjunction with the Neurological Organization Practitioner, support the journey through this new wilderness of emotions. It is essential that parents and therapists stay in close touch throughout this process, so that all therapy modes can be modified quickly to accommodate the powerful changes and deep emotions that emerge in the child.
If you are a parent of an unattached child, or a therapist working with children who do not seem to be moving quickly toward healing, it is an excellent choice to seek Neurological Organization treatment as soon as possible. The peace, security and happiness that will become available to the child as a result of this therapy can make him available for love, joy and a brighter future.
© Bette Lamont, 1998/2009
A Brief Overview of the History and Principles
of Neurological Reorganization Therapy
By Bette Lamont
Neurological Reorganization Therapy and Developmental Movement are two names for a rehabilitation therapy for the brain injured that has its roots in the work of Temple Fay, MD, Glen Doman, Carl Delacato, and later, Florence Scott, RN. Various doctors who have helped advance the work, but whose names are not as strongly associated with this methodology, include Evan Thomas, MD, Edward LeWinn, MD, and Neil Harvey, MD, among others. This treatment method continues with an unbroken record of over 50 years of rehabilitating children and adults with non-progressive brain injuries and learning disabilities.
The work has been found to have a great effect in addressing the problems of autism, developmental disabilities, adoption trauma, ADHD learning disabilities, strokes, and all other nonprogressive brain injuries whether acquired before, during, or at any age after birth. The youngest person treated successfully by this method began the program as a newborn. The oldest successfully treated individual of whom we are aware began the program after suffering a stroke at the age of 90.
Believing that most non-progressive brain injuries were irreversible, medicine in the mid twentieth century was content to diagnose and treat brain-injured children and adults on the basis of symptoms with little or no reference to the brain. This per¬spective discouraged the search for more accurate knowledge about the injured brain. It also prevented attempts to devise and assess treatment programs designed to improve the functioning of an injured brain. There is a great deal of research newly available providing evidence that activating early reflexes can alter the structure and functioning of the brain, but with few exceptions, medical practice has largely ignored the implication of this evidence. Instead, as a rule it has been taken for granted that the treatment of the brain-injured must be symptomatic.
To our knowledge, the first people to take issue with the symptomatic treatment of nonprogressive brain injury were those named in the group above. These individuals became dissatisfied with the results of physical therapy and the overuse and wrong use of braces in the management of cerebral-palsied children. In the late 1940s they decided to seek ways of treating the brain injured.
This group of pioneers recognized that phylogenetically and ontogenetically, the human brain comprises a hierarchy of developmental levels with ultimate control in the cerebral cortex. They were aware that, deprived of appropriate sensory input, the brain fails to develop normal functions. From this knowledge they reasoned that it might be possible to organize or reorganize neuronal systems in an injured brain. In order to accomplish this in brain-injured children, they devised treatment programs that recapitulated, as far as this was possible, the sensory and motor experiences they believed were essential for the development of brain functions during infancy.
Principles on Which This
Treatment Is Based
4. The brain is a hierarchy. The human brain develops from the lowest level upwards recapitulating in part the phylo¬genetic development of the fetus, infant and child.
5. Function determines structure. Genes initially determine structure, but embryonic cells in the development of the embryo differentiate for functional purposes. In the early stages of development, function can determine how the embryonic cells develop. Also, the functional use of nerves and muscles increases the size and efficiency of these structures, while disuse causes atrophy.
6. Sensory input and motor activities are essential for the development of learning as a manifestation of functional neurological organization. Learning is a sensory process that must be reinforced by motor functioning. As stated by Doman and Scott: if input is nonexistent, limited or confused, the sensory pathways will be similarly undeveloped, underdeveloped, or incorrectly developed, and learning will not exist, will be incomplete, or will be incorrect to the same degree.
7. By increasing the duration, frequency, and intensity of sensory and motor activity appropriate for the development of neuro¬logical organization from birth onward, the neurological organization of injured brains can be improved. Treatment programs are therefore based on increased stimulation in six sensory and motor areas: visual competence, auditory competence, tactile competence, mobility, language, and manual skills.
8. To influence the organization or reorganiza¬tion of injured brains, it is necessary to make a fresh start beginning with activities and sensory inputs that have proved beneficial in promoting effective neurological organization from early infancy on. In other words, it is necessary to retrace steps in the normal process of neurological organization going back as far as possible.
The greatest possible unlimited opportunity for bodily movements is essential in the treatment of brain-injured children who have mobility problems. Further, movement activities increase stimulation to injured brains that impact all functions of that brain area. Thus, a child who crawls, increases his capacity to accurately perceive pain and develop sophisticated horizontal visual-motor patterns.
The floor best provides opportunities for body movement for brain-injured children and adults. The restrictive effects of lying in a bed or on a couch, or sitting in a wheelchair during most of the day must be avoided in all cases, unless contraindicated by illness. ”The floor is the athletic field of the child.” (Gesell)
Children and adults who are not so physically limited, but suffer from learning disabilities, attention deficit disorder, hyperactivity, and the confusing symptoms of mild brain injuries are equally benefited by the floor and upright work assigned in programs designed by Developmental Movement Consultants.
Centers around the country offer these services both locally and also travel to other cities and countries to provide this new and effective approach to children with challenges.
A list of these providers appears on an accompanying document.
Over the past 20 years variations of Neurological Reorganization and new clinical studies have made this work known to more areas if the country. However many clinicians who treat children are unaware if the work of these pioneers.
With thousands of clients having successfully completed a program of Neurological Reorganization we have hundreds of testimonials from parents. Please do contact us for these testimonials
Brain Injured Children, Evan Thomas
Charles C. Thomas Publishers
Florence Scott, R.N. various lectures
Copyright, Bette Lamont, 2008