Upload
hanhu
View
219
Download
0
Embed Size (px)
Citation preview
The ChildTrauma Academy Introduction to the NMT
Materials may not be replicated, repurposed or modified without permission
Bruce D Perry, MD, PhD © 2010
All rights reserved © 2010 Bruce D. Perry
!"#$%&'()%"*#%*#+,*
-,'$%.,/',")01*2%&,1*%3*
4+,$05,')(.*6-247*
4+,*8+91&4$0':0*;(0&,:<**
=>?>*
All rights reserved © 2010 Bruce D. Perry
4+,%$<*%3*8+0"@,*
A+<*&%*<%'*&%*#+,*#+9"@.*<%'*&%B*
C%D*&%*<%'*#+9"E*#+,<*D911*(0'.,*
(+0"@,*3%$*#+,*(19,"#*F*3%$*<%'$*(+91&B*
All rights reserved © 2010 Bruce D. Perry
;G**H$09"*I$@0"9J0)%"*0"&*K'"()%"*
-24*8%$,*L$9"(951,.*
All rights reserved © 2010 Bruce D. Perry
4+,*H$09"*20M,$.*
•! 4+,*+':0"*N$09"*9.*#+,*%$@0"*$,.5%".9N1,*3%$*
,O,$<#+9"@*D,*&%G**!#*011%D.*'.*#%*1%O,P*10'@+P*D01EP*
#01EP*($,0#,*%$*+0#,G*
•! 4+,*N$09"*Q*%",*+'"&$,&*N9119%"*",$O,*(,11.*9"*0*(%:51,R*",#*%3*(%")"'%'.*0()O9#<*Q*011%D.*'.*%'$*
+':0"9#<G*
•! K%$*,0(+*%3*'.P*%'$*N$09"S.*3'"()%"9"@*9.*0*$,T,()%"*%3*%'$*,R5,$9,"(,.G*
All rights reserved © 2010 Bruce D. Perry DDDG8+91&4$0':0G%$@* All rights reserved © 2010 Bruce D. Perry
Neocortex
Limbic
Diencephalon
Brainstem
Abstract thought
Concrete Thought
Affiliation
"Attachment"
Sexual Behavior
Emotional Reactivity
"Arousal"
Appetite/Satiety
Blood Pressure
Heart Rate
Body Temperature
Sleep
Motor Regulation
The ChildTrauma Academy Introduction to the NMT
Materials may not be replicated, repurposed or modified without permission
Bruce D Perry, MD, PhD © 2010
All rights reserved © 2010 Bruce D. Perry
Cortex
Limbic
Diencephalon
Cerebellum
Brainstem
Abstract thought
Concrete Thought
Affiliation/reward
"Attachment"
Sexual Behavior
Emotional Reactivity
"Arousal"
Appetite/Satiety
Blood Pressure
Heart Rate
Body Temperature
Sleep
Motor Regulation
!"#$%#
Relational difficulties
Depressive & affect symptoms
Alcohol – substance abuse
Trauma core symptoms
Guilt Shame
ANS - body
&"'#
All rights reserved © 2010 Bruce D. Perry
Complexity Plasticity
Neocortex
Limbic
Diencephalon
Brainstem
All rights reserved © 2010 Bruce D. Perry
Cortical
Limbic
!"#
$%#
&'()*+#
,-./-0#
!"#
$%#
()'*+(%,#-)$.,%*+)!#
&'()*+#
,-./-0#
$/0/12345675/61/89#-:9;</#
All rights reserved © 2010 Bruce D. Perry 1112&3-456(78.79075*.:2'(;#
“Out” “In”
Multi-level Processing
All rights reserved © 2010 Bruce D. Perry
$2##<*8('5*=*4'>.*?)#7?5#@*.'(:#
<@6#&'(*#A(-?0->4*B#
All rights reserved © 2010 Bruce D. Perry
Cell Body
Dendrites
Myelin Sheath
Axon
The Neuron
Synapses
The ChildTrauma Academy Introduction to the NMT
Materials may not be replicated, repurposed or modified without permission
Bruce D Perry, MD, PhD © 2010
All rights reserved © 2010 Bruce D. Perry
!"#$%&'()$*#+#,-./$
!"#$"%&'($)*'+(,$-+."$'//$01$+.2$30&4/#5$2.*%3.%*#$'(6$1%(370(,$60#2$(0.$8%2.$
9404:$+(.0$#5+2.#(3#;$
<($."#$=$&0(."2$10//0-+(>$30(3#470(,$?@@$)+//+0($(#%*0(2$'(6$?@$.*+//+0($>/+'/$3#//2$'*#$
)0*(;$!"#2#$3#//2$0*>'(+A#,$&0B#,$30((#3.$'(6$24#3+'/+A#$.0$3*#'.#$."#$'&'A+(>$'(6$1%(370(+(>$)*'+($01$."#$(#-)0*(;$$$
All rights reserved © 2010 Bruce D. Perry
!"#$&0*#$'$(#%*'/$2C2.#&$+2$9'37B'.#6,:$."#$&0*#$."'.$2C2.#&$3"'(>#2$.0$*#D#3.$."'.$4'E#*($01$
'37B'70(!!!
!"#$%#$%&"'%()$#$%*+,%-'.'/+01'2&3%1'1+,4%)2-%/'),2#25%
USE-DEPENDENT DEVELOPMENT
All rights reserved © 2010 Bruce D. Perry F>#$+($G#'*2$
H%/74/#2$01$I#+>".$'.$J+*."$
@$ K@$L$ ?@$
K@$
?L$
?@$
L$
?L$
J06C$
J*'+($
J*'+($M*0-."$B2;$J06C$M*0-."$
All rights reserved © 2010 Bruce D. Perry ---;N"+/6!*'%&'F3'6#&C;0*>$
6'78'29)/%:'8,+-'.'/+01'2&$
•! !"#$)*'+($+2$%(6#B#/04#6$'.$)+*."$
•! !"#$)*'+($0*>'(+A#2$1*0&$."#$9)0E0&:$%4$O$
)*'+(2.#&$.0$30*.#5$'(6$1*0&$."#$+(2+6#$0%.$
•! P*>'(+A'70($'(6$1%(370('/$3'4'3+.C$01$(#%*'/$2C2.#&2$+2$2#Q%#(7'/$$
•! R54#*+#(3#2$60$(0.$"'B#$#Q%'/$9B'/#(3#:$."*0%>"0%.$6#B#/04&#(.$
All rights reserved © 2010 Bruce D. Perry ---;N"+/6!*'%&'F3'6#&C;0*>$
I"'.$+2$H#&0*C$S$
•! !"#$3'4'3+.C$.0$)*+(>$'/'1'2&$$01$'($#54#*+#(3#$1*0&$0(#$&0&#(.$+($7&#$.0$'(0."#*;$
•! !"+2$+2$."#$%(+Q%#$4*04#*.C$01$/+1#$10*&2;$
•! !"#*#$'*#$&'(C$-'C2$."'.$/+1#$10*&2$60$."+2$O$>#(#2,$+&&%(#$2C2.#&,$(#*B0%2$2C2.#&$
•! T#*B0%2$722%#$+2$-'$#52'-$.0$2.0*#$$#/#&#(.2$01$#54#*+#(3#;$
All rights reserved © 2010 Bruce D. Perry
F2203+'70($
•! !"#$)*'+($&'U#2$'2203+'70(2$)#.-##($2#(20*C$
2+>('/2$30O033%**+(>$+($'(C$>+B#($&0&#(.$+($
7&#$
•! !"+2$3'4'3+.C$'//0-2$"%&'(2$.0$/#'*(,$3*#'.#$+&'>#2$01$."#$1%.%*#$'(6$2%*B+B#;$
•! !"+2$3'4'3+.C$3'($'/20$&'U#$"%&'(2$B%/(#*')/#$$$$.0$1'/2#$'2203+'70(2$O$3*#'7(>$1#'*2$01$(0(O."*#'.#(+(>$0)8#3.2;$
The ChildTrauma Academy Introduction to the NMT
Materials may not be replicated, repurposed or modified without permission
Bruce D Perry, MD, PhD © 2010
All rights reserved © 2010 Bruce D. Perry
!"#$%&'()*"+,(-#./"*#+(
01#(2"+,(+#,(/3(4&*54#(+#&+/"6(+%.47*(+1$8#("$7(9&#,:/";+<(:1*=1(:*77(
9#&=/>#<($&>(+,/"#(?(*&("/&+(?(,1#(,#.87$,#(3/"(34,4"#(+#&+/"6(+%.47*(+*.*7$"(,/(,1*+(/"*'*&$7(+#&+/"6(
#@8#"*#&=#A(
All rights reserved © 2010 Bruce D. Perry :::A!1*7>0"$4.$A/"'(
“Out” “In”
New experience is “filtered”
through past
experience
All rights reserved © 2010 Bruce D. Perry
!A((B#7$%/&$7(C#4"/D*/7/'6($&>(EF$=1.#&,(
C-0(!/"#(G"*&=*87#+(
All rights reserved © 2010 Bruce D. Perry
H4.$&(D#*&'+($"#(+/=*$7(
="#$,4"#+A(
01#("$7(+6+,#.+(:1*=1(.#>*$,#(+/=*$7(*&,#"$=%/&I(=/..4&*=$%/&I(#.8$,16($&>(,1#(
=$8$=*,6(,/(D/&>(:*,1(/,1#"+($"#($77(+1$8#>(D6(,1#(&$,4"#I(54$&%,6($&>(%.*&'(/3(#$"76(7*3#(
"#7$%/&+1*8+A(
All rights reserved © 2010 Bruce D. Perry :::A!1*7>0"$4.$A/"'(
B#7$%/&$7(C#4"/D*/7/'6((
)/4&>$%/&$7(C#4"$7(J6+,#.+(((
01#("$7(+6+,#.+(.#>*$%&'(,1#(+,"#++K
"#+8/&+#I("#:$">I(8"/="#$%/&I("#8"/>4=%/&I(
+/=*$7K$L7*$%/&($&>(=/..4&*=$%/&($"#($77($"#(
*&,#"K"#7$,#>((K(*&>##>I(,1#6(/M#&(+1$"#(,1#(
N#"6(+$.#(34&>$.#&,$7("/,"$&+.*F#"(
&#,:/";+($&>(D"$*&("#'*/&+A(
All rights reserved © 2010 Bruce D. Perry
The ChildTrauma Academy Introduction to the NMT
Materials may not be replicated, repurposed or modified without permission
Bruce D Perry, MD, PhD © 2010
All rights reserved © 2010 Bruce D. Perry All rights reserved © 2010 Bruce D. Perry
All rights reserved © 2010 Bruce D. Perry All rights reserved © 2010 Bruce D. Perry
All rights reserved © 2010 Bruce D. Perry
Intimacy Barrier
History of Relational
Interactions
Casual - Routine - Personal - Intimate All rights reserved © 2010 Bruce D. Perry
NA
DA
Positive Human Interaction
Stimulation of “Reward” Neural Systems in the Human Brain: Sex
Sensation of pleasure and
safety
Release of hormones
and “calmer” regulation of
stress response
neural systems Decrease
physiological distress
Drugs of Abuse cocaine, opiates, stimulants
EtOH
Sweet, salty, fatty
foods
Behavior consistent
with value or belief system
Cut, pick, pull Sex
The ChildTrauma Academy Introduction to the NMT
Materials may not be replicated, repurposed or modified without permission
Bruce D Perry, MD, PhD © 2010
All rights reserved © 2010 Bruce D. Perry
!"##$%&'(()#!*(%&'((#+,-#.&+/0+#
12.#34&'#5&*,6*78'(#
All rights reserved © 2010 Bruce D. Perry 999"3:*8-.&+/0+"4&;#
$%&'((#
Unpredictable!
Vulnerability!
Predictable
Resilience!
Severe Moderate
All rights reserved © 2010 Bruce D. Perry
Time
State of Arousal
Birth
Responsive Caregiving (e.g., feeds, soothes)
External Soothing
All rights reserved © 2010 Bruce D. Perry
<4,-*,;#<':+=*4&(#!'6&'+('#9:',#%:'#
3+&';*='&#*(#>='&9:'80'-#4&#*,#!*(%&'((#
?*%:#*,6&'+(*,;#%:&'+%#+,-#-*(%&'(()#
+,#*,-*=*-/+8@(#6+7+6*%A#%4#B;*='C#%4#
4%:'&(#*(#-*0*,*(:'-"#
All rights reserved © 2010 Bruce D. Perry
Time
State of Arousal
Birth
Inconsistent Caregiving Response
External Soothing
All rights reserved © 2010 Bruce D. Perry 999"3:*8-.&+/0+"4&;# DE#
F'(74,('(#%4#$%&'(()#!*(%&'(()#.&+/0+#
•! !"#"$%&"'"(#)*%+*$",-%',"*-./"$',*•! G-+7H='#6:+,;'(#*,#!"#$%&"$#
•! G-+7H='#6:+,;'(#*,#'()!*+#
•! G-+7H='#6:+,;'(#*,#,)-'.%"/#
•! G-+7H='#6:+,;'(#*,#$)0/"1-2+%"3"#2#
•! G-+7H='#6:+,;'(#*,#1-2+%"3"#24
The ChildTrauma Academy Introduction to the NMT
Materials may not be replicated, repurposed or modified without permission
Bruce D Perry, MD, PhD © 2010
All rights reserved © 2010 Bruce D. Perry !!!"#$%&'()*+,*"-)./ 01/
2%33-4%*5-6/
Trauma Stress
Terror
Fear
Alarm
Alert
Calm
All rights reserved © 2010 Bruce D. Perry !!!"#$%&'()*+,*"-)./ 07/
Females
Young Children
Torture/Pain
Inescapable Helplessness
Males
Older Children
Observer
Action Active Role
Arousal Dissociation
DISSOCIATIVE/AROUSAL BALANCE
All rights reserved © 2010 Bruce D. Perry
89356./:9*);/8*;93</!"#$%&'(#)*+*#$',&*-+".$'
80
90
100
110
120
130
140
3/8/
93
3/13
/93
3/18
/93
3/23
/93
3/28
/93
4/2/
93
4/7/
93
4/11
/93
4/16
/93
4/21
/93
Fire/Parent Visits/
Assault/
All rights reserved © 2010 Bruce D. Perry www.ChildTrauma.org 40
2%=9)965*&/>?;*;9@/89*45A%;B/
Extreme Stress Stress Baseline
Vulnerable
Normal
Resilient
Terror
Fear
Alarm
Alert
Calm
All rights reserved © 2010 Bruce D. Perry !!!"#$%&'()*+,*"-)./
“Out” “In”
Evocative cues
associated with
previous trauma
All rights reserved © 2010 Bruce D. Perry
The ChildTrauma Academy Introduction to the NMT
Materials may not be replicated, repurposed or modified without permission
Bruce D Perry, MD, PhD © 2010
All rights reserved © 2010 Bruce D. Perry All rights reserved © 2010 Bruce D. Perry
Terror
Fear
Alarm
Alert
Calm
The Therapeutic Window: State Dependence
All rights reserved © 2010 Bruce D. Perry
!"##$%&'%()#
$*+#,-.%#/.01(02'%3#
All rights reserved © 2010 Bruce D. Perry
+-#
1%&'%()#4#
(50'6#03#)-#
78.6%.#
)5%7"#
!"#$%&'!"()%#
All rights reserved © 2010 Bruce D. Perry
•! 94(:#-;#4#32%(0<(#24=%.1#-;#%>2%.0%1(%#
68.01%?%'-27%1)#.%38')3#01#[email protected]'#
6%?%'-27%1)#-;#4#(-.%#@.401#;81(A-1#
•! +5%#[email protected]'#6%?%'-27%1)#03#01#)5-3%#
@.401#3B3)%73#C50(5#*%#*%+',%-.%$/%+'
,-).%**+'0$#1%-,-%12+'416#0".1')#2#
01;-.74A-1#.%'4)%6#)-#)54)#32%(0<(#
%>2%.0%1(%#-.#0128)"#
A Neurodevelopmental Definition of Neglect
All rights reserved © 2010 Bruce D. Perry www.ChildTrauma.org
Early Childhood Neglect Family portrait by an 8 year old boy. Adopted at age 3 from an Eastern European orphanage.
The ChildTrauma Academy Introduction to the NMT
Materials may not be replicated, repurposed or modified without permission
Bruce D Perry, MD, PhD © 2010
All rights reserved © 2010 Bruce D. Perry
!"#$%#&'()*+,')-'.&/#&01'
23!45.6'
7+)$)89#'
6)0:9#'
;)/8:$<&'
!)1)*'
=4>>7?.'
7%:,)@:0'
;A9)$0'
>)19#'/#)B9#'
All rights reserved © 2010 Bruce D. Perry
Extreme Neglect Normal
3 Year Old Children
All rights reserved © 2010 Bruce D. Perry
(C''.&"*),&D"&8$9#'!)@&#')-'>A&*9%&"$0,'
.!>';)*&'=*:80:%#&,'
All rights reserved © 2010 Bruce D. Perry
;)*&'&#&+&81,')-'%),:$<&'@&<&#)%+&819#E'
&@"09$)89#'98@'1A&*9%&"$0'&F%&*:&80&,''
•! ?	$)89#'G,9-&H'
•! ?&#&<981'G@&<&#)%+&819##IJ+910A&@H'
•! ?&%&$$<&'G%9K&*8&@H'
•! ?&L9*@:8/'G%#&9,"*9B#&H'
•! ?AI1A+:0'G*&,)8981'L:1A'8&"*9#'%9K&*8,H'
•! ?&,%&0M"#'G0A:#@E'-9+:#IE'0"#1"*&H'
All rights reserved © 2010 Bruce D. Perry
.&"*)9*0A&9)#)/I'
•! >A&'9/&'91'LA:0A'98'9@<&*,&'&<&81'19N&,'%#90&'L:##':8O"&80&'1A&'8&"*)@&<&#)%+&819#':+%901'
98@'1A&'*&,"#$8/'-"80$)89#'0)8,&D"&80&,'
•! >A&*&-)*&E'@&<&#)%+&819#'A:,1)*I')-'9@<&*,&'
&F%&*:&80&,':,'0*"0:9#'1)'"8@&*,198@:8/'0"**&81'
-"80$)8:8/'
•! .!>':80#"@&,'9'@&<&#)%+&819#'*&<:&L')-'
9@<&*,&'&F%&*:&80&,'4.2'1A&'B"P&*:8/'&P&01,'
)-'*	$)89#'A&9#1A'
All rights reserved © 2010 Bruce D. Perry
Neocortex
Limbic
Diencephalon
Brainstem
67QR7.>54S'27T7S3=!7.>''
6&D"&8$9#'T"#8&*9B:#:1I'
The ChildTrauma Academy Introduction to the NMT
Materials may not be replicated, repurposed or modified without permission
Bruce D Perry, MD, PhD © 2010
All rights reserved © 2010 Bruce D. Perry
!"#$%&'()*+%,"-&'%.)",()*%/"0%12)%
)"&%#$2+0-$3%%!"#$%&'()*+%/"0%12)%
#$2+0-$%2-$%)"&%,"-&'%.)",()*3!!
"#$%&'!()*+'%)*!
All rights reserved © 2010 Bruce D. Perry
,%-&./%0%#.12%*'3#!4)+5!
•! 67%!,86!1&.9%++!)*0.#0%+!3++%++)*:!'7%!
;2)*:<!*3'-&%!3*/!)*'%*+)'=!.>!3/0%&+%!%0%*'+!
•! 67%!;2)*:<!*3'-&%!3*/!?-3#)'=!.>!@$-A%&)*:B!
&%#3;.*3#!7%3#'7!)+!3++%++%/!3+!C%##!
•! "*!%+;23'%!.>!@/%0%#.12%*'3#!&)+5B!)+!
.$'3)*%/!3'!03&).-+!;2%+!/-&)*:!/%0%#.12%*'!
$=!9.2$)*)*:!'7%!"(!3*/!4D!+9.&%+!
All rights reserved © 2010 Bruce D. Perry
E-&&%*'!4%#3;.*3#!D%3#'7!
•! "!23F.&!>39'.&!)*!7%3#)*:!311%3&+!'.!$%!'7%!
*3'-&%<!?-3#)'=<!)*'%*+)'=!3*/!+'3$)#)'=!.>!3!
1%&+.*G+!&%#3;.*+7)1+!
•! 67%!,86!3++%++2%*'!1&.9%++!)*9#-/%+!3!+)21#%!
2%'&)9!'73'!#..5+!3'!9-&&%*'!&%#3;.*3#!7%3#'7!
•! 67%!+9.&%!.*!'7)+!2%'&)9!)+!3!5%=!)*/)93'.&!.>!
.-'9.2%!H!:../!&%#3;.*3#!+'3$)#)'=!1&%/)9'+!!
1.+);0%!.-'9.2%!H!3*/!1..&!&%#3;.*3#!7%3#'7!
1&%/)9'+!1..&!.-'9.2%+!
All rights reserved © 2010 Bruce D. Perry
,86!I&3)*!8311)*:!J&.9%++!
•! 67%!5%=!)*/)93'.&!.>!$&3)*!.&:3*)K3;.*!3*/!*%-&.17=+).#.:)93#!+'3'-+!)+!>-*9;.*!
•! I=!9&%3;*:!3!+)21#)L%/!9.*+'&-9'!H!'7%!$&3)*!
231!H!3++%++2%*'!.>!5%=!$&3)*M2%/)3'%/!
>-*9;.*+!93*!7%#1!@#.93#)K%B!
*%-&./%0%#.12%*'3#!0-#*%&3$)#);%+!3*/!
+'&%*:'7+!
•! 67)+!@#.93#)K3;.*B!7%#1+!/)&%9'!/%0%#.12%*'3##=M+%*+);0%!)*'%&0%*;.*+!
All rights reserved © 2010 Bruce D. Perry
E,N!O-*9;.*3#!831!
•! N%0%&3#!@$&3)*!231B!2./%#+!730%!$%%*!-+%/!)*!
'7%!1&.9%++!.>!9&%3;*:!3*/!&%L*)*:!'7%!,86!
•! E-&&%*'!2311)*:!1&.9%++!)*0.#0%+!3!C%$M
$3+%/!2%*-M/&)0%*!&%0)%C!.>!03&).-+!$&3)*M
2%/)3'%/!>-*9;.*+!
•! 67%!&%+-#;*:!@231B!9&%3'%+!3!0)+-3#!
&%1&%+%*'3;.*!'73'!)+!-+%>-#!>.&!'%397)*:<!
'&%3'2%*'!1#3**)*:!3*/!'&395)*:!.-'9.2%+!
All rights reserved © 2010 Bruce D. Perry CCCPE7)#/6&3-23P.&:!
The ChildTrauma Academy Introduction to the NMT
Materials may not be replicated, repurposed or modified without permission
Bruce D Perry, MD, PhD © 2010
All rights reserved © 2010 Bruce D. Perry !!!"#$%&'()*+,*"-)./ All rights reserved © 2010 Bruce D. Perry !!!"#$%&'()*+,*"-)./
All rights reserved © 2010 Bruce D. Perry 0&&/)%.$12/)323)43'/5/6778/9":"/
;3))</=:>/;$:/!!!"#$%&'()*+,*"-)./ All rights reserved © 2010 Bruce D. Perry !!!"#$%&'()*+,*"-)./
All rights reserved © 2010 Bruce D. Perry !!!"#$%&'()*+,*"-)./ All rights reserved © 2010 Bruce D. Perry !!!"#$%&'()*+,*"-)./
The ChildTrauma Academy Introduction to the NMT
Materials may not be replicated, repurposed or modified without permission
Bruce D Perry, MD, PhD © 2010
All rights reserved © 2010 Bruce D. Perry !!!"#$%&'()*+,*"-)./
All rights reserved © 2010 Bruce D. Perry
All rights reserved © 2010 Bruce D. Perry 0&&/)%.$12/)323)43'/5/6778/9":"/
;3))</=:>/;$:/!!!"#$%&'()*+,*"-)./ All rights reserved © 2010 Bruce D. Perry !!!"#$%&'()*+,*"-)./
All rights reserved © 2010 Bruce D. Perry 0&&/)%.$12/)323)43'/5/6778/9":"/
;3))</=:>/;$:/!!!"#$%&'()*+,*"-)./ All rights reserved © 2010 Bruce D. Perry
Primary Somatosensory
Relational/Somatosensory
Traditional Psychotherapy or Primary Cognitive Activity
Primary Neural Impact of Various Therapeutic, Educational or Enrichment Activities
The ChildTrauma Academy Introduction to the NMT
Materials may not be replicated, repurposed or modified without permission
Bruce D Perry, MD, PhD © 2010
All rights reserved © 2010 Bruce D. Perry All rights reserved © 2010 Bruce D. Perry Bruce D Perry, MD, PhD © 2010
All rights reserved © 2010 Bruce D. Perry Bruce D Perry, MD, PhD © 2010 All rights reserved © 2010 Bruce D. Perry
!"##$%&#'(()*+,-./#,/0#123+.456#
$%.85#98*/+*()56#
All rights reserved © 2010 Bruce D. Perry All rights reserved © 2010 Bruce D. Perry
The ChildTrauma Academy Introduction to the NMT
Materials may not be replicated, repurposed or modified without permission
Bruce D Perry, MD, PhD © 2010
All rights reserved © 2010 Bruce D. Perry All rights reserved © 2010 Bruce D. Perry
All rights reserved © 2010 Bruce D. Perry All rights reserved © 2010 Bruce D. Perry
All rights reserved © 2010 Bruce D. Perry All rights reserved © 2010 Bruce D. Perry
!"#$%&% !"#$%#!&#
'# &# (# (# )# '# !*# !*# !*# !*# !*# !*#
(# )# (# (# (# &# !+# !+# !+# !*# !*# !!#
(# !*# '# '# !*# )# !!# !!# !+# !!# !*# !+#
'# )# )# '# !!# !!# !!# !+#
!!# !!# !!# !!# !+# !+# !+# !!#
!+# !!# !+# !!#
!!# !+# !+# !+#
!!# !!# !+# !+#
Developmental
!"#$%'% !!#$%#!,# Functional -# "# "# ,# -# &# '# '# '# '# '# '# !+# ./0/123/.#
(# &# &# "# "# -# !!# !!# !!# '# '# !*# !!# 425671#5748/#
"# "# &# &# (# -# !*# !*# !!# !!# !*# !!# !*#
&# "# +# "# !!# !!# !!# !!# '# /39:2.9;</6/58948#
(# '# '# '# !!# !+# !+# !*# (# 691.#;%=>?@=@AB#
!!# "# !+# !!# )#
(# !*# !+# !+# &# 35/;C5:25#;737;9DE#
(# '# !+# !+# -# 62./57D/#.FAGHIJK%I#
"#
!"#$%(% !"#$%#!&# ,# C4./0/123/.#
)# -# -# &# &# )# !*# !*# !*# !*# !*# !*# +# :/0/5/#.FAGHIJK%I#
(# &# )# &# -# &# !+# !+# !+# !*# !*# !!# !#
&# &# (# )# '# &# !!# !!# !+# !!# !*# !+#
(# &# "# &# !!# !!# !!# !+#
!*# !*# !*# !*# !+# !+# !+# !!#
!!# &# !+# !!#
!*# !!# !+# !+#
'# !*# !+# !+#
Christopher 14 yo M Sandhill Child Development Center
7/08
12/08
10/09
Bruce D Perry, MD, PhD © 2009 The ChildTrauma Academy NMT Project
The ChildTrauma Academy Introduction to the NMT
Materials may not be replicated, repurposed or modified without permission
Bruce D Perry, MD, PhD © 2010
All rights reserved © 2010 Bruce D. Perry
!"
#!"
$!"
%!"
&!"
'!"
(!"
#" $" %" &"
Drop in Restraints at AYN Residential and Day-hospital programs with NMT
12 mos prior 3rd 6 mos NMT 1s t 6 mos NMT 2nd 6 mos NMT
Res
trai
nts/
mon
th
All rights reserved © 2010 Bruce D. Perry
All rights reserved © 2010 Bruce D. Perry All rights reserved © 2010 Bruce D. Perry
All rights reserved © 2010 Bruce D. Perry
)*""+,--./0"123"2.0-45"6.78-09"
123"+8-.":-4/547;.9"
All rights reserved © 2010 Bruce D. Perry
The ChildTrauma Academy Introduction to the NMT
Materials may not be replicated, repurposed or modified without permission
Bruce D Perry, MD, PhD © 2010
All rights reserved © 2010 Bruce D. Perry All rights reserved © 2010 Bruce D. Perry
All rights reserved © 2010 Bruce D. Perry
!"#$%&$"'()*+$,!-(./"+0120#30/$
!"#$%&$403*5%%6$"-*$!-(./"+0120$#30/*27$
!"#$8*59(:*9$''';!-(./"+0120;%+<$
''';!-(./"+0120#30/*27;3%2$