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Neurosequential Model of Therapeutics™

“It’s hard to say what somebody can manage in a state of extreme pain.  We protect ourselves.  All of the things kids do that we see as deviant, disruptive, unhealthy, or ineffective are meeting a need at some point in their lives.  They are amazing survivors.  They’ve come through so much.” – Markley Hawkins, LCSW

What is the Neurosequential Model of Therapeutics™?

The ChildTrauma Academy developed the Neurosequential Model of Therapeutics™ (NMT™) as a developmentally sensitive, neurobiologically informed approach to working with at-risk children, youth and adults. The NMT™ is not a specific treatment technique; it integrates core principles of brain development and traumatology to inform work with children, families and the broader community. The model has three key components including training and capacity building, assessment, and then recommendations for personalized therapeutic, educational, and enrichment activities. The NMT™ process helps match the nature and timing of specific therapeutic techniques to the developmental needs of children.

The Neurosequential Model of Therapeutics™ Assessment

The Neurosequential Model of Therapeutics™ (NMT™) assessment process is designed to identify the strengths and vulnerabilities of a child by considering the child’s developmental history and current functioning. The structured assessment yields a full NMT Metric Report which includes a visual representation of a child’s neurodevelopmental strengths and vulnerabilities. This Functional Brain Map is used to inform the selection of a unique sequence of developmentally appropriate interventions for the child, beginning with the lowest and most underdeveloped regions of the brain.

The image below is an example of a Functional Brain Map. Each box corresponds to a specific set of brain-mediated capabilities (e.g., attention, mood, communication, movement) and is color-coded to represent how well organized and functional these capabities are. Red indicates underdevelopment or significant dysfunction, yellow is moderate dysfunction, and green is fully developed, functionally mature capability.


Brain Map from website

Neurosequential Model of Therapeutics™ Treatment

In 2009, Alexander’s Psychiatric Residential Treatment Facility (PRTF) programming underwent a significant redesign based on the Neurosequential Model of Therapeutics™ (NMT™). We changed from traditional, behavior management programming to relationship-focused, expressive therapies. As a result of these efforts, Alexander became the first behavioral healthcare agency to be recognized as an NMT Flagship Site. Since 2009, our Day Treatment and Intensive In-Home programs have also adopted this approach.

These programs use the 6 R’s identified by Dr. Perry as essential to healing when considering specific milieu enhancements. The 6 R’s include:

  • Relational (safe)
  • Relevant (developmentally-matched to the individual)
  • Repetitive (patterned)
  • Rewarding (pleasurable)
  • Rhythmic (resonant with neural patterns)
  • Respectful (of the child, family and culture)

To learn more about NMT™, please visit the Child Trauma Academy website:

Neurosequential Model of Therapeutics™ Training and Consultation

As a Neurosequential Model of Therapeutics Flagship Site, we are able to provide training in the Core Concepts of NMT™ and interventions that are consistent with the NMT™ approach. We have provided training to community partners such as Charlotte-Mecklenburg Schools, Cabarrus County Schools, Buncombe County Department of Social Services, Behavioral Health Care, Benchmarks, and others.

Our NMT™ certified clinicians are also available to conduct NMT™ assessments and treatment planning consultation for children, families, and agencies nation-wide.

To obtain more information about our NMT™ programs and Training and Consultation services, please contact the Access Department at 855.362.8470 or


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