THE ROOTS OF MENTAL ILLNESS IN EARLY CHILDHOOD DEVELOPMENT:
A Neurological Reorganization Perspective

By Emily Beard Johnson, BA, CD, Asst. Assoc. of ECE, Neurological Reorganization Practitioner and Joy Cripps

Often, families feel stricken by mental illness. Parents may question, “Why our family? How did this happen to my child?” Research has found that incomplete or damaged early childhood development sets the stage for mental illness later in life. Neurological reorganization, based on replication of normal neurological development, is uniquely suited to address the central nervous system dysfunction at the root of mental illnesses and helps individuals live the fullest possible life, free of the symptoms of mental illness.

Many people think of mental illness as something that appears in teen or adult years. Actually, the symptoms of mental illness present between the ages of three to six, as demonstrated by a study undertaken in December, 2006 by the Unit of Child and Adolescent Psychopathology at the Universitat Autonoma de Barcelona in Spain. “The researchers have found that many of the problems and disorders found at later stages in life begin during this period of childhood [age three to six]….This age group is crucial for the future, since 99% of children who do not suffer from any kind of disruptive behavior do not develop these disorders later in life. By contrast, those who do suffer from disruptive behavior continue to have the same problem five years later or develop some other kind of disorder.” Successful neurological development is critical for insuring lifelong mental health. If it is not in place, issues will continue throughout the child’s life.

Functional neurology is laid in place in the first year of life through the completion of the developmental sequence. The first year of life is the most important year of life as it sets the foundation for all later function. Human capacity is cumulative; it’s all based on what comes before. Consequently, if there is an issue in the foundational levels, the more advanced levels do not present optimally. Specifically, the pons and midbrain are the neurological levels put in place in approximately the first year of life which play crucial roles in regulating the emotional and behavioral well-being necessary to avoid mental health issues.

The pons is responsible for all vital, life-preserving activity. This is where our sense of safety and security, attachment and bonding come from and as well as our sense of fear and anxiety. Even in very young children, pons dysfunction is apparent and manifests in a myriad of ways. Developmentally, the baby may not crawl on her tummy. She may not cry in response to normally upsetting situations. She may resist cuddling or eye contact. As a child, she may not feel extreme sensations – hot, cold, pain, and hunger – appropriately, resulting in an array of dysfunctional behaviors, including self-abuse or picking on others. The pons initiates our fight or flight response to stressful situations and, if it is working overactively, triggers an array of disruptive behaviors. This can be the child who takes foolhardy risks, such as diving off the back of furniture repeatedly, is overly affectionate with strangers, does not perceive danger appropriately, or has violent rages. The child may be constantly anxious, controlling, manipulative, or superficially charming. She may also have difficulty bonding with parents, siblings, and other caregivers. These issues result in a sense of profound displacement, isolation, and mistrust. As the child ages, she may be given mental health diagnoses such as anxiety, reactive attachment disorder, oppositional defiance disorder, anorexia, anti-social disorder, and post-traumatic stress disorder.

The midbrain is the region of the brain responsible for filtering, balancing, and regulating. Midbrain dysfunction can be observed in a number of ways in infants and young children. Developmentally, this baby may not creep on hands and knees, may not respond to vocal tonality, and may have a hard time with depth perception and motor coordination. As her filtering system does not prioritize appropriately, she may be extremely distractible or hyperactive; have a short attention span; trouble remembering and following through on tasks; or, when engrossed in a task, have difficulty responding to prompts. The midbrain regulates our perception of nonverbal social cues, so this child may have a hard time reading others and may be out of sync in social situations. Proprioception, or knowing where one is in space, stems from the midbrain. A child may struggle with establishing and maintaining appropriate emotional and physical boundaries. Impulse control may be an issue as the midbrain includes the part of the brain that applies the brakes to inappropriate impulses. Additionally, the two hemispheres of this child’s brain may not effectively communicate, resulting in immense frustration, apparent manipulation, and, possibly, rages. Midbrain dysfunction can also result in inarticulate, atonal, or slurred speech; difficulty accessing words; or auditory processing issues, as this is the level of the brain that allows us to make and interpret the sounds that become words. Neurochemical regulation is controlled by the midbrain. As she ages, this child may be diagnosed with depression, bipolar disorder, schizophrenia, obsessive compulsive disorder, autism spectrum disorders, limbic rage, dyslexia, ADD/ADHD, or addictive behaviors.

As children age and move into the world at large, additional symptoms of dysfunction manifest themselves. When there is a foundational deficit, all subsequent development is based on that shaky foundation. Problems continue to manifest as the child explores different environments. As new issues appear, parents may say, “Oh, she’ll grow out of it,” or, “It’s just a phase.” However, research demonstrates that, for children with poor foundational layers of the central nervous system, this simply isn’t so: the child does not outgrow the root problem as it is hard-wired into her brain. Until her central nervous system dysfunction is addressed through neurological reorganization, issues will occur throughout her life.

A closer look at two eating disorders, anorexia and addictive eating, illustrates how central nervous system dysfunction in the pons and midbrain contribute to mental illness later in life, resulting in a cascade of multiple mental health diagnoses.

Anorexia is described as having three primary characteristics: refusal to maintain a normal weight, intense fear of gaining weight, and distorted body image. Other characteristics may include fear of growing up, inability to separate from the family, an intense need to please or be liked, perfectionism, need to control, lack of self esteem, and a temperament described as the 'perfect child'. Development of an eating disorder, especially anorexia, is often attributed to the effects of our cultural environment heavily emphasizing slimness. However, all women are exposed to these cultural mores, while only 1 - 3% of women develop an eating disorder. Pons dysfunction is a more accurate predictor of whether or not a child may develop anorexia later in life.

A critical developmental milestone for a pons-level infant is the recognition that she is a separate being from her biological mother and can rely on her mother for nurturing. In healthy development, when this infant experiences cold, hunger, or a startling sound, she cries and her mother responds by providing relief. Again and again, this cycle of distress and relief is repeated. Each time, the infant’s perceptions are acknowledged, regulated, and filtered through an attentive and nurturing mother. This cycle allows the infant to experience and develop a sense of safety, security, and belonging.

By comparison, an infant with disrupted development also experiences the cycle of distress but without relief. Her experiences with chronic stress and the related hormones actually cause an injury to the pons. Frequently, this type of pons-level dysfunction manifests itself as an anxiety disorder. This child experiences such a sense of fear and danger that she seeks every way possible to control her environment and her place in it. In the case of anorexia, she exerts the ultimate control on her own body and its very survival.

The pons begins to develop in utero. Research finds that complications during pregnancy set the stage for anorexia later in life. In a study published in the January, 2006 issue of the Archives of General Psychiatry, researchers write, “Observational reports suggest that problems during neurodevelopment in the fetus might lead to anorexia nervosa or bulimia nervosa later in life, and some studies have found a correlation between obstetric complications and anorexia nervosa….Several specific complications in the mother increased a child's risk of developing anorexia nervosa. This type of relationship is considered evidence of a causal link and would indicate that an impairment in neurodevelopment could be implicated in the pathogenesis of anorexia nervosa.” As human development is cumulative, if there is an issue at the very beginning, we can expect that symptoms of that problem will manifest over the child’s entire life.

Babies with impaired development in utero are at risk for developing anxiety disorders as children. Research links childhood anxiety disorders with the onset of anorexia as an adolescent. A study published in the December, 2004 issue of the American Journal of Psychiatry found that “two-thirds of people with eating disorders experienced some sort of clinical anxiety, such as obsessive compulsive disorder or social phobia, at some point in their lives. A significant number of them -- 42 percent -- developed their anxiety disorder when they were children, years before their eating disorder….The strength of the bond between anxiety and eating disorders is bolstered by the fact that nearly all women with eating disorders report having certain anxiety traits, such as harm avoidance, generalized anxiety and perfectionism, even if they do not have a diagnosable illness….The researchers also found that anxiety remains pervasive even after women had recovered from an eating disorder.” Incomplete pons development triggers anxiety which is an enormous predictor for numerous mental health issues, including anorexia, throughout one’s life.

A program of neurological reorganization identifies and addresses the underlying, pons-level dysfunction that, later, may manifest as anorexia. The individual’s ability to feel safe and comfortable in her own body improves significantly as her sensory and emotional processes develop in a healthy manner.

Another eating disorder, addictive eating, derives primarily from midbrain, rather than pons, dysfunction. When the midbrain does not correctly balance neurotransmitter release, symptoms of the dysfunction manifest throughout the child’s life. (For our purposes, the midbrain is a region of the brain, including the hypothalamus, which regulates neurotransmitter release). As a child, she may be overweight and spend endless hours with video games or obsessive television viewing. As a teenager, she may experiment with smoking, marijuana, or alcohol and, as an adult, develop full-blown food addictions, as well as possible addictions to drugs, gambling, sex, or other substances. Neurotransmitter imbalance also plays a large role in several mental health diagnoses, including depression and bipolar disorder.

A healthy midbrain is responsible for several functions, including stress response. When our stress response is not working correctly, an appropriate balance of neurotransmitters is not maintained. Specifically, a neurotransmitter named Cocaine and Amphetamine Regulated Transcript peptide, or CART, stimulates the part of the brain which is affected both during drug use and in determining a sense of satisfaction when eating. Findings from Yerkes Primate Research Center of Emory University cement the relationship between known addictions, such as drugs, and compulsive eating.

These neurotransmitters are the direct connection between a sense of enjoyment during drug use and when compulsively eating. When eating becomes addictive, a multitude of negative consequences arise. One of the most significant is an alarming increase in weight. According to the American Heart Association, more than one in four children are classified as overweight. Additionally, a University of Rochester Medical Center study released in November, 2006 finds that abdominal obesity increased more than 65% among boys and almost 70% among girls between 1988 and 2004. Abdominal obesity has emerged as an accurate predictor of cardiovascular disease and type II diabetes. According to Stephen Cook, M.D., an assistant professor of Pediatrics, “These increases only grow more alarming as you tease out specific age groups over longer periods of time. For example, between the 1988-1994 data and the 1999-2004 data, the largest relative increase in the prevalence of abdominal obesity occurred among 2- to 5-year old boys – 84%-- and 18- to 19-year old girls – 126%.” Research identifies many disturbing trends related to the increase in obesity in children. About one in eight schoolchildren have three or more of the risk factors which lead to cardiovascular disease and type II diabetes, including high blood pressure, elevated triglycerides, low levels of good cholesterol, glucose intolerance, and elevated insulin levels. Furthermore, an inability to moderate eating leads to a plethora of unhealthy behaviors as demonstrated by a November 2006 study released by the University of Minnesota: teen-age girls’ use of diet pills has doubled over a five year period; 62.7% of teen-age girls use unhealthy weight control behaviors; and 21.9% use very unhealthy behaviors, including the use of diet pills, laxatives, vomiting, or skipping meals. When the midbrain does not automatically balance neurotransmitter release, an array of unhealthy behaviors emerge in childhood and adolescence and set the stage for a lifetime of physical and mental illness as well as low self esteem, less success in school, and decreased earnings as a young adult.

Midbrain development requires completion of a variety of neurodevelopmental activities, including sensory stimulation. One of the most important sensory experiences an infant can have is breastfeeding during the first year, as recommended by the American Pediatric Association. Additionally, a study from Harvard Medical School suggests breastfeeding may prevent obesity later in life. Not only are fewer breastfed infants overweight compared to formula-fed infants, but “breast milk itself might provide early ‘metabolic programming’, leading to less fat accumulation.” Infants must complete the developmental sequence to insure healthy neurotransmitter balance and avoid the problems associated with addictive eating.

A program of neurological reorganization has a dual effect. It boosts the stress response so that an individual can manage stress appropriately. It also balances the release of neurotransmitters so that the sense of satisfaction when eating is normalized. When these work together, the physical, emotional, and mental health concerns related to addictive eating subside and the individual is free to live without these issues threatening her future.

While eating disorders are very serious matters, the majority of the clients seen at Northwest Neurodevelopmental Training Center have multiple mental health diagnoses. For instance, a typical child with reactive attachment disorder, associated with pons dysfunction, also exhibits learning disabilities, such as focus issues, difficulty reading, difficulty writing, comprehension challenges, and reversal of letters, associated with midbrain dysfunction. These children tend to be extremely intelligent, but are unable to express their capability. When neurological deficiencies occur at the pons-level, healthy development stops at that level. Consequently, learning disabilities present in the midbrain or cortex, as those levels rely on a healthy pons to function appropriately.

Parents of children with reactive attachment disorder and learning disabilities seek out professional opinions to help their children. Teachers tend to focus on the academic challenges and advise testing and medication for ADD or ADHD. Pediatricians tend towards diagnoses such as pervasive developmental delay and advise treatment for that. Mental health professionals tend to diagnosis anxiety disorders and offer specific treatments. The child accumulates several diagnoses--ADHD, pervasive developmental delay, and anxiety disorder—and a separate treatment for each. Each diagnosis reflects a part of the child’s challenges, as viewed through that professional’s expertise.

The same pattern of multiple diagnoses is observed with a child who suffers birth trauma and is then diagnosed with pervasive developmental delay and then with autism, or the child who suffers post-traumatic stress disorder and is later diagnosed with depression or bipolar disorder. Diagnoses pile upon diagnoses, even compromising the individual’s physical health. In fact, according to a December 2006 study conducted by Indiana University and published in the Journal of General Internal Medicine, 71% individuals with a mental health diagnosis, such as schizophrenia, also had one or more of forty-six common chronic health conditions. “This work highlights the long-term deleterious effects on physical health of living with chronic mental illness,” said Dr. Carney Doebbeling, associate professor of psychiatry and medicine at the Indiana University of Medicine, “Both physical and mental health practitioners should have a heightened awareness of the significant medical morbidity faced by persons with chronic mental illness.”

The whole child and the foundation of all of her issues must be examined to optimize mental health and avoid the pitfalls of multiple diagnoses. Neurological reorganization is the only approach that addresses the underlying concerns that are the foundation for each of her diagnoses. Since healthy neurological function is posited on the completion of the developmental sequence, an individual with pons-level dysfunction will experience midbrain and, possibly, cortical issues. Once a program of neurological reorganization addresses these pons-level issues, healthy midbrain and cortical function can be tackled. The child gains the ability to exhibit healthy emotional, behavioral, and academic function and avoid the prognosis of continued struggle. At this stage, recruiting other professionals to tackle the lingering habits and emotional baggage accumulated from years of strife can be effective.

Again and again, research finds that healing the brain early can stop a mental illness from manifesting later in life. Early intervention targeting neurological dysfunction is the best way to protect a loved one from developing a mental illness later in life. Neurological reorganization is the only discipline to address the central nervous system development that lays the foundation and sustains healthy function throughout one’s entire life.