Neurodevelopment is based on the developmental profile.  The profile represents which functions are associated with which parts of the CNS.  With this information we can do a functional neurological evaluation looking for the functions appropriate to each developmental level, and by noting which functions are absent or inefficiently performed, determine which parts of the CNS is dysorganized and design a tailored made program to address the dysorganization.  Everyone moves through the same developmental steps only at a different rate; some skip steps which can cause inefficiencies.  Our job is to teach-instruct-provide input.  We should concentrate on the level of input, not levels of output.

When the brain receives enough input, it will give the output.

Example, a preschooler has learned the alphabet, what happens?  For the next two weeks that’s all you hear from them–the alphabet!  The child learns to climb, or times tables, or new song whatever–he gladly tells you what he has learned (output).  Input, input = output.  

Next, let’s examine the twelve stages of normal and abnormal development.  For additional information see the Hager Developmental Vortex.

Infants develop from 
         head to toe, 
               shoulders to fingertips, 
                      hips to toes and 
                           internal to external.

Development of the brain begins with the medulla and spinal cord  and progress through the pons and midbrain to the cortex.  It is necessary here to give the qualifier that although the developmental process will be represented in terms of absolutes, in actual fact, we do not develop through strictly differentiated stages.  It becomes necessary to speak in absolutes in order to associate each particular function with a specific brain area.

When a child is born he has all the brain cells he will ever have.  The brain doesn’t rebuild itself like most of the other body cells.  There are trillions of cells but most of them have no connections.  The child is born with all of its body parts although unable to use most of them. The brain of a new  born functions at the spinal cord and medulla levels.  The process that makes these parts available to the baby is called myelination.  Myelin is a white, fatty substance that grows over the nerves of the CNS and serves to insulate them in the same way that the rubber coating insulates an electric cord.  Without the myelin coating signals sent along a nerve pathway becomes short-circuited and are unable to complete their trip.  This is what occurs in people who have multiple sclerosis.  They develop scars on the myelin sheath and every place a scar occurs nerve signals are short-circuited and interrupted.  This process of myelination is generally referred to as development.  Development can be slowed or accelerated with specific stimulation to the sensory areas.

When a baby is first born the myelin has grown over the spinal cord and the base of the brain stem, the medulla.  This area of the brain is primarily responsible for our reflex functions.  Let’s look at what these functions are across the developmental profile.

The visual function that the baby has at this stage is a light reflex.  If you shine a light in the baby’s eyes, his pupils will constrict.  When the light is removed the pupils will dilate, letting more light into the pupils.

The auditory function that the baby has at this stage is a startle reflex.  If there is a sudden noise near the baby he will jump and his arms and legs will fly straight out in front of him. The baby at this stage also has many tactile reflexes.  Such as the rooting reflex if you touch his cheek he will move his head in that direction and start a sucking motion.

At this stage he has a great deal of movement.  His arms and legs move freely, but even with all of this motion, the baby form of locomotion enabling him to move from one place to another. 

In the language area, this infant has a birth cry.  Simply saying “I’m here,” “I’m alive.”

Finally, the level of hand function at this stage is the grasp reflex.  He is able to grasp things but unable to release them.  Doctors test this function by placing their fingers in the baby’s hands and lifting him off the table.  The baby will continue to hold on even as his whole body is lifted off the table, not because he is demonstrating great strength, but because he simply can’t let go.

The common characteristic of all of these functions is that they are reflexes.  And what is the purpose of these functions?  Each time a reflex is activated it causes a specific action response.  And each time that the action response occurs it establishes a nerve pathway, an engram, which becomes ingrained in the CNS.  The presence of these reflex functions at the baby’s birth serves to automatically expand the repertoire of engrams in his CNS.  These new engrams, in turn, serve as a foundation for future developmental progress.  This completes level one of the profile.  Moving up to level two the pons is developing.  All the while that the infant is establishing new engrams, his myelin sheath is steadily advancing up his brain stem.  When it has reached the pons the child gains a new set of functions.  Typically this is at about two months of age.

Just as the functions of the medulla are linked because they are all reflex functions, the functions of the pons are all linked because they all are directed toward life preservation.  The pons, among many other tings, plays a part in controlling heart rate and respiration.  Without it we could not survive.  People killed in car accidents usually die because they have sustained a severe injury to the pons.  The functions of the pons are as follow.

Visually the child perceives outlines.  At this stage the baby’s favorite thing is to look at the human face.  He doesn’t recognize the difference between one human face and another, but he will gaze intently at the faces around him.  The pons is also responsible for horizontal eye movement.  This allows him to watch his care giver approaching or leaving.

It should be noted that, although we are talking about the functional level of a two monthsold baby, this function is critical for reading because horizontal eye movement is necessary for a person to track words across a page.   

In terms of hearing, this baby no longer startles at every sudden noise.  But if the noise is loud and threatening, he will cry for help.

The tactile function of a baby at this stage is limited and very specific.  He can feel extremes of heat, cold, pain and hunger.  If he perceives any of these things, he will respond by crawling (tummy, pull with arms) away.

Crawling is the mobility function of a baby at this stage, who moves from place to place..  Babies crawl to get away from threatening situation.  So, for example, if a baby wets his diaper, he will crawl to get away from the cold wet spot and be found in the corner of his crib.  He does not crawl to find a comfy dry place, but to escape the threat indicated by the cold wet sensation.  Babies do not crawl to pursue an interest or to reach a toy, only to escape perceived dangers.  Crawling only purpose is to protect and preserve the life of baby.

Crying is his form of communication, serves the purpose of life preservation.  It can not be ignored by any normal adult, and it is triggered by his perception of danger.

It is significant to note that this developmental stage is a critical period in the bonding process.  Under normal circumstances when an infant at this stage cries for help an adult comes.  Each time this cry and response is repeated it serves to establish an engram in the nervous system.  This engram is a foundation for evaluating future contacts with others.  When the cycle of cry and response is interrupted a different engram is established which results in a neurological dysfunction.  When this occurs the baby may be unable to form trusting relationships with others.

Hand function has matured from the grasp reflex and not being able to let go to being able to let go.  He will grasp your finger as before, but if you try to lift him up, he will let go before his shoulders leave the table.  For obvious reasons, this function also has a role in life preservation.

Around the time the infant reaches seven months, his myelin sheath has reached the midbrain area of the brain.  The midbrain contains several organs that as a group work together for the purposes of outreach to the world and providing balance in every respect.

The midbrain allows the baby to gather detailed information about his environment.  It is responsible for the development of balance.   Physically he moves into a three-dimensional world, emotionally; he receives and communicate complex emotional messages, and internally; in terms of the autonomic nervous system.

Across the profile functions of the midbrain that we see in the developmental profile are as follows.

The child visual function takes on a new level of sophistication as he begins to see details as well as outlines.  He begins to distinguish one face from another and consequently begins to react to the presence of strangers.  They aren’t developing a new fear of strangers, but are developing the ability to identify who is a stranger and who is not.  Babies at this stage spend a great deal of time visually exploring their surroundings.  At this time they also develop vertical eye movement.  They can now move their eye up and down as well as side to side.

The auditory function of the child makes a giant leap.  He begins to hear and understand meaningful sounds such as the tone of voice.  He will listen carefully to his parents’ tone of voice to gather clues about how to “read” a situation.  If the tone is light and cheerful and she smiles, the baby will follow suit.  However, if the baby hears an angry tone, he becomes upset.

At this stage the baby has available to him all of the sensory experiences that adults to.  As well as heat, cold, pain, and hunger, he can perceive sensations like smooth, soft, cool, fuzzy, prickly, warm, rough, tickle and hundreds of others.  This is the stage in which the toddler fondles the edge of his blanket, or cuddles his soft teddy.  At this stage he also develops proprioception, the understanding of where one part of his body is in relation to the whole. Sometimes these babies combine sensory exploration with proprioceptive exploration by playing with their toes, fingers, hands, and feet.

In terms of mobility, he is now able to get around on his hands and knees, creeping.   A baby who creeps does so to get toward things of interest.  The new form of movement brings him into a three-dimensional world as he raises himself off of the floor, and requires the development of balance.   This movement of up and down with his body parallels the movement of the baby’s eyes at this stage.

The baby communicates by the creation of meaningful sounds.  Just as he is now able to hear and interpret tone of voice, he is experimenting with his own voice by cooing, babbling, shrieks, and giggles.  The child begins to communicate his feelings through his diverse vocal expressions.

Manual function also advances at this stage.  Now his is able to pick up objects using his prehensile grasp (whole hand). He begins to feed himself and to pick up and play with toys.

It is at this point, the baby begins to have influence over his surroundings.  He can communicate with those around him and he can pursue his interests.

In addition to the six categories we have been discussing, the midbrain has several other important functions that are significant to our neurological development.  One of these is that the midbrain acts as a filter for all of the incoming stimuli that the brain receives.  It also prioritizes the incoming stimuli that the brain receives.  It also prioritizes the incoming messages and directs them to the appropriate location in the brain.  For example, the midbrain allow the cortex to consciously pay attention to the words on the page you are reading, while it subconsciously processes the sound of the car that just drove by outside and the sensation of sitting on the chair you are sitting in.   If, however we hear a person get out of the car or the leg of the chair suddenly breaks, it is our midbrain that instantaneously re-directs our conscious attention to the new situation.  In this way the midbrain serves as a traffic cop for all of the stimuli that the brain is receiving.

Another very important function that the midbrain has is to help us operate under stress.  Faced with any of these stresses, our brain must make adjustments to accommodate to new situations.  If the midbrain fails to do this job one will have a decreased ability to accommodate the stress.  A person with this difficulty will experience a decrease in function during times of stress.  A student with “test anxiety” demonstrates this phenomenon.  In timed or graded situation (stress) that students become unable to perform functions that he does competently under more relaxed circumstances.  This function affects what might be called the “internal balance” of an individual, the ability to keep one’s balance under stress.

The midbrain contains many organs, but one of extra importance is the hypothalamus.  It moderates many of the bodily functions often taken for granted.   Among these are our sleep/wake cycles, our blood pressure, our appetite, regulates body temperature, secretion and suppression of hormones, secretion of enzymes (for digestion), and secretion and suppression of neurotransmitters.  These are the functions that “balance” the autonomic nervous system.  They keep the body functioning smoothly and provide for maintenance and continuation as a complete organism. 

When the hypothalamus is affected by neurological dysfunction it can result in problems as wide ranging as digestive problems, circulatory problems, irregular menstrual cycle, and sleep disorders.

It is clear that the midbrain is one of the most multifaceted and complex areas of the brain.  The diversity of its roles is truly remarkable, but they are unified by the fact that they all have to do with our placement in and outreach to the world.

When the child is about a year old he begins to move into the next stage of development.  At this point the myelin reaches the cortex.  The part of the brain which makes us human, not in respect to our soul, but in respect to our function.   The cortex is responsible for the things that are exclusive to human beings.

When the child enters into cortical development he begins to be able to use both eyes together to look at the same thing at the same time, convergence.  Convergence allows us to see things in three dimensions.  When we look at an object we get a picture with one eye and a picture with the other eye.  These pictures match up almost exactly but no quite.  It is this slight mismatch of the two pictures that creates our perception of depth.    The presence of this function depends not only on having reached the stage of cortical development, but also on having good visual-motor and proprioceptive function at the level of the pons and midbrain. 

At more sophisticated stages of cortical function, the child begins to develop the ability to recognize and distinguish symbols.  This begins, for example, with the understanding that a picture of a cat represents, but is not, a real cat.  He progresses through the understanding that pictures of a black cat, a tabby cat, and a calico cat all represent cats, until finally, the child recognizes that the letters C-A-T also represent a cat.  Symbol recognition is the highest visual function of the CNS, and is essential for reading.

In respect to the child’s auditory function, it is at this stage of development that the child begins to understand words.  Now not only receives a message from a speaker’s tone of voice, but also from the verbal content of what the speaker is actually saying.

The child’s sensory function allows him to draw a conclusion about what he has in his hand and name it, without looking at the object; by using the many sensory experiences gathered and stored during development of the midbrain.  An example is, finding and identifying a toy car in the bottom of the toy box without seeing it; or, an adult searching in their pocket of purse looking for the car keys or a coin.  At this point he can turn the pages of a book because he can visually perceive that the book is a three dimensional object and can find the edge of the page using his new sensory ability.

His mobility function is that of a human being.  He can walk upright.  When he begins to walk, he does so with his arms up at or above shoulder level.  He looks like a little tight rope walker.  As he progresses in development he will bring his arms down to his side and slightly behind his body.  You often see a child at this stage dragging a blankey or teddy bear along with him when he walks.  Further along in the process he will begin to run and walk swinging his arms in a cross pattern manner, as adults do.  Finally, when he reaches the peak of his functional development in terms of mobility he will be able to do skipping, hopping and other activities that require sophisticated coordination and balance. 

The child’s language function at the cortical level corresponds with his auditory function.  He is now able to communicate with speech.  First, he’ll begin with using only two word couplets.  They aren’t usually clear and properly pronounced but at this point they all count!  This function continues to develop until the child has a full vocabulary appropriate to his culture and environment. Appropriately, it is at this stage of development that the child gains cortical opposition.  This is the hand function of using the thumb and forefinger opposed to pick up and manipulate small objects.  You will now see the child not only pick up a cracker from his high chair tray, but go back to pick up the crumbs.  This function continues to develop until the child is able to write and perform other tasks involving fine motor coordination.

After all of the developmental gains that have been discussed so far have been established, the child’s brain now begins to differentiate a dominant and subdominant hemisphere. This allows complex tasks to be divided and assigned to one hemisphere or the other so that they can be handled more efficiently.  Consequent on the development of a dominant hemisphere in the brain is the use of the opposite side of the body in a dominant role.  For example, if a person’s left hemisphere is dominant then he will use his right eye, ear, hand, and foot.  This serves to standardize the pathways through which we take in and put out information.  To parents or older children, I explain it as a filing system.  If the information received from the environment is put into the correct file drawer (dominant side) then when that information is recalled you’ll know exactly where is was filed (subconsciously, of course).  If on the other hand, your brain is mix dominant then the information your looking for is misfiled.  You’ll search and search for it; if and when you find it, it is usually reversed or you only find part of it.

The myelination process is usually completed in boys about age eight and girls about age six.  The rate at which this happens is dependent upon the rate of growth of the myelin which is genetically coded. 

This lends significant weight to the argument that all children should not be sent to school at the same age.  Those children, boys, or girls, who have not reached the peak of their neurological development find it difficult to do what is required in the class room.  This includes activities from drawing and coloring to being able to sit still while listening to a story.  Children whose nervous systems are still immature are often believed to be misbehaving or not making an effort to accomplish their assignments when, in fact, they don’t have the capacity to meet these challenges yet.

It has not been determined that the growth rate of myelination is influenced by environmental factors, and until it has grown throughout the CNS the child cannot reach his developmental peak.  The reverse, however, is not necessarily true.  When the myelin has completed its growth, it does not guarantee that the child will have reached his peak.  If he does not have the opportunity to do the activities that correspond with each stage that has been discussed, then he cannot reach his neurological potential.  Even though the growth of myelin in the CNS allows the possibility of successful development, unless the necessary activities are engaged in, normal neurological development will be interrupted.

Now that we have discussed the profile of normal neurological development, we are free to move on to a discussion of how dysorganization or inefficiencies in particular areas of the CNS might manifest themselves when something goes wrong.

We will, for the most part, be brief with our discussion of dysorganization at the level of the medulla because in most cases a person with any significant injury at this level would be severely disabled and require extreme care.  A person with a mild dysfunction at this level might demonstrate an abnormality on one or more reflex functions.

Moving ahead to the pons then, here are some of the observations that might be made.  A person with dysorganization in the pons may have an inability to take in information from the world around him.  He may seem visually and aurally inattentive.  He may not hear you calling, even though, he has no documented hearing loss.  He may not notice his environment, such as pictures hanging on the walls or people in the room.  He may have diminished pain perception, internally, and unaware of hunger, stomach aches, overeats, considered non-thriving at birth, a bed wetter (Enuresis), ear infections; perhaps get cuts and bruises totally unaware of how or where they occurred, craves “rough housing” or “bear hugs” or actually invite spankings.  The brain is craving the deep pressure to stimulate specific nerves.  A person with diminished pain perception may also self-abuse at varying degrees.

A person with a pons injury may also be unable to bond with parents or form strong relationships because he is unable to receive or perceive the love that these people are sending. 

A person with such an injury may express a constant and persistent anxiety.  It is a function of the pons to perceive danger and the anxiety arises when the pons is working too hard at its job and perceives almost everything as threatening or dangerous.

On the other hand, the pons my not perceive anything as being threatening. This is why young children don’t perceive dangers. Older people in this position may behave recklessly or put themselves in dangerous situations.

Since the pons is also responsible for the function of horizontal eye movement, a person with an injury in this area may have difficulty reading because his eyes are unable to track horizontally.

Earlier, it was stated, the pons is responsible for some of our basic motor movements such as crawling (on tummy). As stated earlier, crawling organizes the pons area of the brain and if by chance a child crawled only for a short time or skipped it completely will have dysorganization at this level of the brain which is a contributor to learning, attending and/or behavior problems.  Infants need to crawl on their tummies until they themselves move up to their hands and knee (creeping).  Most children I evaluate either physically can not or can hardly move their body.  Dysorganization at a lower level of the brain sets up dysorganization at higher levels.  Academic learning is at the highest level of neurodevelopment.

Dysorganization in the midbrain presents an even greater variety of possible manifestations.  Here are a few:

A person with dysorganization at the level of the midbrain may have an inability to filter out or prioritize information from the world around him.  He may be easily distracted because he does not have the ability to choose what he should give his attention to.  He may be fidgety.  He may have a short attention span.  He may have trouble prioritizing things to do and following through on projects.  These children are usually labeled ‘hyperactive’, ‘ADD/ADHD’, or ‘learning disabled’.

He may try to exert control over those around him and appear to be bossy and manipulative.  This is due to his feeling of extreme lack of control in his world.  Without the ability to filter out unnecessary stimuli, he may feel bombarded by incoming information and, therefore, try to control the world around him in order to limit the barrage.  He has no other respite.

He may be prone to having altercations with others, because he feels provoked by their actions.  Innocent actions of others that most people would no pay attention to, such as shuffling papers, clearing one’s throat, or washing dishes, seem like a deliberate disruptive act to this person.

A Person with midbrain inefficiencies may also dislike physical contact because he may have hyper (too much) sensation which would interfere with his appreciation of normal sensory experiences.  For this reason, he may be very particular about the clothes he wears, complain about the tags, that the neck is too tight, that the fabric is too scratchy, hate things around his neck or head, hate hair cuts or his face or neck messed with.  Amazingly, the child with low sensation in the pons area many times will have a hyper sensation in the midbrain.

He may also feel cold or hot at temperatures that others would find comfortable.  He may wears clothes inappropriate for the weather, wearing a coat when it is 75 degrees outside, or shorts and a T-shirt when its freezing.  Body temperature regulation is a function of the hypothalamus in the midbrain.

Clumsiness and timidity about movement are frequently associated with a combination of neurological dysorganization.

 First, the midbrain is responsible for our balance and vestibular function.  So a person with dysfunction in this area will be clumsy, poor balance, and timid about movement.  Second, due to poor visual function he may lack depth perception.  The combination of poor balance and lack of depth perception makes a simple action like descending a set of stairs a challenge.  Children with these problems often avoid playground equipment or physically active school yard games.  Adults in this position may beg out of activities claiming  “I have two left feet.” Clumsiness may also result from poor proprioception.  This can lead to movements that seem broad or unsophisticated.

Proprioception is the brain’s subconscious ability of knowing where it is in space.  Are you standing upright, lying down, spinning, or rolling?  A child with large, sloppy writing may have proprioception difficulties.  A child who always has his legs wrapped around chair legs, sorta bounces off the walls as they walk, stand to close to others (personal space), doesn’t brace or catch their fall, and waking up startled in the middle of the night are examples of this problem.  Getting dizzy is one way the brain tells us it’s lost!

 A person with midbrain inefficiencies may have difficulty with digestion, bowel function, and bladder control.  He may frequently be constipated or irregular.  He may have frequently upset stomach or be a finicky eater. He may wet the bed.

This person may persevere.  This means that he may say or do the same thing over and over again or dwell on the same subject for an unusual amount of time. obsessive-compulsive is an extreme example of dysorganization in this area.

There may be problems with articulation words clearly and lack of tonality in his voice.  Speech is an intricate symphony of movements, involving the diaphragm, vocal chords, mouth, tongue, and lips.  The same general clumsiness that affects a person’s physical actions, because of a midbrain injury, also affects the act of speech.

Moving now to the cortex, it is important to note that the cortex is responsible for our ability to process and “think about” the information that comes to us by way of our senses.  Dysorganization in the cortex result in difficulties with processing information.

Auditory Processing causes many problems in daily life, from appropriate behavior to learning to read and speak.  The main cause of auditory processing problems is a history of ear infections or build-up fluid, food sensitivities or allergies.  The child with auditory processing inefficiencies will display delays in receptive (understanding language) and expressive (spoken language). He might have immature language skills, use incomplete sentences. Use pronouns incorrectly, have a limited vocabulary, or difficulty expressing thoughts or ideas.