NEUROSCIENCE AND EARLY CHILD DEVELOPMENT ©
By Leah S. Taylor, Ph.D. prepared for the Medical Division
of the Oklahoma Health Care Authority
Introduction
A great deal of attention currently is focused on the way the brain in young children develops and
how brain functions evolve both in utero and after birth. Until fairly recently most neuroscientists
adopted the notion that our neurology is hard wired, and that genetic information , formulated
out of conception, in unchangeable. Science was on the side of “nature” in the nature vs. nurture
debate. It remained settled in the notion that the most we could do was to provide medical
explanations for certain mental health disorders by looking at chemical imbalances in the brain
(Arden and Linford , p. 17). Research was based on how to create medications that could change
these imbalances to assist those with depression, anxiety, regulation disorders, schizophrenia,
etc. The notion that human beings are biochemically determined left those with mental health
disorders to see themselves as unable to change their thinking and behavioral patterns except
through medically enhanced treatments (Volk, pp. 52-57).
Behaviorists and cognitive behaviorists were aware that repetitive changes in thoughts and
behaviors can change the wiring in the brain. However, they did not explore the way the brain
functions. They were concerned about outcomes and focused on behavioral treatments which
were based on techniques whose application could be measured in terms of successful outcomes,
creating what are known as evidence-based practices (Volk). In so doing, they enhanced the value
of psychotherapies based on changes in cognition and behavior. In the past twenty years or so,
however, the research has shown clearly that it is the relationship between therapist and client
that primarily creates lasting change. It is this profound application of the value of the
relationship that helped in the prevailing research and awareness of how neuroscience works and
the role that relationship plays in wiring and re-wiring the brain. In so doing, neuroscience has
come front and center in the application of modalities which utilize relationships to target specific
areas of the brain to create changes for those with mental illness and problematic behaviors.
In the following narrative, the author has chosen to simplify, as much as possible, the brain
structures and functions for the reader, and, in so doing, may overlook some neuroscientific
functions within the genome and the epigenome for the sake of clarity and ease of understanding.
Neuroscience is an evolving field and discoveries are being made every day which one simple
paper will not be able to address. It is important to note that this paper is designed to shed light
on how the therapist might use its concepts in assisting those children who are developmentally
delayed and emotionally disabled through early physical impairment, inadequate care, trauma,
and abuse.
The Genome
A child at birth comes into the world with at least 100 billion neurons. A newborn has twice as
many neurons as his/her mother. Depending on what happens in the intrauterine experience
(e.g., toxins) and the postnatal experience (enriched parenting, stressful events, neglect, abuse,
etc.), the brain begins a process of “pruning” both neurons and neural circuits as they evolve
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(Arden and Linford, 2009). “Gene-driven” development occurs prenatally. Within 2-3 days the
first embryotic cell layer, called the ectoderm develops and thickens to become the neural plate,
which develops into the central nervous system. This plate rounds up to become the neural tube
which develops into three primary brain vesicles. These fluid filled vesicles create five secondary
brain vesicles from which structures, such as the brain stem (the medulla, pons, and midbrain.)
Atop the brain stem is the diencephalon which contains the thalamus and the hypothalamus. The
cerebrum, a more evolved part of the brain, encompasses the hippocampus and the amygdala.
These structures are the most important in understanding the main concepts in this paper. The
100 billion neurons in the infant brain “come on line” as the structures in the brain evolve. Some
of these neurons are pre-wired to go to specific parts of the brain, some become available to
structures and functions as they evolve, and some migrate to certain anatomical positions and
become specialized during embryonic development. By the 26th week in utero, there are
approximately 250,000 neurons which are using dendrites and axons (extensions from the nerve
cell body) to communicate with collegial neurons in other parts of the brain and become parts of
networks that create brain functions. This gene-driven development of the brain is hard-wired
and the structures of the brain follow an evolutionary order. These structures are organized from
the most simple (e.g. fewer cells – the brainstem) to the most complex (e.g. more cells and more
synapses – the frontal cortex). The functions of the brain evolve from the most simple and
reflexive (e.g., regulations of body temperature) to the most complex (e.g., concrete and abstract
thought). The brain stem contains most of the autonomic nervous system, controlling blood
pressure, heart rate, body temperature and other autonomic functions). The diencephalon
contains the thalamus which is the central relay portion of the brain. It acts as a switchboard
controlling synaptic positioning of neurons and promoting neural circuitry. It also mediates fear,
controls aggression, and is involved with pleasure. The diencephalon also contains the
hypothalamus, which regulates the sleep/awake cycle, appetite, arousal , sexuality, motor
regulation, emotional reactivity, and attachment. The limbic system contains the hippocampus
(memory) and the amygdala (fight/flight/freeze), and other structures. The limbic system is
currently under review as to its function and structure. The hippocampus and the amygdala are
embryologic parts of the cerebrum. As these structures develop, so does the neocortex,
responsible for affiliation, concrete and abstract thought) (Perry, p. 31). The brain develops two
hemispheres, the right hemisphere, involved in novelty and the “whole picture”, and the left
hemisphere, involved with detail and routine. The two hemispheres are connected by the corpus
callosum, the bridge between the left and right hemispheres of the brain, a remarkable structure
made up of axons and which connects nerve cell bodies from one side of the brain to dendrites of
neurons on the other side of the brain. The hypothalamus and the amygdala have a
communication link which becomes important during periods of stress. The cerebellum is a
separate structure which is involved with motor control and balance. The early functionality, as
well as the order of all of these structures continues its development after the child is born.
However, the brain itself is predisposed toward relationships as partners in the development of
its structures, which is why human infants have the highest caretaking maintenance of all species.
Infants require the stimulation of living in families, with forming long-term relationships, and with
the ability, when properly developed, to subdue aggressive desires which might destroy the
maintenance of long-term bonds. This predisposition is the product of an evolutionary process
over the millennia, creating a neuroanatomy and hormonal balance which has conditioned
responses in pregnant women and mothers of newborns that we know as the “mommy brain”.
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Arden states that from the brain’s point of view “love is simply the brain’s way of nurturing
another brain” (Arden, p. 15). All of the neural circuitry and the networks within the newborn
brain come “on line” after birth. The brain over-produces neurons, and based on its post-natal
experience, will prune at least half of them and will prune as many as 100,000 synaptic
connections between neurons as a result of the postnatal environment. The newborn comes into
the world attuned to what it experiences in the environment. John Arden refers to this process as
“nurtured nature” (Arden, 1999, p. 11). Genes provide a starting point and define the potentials
available to a newborn human being. Experience then takes on the role of shaping the brain.
The Epigenome
Children inherit about 20,000 genes located on 46 chromosomes – 23 pairs. Each pair has one
maternal and one paternal chromosome. Chromosomes are composed of DNA, which comprises
the blueprint of a cell. All cells have within them this master blueprint. The genes are considered
the “structured genome”. The structured genome determines what is possible in the developing
child. This structured genome, the DNA sequence, is set in stone. However, during the past few
decade we have come to know what is called the epigenome. The epigenome consists of
structures called “tags” which are markers, or pieces of information, that are stuck on one or
several genes. These tags, or “histones” as they are called, may be changed by environmental
influences – positive or negative – and leave a “chemical” signature on the genes. Early prenatal
or postnatal exposures can influence the functioning of a gene long-term and actually pass from
one generation to another. The signature can be temporary or permanent and different
experiences can result in different epigenomic configurations. These experiences include those of
enrichment (attentive attachment and care), nutrition and diet, external stressors in the
environment (earthquakes, war, tornadoes, etc.), maternal depression, lack of positive
responsiveness from caretakers, severe neglect (which constitutes the majority of child abuse
cases), (see Maternal Depression, working paper #8 and The Science of Neglect, working paper
#12, p.7), severe health problems, surgeries, and lengthy hospitalizations.
By altering exposures and the way in which caregivers react to environmental influences, negative
outcomes can be shifted to positive ones. These shifts actually influence the architecture of the
brain and the connections which affect the functionality of neural circuits. The epigenome is the
most responsive to neuroplasticity in the first few years of a child’s development. The ages of
zero to three seem to be the most available for change. However, some experts see this
availability through the age of six and even beyond. As the child moves into adolescence and
adulthood, new experiences can change the epigenome , and therefore, the gene, and “re-wire”
certain connections in the brain (Schore,2003 and 1994); Arden and Linford,2009); Volk, pp. 5257). Treatments utilizing what we know about the effectiveness of working with the science of
the epigenome will be discussed in the treatment section of this paper.
An extremely important process in the early childhood years, especially from birth to age 2, is the
development of what we still call the limbic system, or emotional, brain. Higher level cortical
functions develop later. The development of the emotional brain evolves through the connection
between what is known as the prefrontal orbital cortex and the amygdala. The prefrontal orbital
cortex rests deep in the brain behind the optic nerve – see diagram A -- and is responsible for the
early recognition of regulation of impulses and primitive awareness of right and wrong. The
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amygdala is connected to impulses and drives. The connection is made through a structure called
the cingulate cortex which is sensitive to hormones and which send stress signals to the amygdala
and partners with the prefrontal lobes to mediate the responses of the amygdala and initiate the
ability to self-regulate (see diagram B). When the child is stressed through maltreatment, the
anterior part of the cingulate sends a signal to the amygdala which immediately creates a reaction
of arousal. The amygdale immediately sends a signal to the hypothalamus which then sends to
the pituitary a message to stimulate the adrenal glands to literally “squirt out” cortisol. This
process is called the Amygdala-Hypothalamic-Adrenocortical (A-HPA) Axis. This action also sends
norepinephrine and epinephrine, stress hormones circulating through the brain, to not only
stimulate the adrenal glands but also to flood the right prefrontal cortex. The cingulate relays
information back and forth from the prefrontal cortex and the amygdala. Too much cortisol
suppresses the immune system. The limbic system (the seat of emotional life) and the prefrontal
orbital cortex (the seat of intentional behaviors such as regulation of impulses, conscious decision
making, and inhibition of the drives of the amygdala), is flooded with norepinephrine,
accelerating anxiety and over-activity, causing a firing of neurons that can create drastic changes
in mood and behavior, especially in the ability to self-regulate (Fallon, p. 100). Through the
epigenome, a perfectly healthy gene can be modified to create the possibility of mental illness,
dysregulation, and the inability to function appropriately later in life. Children are very sensitive
to their early environment, since the brain architecture and functions are in a developmental
process. Children blossom when they are treated with copious amounts of love. A child’s
neurons in the brain, called “mirror neurons”, exist in the frontal lobes of the brain (see diagram
C). These neurons are analogous to mirror neurons in the frontal lobes of the caretaker. One
serves (displays) a behavior and the other returns a similar behavior (such as a smile or a hug).
This “serve and return” interaction between the child and an adult is essential to building the
brain’s architecture. The orbitofrontal cortex (diagram C) processes the child’s awareness of the
caretaker’s intentions (help or harm), ethics (caring or not caring), and morality (right and wrong)
and mirrors those in the child. What is called the “theory of mind” (how one mind understands
the intentions of another’s mind), includes a structure called the Insula. The insula is not shown in
the diagrams, but is a small structure centered in an area where it connects with the temporal and
the parietal lobes. The insula, along with its connection to other brain structures, enables the
perception of intentions and ethics of others. (See diagram D for these lobes). This insula partners
with the orbitofrontal cortex and as these two areas connect, Fallon suggests that they form the
“neuroanatomical circuitry for the Golden Rule” (Fallon, p. 149). Conversely, a deficit of positive
connections can lead to both a lack of empathy and pro-social intention. Chronic maltreatment
and neglect alters the ability of the neurological response systems to enable a child to cope with
stress, thus creating some of the defense mechanisms that therapists know as oppositional
behavior, hyper vigilance, impulsivity, the inability to self-soothe, extreme withdrawal and
paranoid ideation. Neurodynamic modules become activated by stress, which sends information
from the body, the amygdala, and other brain areas to emotional networks in the orbital
prefrontal cortex for information and interpretation. Information such as facial expression and
tone of voice are particularly important in the early development of the infant and provide a
wealth of information to the prefrontal cortex (Arden, p. 105). Through facial expression and tone
of voice the child develops an ability to imitate the caretaker and understand the intentions of the
caretaker. In the early years, the child can become sensitized to others, not through cognition, but
through the feeling provided by the limbic structures. However, by the time a child is 4 years old
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he/she has developed the capacity for experience-dependent awareness and mentalizing these
intentions. Abuse can damage the ability of the brain to be able to accurately mentalize
intentions and, therefore, precipitate unrestrained behaviors based on an inaccurate reading of
another’s behaviors.
In the past 15 years neuroscientists and psychotherapists have begun to speak the same language.
The brain, in the past, has been a mystery to the field of psychotherapy, and the focus was
primarily on the chemistry of the brain, rather than the evolution of function within the dynamic
processes of the brain. What we have learned through the integrated approach to child
development and brain structure and function, is that the limbically and cortically mediated
systems of the brain are the basis for the attachment style of the child through the
actions/reactions of the parent, the caretaker, and the therapist. We now know that the
attachment style is pivotal to developing healthy thinking and behavior, and that it is a “cocreated” process which is replicated in psychotherapy as two brains connect with each other,
developing information which moves the epigenome to act in such a way as to create change in
the gene expression and regulation, even later in life. Although we focus on early child
development in this paper, we know that neuroplasticity exists through the lifespan, and that
therapists can utilize the understanding of neural connections to create healthier, more
functional, and more satisfying ways of living for individuals who suffer from the distractions of
depression, anxiety, and serious mental disorders.
It is important to note that epigenetic and genetic systems are intertwined and work together to
create the expression of a gene (Wright and Saul, p. 217). These modifications are influenced by
the environment but the processes are complex and are not fully known at this time. It is also
possible that an individual may be more or less vulnerable to epigenetic modifications through
heredity. As the medical profession continues to learn more about the variations in how the
epigenome operates (e.g., histone modifications), clinical treatments can be more exact. At this
point in time, however, we do have evidence that excellent outcomes occur through the
attachment/relationship of the child and parent/therapist through brain-related awareness,
Therapeutic Possibilities
Through the study of the brain over the past decade we have come to learn that without
attachment the developing child does not evolve in a pro-social and empathic manner.
Neuroscientists have come to realize that the brains of children are particularly sensitive to
relationships in their environment. These relationships not only allow infants to develop
normally, but they also enable children in their early years to re-wire their existing neural
connections. This promotes healthy interpersonal interaction, interpersonal communication
(verbal and nonverbal), theory of mind, flexibility, positive moods and behaviors, and resiliency
(Arden, p.107). The significance of the importance of attachment can be transferred to the
therapeutic relationship through the concept of “attunement”. The foundation for this concept
was developed by D.W. Winnicott many years ago when he explained the parental/caretaking
environment as one in which the caregiver allows for the separateness of the child while also
creating moments that are completely shared emotionally (see reference for Winnicott).
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Researchers since Winnicott have demonstrated that the therapeutic relationship can provide the
same process in developing the child’s emerging perception of himself and other developing
capacities for empathy and avoid ambivalent or negative attachments. The process of
relationship-based therapy allows for the child to experience both negative and positive thoughts
and feelings for the therapist within the “holding environment” of the therapy, and to experience
an emotional and conceptual integration of the self as a whole, cared-for and co-created through
the actions of the therapist. Without the pivotal attachment through therapeutic relationship,
with only behavioral and cognitive-based therapies – many beyond the scope of the
understanding of the child -- the wiring and re-wiring of neural circuits cannot proceed.
In recent years, relationship-based therapies for infants and children are beginning to attain
traction in the therapeutic literature and some in social policy governing child welfare. Effective
therapies involve learning the ways in which the child organizes and experiences his/her
environment, the type of attachment style the child possess, and the child’s cognitive and
emotional behaviors. These create a dynamic understanding of how the brain works to re-create
neural processes through the mirroring connections of therapist and child. The relationship-based
therapies are based in previous “client-centered” therapies, such as those of Carl Rogers and
Virginia Axline where the therapist mirrors what the client is saying and symbolically holds the
client in “attunement”. The play therapy models of Virginia Axline took Roger’s model and applied
it to a nondirective play therapy model. The therapist mirrors and supports the child’s decisions
and behaviors in the play therapy room, using limited rules to maintain order and provide safety
for the child. Some very new models have emerged based on the understanding of
neurodynamics, as described below.
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Intensive therapist-client therapies which utilize the creative arts, such as art, music,
massage, and dance therapies. These therapies need to be repetitive, patterned, and
consistent. They are sensory inputs to the developing brain and can influence brain
function. They also enhance relationships through the creative processes, some centered
in the right brain which develops more quickly than the left brain. Some even move back
into the brainstem (such as drumming and tapping). Drumming and tapping generate
processes of the brainstem which calm the rest of the brain so that the messages inherent
in calming body movements (the wet feeling of water and clay, the soothing sound of
music, the repetitive sound of tapping). These techniques can enable the higher brain
structures and functions to create new circuits, or re-wire neural circuits by changing those
circuits created from arousal/cortisol reactions (Perry, p. 38).
A summary of the work of Dr. Alan Schore (Schore, 1994 and 2003) includes the regulatory
capacity of the human being as being essential to the continuity of the self. This article
speaks of the lack of the capacity of the infant/toddler to develop this ability without the
relationship of the caretaker’s calming of the stress reactions and mirroring self-soothing
behaviors, and, in so doing, the ability of the child to learn how to self-soothe and regulate
reactions to arousal. The awareness of neuroscience can develop protocols to teach
parents and caretakers how to use mirroring to promote infant and toddler health. Those
who understand the process of anxiety-producing behaviors in young children can be
taught re-parenting processes, self-talk, mindfulness, and meditation. It can alleviate
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aberrant patterns from stress in early childhood, and develop new neural circuits in
adolescence and adulthood.
Filial play therapy, developed by a number of play therapists (see authors in appendix),
involves the training of the parent or caretaker (adoptive or foster parent) in learning the
skills of play therapy with the assistance of the therapist. Often the therapist is in the
session with the parent and child, but strives for the time when he/she supervises weekly
play therapy sessions conducted by the parent. When the parent and the child are ready,
these sessions can be continued at home, and the parent then meets with the therapist for
feedback regarding these sessions. Children learn through play and the parent facilitates
the growing brain of the child by involving herself/himself in the play experience and
facilitating attachment.
In an article on reversing the effects of autism (Gravotta), a hypothesis is posited by the
work of researchers using MRI’s of autistic children at the University of North Carolina at
Chapel Hill that the crucial neurodynamic links developed in the first year of life which
shape the brain’s architecture suddenly go awry. Work done at the University of Georgia
picked up on this hypothesis and developed both a checklist for detecting autistic signs and
a treatment for children who are in their first three years of development. The treatment
focuses on the re-wiring of neural circuits to sculpt a more functional brain. The primary
treatment for autism, applied behavioral analysis, relies on explicit behavioral rewards for
changes in behavior. This method was not working for the children seen at the University
of Georgia. Autism, like many developmental disorders, is highly complex and no one
treatment fits all. The therapists at the Georgia center, after developing a checklist,
discovered a treatment model called the Early Start Denver Model (ESDM), a therapy for
children as young as one year old developed at the University of California at Davis by Sally
Rogers and by Geraldine Dawson of the MIND Institute, now at Duke University. ESDM
emphasizes interaction with a primary parent/therapist and aims to make the activities
themselves, such as smiling, the facial expressions of the caretaker, or pointing, rewarding
in and of themselves. ESDM has so far shown promise in ameliorating the symptoms of
autism and in developing more normal development responses. After two years of the
interaction therapy, instead of the standard ABA therapy, the brains of these children
mirrored those of normal children. In a survey on autism treatments, done by the Oregon
Center for Evidence-based Policy at the Oregon Health and Science University, the findings
on ESDM showed significant gains in children with autism.
In the early ‘80’s Lewis Baxter, M.D. led a team of researchers to explore the neural
mechanisms of obsessive compulsive disorder. Through the evolution of the PET scan
which can trace biological processes, they were successfully able to investigate a structure
called the caudate nucleus, the habit center of the brain, near the orbital frontal cortex
(see diagram E). The team thought it might be the nexus for OCD – a kind of hub where the
rational thinking of the cortex joins with the emotion-ruled centers of the brain. Under Dr.
Baxter’s direction, they were able to identify this structure as pivotal in the obsessive
compulsive disorder. Researchers at UCLA did find hyperactivity in both the caudate and
the orbital frontal cortex in OCD sufferers. Jeffrey Schwartz, M.D. who had joined Baxter’s
team at UCLA then worked with the team on a way to treat OCD using this discovery as the
core of his thesis. (Volk; Schwartz and Begley) Schwartz call this treatment “self-directed
neuroplasticity” – the ability to re-wire the brain through a series of thoughts directed at
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this neurological connection of the caudate nucleus near the orbital frontal cortex. He
explored this area as a “natural ground zero for the noxious brew of repetition and terror
to collide” (Volk, p. 54). In an attempt to prove the theory, he developed a group therapy
process for those with OCD using a form of mindfulness training which separates the self of
the person from his or her own thoughts. He teaches his patients that they have badly
wired brains and that the wiring does not define them and is separate from them. He then
proposes repetitive ways of thinking that successfully undoes the aberrant rewiring in the
connection between the two parts of the brain. After treatment, brain scans of the
patients showed considerable dimming of activity in the orbitofrontal cortex and the
caudate nucleus (Volk, p. 57). Schwartz’s findings have come under attack by other
neuroscientists who claim that one cannot undo the hereditary genetic structure of the
brain, especially after early childhood. However, Baxter’s work, along with that of
Schwartz, has continued work in this area has given hope that with the right
therapist/teacher, OCD sufferers can alter gene expression through environmental
strategies. Since many children and adolescents suffer from OCD related to depression and
anxiety, it may be the beginning of a kind of treatment that, through the relationship of
therapist and child, can re-wire the OCD process and bring relief to these children.
Child-Parent Psychotherapy (CPP) is a specific treatment for abused and traumatized
children, ages 0-5. It is a relationship-based treatment for traumatized young children. The
therapist sees the child/parent dyad and does a history related to the childhood
developmental trajectory and traumatic events. The therapist then works to strengthen
the relationship between the child and the parent and to reduce perceptions and
behaviors that have contributed to maladaptive, trauma-induced behaviors
(hypervigilance, lack of self-regulation, etc.). The goal of the family therapy is to restore
the healthy attachment of the child and parent. It promotes the joint recall of the
traumatic event so that it is possible to use mirroring (reciprocating) behaviors of mother
and child and to restore the capacity for a sense of safety and appropriate affect. The
parent and child are also taught how to identify triggers for the recurrence of memory
which floods the child’s developing brain and can re-create dysregulated behaviors and
affect. CPP can be used with foster and adoptive parents.
Implications for Policy
Because of what we have learned from both research and practice regarding relational needs of
children and relationship-based therapies, there are a number of initiatives recommended for
policy makers. These recommendations cover a wide range of possibilities and only a few
important ones will be mentioned here.


Psychotherapists should all be trained in the stages and trajectory of child development.
They should be able to identify both normal and abnormal behaviors based on
developmental stages.
Psychotherapists should be trained in the basics of neurodynamics and brain
development, so that they can employ treatments based on the relational aspect of early
child development (as well as the relational imperatives at all stages of child and
adolescent development).
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Psychotherapists should maintain close connections with primary care doctors so that
medical evaluations can assist in informing the psychotherapist in those behaviors due to
trauma or inadequate parenting versus a disease process that must be medically treated.
The developing brain of children is often involved in services other than the home. Their
mental health depends on the coordination of all services in their environment so that
similar or same interactions can occur in each environment (see Establishing a Level
Foundation, Harvard working paper # 6).
Child Welfare policies should include training of child welfare personnel in ways to
intervene to create interventions which will mitigate damage to the child’s development
(see Early Childhood Intervention, Casey Foundation).
Policymakers should recognize the importance of engaging families who have problems
with their children in their early years (see Engaging Families, 2010). They should also
recognize the importance of educating payers of services to ensure that families/parents
are involved in the therapeutic treatment of dysregulation problems of early childhood.
“Collaborative learning” processes need to be developed in communities where early
child diagnosis and treatment is a focus of attention. Participants could include
practitioners, university-based centers, child welfare, employment counselors, day care
administrators, etc. (see Frontiers of Innovation, Harvard).
Again, we sit at the beginning of this new frontier of epigenetics and behavioral health
treatments. This paper is only a very short explanation which, hopefully, will inspire our
therapeutic community to develop new ways to help our clientele and, in the process, bring brain
science into the mainstream of our understanding of emotional distress and the therapies that
can alleviate it.
Respectfully submitted to Dr. Sylvia Lopez, Chief Medical Officer and Dr. Garth Splinter, Medicaid
Director, March, 2014
The preparer of this paper wishes to recognize the following specialists who assisted in the
critique of this paper and their suggestions for modifications:
Dr. John Arden, author of many books and articles on brain-based-therapy, and an
internationally renowned researcher and writer in the areas of genetics and epigenetics.
Dr. Robert Powitzky, former director of Mental Health Services of the Oklahoma
Department of Corrections, retired and now consulting with correctional personnel
throughout the country, known for his understanding of behavioral health treatments and
how they affect the mechanisms of the brain.
Dr. Robert Evans, a current medical director in the Medical Services Unit of the Oklahoma
Health Care Authority, to whose help this author is indebted for the clarity of his
explanations regarding brain structures and their functions.
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Brain Diagrams
Diagram A
Diagram B
Diagram C
Diagram D
Diagram E
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