The Boy Who Was Raised as a Dog: And Other Stories from a Child Psychiatrist's Notebook

by Bruce D. Perry

Infants diagnosed with “failure to thrive,” are often found to have reduced levels of growth hormone,

Without love, children literally don’t grow.

Mama P. discovered, long before we did, that many young victims of abuse and neglect need physical stimulation, like being rocked and gently held, comfort seemingly appropriate to far younger children.

I asked her if she’d be willing to have a mother and her child move in with her, so that Virginia could learn how to raise Laura.

“If it will help make my baby better, please take her.” Virginia did love her baby—so much that she was willing to let her go if that’s what it took for her to recover.

In Mama P’s nurturing environment, however, Laura gained ten pounds in one month, growing from twenty-six to thirty-six pounds!

The four-year-old had seemed stuck in the defiant stage of the “terrible twos,” but now she began to mature, both emotionally and physically.

Both Laura and Virginia still bear scars from their early childhoods, however. If you were to secretly observe either mother or daughter, you might find her facial expression vacant, or even sad.

Like people who learn a foreign language late in life, Virginia and Laura will never speak the language of love without an accent.

had left them emotionally crippled and often oblivious to social cues, but not filled with rage and hatred.

It’s no wonder that she was hostile, though. Our brains adapt to our environments, and this place wasn’t likely to elicit kindness or trust.

This split between verbal and performance scores is often seen in abused or traumatized children

with more developmental chaos and threat the brain’s stress response systems and those areas of the brain responsible for reading threat-related social cues will grow, while less affection and nurturing will result in underdevelopment of the systems that code for compassion and self-control.

“theory of mind.” They need to know, in other words, that other people are distinct from them, have different knowledge about the world and have different desires and interests.

The brain is built—our selves are built—from millions of tiny decisions—some conscious, most not. Seemingly irrelevant choices can result in tremendously different later outcomes. Timing is everything.

this nurturing touch isn’t satisfied, the connection between human contact and pleasure isn’t made and being touched can become actively unpleasant.

In older children and adults massage has also been found to lower blood pressure, fight depression, and cut stress by reducing the amount of stress hormones released by the brain.

genetics and intrauterine environment

Intelligence is another critical factor,

Imagining yourself in another setting is not a far leap from imagining the perspective of others—in other words, empathizing.

Another factor is the timing of the trauma:

Justin had nearly a year of loving and nurturing care before he was placed in that dog cage. That affection built the basics of so many important functions—including empathy—into his brain and, I believe, greatly aided his later recovery.

We make memories, but memories make us, too, and it is a dynamic, constantly changing process subject to bias and influence from many sources

What we experience first filters what comes afterwards—just

when you retrieve a memory from where it is stored in the brain, you automatically open it to “edit.” You may not be aware that your current mood and environment can influence the emotional tone of your recall,

Trauma involves an overwhelming and terrifying loss of control, putting people back into situations over which they have no control recapitulates this and impedes recovery.

Training, logic, and intelligence are often no match for the power of groupthink.

If a child has RAD, the lack of connection and attachment goes both ways. There is a reciprocal neurobiology to human relationships—our “mirror neurons” create this. As a result, these children are difficult to work with because their lack of interest in other people and their inability to empathize makes them hard to like.

“One sudden infant death is a tragedy, two is suspicious and three is murder until proved otherwise.

Relationships are the agents of change and the most powerful therapy is human love.

Trauma and our responses to it cannot be understood outside the context of human relationships.

The most traumatic aspects of all disasters involve the shattering of human connections. And this is especially true for children.

Indeed, at heart it is the relationship with the therapist, not primarily his or her methods or words of wisdom, that allows therapy to work.

Because what they needed most was a rich social environment, one where they could belong and be loved.

we need to build a healthier society.

The truth is you cannot love yourself unless you have been loved and are loved. The capacity to love cannot be built in isolation.

This can make them more vulnerable to pedophiles, not less, as children will tend to seek out those who appear affectionate toward them.

Brain development is use-dependent: you use it or you lose it. If we don’t give children time to learn how to be with others, to connect, to deal with conflict, and to negotiate complex social hierarchies, those areas of their brains will be underdeveloped.

We need to allow children to try and fail. And when they do make the stupid, shortsighted decisions that come from inexperience, we need to let them suffer the results.

This constant emphasis on competition drowns out the lessons of cooperation,

THE BRAIN DEVELOPS OVER TIME, with a constant accretion of repetitions and exposures; each moment is a chance to reinforce either positive or negative patterns. Once a pattern is started, it becomes like a groove or a rut, making similar behavior easier, more likely to be repeated.

As a result of this property of the brain, earlier intervention is almost always better than later. But it has to be the right intervention.

These positive feedback loops are every bit as powerful as the negative ones, but they rely upon the sometimes counterintuitive response of first figuring out what drives misbehavior, then dealing with it, rather than acting first.

the importance of simply taking the time, before doing anything else, to pay attention and listen.

I also cannot emphasize enough how important routine and repetition are to recovery. The brain changes in response to patterned, repetitive experiences: the more you repeat something, the more engrained it becomes.

Because safety is critical to recovery and force creates fear, coercive therapies are dangerous and ineffective for victims of trauma. Trauma tends to drive other mental health problems like many teen behavior problems and an enormous percentage of addictions.

Developmental History: Obtain a history of the timing, nature and severity of trauma, adversity and neglect, as well as relational experiences and “connectedness,” which are associated with resilience.

Current Functioning: Assess current functioning with a focus on: a) the individual’s strengths and vulnerabilities

Treatment Planning: Select and sequence educational, enrichment, and therapeutic experiences based upon the individual’s developmental needs.

Implementation: Track the implementation and effectiveness of the plan and make appropriate modifications.