The Committed Parent
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Employing social neuroscience to help parents raise kids we can live with and are crazy about ~
The Kindness of Children
BRUCE D. PERRY, M.D., Ph.D. and MAYA SZALAVITZ
I watched them for a few moments before I walked into the waiting room. The boy’s behavior had an
innocent sweetness to it: I could see him smiling, crawling into his mother’s lap, squirming so that he
could sit face-to-face with her. Then, he tenderly reached his hand up to her mouth and touched her,
playful, exploring. The quiet interaction between the two was classic bonding behavior between a mother
and an infant, even a toddler. But Peter was seven. As I watched them, I could tell that mother and child
had frequently engaged in this gentle, soothing game. When I walked in I also noticed that Amy, the mom,
was embarrassed by it. Her husband, Jason, Peter’s father, seemed even more ashamed when I
appeared to have “caught” them.
“Sit up, Peter,” Jason said as he stood up and shook my hand.
I walked over to the boy, stood over him, looked down, and smiled, “Hi, Peter.” I put my hand out.
Peter reached up to touch my hand.
“Peter, stand up and shake Dr. Perry’s hand,” Jason said. Amy tried to push Peter off her lap to
his feet. Peter went limp and laughed. It seemed like part of their game.
“Peter, stand up,” Jason said again, his voice patient but firm. I could feel his frustration and
exhaustion. I knew they had their hands full.
“That’s OK. You guys just get comfortable. I just wanted to see how you think things went today?’
I sat down across from them, “This first visit is really just to give Peter a chance to come and meet some
of us and start to get familiar with us. Hopefully, you had some fun today?”
Peter nodded.
“Use words, honey,” Amy said.
Peter sat up and said, “Yes.”
The family had just spent three hours in our clinic for an intake ap¬pointment. They had come to see
us because Peter had a long history of speech and language problems, as well as difficulties with
attention and impulsivity. Not surprisingly, he also had social and academic problems in school.
Occasionally he had bizarre and ferocious outbursts in which he seemed to completely lose control. They
were terrifying and, unlike ordinary temper tantrums, could last for hours.
Peter’s parents had adopted him from a Russian orphanage when he was three years old. They had
immediately fallen in love with the blonde, blue-eyed boy with rosy cheeks who looked like a little angel.
The opera¬tors of the orphanage had proudly shown off how well fed he was and how clean their facility
was but, in truth, Peter and the other children who lived there had been profoundly neglected. Amy and
Jason had heard about our work with maltreated children from other adoptive parents. We were at the
end of the first day of a two-day consultation visit at our clinic. The family had traveled over five hundred
miles for the evaluation.
“So, Peter, will you come back and visit us tomorrow?” I asked.
“Yes,” he said with a big smile.
Our clinicians had a lot of work to do before then. During a typical evaluation, our interdisciplinary
group of psychologists, social workers, child psychiatry fellows, and child psychiatrists usually spread
multiple visits out over a few weeks to get to know a child and his family. In Peter’s case the process was
condensed because he lived so far away. Records from the schools, the child’s pediatrician, previous
mental health providers and other professionals were available to review, process and integrate into our
impressions of the child and family. We also did a brain scan, an MRI, as part of a study we were working
on to see how early neglect affected the brain. The data from our research has shown that significant
early life neglect such as that seen in formerly in-stitutionalized children like Peter leads to smaller brain
size over all, brain shrinkage in certain regions, and a host of brain-related functional problems. By
finding which areas were most affected in Peter’s case, we hoped to target our treatments to maximal
effect.
During the evaluation period, sometimes as many as a dozen staff members would meet to talk about
what we were seeing and experiencing with this child. It was a process designed to identify the child’s
strengths and vulnerabilities, and carefully determine his current developmental stage in a host of
domains—from perceptual abilities to motor skills, from emotional, cognitive and behavioral abilities to
moral sentiments. This en¬abled us to come to a preliminary diagnosis and make our initial
recom¬mendations for intervention. Although it would be too time consuming and expensive to replicate
in many settings, we hoped to develop models of care based on this process that would be less staff
intensive.
At the time we began working with Peter and his family, we’d made good progress on our
neurosequential approach to maltreated children. We’d recognized that victims of early trauma and
neglect need experi¬ences—such as rocking and being held—appropriate for the age at which they’d
suffered damage or deprivation, not for their chronological age. We’d found that these develop-mentally
appropriate enrichment and therapeutic experiences had to be provided repeatedly and consistently in a
respectful and caring manner. Coercive, punitive and forceful deliv¬ery only made things worse. We’d
also started to incorporate music, dance and massage in order to stimulate and organize the lower brain
re¬gions, which contain the key regulatory neurotransmitter systems in¬volved in the stress response. As
we’ve seen, these areas are more likely to be affected by early trauma because they undergo important,
fast-paced development early in life. Finally, we’d begun to use medications to help children with
troublesome dissociative or hyper-arousal symptoms.
But while we had realized that ongoing relationships are critical to healing, we hadn’t yet fully
understood how important peer relation¬ships are, especially as children get older.
The details of Peter’s past brought the critical role of relationships into vivid focus for me. Peter had
been raised without adult attention for the first three years of his life. He’d been kept in what was basically
a baby warehouse: a big, bright room with sixty infants in seemingly end¬less, straight rows of perfectly
sanitized cribs. The two caretakers on duty for each shift would work methodically from one bed to the
next, feed¬ing each child, changing his or her diaper, then moving on. That was all the individual adult
attention the babies received: roughly fifteen min¬utes each per eight-hour shift. The infants were rarely
spoken to or held other than during these brief intervals; they were not rocked or cradled or cooed at
because there simply wasn’t time for staff to do more than feed and change, feed and change. Even the
toddlers spent their days and nights caged in their cribs.
With no one but each other to turn to, the children would reach their tiny hands through the bars into
the next crib, holding hands, babbling and playing patty-cake. In the absence of adults, they became
parents to each other. Their interaction, as impoverished as it was, probably helped to mitigate some of
the damage such severe deprivation can cause.
When Peter’s adoptive parents first brought him home, they discovered that he was trying to
communicate with them. Delighted, they sought a Russian translator. But the Russian translator said his
speech wasn’t Rus¬sian—perhaps the orphanage workers had been immigrants from else¬where in
Eastern Europe who had taught the children to speak their native tongue? A Czech speaker said it wasn’t
Czech, however, and soon Amy and Jason learned that Peter wasn’t speaking Hungarian or Polish, either.
To their surprise, they found that the words Peter spoke didn’t belong to any known language.
Apparently, the orphans had developed their own rudimentary language, like the private speech of twins
or the im¬provised signing of deaf children raised together. Like King Psamtik of Egypt, who, according to
Herodotus, isolated two children to learn what language they would “naturally” speak without the
opportunity to learn from people around them, the operators of the orphanage had created a harsh and
accidental experiment in linguistics. On their own, the chil¬dren had apparently created and agreed upon
several dozen words. One word the translators were able to figure out was that “Mum” meant “adult or
caregiver,” just as similar sounds mean mother in almost every known human language, since the “mm”
sound is the first one babies learn to make while suckling.
In our clinical meeting, my team and I went over everything we knew about the boy’s early history;
including his limited exposure to adults and his linguistic deprivation. We also discussed his adoptive
parents. My initial impression of Amy and Jason was confirmed by the rest of the staff: everyone agreed
that they were remarkable. Even before they’d adopted Peter, they had read parenting books, watched
parenting videos and talked extensively with their pediatrician about what to expect when adopting a child
like him. After they brought Peter home they worked with speech and language therapists, occupational
therapists, physical therapists and mental health providers to help Peter catch up.
They followed the advice they were given diligently. They spent money, time and energy trying to give
Peter what he needed to grow up healthy, happy, productive and compassionate. Yet, despite all of their
best efforts, and the efforts of the dozens of specialists, Peter continued to struggle. He had improved
dramatically in many regards, but his progress was spotty, slow and incremental.
He would learn new skills only after hundreds of repetitions, not dozens like other children. He learned
English but his enunciation was strange and his grammar was mangled. His movements were also
unco¬ordinated, and even when he tried to sit still, he would sway. Also, he would rarely estab-lish or
maintain eye contact appropriately. At seven, he still had several primitive self-soothing behaviors,
primarily racking and sucking his thumb. He would sniff extensively at everything that he ate before
putting it into his mouth and also tried noticeably to catch the scent of people whenever he met them. He
was easily distracted and often laughed and smiled to himself, giving the impression that he was in “his
own little world.” And in the last year he seemed to have hit a de¬velopmental plateau, and perhaps even
regressed a bit.
We first discussed Peter’s strengths, starting with his friendly, almost goofy manner. He was also well
above average in some aspects of lan¬guage and seemed to have some mathematical talents. He was
extremely nurturing, but in a blatantly immature fashion, responding to peers and adults the way a toddler
might.
It became clear through our discussions that while Peter was in some ways cognitively seven, in other
domains, he acted much younger. Con¬firming our observations regarding the use-dependent nature of
brain-development, the areas where he was doing better were related to brain regions that had received
stimulation, and those where he had deficits represented brain regions that had either been more
severely deprived or had not yet received enough stimulation to make up for the earlier ne-glect. The
scans of his brain reinforced our observations of his fractured neurodevelopment: he had cortical
atrophy, large ventricles (which meant that spinal fluid was taking up space that would normally have
been occupied by brain tissue) and lower-brain structures that were small for his age and likely
underdeveloped.
Such splintered development is common in children who grow up in chaotic or neglectful
environments. It causes tremendous confusion for parents, teachers and peers. From the outside, Peter
looked like a seven-year-old boy, but in some ways he was only a three-year-old. In terms of other skills
and capabilities, he was eighteen months old, and he was eight or nine years old in still other respects.
This inconsistency was a major source of the family’s problems. There were also important differences
in the way each parent interacted with Peter. When he was home and alone with Amy, she was extremely
at¬tuned to his needs. If he acted like a baby, she would engage him at that age level, and if he acted
like an older child, she would interact with him that way. I believe that her intuitive capacity to meet his
developmental needs was the primary reason he had made as much progress as he had.
But as Peter got older Jason began to question some of Amy’s “babying” of the boy. This caused
tension in the marriage, with Jason arguing that Amy was responsible for Peter’s lack of progress
because she was “smoth¬ering” him, while Amy insisted that he needed the extra affection because of his
past. Such differences are an almost universal feature of parenting. However, when disagreements are
profound as they were becoming in Amy and Jason’s case, they can lead to serious marital problems.
I had seen the conflict in my brief interaction with the family in the waiting room. Part of my job would
be to help the couple under¬stand Peter’s needs and explain to them how it was necessary to meet him
where he was developmentally. That way, they would be able to learn to avoid overwhelming Peter and
frustrating themselves by requir¬ing age-appropriate behavior in a domain for which he did not yet have
the capacity.
When the family came in for the second day of the evaluation we gave Peter some formal
psychological tests. Later we observed more parent/child interactions and sent the boy off for another
play break. Finally, it was time to tell the parents what we thought about Peter’s case and what we
proposed to do to help him. I could see that Amy and Jason were anx¬ious as soon as I walked into the
room.
“What do you tink?” Jason said, clearly wanting to get bad news out of the way.
“I think Peter is really a very lucky boy,” I began, “You are wonderful parents. And he has shown
remarkable progress over the last four years. I paused for a moment to let that sink in. Then, I added,
“Your efforts are heroic. You must be exhausted?” Amy started to cry. Her husband ten¬derly put his arm
around her I got some tissue and handed it to her. She wiped her eyes.
I began to tell them what I thought, asking them to interrupt if I said anything that they thought wasn’t
accurate or didn’t make sense. I re¬lated Peter’s history as I understood it, recounting the details of the
or¬phanage and the list of developmental delays he had experienced.
Then I asked if I was right in suspecting that when Peter became upset all of his developmental
progress would seem to disappear and he would act in primitive, almost frightening ways. Perhaps he’d
lie on the floor in the fetal position, moaning and rocking, or perhaps he’d let out unearthly
screams. I added that I thought that once he started to get stirred up or overwhelmed he probably
reached a “point of no return” and that he seemed to regress before slowly coming back to himself. They
nodded. That’s when I explained how changes in our emotional state can affect how we learn. Skills that
we’ve mastered like comprehension of certain concepts or even use of language itself may dissipate
when we get “worked up.” I talked about how new or frightening situations would be stressful to a child
like Peter and would likely prompt this kind of regression.
Wrapping up what we’d learned from the evaluation, I said, “So, I think we have a pretty good idea
about Peter’s problems and how he ended up with them. We also know some of his strengths—not all,
but some. The key now is whether we can use what we know to help him.” I paused, struggling to strike a
balance between hope and caution.
“Let me take a moment and talk with you about how the brain devel¬ops,”1 began, “I think if you
understand this a little bit more you will feel better about the progress that Peter has made, and I think
you will bet¬ter understand why progress now seems so slow?’ As I spoke, my thoughts about the theory
and practice I’d been working on for so many years seemed to crystallize for the first time as a coherent
whole.
I drew several charts on a blank piece of paper. The first (See Appen¬dix, Figure 1) showed a simple
comparison of the growth of the brain relative to the growth of the rest of the body, making the point that
while the body doesn’t reach its adult height and weight until adolescence, the brain’s growth follows a
much different path. By age three it has reached 85 percent of its full adult size.
“The human brain grows most rapidly early in life,” I explained. “In fact, the majority of brain growth
takes place in the first three years of life.” I wanted to help them understand the full significance of the
fact that Peter had been in a sterile, neglectful institution during that critical period when the brain is
rapidly organizing itself.
Then I drew a pyramid and turned the page upside down (See Ap¬pendix, Figure 2). “The brain is
organized from the bottom to the top,” I said. “The top part here,” I noted as I pointed to the wide base of
the upside-down pyramid, “is the cortex, the most complex part of the brain, responsible for our ability to
think and for integrating many of our functions.” I also described how some of the lower regions work,
how the central emotional areas allow us to make social connections and control our stress and how the
core brainstem areas drive the stress re¬sponse itself. I explained how these regions “awaken”
sequentially during development, starting from the innermost brainstem and moving out toward the cortex
as the child grows. I discussed how the development of higher, more complex brain regions relies on
proper organization of the lower, simpler areas. I explained how deprivation could affect these re¬gions
and cause the wide variations in their son’s behavior.
“The key is to parent Peter where he is developmentally, not where he is chronologically,” I said.
Jason nodded, beginning to understand what I was saying.
“Which is a very difficult thing to do, right?”
Now, both parents nodded.
“The challenge is that, in one moment, you will need to have expecta¬tions and provide experiences
that are appropriate for a five-year-old, for example, when you are teaching him a specific cognitive
concept. Ten minutes later, however, the expectation and challenges will have to match those for a
younger child, for example, when you are trying to teach him to interact socially. He is, developmentally, a
moving target. This is why parenting these children is such a frustrating experience. One moment you are
doing the correct thing and the next, you are out of sync.”
Amy and Jason had experienced this dichotomy many times, but until this conversation they hadn’t
been able to articulate it. My explana¬tions helped them enormously, immediately reducing their conflict
over “babying” Peter and helping Jason not worry when his wife engaged in it. Now, in fact, he could allow
himself to do it as well. Amy, however, could also see from what we’d taught her that there were times
when Jason’s more demanding parenting style would be useful.
But explanations alone would not be enough. The core challenges of parenting Peter would remain
the same—and it would be close to impossible for either parent to be attuned to him always or even most
of the time without more support. Both parents were spent, emotionally and physically. We would need to
help them get some respite care. We suggested bolstering their social network, taking time for
themselves as a couple and doing things they enjoyed so that they could “recharge their batteries” for
their time with Peter.
Amy and Jason were open to all of our suggestions. Since they did not live near our clinic, we had to
work with and through their local providers. Fortunately, most of the pieces of a good clinical team were
in place. Peter had an excellent speech therapist, occupational therapist, master’s level therapist and an
understanding pediatrician. We had talked with all of them. We wanted to add therapeutic massage and a
music and movement class to his routine, which had been useful for other children who suffered early
neglect such as Connor.
But what I thought, at first, would be just another piece of the puzzle turned out to be the most
important element: Peter’s school and, espe¬cially, his classmates. As I looked over his history, I
suddenly recognized that most of Peter’s progress had come in the first three years after he came to the
United States: when he spent his time alone with his parents, or with adults, or one or two peers selected
by them.
When he began attending kindergarten, however, his progress had ceased and his behavior
problems had intensified. His mother had intu¬itively understood that he was chronologically six but
behaviorally two, but his classmates couldn’t comprehend why he behaved so strangely. Even his
teacher didn’t know how to handle him, despite having been told of his background. Peter would grab
toys from other children with¬out asking, missing the social cues the other kindergartners understood
about when it was OK to take something and when it wasn’t. He didn’t understand when he should share
his things and when to keep them to himself, when he should speak and when he should be quiet. At
circle time he’d suddenly get up and slip into the teacher’s lap or begin to wan¬der around without
realizing he wasn’t supposed to. And he’d sometimes shriek and have his terrifying tantrums.
As a result the other children began to fear and marginalize him. His oddly accented English didn’t
help. His classmates viewed him as a strange and frightening boy. He’d done well in the sheltered world
of his adoptive home, with one-on-one relationships with adults who knew and loved him. But the complex
social world of kindergarten, with its varying peer and teacher relationships to negotiate, was beyond him.
Instead of the patient, nurturing, loving responses he got at home, at kindergarten his behavior was
met with suspicion and, often, outright rejection. The classroom filled with noisy children and loud toys
and fre¬quent movement was overwhelming to him. Where once he understood what was expected of
him and was treated gently if he wasn’t able to do it, now he couldn’t figure out what was going on. No
matter how many hours of healthy positive experiences Peter had each week, the hours when he was
marginalized or teased could easily overshadow them.
Peter had no real friends and preferred to play with much younger children; he felt most comfortable
with three- or four-year-olds. His own classmates didn’t know what to make of the boy who talked funny
and often acted like a baby. In many situations children can be kind and nurturing to someone who
appears to be younger and more vulnerable. But Peter frightened them.
The behavior of his classmates was predictable. What was happening was a small version of what
happens all across the planet in various forms every day. Human beings fear what they don’t understand.
The unknown scares us. When we meet people who look or act in unfamiliar or strange ways, our initial
response is to keep them at arm’s length. At times we make ourselves feel superior, smarter or more
competent by dehumanizing or degrading those who are different. The roots of so many of our species’s
ugliest behaviors—racism, ageism, misogyny, anti-Semitism, to name just a few—are in this basic brain-
mediated response to perceived threat. We tend to fear what we do not understand, and fear can so
easily twist into hate or even violence because it can suppress the rational parts of our brain.
Faced with Peter’s growing ostracism and social rejection, Amy and Jason wanted to know what to do:
should they hold him back in kindergarten, hoping he’d learn more socially the second time around? Yet
his cognitive abilities were clearly on grade level for first grade, per¬haps higher.
Peter was intellectually advanced, but socially clueless. I realized that if he was going to catch up, he
was going to need the help of his peers. It seemed to me that we might as well try letting him start first
grade. When I had worked with adolescents, some of them had allowed me to talk with their classmates
about their traumatic experiences and the effect it had on their brain. A bit of understanding had gone a
long way in helping improve their social lives. But could this work with first graders? And would Peter find
it acceptable?
I knew that I would be in his hometown several weeks after his eval¬uation and could talk to his
classmates at that time. I went back to ex¬plore this possibility with Peter. As we were coloring, I asked,
“Peter, do you remember living in Russia?”
He stopped and looked at me for a moment. I kept slowly coloring, not looking back at him. The pace
of his coloring slowed. I was just about to ask again when he took a new sheet of paper and drew a big
blue circle around the entire page.
“This is Russia?’ He held the page up to me. He placed the paper back on the floor, took a color and
made one tiny, delicate, almost invisible dot. “And this is Peter.” I looked at him; he was clearly sad. He
was elo¬quently expressing how he felt at the orphanage, where he’d been special to no one, just one of
dozens of anonymous babies.
I smiled sympathetically at him, then raised my eyebrows and said, “But that isn’t Peter anymore, is it?”
He shook his head no, and smiled back.
“Peter, I was thinking that I would come to your first grade class to visit” I wasn’t sure he would
understand, but I wanted him to know what I wanted to do and why.
“OK”
“You know how we have talked about how your brain is growing and changing? I was wondering if you
would mind if I talked to your class about the brain. And maybe a little about the way you lived before you
came to live with your parents?”
“OK,” he said, thoughtfully, adding, “Will you bring the pictures?”
“Which pictures?”
“The pictures of my brain?’
“Sure. You won’t mind if I show pictures of your brain to your class?”
“No. My brain is cool.”
“You know, Peter, you are so right. Your brain is cool?’ And so, with his permission and with that of his
parents and his school, I decided to see if I could make first graders into a new community of “therapists”
for Peter
I addressed his first grade class at the beginning of the school year. “I’m Peter’s friend,” I said. “I study
the brain and Peter asked me to come from Houston to tell you some of the things about the brain that I
taught him.” I had Peter come up to the front of the class and serve as my assistant.
I told the first graders about the brain, and about how in some ways, it acts like a muscle. I talked
about how they were exercising their “ABC” muscles in school and about the importance of repetition. I
described how they had many other similar kinds of “muscles” in their brains that also needed certain
kinds of attention in order to grow big and strong. I talked about how the brain develops and what makes
everyone’s brain work, emphasizing how the brain changes.
“Remember, Peter, when we were talking about how it takes a lot of practice to learn anything new?
That is because the brain changes when you use it, use it, use it.”
I looked at the children and then back at Peter, “Right, Peter?” He smiled and nodded. “And that is
why your teacher keeps having you practice writing again and again; and practice your letters again and
again and again.
I showed some slides; I brought a model of the brain and Peter passed it around. I answered
questions. What part of the brain makes you talk? What color is the brain? Does the brain keep videos of
your life?
I told the children how important it was for a developing baby’s brain to get stimulation from talk and
touch and human interactions. I told them the same things that I told parents, judges, pediatricians and
my own staff just with fewer big words.
Then I talked a little bit about how different children grow up in dif¬ferent homes. How Japanese
children learn Japanese; how in some cul¬tures mothers carry their babies around all day long during
their first year of life. How some children don’t get as much touch or talk or love early in life, and how that
can change the brain. They were having fun. We laughed.
Peter was smiling. Then, it was time. I didn’t know how much I would say, or even what I would say. I
would let the response of the children— and Peter—guide me. I jumped in, “Well. Thank you for letting
me come to your classroom. Peter told me about you guys when he came to visit me in Houston. I know
he went to kindergarten with many of you.” A few of the children raised their hands. “We asked Peter to
come to our clinic in Houston because we wanted to learn from him about his amaz¬ing brain.”
The children looked at Peter “See, when he was a little boy he spent every minute of every day for the
first three years of his life in one crib.” The children looked interested, but kind of confused. “Peter was
born in another country where they did not know very much about the brain. His parents could not take
care of him so Peter went to an orphanage when he was just a baby. In this orphanage each baby was
put in a crib and that was their home. They didn’t get to wander around, crawl anywhere, or even practice
standing so they could learn to walk. Until his parents came to get him when he was three, Peter never
had a chance to walk around, to play with friends, to get a hug from any loving grown-ups. His brain didn’t
get very much stimulation.” The room was completely silent:
twenty-six six-year-old children didn’t move, speak or fidget.
“And then when he was three, his new parents came and brought him to live in Tulsa.” I paused to let
some of the tension dissipate. “And that is when Peter’s amazing brain started to learn so many things.
Even though he had never heard English, he learned English in just a couple years. He had never had a
chance to walk or run or skip and he learned to do all of those things.” Peter looked embarrassed. I didn’t
want to push too much. “And so even today, Peter’s amazing brain is learning. He has really done great.
And that is why we wanted to meet Peter and learn more about how any person with such a hard start in
life could do so well?’
Then I ended with, “Part of what we learned is that every day in school, Peter learns things from all of
you. He watches how you do things, he learns from playing with each of you and he learns from just
being your friend. So thank you for helping Peter. And thanks for letting me come and talk about the
brain.”
It was a short and simple talk. I tried to take an unknown—Peter— and make him less frightening to
these children. And over time, their natural goodness emerged. No longer an odd and scary boy, Peter
be¬came popular—so popular, in fact, that his peers would argue over who got to sit next to him, who got
to be his partner, who got to be in his group. The brightest and strongest children in his class took a
special in¬terest in him and their leadership made all the difference. They included him, protected him
and, ultimately, provided therapeutic experiences that helped Peter catch up.
They were tolerant of his developmental problems, patient in cor¬recting his social mistakes and
nurturing in their interactions. These children provided many more positive therapeutic experiences than
we ever could have given Peter
Children, just like us adults, react badly to the unknown, to the strange and unfamiliar, especially
when they themselves are trying to adjust to a new situation like the start of a school year. Although their
social hierar¬chies aren’t always so easy to influence, most bullying and social rejection begins with fear
of the unfamiliar, and adults have much more influence over the process than they may believe. When
children understand why someone behaves oddly, they give him or her more slack, generally. And the
younger the children are, the more easily they are influenced by both obvious and subtle cues of
rejection and acceptance from adults. These cues often set the tone for the children’s status systems,
and teachers and parents can either minimize bullying or unfortunately, maximize it, by ei¬ther strongly
discouraging or tolerating the scapegoating of those who are “different.”
Knowing that Peter’s immature behavior came from his history of de¬privation helped his classmates
reinterpret it. When he grabbed some¬thing or talked out of turn, they no longer saw it as a personal
affront or jarring oddity, but simply as a remnant from his past that they’d been taught to expect. The
results were rapid: almost immediately he stopped having tantrums and outbursts, probably because
what had prompted them was frustration, a sense of rejection and feeling misunderstood. Because the
other children were more forgiving and more explicit about the social cues they were giving him, he was
able to read them better and thus able to fit in better. What had been a downward spiral of rejection,
confusion and frustration became instead a cascade of positive rein¬forcement, which fed on itself. The
huge gaps in developmental age across emotional, social, motor and cognitive domains slowly filled in.
By the time Peter reached high school he no longer stood out and he has continued to do well, both
academically and socially.
His peers and his family healed him by creating a rich social world, a nurturing community. While the
neurosequential approach helped us provide the specific stimuli his brain had lacked, massage offering
the physical affection that he’d missed, and music and movement to help re¬store his brain and bodily
rhythms, none of that would have been enough without Amy and Jason’s love and sensitivity and without
the patience and support of his classmates. The more healthy relation-ships a child has, the more likely
he will be to recover from trauma and thrive. Relationships are the agents of change and the most
powerful therapy is human love.
The Who
Boy Was
Raised as a Dog
And Other Stories from a Child Psychiatrist’s Notebook
What Traumatized Children
Can Teach Us About
Loss, Love, and Healing
BRUCE D. PERRY, M.D., Ph.D. MATA SZALAVITZ
A Member of the Perseus Books Group
New York
BRUCE D. PERRY, M.D., Ph.D. and MAYA SZALAVITZ
I watched them for a few moments before I walked into the waiting room. The boy’s behavior had an
innocent sweetness to it: I could see him smiling, crawling into his mother’s lap, squirming so that he
could sit face-to-face with her. Then, he tenderly reached his hand up to her mouth and touched her,
playful, exploring. The quiet interaction between the two was classic bonding behavior between a mother
and an infant, even a toddler. But Peter was seven. As I watched them, I could tell that mother and child
had frequently engaged in this gentle, soothing game. When I walked in I also noticed that Amy, the mom,
was embarrassed by it. Her husband, Jason, Peter’s father, seemed even more ashamed when I
appeared to have “caught” them.
“Sit up, Peter,” Jason said as he stood up and shook my hand.
I walked over to the boy, stood over him, looked down, and smiled, “Hi, Peter.” I put my hand out.
Peter reached up to touch my hand.
“Peter, stand up and shake Dr. Perry’s hand,” Jason said. Amy tried to push Peter off her lap to
his feet. Peter went limp and laughed. It seemed like part of their game.
“Peter, stand up,” Jason said again, his voice patient but firm. I could feel his frustration and
exhaustion. I knew they had their hands full.
“That’s OK. You guys just get comfortable. I just wanted to see how you think things went today?’
I sat down across from them, “This first visit is really just to give Peter a chance to come and meet some
of us and start to get familiar with us. Hopefully, you had some fun today?”
Peter nodded.
“Use words, honey,” Amy said.
Peter sat up and said, “Yes.”
The family had just spent three hours in our clinic for an intake ap¬pointment. They had come to see
us because Peter had a long history of speech and language problems, as well as difficulties with
attention and impulsivity. Not surprisingly, he also had social and academic problems in school.
Occasionally he had bizarre and ferocious outbursts in which he seemed to completely lose control. They
were terrifying and, unlike ordinary temper tantrums, could last for hours.
Peter’s parents had adopted him from a Russian orphanage when he was three years old. They had
immediately fallen in love with the blonde, blue-eyed boy with rosy cheeks who looked like a little angel.
The opera¬tors of the orphanage had proudly shown off how well fed he was and how clean their facility
was but, in truth, Peter and the other children who lived there had been profoundly neglected. Amy and
Jason had heard about our work with maltreated children from other adoptive parents. We were at the
end of the first day of a two-day consultation visit at our clinic. The family had traveled over five hundred
miles for the evaluation.
“So, Peter, will you come back and visit us tomorrow?” I asked.
“Yes,” he said with a big smile.
Our clinicians had a lot of work to do before then. During a typical evaluation, our interdisciplinary
group of psychologists, social workers, child psychiatry fellows, and child psychiatrists usually spread
multiple visits out over a few weeks to get to know a child and his family. In Peter’s case the process was
condensed because he lived so far away. Records from the schools, the child’s pediatrician, previous
mental health providers and other professionals were available to review, process and integrate into our
impressions of the child and family. We also did a brain scan, an MRI, as part of a study we were working
on to see how early neglect affected the brain. The data from our research has shown that significant
early life neglect such as that seen in formerly in-stitutionalized children like Peter leads to smaller brain
size over all, brain shrinkage in certain regions, and a host of brain-related functional problems. By
finding which areas were most affected in Peter’s case, we hoped to target our treatments to maximal
effect.
During the evaluation period, sometimes as many as a dozen staff members would meet to talk about
what we were seeing and experiencing with this child. It was a process designed to identify the child’s
strengths and vulnerabilities, and carefully determine his current developmental stage in a host of
domains—from perceptual abilities to motor skills, from emotional, cognitive and behavioral abilities to
moral sentiments. This en¬abled us to come to a preliminary diagnosis and make our initial
recom¬mendations for intervention. Although it would be too time consuming and expensive to replicate
in many settings, we hoped to develop models of care based on this process that would be less staff
intensive.
At the time we began working with Peter and his family, we’d made good progress on our
neurosequential approach to maltreated children. We’d recognized that victims of early trauma and
neglect need experi¬ences—such as rocking and being held—appropriate for the age at which they’d
suffered damage or deprivation, not for their chronological age. We’d found that these develop-mentally
appropriate enrichment and therapeutic experiences had to be provided repeatedly and consistently in a
respectful and caring manner. Coercive, punitive and forceful deliv¬ery only made things worse. We’d
also started to incorporate music, dance and massage in order to stimulate and organize the lower brain
re¬gions, which contain the key regulatory neurotransmitter systems in¬volved in the stress response. As
we’ve seen, these areas are more likely to be affected by early trauma because they undergo important,
fast-paced development early in life. Finally, we’d begun to use medications to help children with
troublesome dissociative or hyper-arousal symptoms.
But while we had realized that ongoing relationships are critical to healing, we hadn’t yet fully
understood how important peer relation¬ships are, especially as children get older.
The details of Peter’s past brought the critical role of relationships into vivid focus for me. Peter had
been raised without adult attention for the first three years of his life. He’d been kept in what was basically
a baby warehouse: a big, bright room with sixty infants in seemingly end¬less, straight rows of perfectly
sanitized cribs. The two caretakers on duty for each shift would work methodically from one bed to the
next, feed¬ing each child, changing his or her diaper, then moving on. That was all the individual adult
attention the babies received: roughly fifteen min¬utes each per eight-hour shift. The infants were rarely
spoken to or held other than during these brief intervals; they were not rocked or cradled or cooed at
because there simply wasn’t time for staff to do more than feed and change, feed and change. Even the
toddlers spent their days and nights caged in their cribs.
With no one but each other to turn to, the children would reach their tiny hands through the bars into
the next crib, holding hands, babbling and playing patty-cake. In the absence of adults, they became
parents to each other. Their interaction, as impoverished as it was, probably helped to mitigate some of
the damage such severe deprivation can cause.
When Peter’s adoptive parents first brought him home, they discovered that he was trying to
communicate with them. Delighted, they sought a Russian translator. But the Russian translator said his
speech wasn’t Rus¬sian—perhaps the orphanage workers had been immigrants from else¬where in
Eastern Europe who had taught the children to speak their native tongue? A Czech speaker said it wasn’t
Czech, however, and soon Amy and Jason learned that Peter wasn’t speaking Hungarian or Polish, either.
To their surprise, they found that the words Peter spoke didn’t belong to any known language.
Apparently, the orphans had developed their own rudimentary language, like the private speech of twins
or the im¬provised signing of deaf children raised together. Like King Psamtik of Egypt, who, according to
Herodotus, isolated two children to learn what language they would “naturally” speak without the
opportunity to learn from people around them, the operators of the orphanage had created a harsh and
accidental experiment in linguistics. On their own, the chil¬dren had apparently created and agreed upon
several dozen words. One word the translators were able to figure out was that “Mum” meant “adult or
caregiver,” just as similar sounds mean mother in almost every known human language, since the “mm”
sound is the first one babies learn to make while suckling.
In our clinical meeting, my team and I went over everything we knew about the boy’s early history;
including his limited exposure to adults and his linguistic deprivation. We also discussed his adoptive
parents. My initial impression of Amy and Jason was confirmed by the rest of the staff: everyone agreed
that they were remarkable. Even before they’d adopted Peter, they had read parenting books, watched
parenting videos and talked extensively with their pediatrician about what to expect when adopting a child
like him. After they brought Peter home they worked with speech and language therapists, occupational
therapists, physical therapists and mental health providers to help Peter catch up.
They followed the advice they were given diligently. They spent money, time and energy trying to give
Peter what he needed to grow up healthy, happy, productive and compassionate. Yet, despite all of their
best efforts, and the efforts of the dozens of specialists, Peter continued to struggle. He had improved
dramatically in many regards, but his progress was spotty, slow and incremental.
He would learn new skills only after hundreds of repetitions, not dozens like other children. He learned
English but his enunciation was strange and his grammar was mangled. His movements were also
unco¬ordinated, and even when he tried to sit still, he would sway. Also, he would rarely estab-lish or
maintain eye contact appropriately. At seven, he still had several primitive self-soothing behaviors,
primarily racking and sucking his thumb. He would sniff extensively at everything that he ate before
putting it into his mouth and also tried noticeably to catch the scent of people whenever he met them. He
was easily distracted and often laughed and smiled to himself, giving the impression that he was in “his
own little world.” And in the last year he seemed to have hit a de¬velopmental plateau, and perhaps even
regressed a bit.
We first discussed Peter’s strengths, starting with his friendly, almost goofy manner. He was also well
above average in some aspects of lan¬guage and seemed to have some mathematical talents. He was
extremely nurturing, but in a blatantly immature fashion, responding to peers and adults the way a toddler
might.
It became clear through our discussions that while Peter was in some ways cognitively seven, in other
domains, he acted much younger. Con¬firming our observations regarding the use-dependent nature of
brain-development, the areas where he was doing better were related to brain regions that had received
stimulation, and those where he had deficits represented brain regions that had either been more
severely deprived or had not yet received enough stimulation to make up for the earlier ne-glect. The
scans of his brain reinforced our observations of his fractured neurodevelopment: he had cortical
atrophy, large ventricles (which meant that spinal fluid was taking up space that would normally have
been occupied by brain tissue) and lower-brain structures that were small for his age and likely
underdeveloped.
Such splintered development is common in children who grow up in chaotic or neglectful
environments. It causes tremendous confusion for parents, teachers and peers. From the outside, Peter
looked like a seven-year-old boy, but in some ways he was only a three-year-old. In terms of other skills
and capabilities, he was eighteen months old, and he was eight or nine years old in still other respects.
This inconsistency was a major source of the family’s problems. There were also important differences
in the way each parent interacted with Peter. When he was home and alone with Amy, she was extremely
at¬tuned to his needs. If he acted like a baby, she would engage him at that age level, and if he acted
like an older child, she would interact with him that way. I believe that her intuitive capacity to meet his
developmental needs was the primary reason he had made as much progress as he had.
But as Peter got older Jason began to question some of Amy’s “babying” of the boy. This caused
tension in the marriage, with Jason arguing that Amy was responsible for Peter’s lack of progress
because she was “smoth¬ering” him, while Amy insisted that he needed the extra affection because of his
past. Such differences are an almost universal feature of parenting. However, when disagreements are
profound as they were becoming in Amy and Jason’s case, they can lead to serious marital problems.
I had seen the conflict in my brief interaction with the family in the waiting room. Part of my job would
be to help the couple under¬stand Peter’s needs and explain to them how it was necessary to meet him
where he was developmentally. That way, they would be able to learn to avoid overwhelming Peter and
frustrating themselves by requir¬ing age-appropriate behavior in a domain for which he did not yet have
the capacity.
When the family came in for the second day of the evaluation we gave Peter some formal
psychological tests. Later we observed more parent/child interactions and sent the boy off for another
play break. Finally, it was time to tell the parents what we thought about Peter’s case and what we
proposed to do to help him. I could see that Amy and Jason were anx¬ious as soon as I walked into the
room.
“What do you tink?” Jason said, clearly wanting to get bad news out of the way.
“I think Peter is really a very lucky boy,” I began, “You are wonderful parents. And he has shown
remarkable progress over the last four years. I paused for a moment to let that sink in. Then, I added,
“Your efforts are heroic. You must be exhausted?” Amy started to cry. Her husband ten¬derly put his arm
around her I got some tissue and handed it to her. She wiped her eyes.
I began to tell them what I thought, asking them to interrupt if I said anything that they thought wasn’t
accurate or didn’t make sense. I re¬lated Peter’s history as I understood it, recounting the details of the
or¬phanage and the list of developmental delays he had experienced.
Then I asked if I was right in suspecting that when Peter became upset all of his developmental
progress would seem to disappear and he would act in primitive, almost frightening ways. Perhaps he’d
lie on the floor in the fetal position, moaning and rocking, or perhaps he’d let out unearthly
screams. I added that I thought that once he started to get stirred up or overwhelmed he probably
reached a “point of no return” and that he seemed to regress before slowly coming back to himself. They
nodded. That’s when I explained how changes in our emotional state can affect how we learn. Skills that
we’ve mastered like comprehension of certain concepts or even use of language itself may dissipate
when we get “worked up.” I talked about how new or frightening situations would be stressful to a child
like Peter and would likely prompt this kind of regression.
Wrapping up what we’d learned from the evaluation, I said, “So, I think we have a pretty good idea
about Peter’s problems and how he ended up with them. We also know some of his strengths—not all,
but some. The key now is whether we can use what we know to help him.” I paused, struggling to strike a
balance between hope and caution.
“Let me take a moment and talk with you about how the brain devel¬ops,”1 began, “I think if you
understand this a little bit more you will feel better about the progress that Peter has made, and I think
you will bet¬ter understand why progress now seems so slow?’ As I spoke, my thoughts about the theory
and practice I’d been working on for so many years seemed to crystallize for the first time as a coherent
whole.
I drew several charts on a blank piece of paper. The first (See Appen¬dix, Figure 1) showed a simple
comparison of the growth of the brain relative to the growth of the rest of the body, making the point that
while the body doesn’t reach its adult height and weight until adolescence, the brain’s growth follows a
much different path. By age three it has reached 85 percent of its full adult size.
“The human brain grows most rapidly early in life,” I explained. “In fact, the majority of brain growth
takes place in the first three years of life.” I wanted to help them understand the full significance of the
fact that Peter had been in a sterile, neglectful institution during that critical period when the brain is
rapidly organizing itself.
Then I drew a pyramid and turned the page upside down (See Ap¬pendix, Figure 2). “The brain is
organized from the bottom to the top,” I said. “The top part here,” I noted as I pointed to the wide base of
the upside-down pyramid, “is the cortex, the most complex part of the brain, responsible for our ability to
think and for integrating many of our functions.” I also described how some of the lower regions work,
how the central emotional areas allow us to make social connections and control our stress and how the
core brainstem areas drive the stress re¬sponse itself. I explained how these regions “awaken”
sequentially during development, starting from the innermost brainstem and moving out toward the cortex
as the child grows. I discussed how the development of higher, more complex brain regions relies on
proper organization of the lower, simpler areas. I explained how deprivation could affect these re¬gions
and cause the wide variations in their son’s behavior.
“The key is to parent Peter where he is developmentally, not where he is chronologically,” I said.
Jason nodded, beginning to understand what I was saying.
“Which is a very difficult thing to do, right?”
Now, both parents nodded.
“The challenge is that, in one moment, you will need to have expecta¬tions and provide experiences
that are appropriate for a five-year-old, for example, when you are teaching him a specific cognitive
concept. Ten minutes later, however, the expectation and challenges will have to match those for a
younger child, for example, when you are trying to teach him to interact socially. He is, developmentally, a
moving target. This is why parenting these children is such a frustrating experience. One moment you are
doing the correct thing and the next, you are out of sync.”
Amy and Jason had experienced this dichotomy many times, but until this conversation they hadn’t
been able to articulate it. My explana¬tions helped them enormously, immediately reducing their conflict
over “babying” Peter and helping Jason not worry when his wife engaged in it. Now, in fact, he could allow
himself to do it as well. Amy, however, could also see from what we’d taught her that there were times
when Jason’s more demanding parenting style would be useful.
But explanations alone would not be enough. The core challenges of parenting Peter would remain
the same—and it would be close to impossible for either parent to be attuned to him always or even most
of the time without more support. Both parents were spent, emotionally and physically. We would need to
help them get some respite care. We suggested bolstering their social network, taking time for
themselves as a couple and doing things they enjoyed so that they could “recharge their batteries” for
their time with Peter.
Amy and Jason were open to all of our suggestions. Since they did not live near our clinic, we had to
work with and through their local providers. Fortunately, most of the pieces of a good clinical team were
in place. Peter had an excellent speech therapist, occupational therapist, master’s level therapist and an
understanding pediatrician. We had talked with all of them. We wanted to add therapeutic massage and a
music and movement class to his routine, which had been useful for other children who suffered early
neglect such as Connor.
But what I thought, at first, would be just another piece of the puzzle turned out to be the most
important element: Peter’s school and, espe¬cially, his classmates. As I looked over his history, I
suddenly recognized that most of Peter’s progress had come in the first three years after he came to the
United States: when he spent his time alone with his parents, or with adults, or one or two peers selected
by them.
When he began attending kindergarten, however, his progress had ceased and his behavior
problems had intensified. His mother had intu¬itively understood that he was chronologically six but
behaviorally two, but his classmates couldn’t comprehend why he behaved so strangely. Even his
teacher didn’t know how to handle him, despite having been told of his background. Peter would grab
toys from other children with¬out asking, missing the social cues the other kindergartners understood
about when it was OK to take something and when it wasn’t. He didn’t understand when he should share
his things and when to keep them to himself, when he should speak and when he should be quiet. At
circle time he’d suddenly get up and slip into the teacher’s lap or begin to wan¬der around without
realizing he wasn’t supposed to. And he’d sometimes shriek and have his terrifying tantrums.
As a result the other children began to fear and marginalize him. His oddly accented English didn’t
help. His classmates viewed him as a strange and frightening boy. He’d done well in the sheltered world
of his adoptive home, with one-on-one relationships with adults who knew and loved him. But the complex
social world of kindergarten, with its varying peer and teacher relationships to negotiate, was beyond him.
Instead of the patient, nurturing, loving responses he got at home, at kindergarten his behavior was
met with suspicion and, often, outright rejection. The classroom filled with noisy children and loud toys
and fre¬quent movement was overwhelming to him. Where once he understood what was expected of
him and was treated gently if he wasn’t able to do it, now he couldn’t figure out what was going on. No
matter how many hours of healthy positive experiences Peter had each week, the hours when he was
marginalized or teased could easily overshadow them.
Peter had no real friends and preferred to play with much younger children; he felt most comfortable
with three- or four-year-olds. His own classmates didn’t know what to make of the boy who talked funny
and often acted like a baby. In many situations children can be kind and nurturing to someone who
appears to be younger and more vulnerable. But Peter frightened them.
The behavior of his classmates was predictable. What was happening was a small version of what
happens all across the planet in various forms every day. Human beings fear what they don’t understand.
The unknown scares us. When we meet people who look or act in unfamiliar or strange ways, our initial
response is to keep them at arm’s length. At times we make ourselves feel superior, smarter or more
competent by dehumanizing or degrading those who are different. The roots of so many of our species’s
ugliest behaviors—racism, ageism, misogyny, anti-Semitism, to name just a few—are in this basic brain-
mediated response to perceived threat. We tend to fear what we do not understand, and fear can so
easily twist into hate or even violence because it can suppress the rational parts of our brain.
Faced with Peter’s growing ostracism and social rejection, Amy and Jason wanted to know what to do:
should they hold him back in kindergarten, hoping he’d learn more socially the second time around? Yet
his cognitive abilities were clearly on grade level for first grade, per¬haps higher.
Peter was intellectually advanced, but socially clueless. I realized that if he was going to catch up, he
was going to need the help of his peers. It seemed to me that we might as well try letting him start first
grade. When I had worked with adolescents, some of them had allowed me to talk with their classmates
about their traumatic experiences and the effect it had on their brain. A bit of understanding had gone a
long way in helping improve their social lives. But could this work with first graders? And would Peter find
it acceptable?
I knew that I would be in his hometown several weeks after his eval¬uation and could talk to his
classmates at that time. I went back to ex¬plore this possibility with Peter. As we were coloring, I asked,
“Peter, do you remember living in Russia?”
He stopped and looked at me for a moment. I kept slowly coloring, not looking back at him. The pace
of his coloring slowed. I was just about to ask again when he took a new sheet of paper and drew a big
blue circle around the entire page.
“This is Russia?’ He held the page up to me. He placed the paper back on the floor, took a color and
made one tiny, delicate, almost invisible dot. “And this is Peter.” I looked at him; he was clearly sad. He
was elo¬quently expressing how he felt at the orphanage, where he’d been special to no one, just one of
dozens of anonymous babies.
I smiled sympathetically at him, then raised my eyebrows and said, “But that isn’t Peter anymore, is it?”
He shook his head no, and smiled back.
“Peter, I was thinking that I would come to your first grade class to visit” I wasn’t sure he would
understand, but I wanted him to know what I wanted to do and why.
“OK”
“You know how we have talked about how your brain is growing and changing? I was wondering if you
would mind if I talked to your class about the brain. And maybe a little about the way you lived before you
came to live with your parents?”
“OK,” he said, thoughtfully, adding, “Will you bring the pictures?”
“Which pictures?”
“The pictures of my brain?’
“Sure. You won’t mind if I show pictures of your brain to your class?”
“No. My brain is cool.”
“You know, Peter, you are so right. Your brain is cool?’ And so, with his permission and with that of his
parents and his school, I decided to see if I could make first graders into a new community of “therapists”
for Peter
I addressed his first grade class at the beginning of the school year. “I’m Peter’s friend,” I said. “I study
the brain and Peter asked me to come from Houston to tell you some of the things about the brain that I
taught him.” I had Peter come up to the front of the class and serve as my assistant.
I told the first graders about the brain, and about how in some ways, it acts like a muscle. I talked
about how they were exercising their “ABC” muscles in school and about the importance of repetition. I
described how they had many other similar kinds of “muscles” in their brains that also needed certain
kinds of attention in order to grow big and strong. I talked about how the brain develops and what makes
everyone’s brain work, emphasizing how the brain changes.
“Remember, Peter, when we were talking about how it takes a lot of practice to learn anything new?
That is because the brain changes when you use it, use it, use it.”
I looked at the children and then back at Peter, “Right, Peter?” He smiled and nodded. “And that is
why your teacher keeps having you practice writing again and again; and practice your letters again and
again and again.
I showed some slides; I brought a model of the brain and Peter passed it around. I answered
questions. What part of the brain makes you talk? What color is the brain? Does the brain keep videos of
your life?
I told the children how important it was for a developing baby’s brain to get stimulation from talk and
touch and human interactions. I told them the same things that I told parents, judges, pediatricians and
my own staff just with fewer big words.
Then I talked a little bit about how different children grow up in dif¬ferent homes. How Japanese
children learn Japanese; how in some cul¬tures mothers carry their babies around all day long during
their first year of life. How some children don’t get as much touch or talk or love early in life, and how that
can change the brain. They were having fun. We laughed.
Peter was smiling. Then, it was time. I didn’t know how much I would say, or even what I would say. I
would let the response of the children— and Peter—guide me. I jumped in, “Well. Thank you for letting
me come to your classroom. Peter told me about you guys when he came to visit me in Houston. I know
he went to kindergarten with many of you.” A few of the children raised their hands. “We asked Peter to
come to our clinic in Houston because we wanted to learn from him about his amaz¬ing brain.”
The children looked at Peter “See, when he was a little boy he spent every minute of every day for the
first three years of his life in one crib.” The children looked interested, but kind of confused. “Peter was
born in another country where they did not know very much about the brain. His parents could not take
care of him so Peter went to an orphanage when he was just a baby. In this orphanage each baby was
put in a crib and that was their home. They didn’t get to wander around, crawl anywhere, or even practice
standing so they could learn to walk. Until his parents came to get him when he was three, Peter never
had a chance to walk around, to play with friends, to get a hug from any loving grown-ups. His brain didn’t
get very much stimulation.” The room was completely silent:
twenty-six six-year-old children didn’t move, speak or fidget.
“And then when he was three, his new parents came and brought him to live in Tulsa.” I paused to let
some of the tension dissipate. “And that is when Peter’s amazing brain started to learn so many things.
Even though he had never heard English, he learned English in just a couple years. He had never had a
chance to walk or run or skip and he learned to do all of those things.” Peter looked embarrassed. I didn’t
want to push too much. “And so even today, Peter’s amazing brain is learning. He has really done great.
And that is why we wanted to meet Peter and learn more about how any person with such a hard start in
life could do so well?’
Then I ended with, “Part of what we learned is that every day in school, Peter learns things from all of
you. He watches how you do things, he learns from playing with each of you and he learns from just
being your friend. So thank you for helping Peter. And thanks for letting me come and talk about the
brain.”
It was a short and simple talk. I tried to take an unknown—Peter— and make him less frightening to
these children. And over time, their natural goodness emerged. No longer an odd and scary boy, Peter
be¬came popular—so popular, in fact, that his peers would argue over who got to sit next to him, who got
to be his partner, who got to be in his group. The brightest and strongest children in his class took a
special in¬terest in him and their leadership made all the difference. They included him, protected him
and, ultimately, provided therapeutic experiences that helped Peter catch up.
They were tolerant of his developmental problems, patient in cor¬recting his social mistakes and
nurturing in their interactions. These children provided many more positive therapeutic experiences than
we ever could have given Peter
Children, just like us adults, react badly to the unknown, to the strange and unfamiliar, especially
when they themselves are trying to adjust to a new situation like the start of a school year. Although their
social hierar¬chies aren’t always so easy to influence, most bullying and social rejection begins with fear
of the unfamiliar, and adults have much more influence over the process than they may believe. When
children understand why someone behaves oddly, they give him or her more slack, generally. And the
younger the children are, the more easily they are influenced by both obvious and subtle cues of
rejection and acceptance from adults. These cues often set the tone for the children’s status systems,
and teachers and parents can either minimize bullying or unfortunately, maximize it, by ei¬ther strongly
discouraging or tolerating the scapegoating of those who are “different.”
Knowing that Peter’s immature behavior came from his history of de¬privation helped his classmates
reinterpret it. When he grabbed some¬thing or talked out of turn, they no longer saw it as a personal
affront or jarring oddity, but simply as a remnant from his past that they’d been taught to expect. The
results were rapid: almost immediately he stopped having tantrums and outbursts, probably because
what had prompted them was frustration, a sense of rejection and feeling misunderstood. Because the
other children were more forgiving and more explicit about the social cues they were giving him, he was
able to read them better and thus able to fit in better. What had been a downward spiral of rejection,
confusion and frustration became instead a cascade of positive rein¬forcement, which fed on itself. The
huge gaps in developmental age across emotional, social, motor and cognitive domains slowly filled in.
By the time Peter reached high school he no longer stood out and he has continued to do well, both
academically and socially.
His peers and his family healed him by creating a rich social world, a nurturing community. While the
neurosequential approach helped us provide the specific stimuli his brain had lacked, massage offering
the physical affection that he’d missed, and music and movement to help re¬store his brain and bodily
rhythms, none of that would have been enough without Amy and Jason’s love and sensitivity and without
the patience and support of his classmates. The more healthy relation-ships a child has, the more likely
he will be to recover from trauma and thrive. Relationships are the agents of change and the most
powerful therapy is human love.
The Who
Boy Was
Raised as a Dog
And Other Stories from a Child Psychiatrist’s Notebook
What Traumatized Children
Can Teach Us About
Loss, Love, and Healing
BRUCE D. PERRY, M.D., Ph.D. MATA SZALAVITZ
A Member of the Perseus Books Group
New York