The Kindness of ChildrenBRUCE 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 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 appointment. 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 operators 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 for review to 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 enabled us to come to a
preliminary diagnosis and make our initial recommendations 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 experiences 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 delivery only made things worse. We’d
also started to incorporate music, dance and massage in order to stimulate and organize the lower
brain regions, which contain the key regulatory neurotransmitter systems involved 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 relationships are, especially as children get older. The details of Peters
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 endless, straight rows of perfectly sanitized cribs. The
two caretakers on duty for each shift would work methodically from one bed to the next, feeding each
child, changing his or her diaper, then moving on. That was all the individual adult attention the babies
received: roughly fifteen minutes 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 Russian; perhaps the orphanage workers had been immigrants from elsewhere 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 improvised 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 children 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 uncoordinated, and
even when he tried to sit still, he would sway. Also, he would rarely establish or maintain eye contact
appropriately. At seven, he still had several primitive self-soothing behaviors, primarily rocking 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 developmental 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 language 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. Confirming 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 neglect. 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 attuned 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 smothering 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 understand 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 requiring 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 anxious as soon as I walked into the room. “What do
you think?” 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 tenderly put his arm around her, and 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 related Peter’s history as I
understood it, recounting the details of the orphanage 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 develops,” I 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 better 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 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. 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 response 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 regions 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 expectations 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 explanations 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.
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, especially, 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 intuitively 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 without 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 wander 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 frequent 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 in this classroom 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’ 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, perhaps 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 evaluation and could talk to his
classmates at that time. I went back to explore 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 eloquently
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 different homes. How Japanese children
learn Japanese; how in some cultures 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
amazing 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 became 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 interest 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 correcting 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 hierarchies 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 either strongly
discouraging or tolerating the scapegoating of those who are different. Knowing that Peter’s immature
behavior came from his history of deprivation helped his classmates reinterpret it. When he grabbed
something 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 reinforcement, 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 restore 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 relationships 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 DogAnd Other Stories from a Child Psychiatrist’s Notebook
What Traumatized Children Can Teach Us About Loss, Love, and HealingBRUCE D. PERRY, M.D., Ph.D. MATA 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 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 appointment. 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 operators 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 for review to 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 enabled us to come to a
preliminary diagnosis and make our initial recommendations 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 experiences 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 delivery only made things worse. We’d
also started to incorporate music, dance and massage in order to stimulate and organize the lower
brain regions, which contain the key regulatory neurotransmitter systems involved 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 relationships are, especially as children get older. The details of Peters
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 endless, straight rows of perfectly sanitized cribs. The
two caretakers on duty for each shift would work methodically from one bed to the next, feeding each
child, changing his or her diaper, then moving on. That was all the individual adult attention the babies
received: roughly fifteen minutes 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 Russian; perhaps the orphanage workers had been immigrants from elsewhere 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 improvised 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 children 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 uncoordinated, and
even when he tried to sit still, he would sway. Also, he would rarely establish or maintain eye contact
appropriately. At seven, he still had several primitive self-soothing behaviors, primarily rocking 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 developmental 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 language 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. Confirming 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 neglect. 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 attuned 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 smothering 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 understand 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 requiring 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 anxious as soon as I walked into the room. “What do
you think?” 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 tenderly put his arm around her, and 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 related Peter’s history as I
understood it, recounting the details of the orphanage 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 develops,” I 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 better 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 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. 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 response 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 regions 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 expectations 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 explanations 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.
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, especially, 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 intuitively 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 without 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 wander 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 frequent 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 in this classroom 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’ 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, perhaps 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 evaluation and could talk to his
classmates at that time. I went back to explore 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 eloquently
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 different homes. How Japanese children
learn Japanese; how in some cultures 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
amazing 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 became 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 interest 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 correcting 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 hierarchies 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 either strongly
discouraging or tolerating the scapegoating of those who are different. Knowing that Peter’s immature
behavior came from his history of deprivation helped his classmates reinterpret it. When he grabbed
something 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 reinforcement, 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 restore 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 relationships 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 DogAnd Other Stories from a Child Psychiatrist’s Notebook
What Traumatized Children Can Teach Us About Loss, Love, and HealingBRUCE D. PERRY, M.D., Ph.D. MATA SZALAVITZ
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