The Boy Who Was Raised as a Dog

by Bruce Perry

  Maia Szalavitz acknowledgments:

  It has been a real honor to work with one of my scientific heroes, Bruce D. Perry, and I couldn’t have asked for a better collaborator. I thank him first and foremost for his kindness, wisdom, generosity, support and inspiration and for allowing me to help this book come into being. As a science writer, my idea of heaven is being paid to ask important questions of great minds—and this project involved just that. Kudos are due as well from me to our agent Andrew Stuart for his guidance and help in shaping this book from proposal onwards and to Jo Ann Miller for elegant editing and support. Special thanks to Lisa Rae Coleman for her fine transcription, friendship and sharp wit and to Trevor Butter-worth and stats.org for their ongoing support. My mom, Nora Staffanell, and my Dad, Miklos Szalavitz, my siblings Kira Smith (and her children, Aaron, Celeste and Eliana), Sarah and Ari Szalavitz also deserve credit. As ever, my gratitude also goes to Peter McDermott for making both my work and my life better.

  Notes

  INTRODUCTION

  2 affect at least 7 percent of all Americans: Kessler, R. C., Berglund, P., Demler, O., Jin, R., Merikangas, K. R., & Walters, E. E. (2005, June). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62(6), 593-602. See also: Kessler, R. C., et al. (1995, December). Posttraumatic Stress Disorder in the National Comorbidity Survey. Archives of General Psychiatry, 52(12), 1048-1060.

  2 about 40 percent of American children: Franey, K., Geffner, R., & Falconer, R. (Eds.). (2001). The Cost of Maltreatment: Who Pays? We All Do (pp. 15-37). San Diego, CA: Family Violence and Sexual Assault Institute. See also: Anda, R. F., Felitti, V. J., Bremner J. D., Walker, J. D., Whitfield, C. H., Perry, B. D., Dube, S. R., & Giles, W. H. (2006, April). The enduring effects of abuse and related adverse experiences in childhood: A convergence of evidence from neurobiology and epidemiology. European Archives of Psychiatry and Clinical Neuroscience, 256(3), 174-186. Epub 2005, November 29.

  3 around 872,000 of these cases were confirmed: http://www.acf.hhs.gov/programs/cb/pubs/cm04/index.htm

  3 one in eight children under the age of seventeen : Finkelhor, D., Ormrod, R., Turner, H., & Hamby, S. L. (2005, February). The victimization of children and youth: a comprehensive, national survey. Child Maltreatment, 10(1), 5-25.

  3 about 27 percent of women and 16 percent of men: Finkelhor, D., Hotaling, G., Lewis, I. A., & Smith, C. (1990). Sexual abuse in a national survey of adult men and women: Prevalence, characteristics, and risk factors. Child Abuse & Neglect, 14, 19-28.

  3 6 percent of mothers and 3 percent of fathers: A statistical portrait of fathers and mothers in America. (2002). (p. 24). Washington, D.C.: ChildTrends. Survey results from 1995 Gallup Survey on Disciplining Children in America.

  3 up to ten million American children: Strauss, M. A. (1991). Children as witnesses to marital violence: A risk factor for lifelong problems among a nationally representative sample of American men and women. [Paper presented at the Ross Roundtable on “Children and Violence.”] Washington, D.C.

  3 4 percent of American children under the age of fifteen: Strauss, M. A. (1991). Ibid.

  3 some 800,000 children will spend time in foster care: Child Welfare League of America. (2005, June 5). Statement of the Child Welfare League of America for House Subcommittee on Human Resources of the Committee on Ways and Means for the hearing on federal foster care financing. http://www.cwla.org/advocacy/fostercare050609.htm

  3 more than eight million American children suffer from serious, diagnosable, trauma-related psychiatric problems: Perry, B. D. & Pollard, R. (1998, January). Homeostasis, Stress, Trauma and Adaptation. Child and Adolescent Psychiatric Clinics of North America, (7)1, 33-51.

  3 one third of children who are abused: Perry, B. D. & Azad, I. (1999, Aug). Posttraumatic stress disorders in children and adolescents. Current Opinion in Pediatrics, 11(4), 310-316.

  CHAPTER 1

  24 respond properly to stress for a lifetime: Perry, B. D., Stolk, J. M., Vantini, G., Guchhait, R. B., & U’Prichard, D. C. (1983). Strain differences in rat brain epinephrine synthesis and alpha-adrenergic receptor number: Apparent in vivo regulation of brain alpha-adrenergic receptors by epinephrine. Science, 221, 1297-1299.

  24 change a rat’s stress response forever: Reviewed in Levine, S. (2005, November). Developmental determinants of sensitivity and resistance to stress. Psychoneuroendocrinology , 30(10), 939-946. See also generally: Terr, L. (1990). Too scared to cry: how trauma affects children and ultimately, us all. New York: Basic Books.

  CHAPTER 2

  36 stress-response systems in vets with PTSD: Perry, B. D., Giller, E. L., & Southwick, S. (1987). Altered platelet alpha2-adrenergic binding sites in post-traumatic stress disorder. American Journal of Psychiatry, 144(11), 1511-1512; Perry, B. D., Southwick, S. W., Yehuda, R., & Giller, E. L. (1990). Adrenergic receptor regulation in post-traumatic stress disorder. In E. L. Giller, (Ed.), Advances in psychiatry: biological assessment and treatment of post traumatic stress disorder (pp. 87-115). Washington, D.C.: American Psychiatric Press; Giller, E. L., Perry, B. D., Southwick, S. M., Yehuda, R., Wahby, V., Kosten, T. R., & Mason, J. W. (1990). Psychoendocrinology of posttraumatic stress disorder. In M. E. Wolf & A. D. Mosnaim (Eds.), PTSD: biological mechanisms and clinical aspects (pp. 158-170). Washington, DC: American Psychiatric Press.

  37 improve their schoolwork and interpersonal skills: Perry, B. D. (1994). Neurobiological sequelae of childhood trauma: Post traumatic stress disorders in children. In M. Murburg (Ed.), Catecholamine function in post traumatic stress disorder: emerging concepts (pp. 253-276). Washington, D.C.: American Psychiatric Press.

  39 pattern of drug use is different: Kleven, M., Perry, B. D., Woolverton, W., & Seiden, L. (1990). Effects of repeated injections of cocaine on D1 and D2 dopamine receptors in rat brain. Brain Research, 532, 265-270; Farfel, G., Kleven, M. S., Woolverton, W. L., Seiden, L. S., & Perry, B. D. (1992). Effects of repeated injections of cocaine on catecholamine receptor binding sites, dopamine transporter binding sites and behavior in Rhesus monkeys. Brain Res, 578, 235-243.

  CHAPTER 3

  58 violated to those of hunted animals: Breault, M. & King, M. (1993). Inside the cult: a member’s chilling, exclusive account of madness and depravity in David Koresh’s compound . New York: Signet Nonfiction.

  71 post-traumatic stress disorder following such “treatment.”: Rose, S., Bisson, J., Churchill, R., & Wessely, S. (2002). Psychological debriefing for preventing post traumatic stress disorder (PTSD). The Cochrane Database of Systematic Reviews, 2.

  76 in response to the event itself: Perry, B. D., Pollard, R., Blakely, T., Baker, W., & Vigilante, D. (1995). Childhood trauma, the neurobiology of adaptation and ‘use-dependent’ development of the brain: How “states” become “traits.’” Infant Mental Health Journal, 16(4), 271-291.

  CHAPTER 4

  86 sight and depth perception is lost: Hubel D. H. and Wiesel, T. N. (1959, October). Receptive fields of single neurons in the cat’s striate cortex. Journal of Physiology, 148, 574-591.

  86 speak or understand speech normally: Rymer, R. (1994). Genie: a scientific tragedy. New York: Harper Paperbacks.

  86 language he does learn with an accent: Pinker, S. (2000). The language instinct: how the mind creates language (pp. 295-296). New York: Harper Perennial Modern Classics.

  88 by age two—an extraordinarily high death rate: Iwaniec, D. (2004). Children who fail to thrive: a practice guide. Chichester, UK: Wiley.

  92 reduced levels of growth hormone: Stanhope, R., Wilks, Z., Hamill, G. (1994, November-December). Failure to grow: lack of food or lack of love? Professional Care of the Mother and Child, 4(8), 234-7; Albanese, A., Hamill, G., Jones, J., Skuse, D., Matthews, D. R., Stanhope, R. (1994, May). Reversibility of physiological growth hormone secretion in children with psychosocial dwarfism. Clinical Endocrinology, (Oxf), 40(5), 687-692.

  CHAPTER 5

  104 often seen i
n abused or traumatized children: Perry, B. D. (1999). Memories of fear: How the brain stores and retrieves physiologic states, feelings, behaviors and thoughts from traumatic events. In J. M. Goodwin and R. Attias (Eds.), Splintered reflections: images of the body in trauma (pp. 26-47). New York: Basic Books; Perry, B. D. (2001). The neurodevelopmental impact of violence in childhood. In D. Schetky & E. P. Benedek (Eds.), Textbook of Child and Adolescent Forensic Psychiatry (pp. 221-238). Washington, D.C.: American Psychiatric Press.

  105 proportion rises to over 35 percent: Yeudall, L. T. (1977). Neuropsychological assessment of forensic disorder. Canada’s Mental Health, 25, 7-15; Gillen, R. & Hesselbrock, V. (1992, April). Cognitive functioning, ASP, and family history of alcoholism in young men at risk for alcoholism. Alcoholism: Clinical and Experimental Research, 16(2), 206.

  114 tends to escalate bad behavior: Dishion, T. J.; McCord, J., & Poulin, F. (1999). When interventions harm: Peer groups and problem behavior. American Psychologist, 54(9), 755-764; Poulin, F.; Dishion, T. J. & Burraston, B. (2001). 3-year iatrogenic effects associated with aggregating high-risk adolescents in cognitive-behavioral preventive interventions. Applied Development Science, 5(4), 214-224.

  116 frontal cortex, just over the eyes: Frith, U. (1998). What autism teaches us about communication. Logopedics, Phoniatrics Vocology, 23, 51-58.

  117 (which can be measured in a saliva test): Susman, E. J. (2006). Psychobiology of persistent antisocial behavior: stress, early vulnerabilities and the attenuation hypothesis. Neuroscience Biobehavior Review, 30(3), 376-89. Loney, B. R., Butler, M. A., Lima, E. N., Counts, C. A., & Eckel, L. A. (2006, January). The relation between salivary cortisol, callous-unemotional traits, and conduct problems in an adolescent non-referred sample. Journal of Child Psychology and Psychiatry and Allied Disciplines, 47(1), 30-36. van Bokhoven, I., Van Goozen, S. H., van Engeland, H., Schaal, B., Arseneault, L., Seguin, J. R., Nagin, D. S., Vitaro, F., & Tremblay, R. E. (2005, August). Salivary cortisol and aggression in a population-based longitudinal study of adolescent males. Journal of Neural Transmission, 112(8), 1083-1096.

  117 anything except extreme stimulation: Unis, A. S., Cook, E. H., Vincent, J. G., Gjerde, D. K., Perry, B. D., & Mitchell, J. (1997). Peripheral serotonergic measures correlate with aggression and impulsivity in juvenile offenders. Biological Psychiatry, (42)7, 553-560; Perry, B. D. (1997). Incubated in terror: Neurodevelopmental factors in the ‘cycle of violence.’ In J. Osofsky (Ed.), Children in a violent society (pp. 124-148). New York: Guilford Press.

  122 by the time they reach the pros: Dubner, S. J. and Levitt, S. D. (2006, May 7). A star is made. New York Times Magazine.

  CHAPTER 6

  125 services for maltreated and traumatized children: Perry, B. D. (2001). The neuroarcheology of childhood maltreatment: the neurodevelopmental costs of adverse childhood events. In K. Franey, R. Geffner, & R. Falconer (Eds.), The Cost of Maltreatment: Who Pays? We All Do (pp. 15-37). San Diego, CA: Family Violence and Sexual Assault Institute; Perry, B. D. (2006). Applying principles of neuroscience to clinical work with traumatized and maltreated children: the neurosequential model of therapeutics. In N. B. Webb (Ed.), Working with traumatized youth in child welfare (pp. 27-52). New York: The Guilford Press.

  125 neglect far, far worse than what had been done to Leon: Research supporting treatment used in neurosequential approach: Jones, N. A. & Field, T. (1999, Fall). Massage and music therapies attenuate frontal EEG asymmetry in depressed adolescents. Adolescence , 34(135), 529-534; Field, T. (1998, March-April). Maternal depression effects on infants and early interventions. Preventive Medicine, 27(2), 200-203; Diego, M. A., Field, T., Hart, S., Hernandez-Reif, M., Jones, N., Cullen, C., Schanberg, S., & Kuhn, C. (2002). Facial expressions and EEG in infants of intrusive and withdrawn mothers with depressive symptoms. Depress Anxiety, 15(1), 10-17; Field, T., Martinez, A., Nawrocki, T., Pickens, J., Fox, N. A., Schanberg, S. (1998, Spring). Music shifts frontal EEG in depressed adolescents. Adolescence, 33(129), 109-116; Khilnani, S., Field, T., Hernandez-Reif, M., & Schanberg, S. (2003, Winter). Massage therapy improves mood and behavior of students with attention-deficit/hyperactivity disorder. Adolescence, 38(152), 623-638.

  129 visibly smaller head sizes and tinier brains: Perry, B. D. (2002). Childhood experience and the expression of genetic potential: what childhood neglect tells us about nature and nurture. Brain and Mind, 3, 79-100; Johnson, R., Browne, K., & Hamilton-Giachritsis, C. (2006, January). Young children in institutional care at risk of harm. Trauma Violence Abuse, (1), 34-60; Anda, R. F., Felitti, V. J., Bremner, J. D., Walker, J. D., Whitfield, C. H., Perry, B. D., Dube, S. R., & Giles, W. H. (2006, Apr). The enduring effects of abuse and related adverse experiences in childhood: A convergence of evidence from neurobiology and epidemiology. European Archives of Psychiatry and Clinical Neuroscience, 256(3), 174-186. Epub 2005, November 29. Additional background on effects of neglect: Smith, M. G. & Fong, R. (2004). The children of neglect: when no one cares. New York: Brunner-Routledge.

  140 compared to sight, smell, taste and hearing: Weiss, S. J. (2005). Haptic perception and the psychosocial functioning of preterm, low birth weight infants. Infant Behavior and Development, 28, 329-359.

  140 almost a week earlier on average: Field, T. (2002, December). Preterm infant massage therapy studies: an American approach. Seminars in Neonatology, 7(6), 487-494.

  140 stress hormones released by the brain: Field, T., Hernandez-Reif, M., Diego, M., Schanberg, S., Kuhn, C. (2005, October). Cortisol decreases and serotonin and dopamine increase following massage therapy. International Journal of Neuroscience, 115(10), 1397-1413.

  141 escalate the parents’ commitment to therapy: Cullen-Powell, L. A., Barlow, J. H., Cushway, D. (2005, December). Exploring a massage intervention for parents and their children with autism: the implications for bonding and attachment. Journal of Child Health Care, 9(4), 245-255.

  144 important role in infant development: Mithen, S. (2005). The singing neanderthals: the origins of music, language, mind and body. London: Weidenfeld and Nicholson.

  151 genetics and intrauterine environment is one: Cowen, E. L., Wyman, P. A., & Work, W. C. (1996, Winter). Resilience in highly stressed urban children: concepts and findings. Bulletin of the New York Academy of Medicine, 73(2), 267-284.

  151 Intelligence is another critical factor: Masten, A. S., Hubbard, J. J., Gest, S. D., Tellegen, A., Garmezy, N., & Ramirez, M. (1999, Winter). Competence in the context of adversity: pathways to resilience and maladaptation from childhood to late adolescence. Development and Psychopathology, 11(1), 143-169.

  CHAPTER 7

  156 seeing someone possessed by a demon: Elizabeth Loftus, award for distinguished scientific applications of psychology. (2003, November). American Psychologist, 58(11), 864-867; Loftus, E. F. (2005, July-August). Planting misinformation in the human mind: a 30-year investigation of the malleability of memory. Learning and Memory, 12(4), 361-366. Epub 2005, July 18.

  157 until the back of his head “was mushy.”: Loe, V. (1993, December 3). Satanic Cult Scare Takes Massive Human Toll on Texas Town. Dallas Morning News.

  159 one in four adult residents cannot read: Wade, R. M. (1999). When Satan Came to Texas. The Skeptic, 7(4).

  162 events they recall are literally true: Loftus, E. (2003, November). Make believe memories. American Psychologist; Pendergrast, M. (1996). Victims of Memory: Sex Abuse Accusations and Shattered Lives. Vermont: Upper Access Books; Ofshe, R. J. (1992, July). Inadvertent hypnosis during interrogation: false confession due to dissociative state; mis-identified multiple personality and the Satanic cult hypothesis. International Journal of Clinical and Experimental Hypnosis, 40(3), 125-156. Ofshe, R. and Watters, E. (1996). Making Monsters: False Memories, Psychotherapy and Sexual Hysteria. Berkeley & Los Angeles: University of California Press.

  163 deaths associated with their “therapy.”: Bowers, K. (2000, July 27). Suffer the children. Westword (New Times).

  164 the devil would get us.: Wade, R. M. (1999). Wh
en Satan came to Texas. The Skeptic, 7(4).

  166 ruminating on past negative events: Nolen-Hoeksema, S., Morrow, J., Fredrickson, B. L. (1993, February). Response styles and the duration of episodes of depressed mood. Journal of Abnormal Psychology, 102(1), 20-28; Lyubomirsky, S. & Nolen-Hoeksema, S. (1993, August). Self-perpetuating properties of dysphoric rumination. Journal of Personality and Social Psychology, 65(2), 339-349.

  170 financially and in every other way: Vaughn, V. (1995, February). Witch hunt. North Texas Skeptic.

  CHAPTER 8

  182 sense of distance from one’s troubles: Perry, B. D. (1994). Neurobiological sequelae of childhood trauma: Post traumatic stress disorders in children. In M. Murburg (Ed.), Catecholamine function in post traumatic stress disorder: emerging concepts (pp. 253-276). Washington, D.C.: American Psychiatric Press.

  182 known as endorphins and enkephalins: van der Kolk, B., Greenberg, M., Boyd, H., & Krystal, J. (1985, March). Inescapable shock, neurotransmitters, and addiction to trauma: toward a psychobiology of post traumatic stress. Biological Psychiatry, 20(3), 314-325.

  189 becoming a Goth didn’t increase self-harm: Young, R., Sweeting, H., & West, P. (2006, April 13). Prevalence of deliberate self harm and attempted suicide within contemporary Goth youth subculture: longitudinal cohort study. British Medical Journal.

  189 Research on addicts and alcoholics: Felitti, V. J. (2003, October). The origins of addiction: evidence from the adverse childhood experiences study. Prax Kinderpsychology and Kinderpsychiatry, 52(8), 547-559; Dube, S. R., Felitti, V. J., Dong, M., Chapman, D. P., Giles, W. H., & Anda, R. F. (2003, March). Childhood abuse, neglect, and household dysfunction and the risk of illicit drug use: the adverse childhood experiences study. Pediatrics, 111(3), 564-572; Clark, H. W., Masson, C. L., Delucchi, K. L., Hall, S. M., & Sees, K. L. (2001, March). Violent traumatic events and drug abuse severity. Journal of Substance Abuse Treatment, 20(2), 121-127.