The Boy Who Was Raised as a Dog (32 page)

I hear occasionally from the prosecutor in the case, who has stayed in touch with James and his new adoptive parents. His name has been changed and, last I heard, he was thriving in his new life. His “disruptive” behavior and running away was entirely a product of his attempt to get help. I believe he saved not only his own life, but those of his siblings as well. His story reminds me to trust my gut and always keep listening to the child, no matter what other therapists, official reports and even parents may say.

chapter 10

The Kindness of Children

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 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 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 institutionalized 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 developmentally 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 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 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 this 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.