The Boy Who Was Raised as a Dog (21 page)

Jane told me she felt guilty about returning to work so soon. She described how, for the first two weeks after she returned to the office, Connor's cries as she left him were terribly distressing. But after that, he stopped crying, so Jane thought everything was fine. “My baby was content,” she told me, describing how even when she accidentally stuck him with a safety pin, Connor didn't even whimper. “He never cried,” she said, emphatically, not aware that if a baby never cries, this is as much a sign of potential problems as crying too much can be. Again, she was stymied by ignorance of basic child development. Like Maria, she thought that a quiet baby meant a happy baby.

Within a few months, however, Jane began to suspect that something was wrong. Connor didn't seem to be maturing as fast as her friends' babies did. He wasn't sitting up or turning over or crawling at the ages that others reached those milestones. Concerned about his lack of progress, she took him to the family's pediatrician, who was excellent at recognizing and treating physical diseases, but didn't know much about how to check for mental and emotional difficulties. She didn't have children of her own, so she was not personally familiar with their psychological development and, like most doctors, hadn't been given much education on it. The doctor also knew the parents well, so she had no reason to suspect abuse or neglect. Consequently, she didn't ask, for example, whether Connor cried or about how he responded to people. She simply told Jane that babies develop at different rates and tried to reassure her that he would catch up soon.

One day, however, when Connor was about eighteen months old, Jane came home from work sick. The house was dark, so she assumed the nanny had taken the child out. There was a terrible smell coming from Connor's room. The door was part way open, so she peeked in. She found her son sitting in the dark, alone, with no toys, no music, no nanny and a full, dirty diaper. Jane was horrified. When she confronted her cousin, the woman confessed that she had been leaving Connor and going to the other job. Jane fired the cousin and quit her job to stay home with the baby. She thought she'd dodged the bullet: she thought that because he hadn't been kidnapped, harmed in a fire or become physically ill, the experience would have no lasting effects. She didn't connect his increasingly odd behavior with over a year of near-daily neglect.

As he grew socially isolated and began to engage in peculiar, repetitive behaviors, no one in the mental health system, no one in the school system, not one of the special education teachers or occupational therapists or counselors to whom he was sent discovered Connor's history of early neglect. Hundreds of thousands of dollars and hundreds of hours were spent fruitlessly trying to treat his various “disorders.” The result was this fourteen-year-old boy, rocking and humming to himself, friendless and desperately lonely and depressed; a boy who didn't make eye contact with other people, who still had the screaming, violent temper tantrums of a three- or four-year-old; a boy who desperately needed the stimulation that his brain had missed during the first months of life.

When Mama P. had rocked and held the traumatized and neglected children she cared for, she'd intuitively discovered what would become the foundation of our neurosequential approach: these children need patterned, repetitive experiences appropriate to their developmental needs, needs that reflect the age at which they'd missed important stimuli or had been traumatized, not their current chronological age. When she sat in a rocking chair cuddling a seven-year-old, she was providing the touch and rhythm that he'd missed as an infant, experience necessary for proper brain growth. A foundational principle of brain development
is that neural systems organize and become functional in a sequential manner. Furthermore, the organization of a less mature region depends, in part, upon incoming signals from lower, more mature regions. If one system doesn't get what it needs when it needs it, those that rely upon it may not function well either, even if the stimuli that the later developing system needs are being provided appropriately. The key to healthy development is getting the right experiences in the right amounts at the right time.

Part of the reason for Justin's rapid response to our therapy, I soon recognized, was that he had had nurturing experiences during his first year of life, before his grandmother had died. This meant his lowest and most central brain regions had been given a good start. If he'd been raised in a cage from birth, his future might have been far less hopeful. It worried me that Connor, like Leon, had suffered neglect virtually from birth to eighteen months. The one hope was that during the evenings and weekend hours when his parents were caring for him there was at least some exposure to nurturing sensory experiences.

Drawing on these insights, we decided that we would systematize our approach to match the developmental period at which the damage had first started. By looking carefully at Connor's symptoms and his developmental history, we hoped we could figure out which regions had sustained the most damage and target our interventions appropriately. We would then use enrichment experiences and targeted therapies to help the affected brain areas in the order in which they were affected by neglect and trauma (hence, the name neurosequential). If we could document improved functioning following the first set of interventions, we would begin the second set appropriate for the next brain region and developmental stage until, hopefully, he would get to the point where his biological age and his developmental age would match.

In Connor's case it was clear that his problems had started in early infancy when the lower and most central regions of the brain are actively developing. These systems respond to rhythm and touch: the brainstem's regulatory centers control heartbeat, the rise and fall of neurochemicals
and hormones in the cycle of day and night, the beat of one's walk and other patterns that must maintain a rhythmic order to function properly. Physical affection is needed to spur some of the region's chemical activity. Without it, as in Laura's case, physical growth (including the growth of the head and brain) can be retarded.

Like Leon and others who have suffered early neglect, Connor couldn't stand to be touched. At birth human touch is a novel and, initially, stressful stimulus. Loving touch has yet to be connected to pleasure. It is in the arms of a present, loving caregiver that the hours upon hours of touch become familiar and associated with safety and comfort. It seems that when a baby's need for this nurturing touch isn't satisfied, the connection between human contact and pleasure isn't made and being touched can become actively unpleasant. In order to overcome this and help provide the missing stimuli, we referred Connor to a massage therapist. We would focus first on meeting his needs for skin-to-skin contact; then, we hoped, we could further address his asynchronous bodily rhythms.

As we saw in Laura's case, touch is critical to human development. Sensory pathways involved in the experience of touch are the first to develop and are the most fully elaborated at birth compared to sight, smell, taste and hearing. Studies of premature babies find that gentle, skin-to-skin contact helps them gain weight, sleep better and mature more quickly. In fact, preemies who received such gentle massage went home from the hospital almost a week earlier on average. In older children and adults massage has also been found to lower blood pressure, fight depression and cut stress by reducing the amount of stress hormones released by the brain.

Our reason for starting with massage was also strategic: research finds that parents who learn infant and child massage techniques develop better relationships with their children and feel closer to them. With children who have autism or other conditions that make them seem remote, creating this sense of closeness can often rapidly improve
the parent-child relationship and thus escalate the parents' commitment to therapy.

This was particularly important in Connor's case because his mother was very anxious about our approach to his treatment. After all, previous psychologists, psychiatrists, counselors and well-meaning neighbors and teachers kept telling her not to indulge his “babyish” behavior and to ignore his tantrums. He needed more structure and limits, they said, not more cuddles. Everyone else had told her that Connor was immature and must be forced to abandon his primitive self-soothing methods like rocking and humming. Now we were saying he should be treated gently, which seemed to her overindulgent. In fact, rather than ignore him when his behavior threatened to escalate out of control, as behavioral therapists often suggested, we were saying that he should actually be “rewarded” with massage. Our approach seemed radically counterintuitive, but because nothing else had helped, she agreed to give it a try.

Connor's mom was present during his massage sessions, and we made her an active participant in this part of his therapy. We wanted her there to comfort him and help him if he found the touch stressful. We also wanted her to learn this physically affectionate way of showing her love for her son, to help make up for the hugs and nurturing touches he'd missed during his infancy. This massage approach was gradual, systematic and repetitive. The initial motions involved Connor's own hands, guided in massaging his arm, shoulders and trunk. We used a heart rate monitor to track the level of his distress. When his own touch to his own body did not cause changes in his heart rate we started to use his mother's hands in the same repetitive, gradual massage process. Finally, once his mother's massaging touch was no longer anxiety-provoking, the massage therapist started with more conventional therapeutic massage. The approach was very slow and gentle: the idea was to acclimate Connor to physical touch and, if possible, help him begin to enjoy it. After being taught to give her son neck and shoulder massages Jane would continue the therapy at home, especially when Connor seemed
upset or asked for a massage. We explained to both of them why we were trying this approach.

Nothing was forced. We knew that Connor found touch aversive at first and instructed the therapist to carefully respond to any signals from him that it was “too much.” She would progress to more intense stimulation only when the previous form and degree of touch had become familiar and safe. She would always start her work by having him use one of his own hands to “test” the massage, and then, when he was used to that, she began massaging his fingers and hands. She was gradually able to touch and then massage more deeply all of the appropriate bodily zones. Connor's mom was also instructed to follow her son's lead and not push contact if he found it overwhelming.

Over the course of six to eight months Connor gradually began to tolerate and then enjoy physical contact with others. I could tell he was ready to move on to the next phase of treatment when he came up to me and reached his hand out, as if to shake my hand. He wound up patting my hand, like a granny would do with a young child, but for him, even a bizarre type of handshake was progress. He would never previously have sought—let alone initiate—physical contact. In fact, he would have actively avoided it.

Now it was time to work on his sense of rhythm. It may seem odd, but rhythm is extraordinarily important. If our bodies cannot keep the most fundamental rhythm of life—the heartbeat—we cannot survive. Regulating this rhythm isn't a static, consistent task, either: the heart and the brain are constantly signaling each other in order to adjust to life's changes. Our heart rate must increase to power fight or flight, for example, and it must maintain its rhythmic pulse despite the varying demands placed on it. Regulating heart rate during stress and controlling stress hormones are two critical tasks that require that the brain keep proper time.

Also, numerous other hormones are rhythmically regulated as well. The brain doesn't just keep one beat: it has many drums, which must all
synchronize not only with the patterns of day and night (and in women, with menstrual cycles or phases of pregnancy and nursing), but also with each other. Disturbances of the brain's rhythm-keeping regions are often causes of depression and other psychiatric disorders. This is why sleep problems (in some sense, a misreading of day and night) almost always accompany such conditions.

Most people don't appreciate how important these rhythms are in setting the tone for parent/child interactions, either. If a baby's primary metronome—his brainstem—doesn't function well, not only will his hormonal and emotional reactions to stress be difficult to modulate, but his hunger and his sleep cycle will be unpredictable as well. This can make parenting him much more difficult. Babies' needs are much easier to read when they reliably occur at predictable times: if their infants become hungry and tired at consistent times, parents can adjust to their demands more easily, reducing stress all around. The implications of poorly regulated bodily rhythms, then, are far greater than one would initially suspect.

In the usual course of development a baby gets into a rhythmic groove that drives these various patterns. The infant's mother cuddles him while he eats, and he is soothed by her heartbeat. In fact, the infant's own heart rhythm may be partly regulated by such contact: some Sudden Infant Death Syndrome (SIDS) deaths, according to one theory, occur when babies are out of physical contact with adults and thus lacking crucial sensory input. Some research even suggests that while in utero the child's heart can beat in time with his mother's. We do know that maternal heart rate provides the patterned, repetitive signals—auditory, vibratory and tactile—that are crucial to organizing the brainstem and its important stress regulating neurotransmitter systems.

When a baby gets hungry and cries his levels of stress hormones will move upward. But if Mom or Dad regularly comes to feed him, they go back down, and over time, they become patterned and repetitive thanks to the daily routine. At times, nonetheless, the baby will feel distress and
cry: not hungry, not wet, not in discernible physical pain, she will appear inconsolable. When this happens most parents hug and rock their children, almost instinctively using rhythmic motion and affectionate touch to calm the child. Interestingly, the rate at which people rock their babies is about eighty beats per minute, the same as a normal resting adult heart rate. Faster and the baby will find the motion stimulating; slower and the child will tend to keep crying. To soothe our children we reattune them physically to the beat of the master timekeeper of life.