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Born for Love
A Boy Who was Raised as a Dog

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Dr. Bruce Perry

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Therapeutic Services and Trauma Team

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Click here to view our animated version of Repair of Early Trauma: A Bottom Up Approach Told to us through the voices of children, this unique animation teaches us that by putting together the seven-piece jigsaw puzzle of 'Developmental Trauma' we can repair it using the Neuro-Sequential Model of Therapeutics.

Click here to view our animation 'The Window of Tolerance' Find out how a traumatised child swings from fight/flight to freeze/collapse; and what adults can do to help bring the child back into their window of tolerance so they can be at their personal best.

Click here to view James' story - a story about how a childhood of trauma and adversity led James to feel despair, loneliness and rage. Walk with James through his pain to a new chapter in his life where he begins to heal, and create a new and hopeful future. James' story and the images you'll see may trigger powerful feelings - look after yourself as you walk by his side.

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Click here to view our animated version of Repair of Early Trauma: A Bottom Up Approach Told to us through the voices of children, this unique animation teaches us that by putting together the seven-piece jigsaw puzzle of 'Developmental Trauma' we can repair it using the Neuro-Sequential Model of Therapeutics.

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Marcy Reed

Marcy Reed has been a certified nurse midwife since 2004 and a writer since 2007. She has been published in "Midwifery Today." Reed earned a bachelor's degree in nursing in California and received her midwifery education in Kentucky.

Premature babies are born before 37 weeks gestation, or a full three weeks before the estimated date of delivery. A preterm birth might have a variety of causes, including premature contractions or premature rupture of the amniotic sac. Cervical incompetence, which can be the result of surgery or other procedures on the cervix, can result in rapid and painless dilation and delivery of a premature infant. Certain clinical conditions might trigger your doctor to recommend elective delivery of a preterm infant. While rare, such situations might include multiple gestation, severe chronic hypertension, poor fetal growth and preeclampsia.

A baby weighing less than 2,500 g, or 5 pounds, 8 ounces, at birth is considered to have a low birth weight. While many of these small babies also are premature, some term babies might be born with a low birth weight. Causes of low birth weight include maternal hypertension, smoking, drug use and poor maternal weight gain. Older mothers, teenage mothers and poor mothers also have a greater risk for delivering a baby with a low birth weight.

Premature infants can experience a range of medical problems. The lungs are one of the last organ systems to mature and preterm babies might significantly struggle with breathing independently. Very preterm babies require intubation to survive. A very preterm baby also is at risk for bleeding into his brain. These babies are susceptible to infection and might struggle with learning disabilities as they grow. Low birth weight babies born at term fare better than preterm babies of any weight, as their organs are mature and they often can eat, maintain their temperatures and fight infection better than their premature peers.

Preterm and low birth weight infants struggle with adapting to life outside of the uterus more than babies born close to their due dates at healthy weights. While some causes of preterm and low birth weight infants are beyond a mother's control, you can follow some recommendations to maximize the chances you will have a normal size term baby. If you smoke, quit. Consider seeing a medical professional before becoming pregnant. If you already are pregnant, establish prenatal care early in your pregnancy. Eat a wide variety of nutritious foods and discuss any problems or concerns you experience during your pregnancy with your doctor or midwife, such as decreased fetal movement or poor appetite.

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Differences Between Low Birth Weight & Preterm Infants

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Low birth weight and preterm infants are extremely vulnerable to a variety of problems, including difficulty thriving and maintaining their blood sugar levels. Some babies have a low birth weight because they are premature, while others have a low birth weight even though they are born close to term.

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Information & Resources

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When you think of child abuse, your first thought may be of a child with bruises or other marks that raise red flags. But the signs aren't always so clear. It can be physical, sexual, or emotional. She may be neglected, meaning her caregivers don't provide for basic needs, like food or safety.

What makes abuse even harder to stop is that most of the time, the abuser is someone the child knows. She may be reluctant to say something because she may want to protect that person or is afraid of what they will do if she speaks up.

It's important to know how to recognize different types of abuse, and what you can do if you suspect it.

Types of Child Abuse

Child abuse happens when someone harms a child's body or emotional health, development, and well-being. There are 4 main types.

Physical abuse means that someone hurts a child's body or puts her in physical danger. It doesn't matter if the child gets seriously hurt or if it leaves a mark. Any harm is abuse. It includes when someone:

Burns a child

Hits, kicks, or bites

Holds the child under water

Shakes or throws the child

Throws objects at the child

Ties up the child

Sexual abuse is any kind sexual activity with a child, not just physical contact. It includes when someone:

Forces a child to take part in pornographic pictures or videos

Has any sexual contact with the child, from kissing in a sexual way to having sex

Makes phone calls or sends emails, texts, or other messages that are sexual in any way

Shows the child someone else's genitals, as with "flashing"

Shows pornography

Tells "dirty" jokes or stories

Emotional abuse is a pattern of behaviors that harm a child's emotional well-being and development. This can mean when someone:

Abuses others when the child is around, such as a parent, brother, sister, or pet

Fails to show love and affection

Ignores the child and doesn't give emotional support and guidance

Shames, belittles, criticizes, or embarrasses

Teases, threatens, bullies, or yells

Neglect is when a caregiver doesn't give the child basic care and protection, such as:

Clothing

Food

Heat in cold weather

Housing with clean living conditions

Medical care

Neglect is also when someone leaves the child alone for long stretches of time or under dangerous conditions.

Continued

Signs of Abuse

Abuse can be hard to recognize. Kids can get cuts and bruises or show signs of stress for lots of reasons that are a normal part of childhood. So it helps to know specific signs to look for, and trust your gut as you look at the whole picture of the child's physical and emotional health.

Signs of physical abuse may include:

Bruises, welts, or other injuries that can't be explained or don't match with the child's story

Burns, especially from cigarettes, that can't be explained

Injury marks that have a pattern, like from a hand, belt, or other objects

Injuries that are at different stages of healing

Medical or dental issues that go untreated

Kids who've been physically abused may also:

Avoid any kind of touch or physical contact

Be afraid to go home

Seem to always be on high alert

Wear clothing that doesn't match the weather -- such as long sleeves on hot days -- to cover up bruises

Withdraw from friends and activities

Signs of sexual abuse may include:

Avoiding a certain person for no clear reason

Bloody, torn, or stained underwear

Bruising or bleeding around the genitals

Pain or itching around the genitals that might cause problems walking or sitting

Pregnancy or STDs, especially for boys and girls under 14 years old

Refusing to change clothes in front of others

Running away from home

Sexual activity or knowledge that people usually have only when they're older

Signs of emotional abuse may include:

Constant worry about doing something wrong

Speech problems or delays in learning and emotional development

Depression and low self-esteem

Doing poorly in school

Extreme behavior, such as being way too obedient or way too demanding

Headaches and stomachaches with no clear cause

The child doesn't seem close to a parent or caregiver

Showing little interest in friends and activities

Signs of neglect may include:

Always looking dirty

Being left alone or in the care of other young children

Eating more than usual at a meal or saving food for later

Doesn't get medical, dental, or mental health care

Missing a lot of school

Poor weight gain and growth

Continued

What to Do if You Suspect Abuse

If you suspect child abuse, it's important to report it. It isn't a private matter or a family problem. A child's physical and emotional well-being, and maybe even her life, could be at stake.

You don't need proof to report abuse. If you suspect it, call your local child protective services, police, a hospital, or a hotline, such as the Childhelp National Child Abuse Hotline at 800-422-4453. You don't have to give your name.

Depending on the situation, there are many ways you can help the child:

If he needs medical care right away, call 911.

Take him to the hospital -- it's a haven for abused children. Doctors can check for signs of abuse and give medical care.

If you think someone like a baby sitter or day-care worker has abused your child, keep her away from that person and contact police.

Help the child get therapy to start healing the emotional damage of the abuse.

Make sure she feels supported and knows this is not her fault.

It's best to not confront the abuser yourself. Instead, contact police and let them handle it.

Sources

SOURCES:

KidsHealth: "Child Abuse."

Queensland Government, Department of Communities, Child Safety and Disability Services: "What Is Child Abuse?"

Mayo Clinic: "Child Abuse."

Massachusetts Executive Office of Health and Human Services: "Warning Signs for Child Abuse and Neglect."

HelpGuide.org: "Child Abuse and Neglect."

The National Child Traumatic Stress Network: "Child Sexual Abuse Fact Sheet."

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When you think of child abuse, your first thought may be of a child with bruises or other marks that raise red flags. But the signs aren't always so clear. It can be physical, sexual, or emotional. She may be neglected, meaning her caregivers don't provide for basic needs, like food or safety.

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A good overview of self-regulation and issues surrounding it

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What is self regulation?

Self-regulation is a person's ability to adjust and control their energy level, emotions, behaviours and attention. Appropriate self regulation suggests that this adjustment and control is conducted in ways that are socially acceptable.

Self-regulation development occurs in the following manner:

12-18 months is when children become aware of social demands and develop the ability to change their behaviour when a parent asks. In most cases, this early step in self-control requires an adult to be nearby and directing behaviour.

By 2 years of age, this ability improves to the point where children start to develop self-control, or the ability to follow others behaviour guidelines more often even when mum and dad aren't around.

Then by 3 years old, most children can generalise self regulation strategies used from previous experiences. In other words, children will act in ways that reflect how they think mum or dad would want them to act in different situations.

The processes involved in self-regulation can be divided into three broad areas: sensory regulation, emotional regulation and cognitive regulation.

Sensory Regulation: Allows children to maintain an appropriate level of alertness in order to respond appropriately across environments to the sensory stimuli present.

Emotional Regulation: Allows children to respond to social rules with a range of emotions through initiating, inhibiting, or modulating their behavior in a given situation to ensure social acceptance.

Cognitive Regulation: Allows children to use cognitive (mental) processes necessary for problem solving and related abilities in order to demonstrate attention and persistence to tasks.

Why is self regulation important?

Self-regulation skills are linked to how well children manage many tasks during early childhood. With these skills, children are more able to manage difficult and stressful events that occur as part of life, such as the loss of a pet, death of a family member or family separation. This helps to decrease the ongoing impact of stress that can contribute to mental health difficulties.

As a child learns to self-regulate, skills such as concentrating, sharing and taking turns also develop. This enables a child to move from depending on others to beginning to manage by themselves. Most children at some stage will struggle to manage their feelings and behaviours, particularly when they are tired, hungry or facing new experiences. When this happens, they might become upset, sulky or angry. This is all part of being a young child and is not necessarily cause for concern. If however this is problematic on a regular basis and there are seemingly little reasons for a child to be displaying such behaviours it is likely to be problematic in that it will impact upon academic performance.

What are the building blocks necessary to develop self regulation?

Behaviour: The actions of a person, usually in relation to their environment.

Sensory processing: Accurate processing of sensory stimulation in the environment as well as in one's own body.

Emotional Development/regulation: Involving the ability to perceive emotion, integrate emotion to facilitate thought, understand emotions and to regulate emotions.

Attention and Concentration: Sustained effort, doing activities without distraction and being able to hold that effort long enough to get the task done.

Executive Function: Higher order reasoning and thinking skills (e.g. what would mum want me to do in this situation?).

Planning and sequencing: The sequential multi-step task or activity performance to achieve a well-defined result.

Receptive Language: Comprehension of spoken language.

Social skills: Are determined by the ability to engage in reciprocal interaction with others (either verbally or non-verbally), to compromise with others, and be able to recognize and follow social norms.

Working memory: The ability to temporarily retain and manipulate information involved in language comprehension, reasoning, and learning new information.

How can you tell if my child has problems with self regulation?

If a child has difficulties with self regulation they might:

Be under-reactive to certain sensations (e.g. not noticing name being called, being touched, high pain threshold).

Appear lethargic/disinterested; appearing to mostly be in their 'own world'.

Have difficulty regulating their own behavioural and emotional responses; increased tantrums, emotional reactive, need for control, impulsive behaviours, easily frustrated or overly compliant.

Have tantrums that last for longer than typical

The number of tantrums or behavioural episodes per day is more than typical

Is difficult to discipline

Typical behavioural strategies are ineffective.

Is easily distracted, shows poor attention and concentration.

Has poor sleep patterns.

Loves movement. Seeks out intense pressure (e.g. constant spinning, running around, jumping, crashing in objects/people).

Has delayed communication and social skills, is hard to engage in two-way interactions.

Prefers to play on their own or has difficulty in knowing how to play with other children.

Has difficulty accepting changes in routine or transitioning between tasks.

Has difficulty engaging with peers and sustaining friendships.

What other problems can occur when a child has self regulation difficulties?

When a child has self regulation difficulties, they might also have difficulties with:

Heightened reactivity to sound, touch or movement.

Being under-reactive to certain sensations (e.g. not noticing name being called, being touched, high pain threshold).

Appearing lethargic/disinterested; appearing to mostly be in their 'own world'.

Being easily distracted, showing poor attention and concentration.

Have poor motor skills; appearing clumsy, have immature coordination, balance and motor planning skills, and/or poor handwriting skills.

Have poor sleep patterns

Have restricted eating habits or be a picky eater.

Become distressed during self-care tasks (e.g. hair-brushing, hair-washing, nail cutting, dressing, tying shoe laces, self-feeding).

Love movement so they seeks out intense pressure (e.g. constant spinning, running around, jumping, crashing into objects/people). or

Avoid movement such as avoiding movement based play equipment (e.g. swings, slides etc).

Appear floppy or have 'low muscle tone', tire easily and shows a slumped posture.

Perform tasks with too much force, have big movements, move too fast, write too light or too hard.

Have delayed communication and social skills, is hard to engage in two-way interactions.

Prefer to play on their own or have difficulty in knowing how to play with other children.

Have difficulty accepting changes in routine or transitioning between tasks.

Have difficulty engaging with peers and sustaining friendships.

Display risky behaviours in play.

Flits between play activities, instead of sticking with one long enough to actually engage in it.

Seem less 'mature' than other of the same age.

Being emotionally labile (showing rapidly fluctuating emotion levels in a short time).

What can be done to improve self regulation?

Trialing Management strategies: Trialing and refining the variety of management strategies as not all management strategies work with all children.

Sensory Processing: Enhancing the child's efficient and appropriate response to sensory stimulation through therapeutic intervention.

Social stories: Visually depicted stories which are used to teach children specific social skills that they may find confusing or difficult to understand. The goal of the story is to increase the child's understanding by describing in detail a specific situation and suggesting an appropriate social response.

Role playing: As a means of addressing possible scenarios to teach appropriate ways to act and interact.

Improve language and communication to improve the ability to cognitively regulate better.

Alert (Engine) program to promote self-regulation through sensory and cognitive strategies.

M.O.R.E program implementation using motor components, oral organization, respiratory demands, and eye contact to assist with sensory regulation.

The Wilbarger Protocol (Deep Pressure Proprioceptive Technique sometimes known as the "Brushing" program) is a therapy program designed to reduce sensory or tactile defensiveness and assist with sensory regulation.

What activities can help improve self regulation?

Sensory diet to provide sensory feedback to the body which enables better sensory regulation.These activities might include:

Wheelbarrow walking

Animal walks

Trampolining

Cycling

Swings (forward and back, side to side, rotary)

Rough and tumble play / squishing or sandwiching with pillows or balls.

Wearing a heavy backpack

Weighted items (wheat bag on lap while sitting or heavy blanket for sleep).

Chewy toys

Discrete skills: Activities that have a defined start and end point such as puzzles, construction tasks, mazes, and dot to dots.

Narrowly focused tasks: Sorting, organising and categorising activities (e.g. card games such as Uno, Snap or Blink).

Visual schedules enable a child to see and understand what is going to happen next. Schedules also help people to organise themselves and to plan ahead.

Timers help with transitions as they tell the child how long and when they are going to have to do an activity.Timers also allow us to pre-warn the child when a favoured activity is coming to an end.

Talking/question counters for the over-talkers: For small discrete periods of time where the child is engaged in an activity, provide a series (maybe 5) of talking or question counters. Each time the child talks or asks a question one counter is removed. When the child has no more counters, adults do not respond and the child learns to hold onto questions and when to ask them.

Why should I seek therapy if I notice difficulties with self regulation in my child?

Therapeutic intervention to help the child with self regulation is important to:

Enable the child to reach their full potential.

Assist with the child's ability to regulate for sleep.

School transition may be difficult if they are unable to follow instructions within the educational setting (e.g. classroom instructions, academic task requirements).

Ensure the child is well equipped to manage social situations where they need to play with peers.

Allow the child to cope in busy environments.

If left untreated what can difficulties with self regulation lead to?

When children have difficulties with self regulation difficulties, they might also have difficulties with:

Anxiety and stress in a variety of situations leading to difficulty reaching their academic potential.

Appropraite behaviour, contributing to extreme fatigue as they may have an inability to settle themselves to sleep.

Challenges working in small groups/with others for play or group learning tasks.

Making and keeping friends.

Families of a child experiencing self regulation difficulties are also likely to be negatively impacted through stress and the inability to participate in day-to-day activities due to their child's difficulty coping with change.

What type of therapy is recommended for self regulation?

If your child has difficulties with self regulation, it is recommended they consult an Occupational Therapist.

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Self Regulation - Kid Sense Child Development

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Occupational Therapists assist with self-regulation, which is a person's ability to adjust and control their own energy level, emotions, behaviours and attention.

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Links to a fun quiz on how you self-regulate

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Self-regulation is the ability to adjust or regulate the level of alertness depending on the time of the day and the stimuli presented. For instance the ability to wake up in the morning, become...

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Chapter 4 of a compendium of research from the National Academies Press

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Read "From Neurons to Neighborhoods: An Update: Workshop Summary" at NAP.edu

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From Neurons to Neighborhoods: An Update: Workshop Summary is based on the original study From Neurons to Neighborhoods: Early Childhood Development, which released in October of 2000. From the time of the original publication's release, much has occurred to cause a fundamental reexamination of the nation's response to the needs of young children and families, drawing upon a wealth of scientific knowledge that has emerged in recent decades.

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Scholarly article on interventions to mitigate effects of poverty in early childhood

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"The ... greatest environmental influence on babies"

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The lack of balanced, quality meals during the first years of life have a profound impact on health and development.

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PBS The Secret Life of the Brain - The Baby's Brain (mini).wmv

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Video that explains the biology of trauma

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Video that explains the biology of trauma

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An animated explanation of ACES

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Over the past decade, new research has revealed the link between early trauma and lifelong mental health issues. These discoveries have since revolutionized social work, healthcare, and early education. Policy changes enacted in response to our understanding of the biology of trauma are prioritizing earlier interventions like nurse home visiting services for at-risk families, and an increase in pre-kindergarten programs.

This short animation by Nadja Oertelt is part of The Atlantic's Next America: Early Childhood project, which is supported by grants from the Annie E. Casey Foundation and the Heising-Simons Foundation.

About This Series

Short, animated videos from The Atlantic

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How the Latest Early Childhood Development Research is Steering Policy

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Over the past decade, new research has revealed the link between early trauma and lifelong mental health issues. These discoveries have since revolutionized social work, healthcare, and early education.

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Understand your child better

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These 9 Temperament Traits Will Help You Understand Your Baby

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Bashful baby? Toddler tantrums? Understanding the 9 temperament traits will help you understand your little one's behavior and learn what their temperament really means.

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Healthy Development can be derailed by chronic stress

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Center on the Developing Child at Harvard University

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Learn about toxic stress response; how it differs from two other stress responses, positive and tolerable; and how it can be prevented or even reversed.