The Boy Who Was Raised as a Dog

Author's Note

THE STORIES IN THIS BOOK are all true, but in order to ensure anonymity and protect privacy, we have altered identifying details. The children's names have been changed, as have the names of their adult family members if that information would identify the child. All other adult names are real names, except those identified with an asterisk. Despite these necessary changes, the essential elements of each case are reported as accurately as possible. Conversations, for example, are depicted as recalled and/or as recorded in notes, audio tapes, or video.

The sad reality is that these stories are but a tiny percentage of the many we could have told. Over the last ten years, our clinical group at The ChildTrauma Academy has treated more than a hundred children who have witnessed the murder of a parent. We have worked with hundreds of children who endured severe early neglect in institutions or at the hands of their parents or guardians. We hope that the strength and spirit of the children whose stories we tell in this book, and the many others who have suffered similar fates, come through on these pages.

Preface to the 2017 Edition

ONE LATE AFTERNOON IN THE SPRING of 2001, I was sitting in the Minneapolis-St. Paul Airport listening to my voicemail. I had spent the whole day talking; first to community leaders at a breakfast meeting, then at an all-day training session for clinicians working with maltreated children, and finally, at a meeting with academic colleagues who were hosting my visit. After fourteen hours of talking, the last thing I wanted to do was be on the phone—there were dozens of messages waiting. I decided to return just one call and deal with the rest later.

Maia Szalavitz, a science writer and reporter, wanted to get my thoughts for a story she was writing. Maia and I had spoken before. I liked her; she was very curious, well prepared, asked great questions, and, to the degree possible in the popular press, was accurate with both the context and content of our conversations when she wrote her final story. Unlike most of the journalists I had run into, she always read the key scientific literature related to the stories she was writing—and was willing to read more. She also had a deadline.

I have no recollection of what we talked about, but at the end of the call she said, "You should write a book."

"I've thought about it, but I just don't have time. And the currency of academics is research articles and grants. Although I like to write—maybe someday—but I'm just too busy."

"I can help; we can write it together." And this started a series of conversations that led to our ongoing collaboration and The Boy Who Was Raised as a Dog.

When we started writing, we had no idea how the emerging field of traumatology was about to change, how many people hungered to understand the effects of trauma on the mind and brain, and the tremendous interest that would soon be generated in "trauma-informed" care. We didn't know that the book would be used as a textbook in undergraduate and graduate classes in sociology, neuroscience, psychology, criminology, and many other disciplines.

While we had hoped, of course, to have an impact, we did not expect the flood of responses we got from so many youth and adults who had been affected by trauma and neglect. Parents, teachers, social workers, police officers, military personnel, child welfare workers, juvenile justice officials, judges, coaches, psychiatrists, nurses, psychologists, pediatricians—and just about anyone else who lives or works with individuals experiencing trauma or maltreatment—have contacted us and written or spoken about having read and used concepts from the book in their work.

In the last ten years, awareness of the importance of developmental trauma and "adverse childhood experiences" (now widely known as "ACE's") in mental, physical, and even societal health has spread—almost explosively—from a relatively small group of clinicians and researchers into public systems and to the lay public. Public and private systems in education, child welfare, heath, mental health, juvenile justice, and more are implementing "trauma-informed," "trauma-aware," "trauma-focused," and "ACE aware" initiatives. The Boy Who Was Raised as a Dog has been a useful introduction to many of the core concepts, principles, and practice elements for a "trauma-informed" approach.

But when we started, I didn't really know what I was doing, at least as a writer. Unlike Maia, I had never written a book. We had several discussions about how to put everything together. We decided to use a series of clinical narratives—stories, basically—about patients whose experiences illustrated key concepts about the brain, development, or trauma. We sought a balance between these detailed, individual stories and the teaching of scientific material; we wanted the reader to be engaged and not overwhelmed by either the complexities of the brain or the emotional intensity of a child's painful history. It was a fine line, and, as it turns out, for some readers the intensity or complexity were too much. So please note: if you are reading this book for the first time and have a history of traumatic experience, be aware that it does contain some extremely disturbing material. Pace yourself accordingly.

For most, however, the balance worked. And if, for some moments, the reader was overwhelmed, she could put it down and come back to it later. We sought rhythm in our writing; both in the structure and the prose. I would like to say we were intentional about finding the right "doses" of emotional intensity, which can obviously be a stressor for the reader, and novelty, which can also cause stress. I'd also like to say that we intentionally had the proper pace to allow optimal learning to take place; that we were intentionally creating a resilience-building pattern of stress activation that included moderate, controllable and predictable stress for the reader. But we didn't know as much about those concepts then as we do now.

We both appreciated the beat of language and the power of storytelling but we went by feel—and ultimately, I think we got the balance mostly right. In the new sections we've added to this edition, we will highlight just how crucial the rhythm, "dose," and spacing of experience is for building resilience. In the last ten years, we have come to much better understand these concepts as they apply to development, learning, therapy, parenting, and any other intentional process of changing the brain. But more on that later…

A second major choice in the book was the sequencing of the clinical vignettes.

We felt it was important to present these in roughly chronological order—to reflect the growth of the field and my personal growth as a clinician and researcher over time. My educational experiences in the neurosciences, medicine, and child and adolescent psychiatry occurred in parallel with the growth of the general field of traumatology. Being very developmentally focused, I knew it was always useful to understand "history"—how did this person come to be this way? How did this field come to be this way? Where did this idea come from? It has always been easier for me to understand the present if I knew what had happened in the past.

As we wrote The Boy Who Was Raised as a Dog, I had a rough outline of the key concepts that I felt were important in understanding trauma and maltreated children, as well as the sequence in which I first learned about these ideas and theories during my professional development. With this general structure in mind, we got to work.

Our process involved a set of hour-long interview style phone conversations; I lived in Houston and Maia lived in New York. Roughly once a week we would have an hour-long call in which I would either narrate the clinical work I had done with a client or elaborate on a concept or principle about development or the neurosciences. These interviews were recorded, transcribed and Maia would edit, arrange, and add to these and then send me a copy; then I would revise as well. Through this back and forth process our work together went remarkably smoothly.

After the publication of the book a trickle of positive feedback started. We received emails and letters from readers; many of these shared powerful personal experiences of childhood trauma, some were grateful that the book helped them "connect the dots" in their own lives. Over the years, as the popularity of the book has grown, it has been translated into twelve languages, and as noted above, has been adopted for use all types of classes that cover child development, trauma, and how they affect psychology and physiology.

In addition, the approach to clinical problem solving outlined in The Boy Who Was Raised as a Dog—the Neurosequential Model of Therapeutics (NMT)—has continued to generate strong interest. As we will discuss in more detail in the new final chapter (Chapter Twelve), "A Picture, Not a Label," the growth of this approach has been equally explosive. When we first published this book, my colleagues at The ChildTrauma Academy were the only people trained to use the approach. Today, over 10,000 clinicians are using some version of the Neurosequential Model in their work, directly affecting more than 200,000 clients. We estimate that more than 1,000,000 children, youth, and adults have been exposed to some aspect of the NMT.

We decided to write this updated and annotated version to ensure that The Boy Who Was Raised as a Dog continues to be a useful and accurate resource. In the last ten years, there have been advances in research, practice, program development, and policy related to trauma in childhood. This updated version will 1): correct and clarify content in the original book; 2) expand, elaborate, and update key concepts and principles described in the original and 3) present new and promising directions in these fields.

Again, we had some discussion on how best to accomplish this. The overwhelming feedback we had about the book was positive; the rhythm and balance of the narrative and the science worked well for most people. The science was overwhelmingly still accurate. We decided to leave each chapter fully intact (only making a few corrections in factual content where the data, in fact, has changed). At the end the book, a series of essays related to each chapter have been added to reflect and comment on the key elements in that chapter from our current perspective.

As we write these commentaries, we'd like to imagine sitting with our readers and having a short conversation about what you just read. Sometimes it might be updating you on the most current thinking about one of the key neuroscience concepts presented; in another instance, it may be elaborating on the clinical work or progress related to the issues of the particular case. In all cases, the intent is to enrich, update, and elaborate.

Of course, the process of creating these small sections required that I go back and actually read each chapter. As odd as this sounds, when the book was ultimately published, I never picked it up and read it. Obviously when we were writing—and doing the back and forth revisions—I read each chapter again and again. However, by the time we sent off the final draft for publication, I couldn't stand to even look at it. In some ways, now ten years later, I read each chapter with new eyes. Sometimes I was impressed with how well we explained something; other times, I cringed. I know more now; I have taught about these concepts more—I've learned more from my colleagues and my patients. And I think that we can use that to make the reader's experience more complete.

In keeping with our sequential presentation, we have also added one new chapter at the end of the book, as well as a study guide. This new chapter brings us to the present. We hope that here we can clarify the important core concepts and foreshadow future directions in this field.

The new study guide is adapted from a teacher's book study that I wrote with my colleague Steve Graner, a retired teacher and the Director of our Neurosequential Model in Education (NME) initiative. We hope it will be helpful for anyone who would like to have more structured discussion of the key concepts presented in The Boy Who Was Raised as a Dog and who would like to consider how to use the ideas in it for their interactions and work with children.

Taken together, the updates, the chapter addenda, the new chapter, and the book study guide are intended to ensure that The Boy Who Was Raised as a Dog remains an accessible and up-to-date source for anyone interested in—or affected by—childhood trauma.