The Boy Who Was Raised as a Dog: And Other Stories from a Child Psychiatrist's Notebook

Content Warning: This section of the guide includes discussion of child abuse, emotional abuse, child sexual abuse, graphic violence, and death.

Perry and Szalavitz demonstrate that the developing brain’s architecture is fundamentally shaped by the frequency and pattern of neural activation, a principle Perry terms “use-dependent” development. This neurobiological concept reveals that repeated experiences affect brain structure, with frequently activated systems growing stronger while neglected systems atrophy. Through his clinical work with traumatized children, Perry illustrates how this principle explains both the devastating effects of chronic trauma and the potential for therapeutic intervention through carefully structured experiences.

Perry’s work with over 100 boys at a residential treatment center provides evidence of how chronic trauma creates maladaptive neural patterns through repeated activation of stress response systems. These children, most of whom had experienced at least six major traumatic events, displayed symptoms that traditional psychiatry labeled as attention deficit disorder or oppositional defiant disorder. However, Perry recognized that their hypervigilance and aggression resulted from overactive stress systems that had been repeatedly triggered during their developmental years. As Perry explains, “If a system is overloaded—worked beyond capacity—the result can be profound deterioration, disorganization, and dysfunction whether you are overworking your back muscles at the gym or your brain’s stress networks when confronted with traumatic stress” (41).