What Traumatized Children Need Most

Most Therapeutic Experiences Don't Take Place in Therapy

Bruce Perry and Maia Szalavitz

Inside the Branch Davidian compound in Waco, Texas, children lived in a world of fear. Even babies were not immune: cult leader David Koresh believed that the wills of infants—some just eight months old—needed to be broken with strict physical discipline if they were to stay "in the light." Koresh was mercurial: one moment kind, attentive and nurturing, and the next, a prophet of rage. The Davidians, as the members of the Mount Carmel religious community were called, became exquisitely sensitive to his moods as they attempted to curry his favor and tried, often in vain, to stave off his vengeance.

With his volatile temper and fearsome anger, Koresh excelled at using irregular doses of extreme threat—alternating with kind, focused attention—to keep his followers off balance. He maintained an iron grip, controlling every aspect of life in the compound. He separated husband from wife, child from parent, friend from friend, undermining any relationship that could challenge his position as the most dominant, powerful force in each person's life. Koresh was the source of all insight, wisdom, love and power; he was the conduit to God, if not God himself on earth.

I came to Texas in 1992 to become the vice chairman for research in the department of psychiatry at Baylor College of Medicine (BCM) in Houston. I also served as chief of psychiatry at Texas Children's Hospital (TCH) and director of the Trauma Recovery Program at the Houston Veterans Administration Medical Center (VAMC). My past experiences at a residential center had convinced me that we did not know enough about trauma and its effects on children's mental health. We did not know how trauma during development produced particular problems in particular children. The only way to figure this out, it seemed, was to closely study groups of children immediately after a traumatic event. Unfortunately, children were usually brought to us for help only years after they had suffered trauma, not right away.

It was to attempt to solve this problem that I, in coordination with BCM, TCH and VAMC, put together a "rapid response" Trauma Assessment Team. It was our hope that while helping children cope with acute traumas like shootings, car accidents, natural disasters and other life-threatening situations, we could learn what to expect from children in the immediate aftermath of a traumatic experience and how this related to any symptoms they might ultimately suffer. The children of Waco would provide one unfortunately apt sample to study.

On February 28, 1993, the Bureau of Alcohol, Tobacco and Firearms (BATF) came to the Branch Davidian compound to arrest David Koresh for firearms violations. He would not allow himself to be taken alive. Four BATF agents and at least six Branch Davidians were killed in the ensuing raid. The FBI and its hostage-negotiation team managed to secure the release of twenty-one children over the following three days. It was at this point that my team was brought in to help with what we thought would be the first wave of children from the compound.

When I arrived in Waco I found disarray, both in the official agencies responding to the crisis and in the care of the children. During the first few days, when the children were released, they were driven away from the compound in large tank-like vehicles. No matter what time of day or night it was when they came out, they were immediately interrogated by the FBI and the Texas Rangers, often for hours. The FBI had the best intentions; they wanted information quickly so that they could help defuse the situation at the Ranch and get more people out safely. But no one had thought through how overwhelming it would be for a child to be taken from his parents, put in a tank after witnessing a deadly raid on his home, driven to an armory and questioned at length by numerous armed, strange men.

We immediately recognized that we had a group of children that had essentially been marinated in fear. The only way we could get them the help they needed was to apply our understanding of how fear affects the brain and then consequently changes behavior.

Fear is our most primal emotion, and with good evolutionary reason. Without it few of our ancestors would have survived. Fear literally arises from the core of the brain, affecting all brain areas and their functions in rapidly expanding waves of neurochemical activity.

The brain evolved from the inside out, and it develops in much the same order. The lowest, most primitive region—the brainstem—completes much of its development in utero and in early infancy. The midbrain and limbic systems develop next, elaborating themselves exuberantly over the first three years of life. Parents of teenagers will not be surprised to learn that the frontal lobes of the cortex, which regulate planning, self-control and abstract thought, do not complete their development until late in adolescence, showing significant reorganization well into the early twenties.

The fact that the brain develops sequentially—and also so rapidly in the first years of life—explains why extremely young children are at such great risk of suffering lasting effects of trauma: their brains are still developing. The same miraculous plasticity that allows young brains to quickly learn love and language, unfortunately, also makes them highly susceptible to negative experiences as well. As a result different symptoms may result from trauma experienced at different times.

At any age, however, when people are faced with a frightening situation their brains begin to shut down their highest cortical regions first. We lose the capacity to plan, or to feel hunger, because neither are of any use to our immediate survival. Often we lose the ability to "think" or even speak during an acute threat. We just react. And with prolonged fear there can be chronic or near-permanent changes in the brain. The brain alterations that result from lingering terror, especially early in life, may cause an enduring shift to a more impulsive, more aggressive, less thoughtful and less compassionate way of responding to the world.

During my first two days in Waco I began the delicate task of individually interviewing each child to try to get useful information to help the FBI negotiators defuse the standoff. To my horror, every child gave me the distinct sense that they had a big, terrible secret. When I asked what was going to happen at the Ranch, they would say ominous things like, "You'll see." Every child, when asked explicitly where his or her parents were, replied, "They're dead," or, "They're all going to die."

It is not unusual for children to be deceptive or withholding or to purposefully lie in order to avoid things they do not want to share, especially when they have been instructed to do so by their families. However, it is far more difficult for them to hide their true thoughts and feelings in their artwork. And so, with each child old enough to color, I sat with him and colored as we talked. I asked one ten-year-old boy named Michael, who was one of the first children interviewed, to draw me a picture of whatever he wanted. He went to work quickly, producing a fine unicorn surrounded by a lush, earthly landscape of forested hills. In the sky were clouds, a castle and a rainbow. I praised his drawing skills and he told me that David loved it when he drew horses. He had also received kudos from the group and its leader for his renditions of heavenly castles and the incorporation of the group's symbol into his drawings: the star of David.

Then I asked him to draw a self-portrait. What he drew was virtually a stick figure, something that a four-year-old could produce. Even more shockingly, when I asked him to draw his family, he paused and seemed confused. Finally, he created a page that was blank but for a tiny picture of himself, squeezed into the far right-hand corner. His drawings reflected what he had learned in the group: the elaboration of things that Koresh valued, the dominance of its supreme leader, a confused, impoverished sense of family and an immature, dependent picture of himself.

Inside the compound almost every decision—from what to eat and wear to how to think and pray—had been made for them. And, just like every other area in the brain, the regions involved in developing a sense of self grow or stagnate depending upon how often they are exercised. To develop a self, one must exercise choice and learn from the consequences of those choices; if the only thing you are taught is to comply, you have little way of knowing what you like and want.

Working with the Davidian children—and seeing the unfolding crisis in Waco from the inside—repeatedly reiterated to me how powerful group influences are in human life and how the human brain cannot really be understood outside of its context as the brain of a member of a highly social species.

Now, fourteen years later, we have had various opportunities to follow the Davidian children—all informal. We know that all of them have been permanently and profoundly affected by what occurred. About half left to live with relatives who still believed in Koresh's message, and some still follow the religion in which they were raised. Some have gone on to college and careers, and have had their own families; others have led troubled and chaotic lives.

There were inquiries, Congressional hearings, books, exposes and documentaries. However, despite all this attention, it was still only a few short months before interest in these children dropped away. There were criminal trials, civil trials, lots of sound and fury. All of the systems—CPS, the FBI, the Rangers, our group in Houston—returned, in most ways, to our old models and our ways of doing things. But while little changed in our practice, a lot had changed in our thinking.

We learned that some of the most therapeutic experiences do not take place in "therapy," but in naturally occurring healthy relationships, whether between a professional like myself and a child, between an aunt and a scared little girl or between a calm Texas Ranger and an excitable boy. The children who did best after the Davidian apocalypse were not those who experienced the least stress or those who participated most enthusiastically in talking with us at the cottage. They were the ones who were released afterwards into the healthiest and most loving worlds, whether it was with family who still believed in the Davidian ways or with loved ones who rejected Koresh entirely. In fact, the research on the most effective treatments to help child trauma victims might be accurately summed up this way: what works best is anything that increases the quality and number of relationships in the child's life.

I also saw how bringing disparate groups together—even those with conflicting missions—could often be effective. Dozens of state, federal and local agencies had worked together to care for these children. The power of proximity—spending time side-by-side—had pulled us all to compromise in our efforts to help.

Relationships matter: the currency for systemic change was trust, and trust comes through forming healthy working relationships. People, not programs, change people. The cooperation, respect and collaboration we experienced gave us hope that we could make a difference, even though the raids themselves had ended in such catastrophe. The seeds of a new way of working with traumatized children were sown in the ashes of Waco.


This blog is excerpted from "Stairway to Heaven" by Bruce Perry and Saia Szalavitz. The full version is available in the March/April 2007 issue, The Networker 25th Anniversary Issue: Featuring the 10 Most Influential Therapists.

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Topic: Children/Adolescents | Trauma

Tags: 2007 | brain | brain functions | brain research | child trauma | childhood trauma | childhood traumas | Children | Children & Adolescents | early childhood trauma | kids | mental trauma | post traumatic stress | post-traumatic stress disorder ptsd | PTSD | PTSD diagnosis | ptsd research | ptsd symptoms | ptsd treatment | retraumatization | the brain | treating ptsd

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1 Comment

Tuesday, July 25, 2017 7:41:12 AM | posted by Anne
Very hopeful with so much understanding growing about trauma and childhood. The ACES study shows clearly the work to be done. But i still remain baffled how we can talk about trauma and children while we continue to circumcize our infant boys. Day 2 usually if their lives. The Canadian study of 1997 was stopped due to heart rates and breathing patterns that indicated these babies wrre experiencing torture. How can this not be on the forefront of any healing professional who understands that affects of trauma. I dont even think the ACE study included circumcision? This early trauma alters potential and carries significant personal and social consequences. We must get out of denial on this if we are ever going to live in peace. Informed consent and the Hippocratic Oath: First Do No Harm.