Chapter 2: For Your Own Good

I found Perry's explanations of the "use-dependence" function of our brains and his arguments against children being wholly "resilient" to trauma quite helpful. The way he explained that young children are often more deeply affected by persistent and intense traumatic experiences than are adults because they are relatively powerless and vulnerable reframed the “resiliency” argument nicely for readers. Even though CPS, the court, and Sandy’s guardian-at-litem did not have this information about trauma’s impact on the brain at the time, I was deeply shocked at their hope for Sandy to testify against the man who raped and murdered her mother and slit her throat. No one appeared to have this young girl’s psychological or physical health in mind, nor did they consider the devastating impact that testifying in front of her attacker would have on her in both the short- and long-term. I was relieved that Perry decided to take her case and once again was thoroughly impressed with how he established a strong alliance with her by allowing her to guide their play and her own treatment and how he advocated for her within multiple systems.

It was surprising that Perry had chosen to prescribe Clonidine to the boys at the residential treatment facility, especially after his decision to not medicate Tina after his supervisor's suggestion in the first chapter. While it seemed that this medication was helpful for these young patients who were exhibiting symptoms of PTSD, I wondered about the impact that the long-term and possibly unsupervised use of this medication would have on these boys’ developing brains. I thought about our brief discussion in class about the use of medication with children. While Perry seemed to have thoroughly contemplated the potential consequences of Clonidine, I wondered about the quality of therapeutic care/follow-up at this RTC and whether the staff working with these patients were using trauma-informed practices and interventions to supplement the use of this medication. While this medication seemed to “level the playing field” for these young residents to benefit from any treatment that was being provided, I wish Perry had given us more information about any of the long-term therapeutic outcomes for these patients.

Even though I was skeptical of this decision, Perry’s discussion of the absence of differential diagnoses for these young patients is a timely one, even decades later. Children and adolescents are often still diagnosed with ODD, ADHD, and conduct disorder based on their behavior in school settings, with peers, and at home, without consideration of other external dimensions that may help explain their behaviors and responses to stimuli (i.e. violence at home, essential needs for shelter, sleep, food, care, or consistency not being met, exposure to traumatic events, etc.). Clinicians and doctors who work directly with children may still be hesitant to include PTSD in their differential diagnosis list possibly due to the stigmatizing nature of this diagnosis and the complexity that comes with treating and managing PTSD symptoms (although a diagnosis of ADHD or ODD can be just as stigmatizing and can follow a child throughout their young life). While I think a paradigm shift is occurring around the importance of identifying the symptoms of PTSD and providing trauma-informed care, this shift may take longer than Perry initially expected.