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November 2010 CTA Newsletter
CTA Welcomes New NMT Partner Site
Failure to Thrive: Psychosocial Dwarfism


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One word seems to define The ChildTrauma Academy this fall - growth.  We are expanding our list of NMT Partners and our group of Fellows, growing the impact of our website and social media, and developing new assessment and educational tools.  And while growth always meets with new challenges, we are resolved to stay at the forefront of research and innovative thinking with regard to helping traumatized and maltreated children and their families.  Read more in this month's newsletter about one of our new partners.  In future months we will update you on the progress of our web-based NMT metrics and brain-mapping process which has been in beta testing this fall.

CTA Welcomes New NMT Partner Site - Cal Farley's Boys Ranch

Last month, the CTA began exciting work with our newest NMT Partner Site - Cal Farley's Boys Ranch in Amarillo, Texas.  "Cal Farley's is one of America's largest privately-funded child and family service providers, specializing in both residential and community-based services
at no cost to the families of children in their care."  "Cal Farley's Boys Ranch is a modern community of boys and girls who have found 'a shirttail to hang onto'.
  In a nurturing, structured environment, boys and girls from pre-school through high school live in group homes with house parents and a supportive community." 
   The Boys Ranch focuses on integrating children into a functional family setting as well as a broader community environment; the Ranch itself is a "self-contained community complete with its own school district, post office, bank and government-type services such as fire and public safety."  They work to develop close, trusting relationships as well as a sense of belonging and purpose for each child.  Dr. Perry had a two-day visit to the Ranch and came away very impressed with the infrastructure, the staff and the children.  He sends a special thanks to Joe, his excellent and well-informed tour guide while at the Ranch. 
    We are all excited to be working with Cal Farley's and look forward to a mutually beneficial learning exchange with them.Cal Farley logo
For more about Cal Farley's, visit their website
Failure to Thrive: Psychosocial Dwarfism

Failure to Thrive (FTT), or the dramatic deceleration of appropriate weight gain, delays in height gain, and associated developmental delays (e.g., cognitive and social), occurs in anywhere from 1 to 20 % of children under age five, depending on diagnostic criteria. A child who weighs less than 70% of his/her expected weight is considered a medical emergency, and most children with FTT weigh less than 80% of their expected weight. Causes of FTT are often multi-factorial.  FFT due to neglect and/or maltreatment is also referred to as Psychosocial Dwarfism.

In a set of classic papers in 1967, Powell and colleagues described a group of children with growth retardation and a neuroendocrine profile that mimicked idiopathic hypopituitarism.  The unique characteristic of this group of children was their emotionally abusive caregiving environment.  In 1977, John Money described a similar set of children and coined the phrase "psychosocial dwarfism."  A simple review of the characteristics of these children sounds familiar to any clinician working with severely negelected children: he described : "(1) a history of unusual eating and drinking behavior, reversible on change of domicile, such as eating from a garbage can and drinking from a toilet bowl, stealing food, alleged picky eating and rejecting food at the table, polydipsia and polyphagia, possibly alternating with vomiting and possibly also with self-starvation; (2) a history of such behavioral symptoms as enuresis, encopresis, social apathy or inertia, defiant aggressiveness, sudden tantrums, crying spasms, insomnia, eccentric sleeping and waking schedule, pain agnosia, and self-injury, all occurring only in the growth-retarding environment; (3) retarded motor development, with improvement on removal of the child from the domicile of abuse; (4) retarded intellectual growth, reversible on change of domicile by as much as 30 to 50 IQ points; and (5) a history of pathologic family relationships, including unusual cruelty and neglect, either somatic or psychic or both."

                  By 1984, Green and colleagues again reviewed the evidence connecting developmental neglect and trauma with significant neuroendocrine and growth problems - and again concluded that the growth retardation and unusual neuroendocrine findings in these children was independent of malnutrition.  Yet despite a long heritage of excellent work in this area, published in well-established journals (e.g., New England Journal of Medicine), most physicians continue to be uniformed about the fundamental neuroendocrine, emotional and behavioral problems associated with severely neglected children.

Evidence of child neglect and/or maltreatment's effect on physical growth is robust. Negative parenting (e.g., lack of attention, physical stimulation) has been shown to decrease growth in primates, indicating that psychosocial experiences can affect biological processes. In the original case series of psychosocial dwarfism, putting the children in emotionally supportive and consistent environments reversed growth retardation and the neuroendocrine findings. In more recent studies, children removed from emotionally and physically under-stimulating orphanages before one year of age, who then enter more positive environments, improve dramatically. Even long-term effects (e.g., cognitive effects) become minimal (Johnson et al., 2010).

Unfortunately the long-term effects of untreated neglect-related FTT are pervasive and multi-domain.  Neglect of this magnitude will alter normal development and functioning in all areas of neural functioning. In general the longer the child is in the depriving environment the more pervasive and resistant to reversal are the adverse effects.  Cognitive defects are common and include inability to obtain higher order language or reasoning skills. These cognitive deficits impact the child's ability to logically reason or interact with others. Physical effects such as gastrointestinal problems and disorders related to malnutrition (e.g., marasmus) are also common. The most common consequences, however, and the most resistant to treatment, are the effects of severe early neglect on relational functioning.   

To learn more about FTT and the impact of severe early neglect, visit the CTA website.


Green, W.H., Campbell, M. & David, R. (1984) Psychosocial dwarfism: A critical review of the evidence. J. Amer. Acad. Child Psychiatry 23: 39-48

Johnson, D. E. et al. (2010) Growth and associations between auxology, caregiving environment, and cognition in socially deprived Romanian children randomized to foster vs ongoing institutional care. Archives of Pediatric and Adolescent Medicine, 164, 507- 515.

Money, J. (1977) The syndrome of abuse dwarfism (psychosocial dwarfism or reversible hyposomatotropism): Behavioral data and case report Am J Dis Child. 131(5):508-513

Powell, G.F., Brasel, J.A. & Blizzard, R.M. (1967a) Emotional deprivation and growth retardation simulating idiopathic hypopituitarism. I  Clinical evaluation of the syndrome. New Eng. J. Med 276:1271-1278

Powell, G.F., Brasel, J.A., Raiti, S. & Blizzard, R.M. (1967b)  Emotional deprivation and growth retardation simulating idiopathic hypopituitarism.II Endocrinologic evaluation of the syndrome. New Eng. J. Med. 276: 1279-1283.

CTA News
CTA Welcomes Second Class of NMT Individual Certification Participants

This fall CTA welcomes its second class of 17 individuals participating in NMT Certification Training, Phase I.  We are pleased to have joining us:

          Maribela Arruda, M.Ed., CCC, RPT - Fort Vermilion, Alberta
          Jody Bekhuys, M.Ed., R.C.C. - Kelowna, British Columbia
          Scott Chausse, M.A., LPC-I - Grand Junction, CO
          Kay Dechairo, M.A., LPC - Fort Collins, CO
          Lydia Hantke - Berlin, Germany
          Diane Kukulis, ACSW, LMSW - Saginaw, MI
          Deanne Leung M.Ed., R.C.C. - Kelowna, British Columbia
          Jeannie Lockinger - Staunton, VA
          Lois Neace, LSCWS - Wichita, KS
          Renee Potgieter-Marks, Ph.D. - England
          Kimberly Schellenberg - Fort Vermilion, Alberta
          Lisa Schwab - Peoria Heights, IL
          Shirley J. Smith, M.S., LCMFT, RPT - Wichita, KS
          Kim Viljoen - Vancouver, BC
          Kelly Winters, MA, LPC - Fort Collins, CO
          Zohreh Zarnegar - San Juan Capistrano, CA

Read more about all of our Individual Certification participants on our NMT Partner Page.

Two New Upcoming Training Series

Winter 2011 NMT Case-Based Training Series - Begins January 7, 2011

          We are currently accepting applications for our Winter 2011 NMT Training Series.   This training experience is part of an ongoing clinical care conference series offered by the CTA.  This teaching model has been useful for helping clinicians and front-line staff better understand the neurodevelopmental principles involved in many of the primary symptoms as well as strengths in the children they serve.  This practical teaching model provides an opportunity for ongoing capacity building within an institution or for individuals.
          We recommend this series as a complement to any more intensive training/program development projects that our partners have with the CTA. However, individual and institutional participation does not require any other program development activities or projects with the CTA and can serve as a good introduction to viewing maltreated and traumatized children through the "lens" of neurodevelopment.

See 2011 Winter Schedule & Enroll here.

CTA/Take Two NMT Case-Based Training Series - AUSTRALIA - Begins Jan. 13, 2011

        This winter we are very pleased to offer an NMT Training Series especially for those of you in Australia.  Co-sponsored by Take Two, Berry Street, this series will follow our usual case-based model and be conducted via the internet.  However, these sessions will take place at NOON EST (MELBOURNE) - a new convenience for participants in this region of the world.  The training sessions will also be recorded for more convenient viewing.  This series is also open for participants outside of Australia. 

See 2011 AU Schedule & Enroll here.
One final update: In order to spread the word about our upcoming trainings, we will now be posting each as a CTA Facebook event.  Our fans will receive specific information about each of our trainings approximately one month in advance.  If you'd like to receive these notifications, become our Fan!

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Bruce D. Perry, M.D., Ph.D.
The ChildTrauma Academy