NO ONE has to tell a new mother to pick up a crying infant. Or explain the gentle rock that soothes a child. Every father instinctively tosses his little one toward the sky to elicit surprised giggles.

Ground-breaking research with British war orphans in the 1940s was the first clue that such child's play was immensely essential, said Karyn Purvis, a TCU psychology researcher and doctoral student. These studies proved that babies needed more than food and shelter. Without love and attention, children could not develop into functional adults.

The problems neglected or abused children face now have names -- sensory integration and attachment disorders -- and are the focus of Purvis' work.

Just as lack of nutrition causes severe physical disorders, lack of sensory stimulation during early years produces emotionally and mentally dysfunctional people. Human brain development is directly tied to the input we receive through our senses. Everyone knows about sight, sound, taste and touch. Those are the tactile senses. Two others -- vestibular and proprioceptive -- work deep in our unconscious mind but are equally essential for our well-being.

Our vestibular sense, tied to the inner ear, processes information relating to gravity and balance and our location in the world. It is the unifying framework of all other senses. If the vestibular is poorly developed -- or off -- everything else is off.

Proprioceptive input is received through our muscles, ligaments and joints. It is "muscle memory," the sense that allows us to walk down steps without looking, to tie a shoe with our eyes closed, hit the ball sailing out of the pitcher's hand. It tells us about body position and how we fit together, connects left with right.

Put a kink in either of these sensory systems and the brain won't process information, the person won't think or act normally. Imagine a computer with glitches in the software. It looks fine until you try to enter or recall information you know you already put in there.

Thus, the thousands of times an infant is picked up, rocked side to side or swung high into the air is not only practical and natural in terms of care giving, it is essential to cognitive and emotional development. Leave a child in a crib for days or weeks or months and that child's hard wiring shorts out, or never develops.

Speaking of a lack. In the thirteenth century, Frederick II, German King, King of Sicily and Emperor of the Holy Roman Empire, wanted to know what language children, if deprived of any verbal influence, would speak as they grew. He took a group of infants from their mothers and ordered they be raised by caretakers who provided food and shelter but were forbidden to speak in their presence. He never found out. None of the children in this bizarre experiment ever spoke a word, all having withered and died from lack of connection to the world they were born into.

Sensory integration (SI) dysfunction, then, is a failure of the central nervous system. It keeps people from analyzing, organizing or connecting sensory messages -- and from behaving in an organized or rational way. As children grow, this dysfunction directly affects cognitive thinking and emotional maturity.

An unusually high or low level of activity, impulsiveness, distractibility, high frustration and self-regulation problems are a direct result of early years of deprivation. It's not that these children won't cooperate, it's that they can't.

EACH FAIR-WEATHER day at the Romanian orphanage the children spend several hours in the maze of hidden dangers they call the yard. Sheets of jagged aluminum wrapped around old pipes hang at face level, large holes dug for incomprehensible reasons wait to swallow unsuspecting toddlers. Bits of broken glass lie like land mines, rocks and cracked concrete and sticks become chew toys for little ones not properly supervised. Yet the staff, for the most part, seems unconcerned, even though the toddlers in this yard have, effectively, 54 brothers and sisters. Ten or more 2-year-olds per caregiver.

The crying eventually becomes white noise. Always someone. One little dark-haired fellow, close to age 3, spends his days terrorized by two other boys. Each toy he picks up immediately becomes the property of another. With a screech of anger, the bullied boy throws himself to the ground, over and over again, screaming to the sky. The caregiver glances that way but never sees the incident so ignores them both. Neither the screamer nor the bully are given guidance. So the game continues unabated all day.



 
A small toddler in a bright dress and a foul-smelling diaper sat on the ridge of a former ditch in the hot sun for two hours, rocking, occasionally putting some dirt in her mouth. No one bullied her. No one spoke to her. She made no noise. When outside time ended, she was pulled to her feet by the arm, called by name by a friendly voice and walked back into the building. She would soon be changed and washed up, fed and placed in her bed or on the floor. She has shelter, food, clothing.

Attachment disorder is a physical and emotional impairment that short circuits a child's ability to connect with others. They cannot return love because loving behaviors are associated with fear or pain because of prior abuse and neglect. The inability to trust manifests itself in many forms: severe control issues, manipulative and oppositional behaviors, dislike of praise or gifts and behaviors that sabotage close relationships.

This is not just an emotional need, it is a physical dysfunction, said Lyda Simmons, PhD '82, a North Richland Hills therapist who specializes in sensory and attachment disorders.

"These children's brains are altered from the abuse and neglect," she said. "And the first step to helping them is admitting that there is a neurological problem."

Newborn brains contain masses of neurons that must connect as the child grows. After birth, the brain begins a natural pruning process -- what is used remains, what's unused is trimmed. If there's no touch, taste, voice or mimicking, many necessary connections are trimmed.

Children with severe attachment disabilities are on a sure trajectory for sociopathic behaviors -- antisocial activities, mental illness, suicide and juvenile and criminal problems unless there is intervention, Purvis said. Many, like Dmitri, are already on anti-depressants or anti-psychotic drugs.

"Data indicates that these children behave like this because of the attachment disorder," she said. "A child who has never been connected to anyone lacks moral development because it hinges on I care about you and don't want to hurt you, while social development follows on You are responsive to me, I want to be responsive to others." 

A touching moment. Karyn Purvis takes a moment with Dmitri and a fellow camper for a hug.

Children with attachment disorder develop strong survival behaviors though their normal cognitive development is usually markedly delayed, Purvis said. A large part of their energy goes toward self- preservation -- Am I going to get some food? Are my needs going to be met? Is anyone going to take care of me?

They appear mystically charming to most of the world but are setting the cat on fire or terrorizing their siblings at home. There is a core group of traits -- stealing, lying about the obvious, cruelty and food issues. The children appear to connect to everybody, but it's all superficial, manipulative.

These are not malicious behaviors, they are survival skills. These children just are not attached.

The Whites were told Dmitri was a house favorite. More likely they just wanted to get rid of him. People always want to get rid of the bully.

Even with his limited experience, Dmitri knew something was going to change in his life, he was leaving, whatever that meant. When it was time to go, the workers told him to say good-bye to the others. He refused, but they insisted and sent him into a room of children. Like the parting of the Red Sea, the children scattered as he strode into the mass, shoving some and heading for one boy. A quick hug to the only one he believed deserved this sentiment and Dmitri turned and walked toward the Whites. He never looked back.

Carol watched her new son and thought, "This kid's a survivor. This is how he's made it through this."

And Mike's thoughts?

"Uh, oh."

CHILDREN RAISED in institutions seem to develop a remarkable capacity for figuring things out, putting things together, Purvis said, which translates to a remarkable ability for lying and stealing and manipulating other people. And though some of these children test with a genius I.Q., they have horrific attention deficits and emotional and social deficits.

That sort of behavior was dominant in the children at Camp Celebration this summer, Purvis said. A joint project between the TCU psychology department, the Parent's Network for Post-Institutionalized Children and the Child Study Center in Fort Worth, Camp Celebration was a pilot project, the first of its kind in the nation, designed to study and treat children with sensory and attachment disorders, primarily children from foreign orphanages.

Finding safe haven. Camp Celebration provided an environment that allowed children damaged by early years of neglect and abuse to recover a sense of security and begin to heal.

A lot of enthusiasm went into the planning, but even the optimistic Purvis said they didn't expect a whole lot going in. What they found left them slack-jawed.

"We had three children who went into spontaneous regression; that is they went back to infantile behaviors that they missed or were denied in the orphanages," she said. "It appears that what they got at camp allowed them to organize their thinking enough to regress to a time when they needed to bond to someone but couldn't, but this time there was a loving parent at home and they connected."

Marked, nearly miraculous advances in the children's emotional and cognitive behaviors followed. Several moved from two-word to complex sentences, from total detachment from families to the beginnings of loving, trusting connections. Camp results were dramatic testimony of the resilence of these children's minds and their ability to relearn, Purvis said.

Children who leave the orphanages before age 2 appear to have a better chance at adjustment. Longer than that and the brain continues to prune until the children develop a form of institutional retardation or autism.

"Some of those who were adopted at say, 7 or 8, present as retarded," Purvis said. "You would see them and say they must have had some damage at birth."

One boy at camp hoarded food and stole it from the other children even though there is an abundance in his life now. His parents had stocked his room with food, including a special kind of chocolate he used as a comfort food. It was his attachment substitute. Near the end of camp his mother reported that the boy brought her the chocolates and announced she could have them. He didn't need them anymore.

He then lifted one from the box and placed it in her mouth. "The mother was in tears," Purvis said. "This was so remarkable that he would offer her something, feed her something and touch her in the process."

Until then, the cognitive aspect -- I know I have enough food -- was less powerful than the hunger that was built into his emotions.

One of the most startling discoveries for the camp researchers was the direct relationship between sensory input and attachment disorders.

"The importance of that is something no one has evaluated yet," Purvis said. "But think about this, if I'm a mother of a newborn, within 15 minutes of birth he's laid in my arms, feels my hands, my warmth, my touch, hears my voice, he sees my face, feels the vibrations of my voice and heart, tastes the milk.

"Attachment can be defined as a sensory experience. These children are born, swaddled in a tight blanket and laid in a crib and somebody props a bottle up every four hours a day for two years. As the child gets older the mush gets a little thicker and the hole in the bottle gets a little bigger."

Purvis tears up at the thought.

"We took these children who have been in that kind of environment, where they missed the message of the first year -- someone will take care of my needs -- and put them in a sensory- and attachment-rich environment where they could pick that up." Dmitri's inability to bond to the Whites has had a chilling effect on the whole family.

"His attachment disorder keeps him from bonding to us," Mike noted, "But whether he knows it or not, he's kept us from bonding to him, it's a two-way street."

The problems reached critical just before camp. The Whites, emotionally bankrupt, were ready to give up on the disturbed little boy. Three weeks of camp not only gave them a chance to re-establish normality with the other two children, it somehow effected a marvelous change in Dmitri.

"He was saying one word, maybe two before, but something at camp really clicked in his brain, as if a pathway opened," Carol said. "I wish I knew why, but his vocabulary exploded, he began to speak three- and five-word sentences, he began to articulate really complex issues, and he suddenly understood things he hadn't had a clue about before."

Crash and Bump. The daily crash and bump activity was not only fun, it was critical sensory input for children starved for such stimulation.

To build on the advances made at camp, the Whites are following the advice of Dmitri's therapist and "belt-looping" mother and son. Belt-looping is a radical therapy proposed by Dr. Ronald Federici, an internationally recognized neuropsychologist and attachment expert. To facilitate bonding, Federici suggests the belt-looping, in effect keeping the child within several feet of a parent to control their environment 24 hours a day until bonding and healing begins. Carol has put her business up for sale to practice this therapy.

Carol said one of the biggest challenges has been to get the people around Dmitri to understand why their parenting seems so out of the ordinary.

"Nobody understands what attachment disorder really is," she said. "It's hard because he selects people to superficially warm up to, and they say he's wonderful. We see it as manipulation and want to keep him away, but the family doesn't see this, they say 'We saw a normal kid, why are you acting this way?' He's able to separate the extended family from you, which you need very much for support."

Psychology Prof. David Cross, who oversees the day camp and research, said they hoped for some minuscule changes in the campers and accepted that there might be none. They were completely unprepared for what they found.

"I interviewed six or eight of the families from the first group at the end, and it was really dramatic. In two of the cases, the parents completely broke down in tears of joy," he said. "The impact on their family was monumental. And in two of those cases they had already started the paperwork to let those kids go.

"The question is not did something happen?" he said. "But Why did it happen?"

Effecting permanent change in children so damaged will take much longer than three weeks. But it is a start. The Whites feel guarded encouragement but admit they would never have brought problems like Dmitri's into their family knowingly. Had they been better informed, they would have followed a different path.

Better information is one goal of legislation proposed by Sen. Jesse Helms. This fall, Federici presented data from Cross' and Purvis' reseach and the camp before a Senate subcommittee dealing with this issue.

An aide at Helms' office said the bill would require all agencies dealing with foreign adoptions to be accredited. Part of the accreditation would require six weeks of pre-adoption training for all prospective parents, as well as follow-up support for the families.

TCU's pioneering efforts in treatment will put it in a position to help with that training and support, Cross said.

"There are few really dramatic things in psychology, in terms of theory or interventions," he said. "When drugs were discovered to treat schizophrenia or depression, that was big. One of the most recent was the treatment for autistic kids. That is a tremendous success story.

"I think this is going to be the next success story."

Federici praised the camp program, acknowledging that it is a first-of-its-kind.

"It is a model of dealing with the very disturbed Eastern European child," he said. " Actually, I think the camp program should serve as a model for other intensive treatment programs for these children, as so many families waste their time and money in nonproductive therapies."

The need is likely to become immense. Statistics show that of the children coming from overseas, one-third will adjust well, one-third will need some help and one-third may never recover. That means that more than 10,000 children will arrive in this country each year with at least some need for professional counseling and help.

Creating a consortium in Fort Worth that will provide service, training and reseach for post-institutionalized children and their familes is the ultimate goal, Cross said.

"TCU can't do it all by ourselves, but we can facilitate the process," he said. "This is an area that has a lot of exciting potential, and TCU has a lot of resources -- the School of Education, Miller Speech and Hearing, Harris School of Nursing and the Starpoint School.

"We're going to make it happen one way or another.

LIFE WITH DMITRI will continue to be a challenge, the Whites know that. They glean as much pleasure as they can from the small advances and try to imagine a better day. But they won't give up.

Happier days. The Whites after camp: Lauren, Mike, Dmitri, Carol and Chris.

"He's here and I will work with him until my dying day," Carol said. "In my heart, he is my child. I could have had a birth child with a problem. He's disabled, you just can't see his disability.

"He's here, he's in this family, and he's staying."

A celebrated camp

As expected, younger children showed more marked results, though behavioral changes were also noted in the older group.

Preliminary camp data reflects an average 31.1 percent decrease in attachment deficit behaviors at the end of the camp. The children ages 4 to 8 showed an average 41.2 percent decrease; the children 10 to 13 showed an average 21 percent decrease. Overall, the children also showed a 19 percent increase in positive attachment behaviors. Each of the camp counselors -- TCU graduate and undergraduate students -- attended three days of training by nationally recognized experts in the field of sensory and attachment disorders.

Planning for next summer's camp has already begun, and lessons learned this year will be incorporated into the new curriculum and training. Purvis and Cross hope to obtain grant monies that would allow expansion of the camps, eventually developing the program into a comprehensive center for training, treatment and research.