JOINING FORCES
Joining Families
Volume 10, Issue 3 " January 2008
REAL WORLD RESEARCH FOR FAMI L Y ADVOCACY PROGRAMS
FEATURED I NTERVI EW
Healthy Families, Healthy Communities
An Interview with Bruce D. Perry, MD, PhD, by James E. McCarroll, PhD
Dr. Perry has conducted both basic neuroscience
Bruce D. Perry, MD, PhD
and clinical research. His focus over the last ten
Bruce D. Perry, MD, PhD is the Senior
years has been integrating concepts of develop-
Fellow of The Child Trauma Academy, a non-
mental neuroscience and child development into
profit organization based in Houston, Texas,
clinical practice. Dr. Perry is the author of over
that promotes innovations in service, research
300 journal articles, book chapters and scientific
and education in child maltreatment and
proceedings, and recipient of numerous profes-
childhood trauma (www.ChildTrauma.org).
sional honors. He attended medical and gradu-
ate school at Northwestern University, completed
In This Issue
a post-doctoral fellowship in psychiatry at Yale
A new and exciting lens for FAP to view and practice its work with high
University School of Medicine in 1987, and a
risk children and parents is neuroscience, the frontier and cornerstone for
fellowship in child and adolescent psychiatry at
understanding how human experience and human biology influence each other.
the University of Chicago in 1989.
Neuroscience and its implication for FAP outreach is the theme of this issue, the
first JFJF of 2008.
Dr. McCarroll: In addition to your clinical and
Our featured interview is with Bruce D. Perry, MD, PhD, a noted neurosci-
research work, you have been involved with
ence researcher and child advocate. His work addresses the relationship of
the Army s Family Advocacy Program (FAP) for
children s needs to the developing brain, and is relevant to our nation s military
many years teaching in the Family Advocacy
children, families and family prevention and education programs for healthy and
Staff Training program.
high risk families.
Dr. Perry: Most of my FAP teaching is
We summarize two articles by Dr. Perry that describe basic principles
focused on understanding the normal stress
of brain development and their relationship to maltreatment, as well as two
response, its implications for people exposed to
articles on gene-environment interaction that shed light on recent neurobiologi-
traumatic events like combat, and how chronic
cal research on maltreatment. In our regular statistics article, Building Bridges
and prolonged stress can impact families that
to Research, we provide an overview of logistic regression, a widely used
have a deployed parent. I cannot think of any
procedure in social science research. Websites of Interest focuses on the Child
system where understanding stress and the
Trauma Academy and the Adverse Childhood Experiences studies.
consequences of stress are more important than
Healthy Families, Healthy Communities, An Interview with Bruce D. Perry,
the military. We think about military stress in
MD, PhD ....................................................................................................... 1
terms of exposure to combat and traumatic
The Role of Genetics in Children s Brain Development....................................3 stress, but there are other stressful components
for the military family. In the last three or four
Bridges to Research: Logistic Regression and Adverse Childhood
years the rate of deployment and the stressors
Experiences Research....................................................................................4
on children, spouses, and other family members
The Effects of Violence on the Brain of the Developing Child ..........................5
of the military have been high. Increasingly, our
Recent Studies in Gene-Environment Interactions on the Biological Basis
focus has been on intervention strategies and
of Violence .....................................................................................................6
activities that increase resilience of the military
Websites of Interest .......................................................................................7
Continued on page 2
and on those things that make the military ress end up getting physically run down and are
community more vulnerable, especially during much more likely to get colds, have a hard time
deployments. recovering from an infection or have cardiac
problems. Their underlying genetic tenden-
Dr. McCarroll: Where does one draw the
cies or vulnerabilities will be unmasked by this
line between psychological stress and
chronic stress.
psychological trauma?
One of the challenges is to create systems in
Dr. Perry: That is an important question
education, health care and human services that
Traumatic events
for the field of mental health. Two people can
are responsive to these issues. For example, chil-
activate the body s stress
have the same experience, but for one person
dren may attend a school where there are only a
the level of stress is so high that it is traumatic
few military children. These children may have
response systems often
and for the other person it is not. From a
difficulty concentrating, and be tired from lack
changing them from an
neurobiological perspective, events become
of sleep because of worries about their Dad or
traumatic when stress response systems are
Mom. They may look like they have academic
adaptive response system
activated in such an extreme way that they go
problems or an Attention Deficit Disorder.
to a maladaptive system.
from being adaptive to being maladaptive.
These children are often misunderstood by
the public education system. Their problems go
Dr. McCarroll: How would one recognize the
unnoticed because adults who play significant
change?
roles in their lives are not trauma-informed or
Dr Perry: You look for physiological
military-sensitive.
changes such as changes in sleep patterns, ir-
ritability, mood and energy levels. When those
Dr. McCarroll: Can some of these problems be
things happen, you need to step back and say,
prevented? If so, what general principles of
 My life is too complicated. There is too much
prevention do you recommend?
stress going on. I am wearing out my body.
Dr. Perry: One of the most important fac-
The stress response system affects the brain, the
tors in prevention is group cohesion. If you feel
immune system, the heart, the lungs, the skin,
you are part of a supportive community you
and the gut. People who are under chronic du- can sustain a tremendous amount of duress. If
all the families left behind when soldiers deploy
support and assist each other, that support
can be a tremendous help. The people who are
JOINING FORCES
most isolated and the most vulnerable are the
Joining Families
military families living in the wider community.
There may not be another military family living
Editor-in-Chief
on their block that is experiencing deployment
James E. McCarroll, Ph.D. Editorial Advisor
or goes to their church or whose child goes to
Email: [e-mail] LTC Ben Clark, Sr., MSW, PhD
their child s school.
Family Advocacy Program Manager
One lesson we have learned about preven-
Editor Headquarters, Department of the
tion and dealing with traumatic stress is that
John H. Newby, MSW, Ph.D. Army
relationships matter. Your social network is
Email: [e-mail] E-mail: [e-mail]
tremendously important. The more you are
isolated and physically or emotionally separated
Joining Forces Joining Families Editorial Consultants
from the rest of the military community, the
is a publication of the U. S. David M. Benedek, M.D., LTC, MC, USA
more vulnerable you become.
Army Family Morale, Welfare Associate Professor and Scientist
and Recreation Command Center for the Study of Traumatic Stress
Dr. McCarroll: So, your advice to isolated
and the Family Violence and Uniformed Services University of the
families would be to increase their social
Trauma Project of the Center Health Sciences
support?
for the Study of Traumatic [e-mail]
Dr. Perry: Yes. Tap into your extended fam-
Stress, part of the Depart-
ily, into your community, your neighbors, or
Nancy T. Vineburgh, M.A.
ment of Psychiatry, Uni-
whatever social network you have. That will
Director, Office of Public Education
formed Services University of
help sustain you, and is probably the most
and Preparedness
the Health Sciences, Bethes-
important principle. Other important fac-
Center for the Study of Traumatic Stress
da, Maryland 20814-4799.
tors are information and education. The more
Email: [e-mail]
Phone: [phone].
Continued on p. 3
2 " Joining Forces/Joining Families January 2008
The Role of Genetics in Children s Brain Development
By James E. McCarroll, PhD
Promoting greater understanding of the % loss of cells that are redundant or are not
brain and its critical relationship to child devel- used,
opment will help the Army Family Advocacy
% development of nerve cells so they can con-
Program (FAP) develop innovative prevention
nect with different parts of the brain,
and treatment processes. Dr. Perry s article (see
reference) discusses the basic needs of children % development of cell-to-cell communication,
and the consequences for
% development of struc-
the child s developing brain
Generally, the environment of
tural supports for nerve
if these needs are not met.
cells, and
childhood interacts with the
Generally, the environment
of childhood interacts with
% improvement of effi-
child s genetic endowment to
the child s genetic endow-
ciency of neural trans-
produce healthy development.
ment to produce healthy
mission.
development. When there
Promoting greater
is chronic abuse or neglect,
lasting damage may result. Dr. Perry s clinical These steps are dependent upon genetic
understanding of the
and laboratory experience around chroni- and environmental interaction for their proper
brain and its critical
cally neglected children reinforce the need for development.
relationship to child children s stable emotional attachments, touch Understanding the neuroscientific implica-
from primary adult caregivers, and spontane- tions of early childhood brain development
development will
ous interaction with peers. He describes how lends a greater appreciation of children s needs.
help the Army Family
developments in modern technology can un- During early childhood, when the greatest
dermine the strength of the family and the de- changes occur, the caregiver has the opportu-
Advocacy Program
velopment of peer relationships that promote nity to create an environment for the child to
(FAP) develop
the growth of cognitive and caring potentials maximize the expression of genetic potential.
in the developing brains of children. For further illustrations of the interaction of
innovative prevention
Prior to birth and during childhood, genetics and the environment on the brain as
and treatment
important processes of brain development nec- related to maltreatment, see  Recent Studies in
processes. essary for adult cognition occur. The develop- Gene-Environment Interactions on the Biologi-
ment of the brain proceeds in steps: cal Basis of Violence in this issue of JFJF.
% the development of nerve cells,
Reference:
Perry BD. (2002). Childhood experience and
% movement of the cells to their proper place
the expression of genetic potential: What
in the brain,
childhood neglect tells us about nature and
% the expression of the function of each type
nurture. Brain and Mind, 3:79 100.
of cell,
Dr. Bruce D. Perry Interview, from page 2
One of the most
you know about an expected set of events,
Dr. McCarroll: If you have a child or
important factors in the
the more you will be able to deal with them.
adolescent with behavior problems that
Information is power. You can tell people what
emerged during a deployment, where do you
prevention of stress
to expect and the anticipated time course. You
start?
is to maintain group
can tell them,  You are not crazy. Most people
Dr. Perry: Most people know that a child s
experience these things. If it gets worse or it is
main support system is his or her parents. You
cohesion. If you feel you
so prolonged that you cannot manage it, here
can have a child overwhelmed by a trauma
are part of a supportive
are some resources. These are the people you
that also impacts the parent, e.g., the father
community, then you can talk to and this is the person who may be
was killed or wounded in combat. The mother
able to help you. We find that the combina- would also be overwhelmed and her ability to
can sustain greater
tion of information and access to resources
help the child would be compromised. Con-
adversity.
can be very helpful.
Continued on p. 8
http://www.centerforthestudyoftraumaticstress.org Joining Forces/Joining Families " 3
BRIDGES TO RESEARCH
Logistic Regression and Adverse Childhood
Experiences Research
By James E. McCarroll, PhD, David M. Benedek, MD, and Robert J. Ursano, MD
The determination of risk is one of the 2.0 means that individuals with the risk factor
Logistic regression
key aims of Family Advocacy Program (FAP) are at twice the risk compared to those without
is a commonly used
researchers and clinicians. In this article, we it. The OR can also be statistically significant
present a brief discussion of logistic regression, and be less than 1 in which case it is a protective
statistical procedure
a statistical procedure that has become increas- factor. A protective factor is the opposite of risk,
for determining
ingly common in social science research to e.g., being employed may be a protective factor
the significance of
estimate risk when several possible risk factors against a person becoming an abuser.
are present. Regression is the general name for An example of the use of logistic regres-
possible risk factors in
statistical procedures that examine the rela- sion is taken from a publication on the relation
relation to a particular
tionship between an independent variable (i.e., between adverse childhood experiences (ACEs)
height) and a dependent variable (i.e., age). In and negative health outcomes in adulthood,
outcome.
this relationship, both measures are continu- and is based on a collaborative research project
ous. (A continuous variable is one in which between the Kaiser Permanente Health Foun-
you can count values like 1, 2, 3, & n.) dation in San Diego, CA, and the Centers for
Logistic regression is a special type of Disease Control and Prevention (CDC). The lo-
regression. Its name derives from the type of gistic regression model was used as the primary
mathematical function, the logit function, that analytic technique in which ACEs were inde-
is used to calculate the relationship between in- pendent (predictor) variables and the outcome
dependent variables and a dependent variable. was measured in adulthood. The predictor
In logistic regression, the dependent variable variables (ACEs) included emotional, physical,
is dichotomous, as in  yes no or  present or sexual abuse of the person being evaluated,
absent as in a diagnosis such as depressed substance abuse or mental illness of someone
or not depressed. The independent variables in the household, a mother who was treated
in logistic regression can be dichotomous or violently, an incarcerated household member,
continuous. parental separation or divorce, and their sum
A benefit of the logistic regression proce- (the number of ACEs of each person). The
dure is that it allows the investigator to simul- investigators found that the risk of intimate
taneously control the effects of all the predictor partner violence (IPV) increased as the ACE
variables on the outcome while examining the score increased. The more ACEs, the greater the
predictor variables of interest. For example, risk of IPV. The odds ratio of perpetrating IPV
one might want to examine the relationship increased from 1.8 for persons with one ACE
between witnessing domestic violence as a to 5.5 for those with 4 or more ACEs (Anda
child (independent variable, continuous or di- et al., 2006). When odds ratios are presented,
chotomous) and being a perpetrator of domes- typically confidence intervals (also called
tic violence as an adult (dependent variable, confidence limits) are also included. Investiga-
yes or no). In this attempt to estimate risk, one tors usually present 95% confidence intervals.
might control for age, gender, marital status, These intervals are interpreted to show that the
and other variables (called co-variates) that are results of the study can allow the investigator to
held constant statistically while examining the be 95% confident that the OR lies between the
effect of the variable of interest  childhood lower and the upper boundary. The confidence
exposure to domestic violence on the risk of limits for the OR of IPV given one ACE were
domestic violence perpetration as an adult. 1.2 2.6. Thus, the investigator is 95% confident
One of the main outcomes of interest in that the odds of IPV for a person with one ACE
logistic regression is the odds ratio (OR). The is between 1.2 and 2.60 compared to a person
OR indicates how much risk (if any) is due to with no ACEs.
each predictor. If there is no effect of the pre- The logistic regression procedure is appeal-
dictor on the outcome, the value of the odds ing because of its apparent simplicity in inves-
ratio is 1. If the value is statistically significant tigating the effect of a predictor while holding
and greater than 1, it is a risk factor. An OR of
Continued on p. 8
4 " Joining Forces/Joining Families January 2008
The Effects of Violence on the Brain of the
Developing Child
By James E. McCarroll, PhD
Dr. Perry presented the inaugural lecture % Promote education about brain development.
in the McCain Lecture Series (www.lfcc.on.ca) While FAP personnel are not neuroscientists,
in London, Ontario, Canada, on his work on they can help educate the public about key
the effects of family violence on children. The principles of brain development to help par-
The development
lecture describes optimal as well as disrupted ents understand the long-term importance
child brain development, and provides practi- and implications of their actions.
of the brain is  use-
cal advice on strategies to shape optimal devel-
% Respect the gifts of early childhood. High
dependent meaning
opment for children.
quality early childhood care settings should
Dr. Perry explains that early life experience
that brains develop
provide enriching, safe, predictable, and
determines how a child s genetic potential is
according to the
nurturing environments. During early child-
expressed. The development of the brain is
hood, the brain is developing most rapidly.
stimuli they encounter.
 use-dependent meaning that brains develop
This phase presents the best opportunity to
according to the stimuli they encounter. Be-
Because each child s
foster optimal brain development.
cause each child s experience is different, each
experience is different,
brain adapts uniquely. Optimal development % Address relational poverty in our modern
is achieved when the child experiences con- world. In today s world of smaller fami-
each brain adapts
sistent, predictable, enriched, and stimulating lies and frequent deployments for military
uniquely.
interaction in attentive and nurturing relation- families, there are fewer opportunities for the
ships. Brain development is also susceptible development of connections between people.
to negative influences. Children who do not Dr. Perry s message is to increase the oppor-
have a stable and nurturing environment are tunities for children to interact with others:
subject to damage to their developing brain. have family meals, play games, increase con-
Prolonged, chronic stress leads to maladaptive tact with extended families and neighbors,
neural systems, which may be adaptive for the and limit watching television.
child s survival in the short term, but problem-
% Foster health developmental strengths. Certain
atic for later intellectual, emotional, and social
skills and attitudes help children meet the
development.
challenges of life and may inoculate them
Dr. Perry s lecture addresses points for
against the adverse effects of violence. Dr.
parents, service providers, and community
Perry presents six core strengths for children,
leaders to foster improved child and family
which he calls  a vaccine against violence .
development and functioning. He emphasizes
The child who develops these core strengths
key scientific principles paired with practical
will be resourceful, successful in social situa-
suggestions that can be implemented widely in
tions, resilient, and may recover more quickly
public education programs:
from stressors and traumatic incidents. [See
box, Six Core Strengths for Children]
Six Core Strengths for Children
Helpful for parents, caregivers, and healthcare providers
1. Attachment: ability to form and maintain healthy 5. Tolerance: understanding and accepting differences
emotional relationships in others
2. Self-regulation: capacity to contain impulses, notice 6. Respect: valuing differences and appreciating worth
and control urges as well as feelings such as frustration in yourself and others
3. Affiliation: being able to join and contribute to a group
Perry BD. Maltreatment and the developing child: How
early childhood experience shapes child and culture.
4. Attunement: being aware of others, recognizing their
The Margaret McCain Lecture Series, September 23,
needs, interests, strengths, and values
2004. www.lfcc.on.ca
http://www.centerforthestudyoftraumaticstress.org Joining Forces/Joining Families " 5
Recent Studies in Gene-Environment Interactions on
the Biological Basis of Violence
By James E. McCarroll, PhD, David M. Benedek, MD, and Robert J. Ursano, MD
There is an expanding body of scientific based on arrest, self-report, and medical records
There is an
research exploring the biological basis for the between individuals with high and low activity
expanding body of
interaction between genetics, the environment, levels of MAOA. The investigators found that
and behavior. Human behavior can no longer high levels of MAOA activity lowered the risk
scientific research
be dichotomized as resulting from either for abused and neglected white males becoming
exploring the
genetic or environmental violent or antisocial in
factors (i.e., the nature- adult life. The effect was
biological basis
New technologies are allowing
nurture dichotomy). New not found for non-white
for the interaction
technologies are allowing abused and neglected
for the investigation of the
between genetics, for the investigation of the males. The investigators
biological mechanisms mediating
biological mechanisms suggested that these dif-
the environment,
mediating the interaction ferences between white
the interaction between genes
and behavior.
between genes and the and non-white males may
and the environment.
environment. For example, be related to contextual
it has long been observed factors in their environ-
that childhood victimiza- ments such as different
tion increases the risk for becoming a violent environmental stressors.
offender as an adult. Both studies found that maltreatment dur-
Two recent articles exemplify the re- ing childhood and adolescence is a risk factor
search that is shedding light on the molecu- for adult antisocial and violent behavior, but the
lar processes mediating this risk. These two risk is moderated by the gene that produces an
studies are based on the function of a gene, enzyme that breaks down neurotransmitters in
which produces an enzyme that breaks down the brain.
neurotransmitters within the brain. These There are many methodological complexi-
neurotransmitters are thought to be related ties in the investigation of genes, the environ-
to impulsive, aggressive, and violent behavior. ment, and behavior. In addition, findings in
The enzyme is monoamine oxidase (MAOA). neuroscience tend to be highly specific. Devel-
It was suggested that this enzyme may mod- opments in such research depend on the accu-
erate (through increased or decreased gene mulation of results and replications of the basic
activity) the relationship between childhood research. This field of inquiry, once thought
maltreatment and later antisocial and violent improbable, will continue to develop and shed
behavior (Caspi et al., 2002). The hypothesis light on human behavior, human development
was that maltreated children with low activ- and the brain.
ity of the gene producing MAOA would be at
References
higher risk for conduct problems than children
Caspi A, McClay J, Moffitt TE, Mill J, Martin J,
with higher levels of MAOA. Research sup-
Craig IW, et al (2002). Role of genotype in the
ported this hypothesis. There was an interac-
cycle of violence in maltreated children. Sci-
tion between maltreatment and gene activity.
ence, 297, 851 854.
Of all maltreated children, only those with
low activity of the gene that produces MAOA
Widom KS & Brzustowicz LM. (2006). MAOA
later exhibited conduct and other violent and
and the  Cycle of violence: Childhood abuse
antisocial problems.
and neglect, MAOA genotype, and risk for
In another study, investigators compared violent and antisocial behavior. Biological Psy-
631 adult victims of substantiated child physi- chiatry, 60:684 689.
cal abuse and neglect (Widom & Brzustow-
icz, 2006). They compared levels of violent
antisocial behavior as determined by an index
6 " Joining Forces/Joining Families January 2008
Websites of Interest
% The Child Trauma Academy (CTA) is a non-profit
organization based in Houston, Texas. Its goal is to
improve the lives of high-risk children through direct
service, research, and education. Its website, www.
childtrauma.org, includes training packages consist-
ing of web-based and distance learning opportuni-
ties, as well as educational materials for educators,
caregivers, and clinicians. Free, on-line courses are
available including one entitled  Surviving Childhood:
An Introduction to the Impact of Trauma. The CTA
also provides clinical, program, and research consulta-
tions. The description of the neurosequential model
of therapeutics (NMT) is particularly relevant to Dr.
Perry s interview and summary of his recent work.
The NMT is a model to help professionals working
with high risk children determine their strengths and
vulnerabilities and create individualized interventions
along a developmental timeline.
% The Adverse Childhood Experiences (ACE) Study is
a large-scale investigation of the links between child-
hood maltreatment and later-life health and well-
being. It is a collaboration between the Centers for
Disease Control and Prevention and Kaiser Permanen-
te s Health (KPH) Appraisal Clinic in San Diego, CA.
The ACE Study findings suggest that adverse child-
hood experiences are major risk factors for the leading
causes of illness and death as well as poor quality of
life in the United States. The study is described in great
detail at www.cdc.gov/nccdphp/ace. The site includes
a description of the concept of the study and its appli-
cation to public health and preventive programs. From
the links, a wide variety of information and publica-
tions can be obtained.
% The Centre for Children and Families in the Justice
System (www.lfcc.on.ca) contains Dr. Perry s McCain
Lecture as well as other valuable, free publications and
resources. Among the resources are descriptions of
clinical programs, applied research, training services,
and materials to enhance intervention and prevention
efforts. One of their most popular resources is a pub-
lication entitled  What About Me? , a summary of the
best evidence to inform better practice on the effects of
domestic violence on children.
Continued on p. 6
http://www.centerforthestudyoftraumaticstress.org Joining Forces/Joining Families " 7
Dr. Bruce D. Perry Interview, from page 3 Dr. McCarroll: Our Army statistics reveal that the rates of
child neglect have increased since the war started. This has
sequently, we need to pay attention to the emotional needs of
been attributed to lack of (parental) supervision, unkempt
the parent. That is an important place to start. If the mother s
homes, and mothers with depression. Have you encountered
needs can be met, she can become stronger and better able to
this?
meet the needs of her child(ren). The child s needs must be met
Dr. Perry: Our colleagues report this. If you look at the
also. If you meet the needs of the parent and the needs of the
waxing and waning of child abuse and neglect complaints, it is
child, you will be more effective than just
very much tied to community cohe-
targeting your interventions to the child.
sion, economics, and mobility. When-
When there is a downturn in
The act of intervening and giving support
ever there is a downturn in factors that
to the parent and the child can prevent a
factors that would stabilize a
would stabilize a community, there is an
negative cycle from feeding on itself.
increase in neglect and abuse.
community, there is often an
One should also question the health
of the community.  Is this a community
increase in neglect and abuse.
Dr. McCarroll: Treatments and
where there is a support group? Is this
prevention might extend beyond the
a community where there is an isolated
issues of community cohesion. How
National Guard family? Has a family been
do you help people who enter a system and do not share the
in this community long enough to make friends? Your inter-
same priorities (i.e., cleanliness in one s home and attentive
vention would be to provide a combination of social work,
parenting)?
conventional psychiatric or psychological interventions, and
Dr Perry: Teaching people about parenting is a huge chal-
the sharing of information about resources. If the family is
lenge. We used to live as big extended families in which you
connected to a healthy community, minor interventions can be
experienced child-rearing practices. You learned a lot about
extremely helpful.
children because you were around them. Today s families are
much more mobile and smaller. It is not unusual for someone
Dr. McCarroll: How do you work with parents to make them
to be an only child or have one sibling
trauma-informed? To what extent can you
and grow up in a system in which there
bring together neurobiological structures
is no mechanism for effectively transfer-
If you meet the needs of the
and functions with behaviors, needs, and
ring child-rearing practices. People are
treatments, and do you think it enhances
parent as well as the needs of
talking about the need to get some of
understanding these issues?
the child, you are much more these practices into public education
Dr. Perry: We do quite a bit of that, and
because we are not teaching them in
effective than if you just target
we use materials that we have written for
families any more.
families including slides and mini-lectures.
interventions to the child.
We also have lay teachers. If a parent or a
Dr. McCarroll: How does one remediate
child is killed in a car accident, we will have
those families?
a client we worked with five years ago who
Dr. Perry: You can identify high-risk family situations and
also lost a child help us with that parent. This approach is very
provide non-punitive education and support services for these
helpful because sometimes our typical jargon does not translate
families. They would benefit from home visitation models.
well. The information is communicated better by someone who
However, these programs are often inefficient because they are
shares the same perspective as the person with whom we are
poorly targeted.
working.
Dr. McCarroll: Thank you for your contributions to the military
community and for this interview.
Dr. Perry: Thank you for the opportunity.
Building Bridges to Research: Logistic Regression, from page 4
constant the effects of other variables. This approach is prefer- ing research studies or viewing research presentations, look for
able to performing individual tests on the outcome of each pre- the use of this procedure and the nature of the results.
dictor variable where the other variables are not held constant.
The only definite conclusions that can be drawn from using
Reference
this model are those related to the data in the study. Depending
Anda RA, Felitti VJ, Bremner JD, Walker JD, Whitfield C, Perry
on the study design, the results may or may not be generaliz- BD, Dube SR, & Giles WH. (2006) The enduring effects of
able to other populations. There are many variations of logistic abuse and related adverse experiences in childhood. A conver-
regression. Here, we have outlined the basic procedure. In read- gence of evidence from neurobiology and epidemiology. Eur
Arch Psychiatry Clin Neurosci, 256:174 186.
8 " Joining Forces/Joining Families January 2008