Concerned About Unconventional Mental Health Interventions?

Concerned About Unconventional Mental Health Interventions?
Alternative Psychotherapies: Evaluating Unconventional Mental Health Treatments

Monday, December 6, 2010

Federici v. Mercer: The Story Behind the Lawsuit

A phone call this morning alerted me to the fact that the Virginia psychologist Ronald S. Federici is suing me and other critics in Fairfax, VA (CL10-16657, filed Nov. 24). As of today, I have not yet been served in this matter, but I assume that his complaint is that I have defamed him and interfered with his business, as he already brought such a suit in Small Claims Court and lost it, but is allowed to appeal.

What is behind this suit? The event that seems to have triggered it is that I published on my former Psychology Today blog a piece which I will present below. This piece, which I entitled “The Hungry Boy”, was based on a published opinion of the North Carolina Court of Appeals (www.aoc.state.nc.us/www/public/coa/opinions/pdf/090504-1.pdf), which discussed Federici’s involvement in an adoptive family situation that resulted in the incarceration of both parents for felony child abuse. The COA opinion quotes testimony Federici gave during the trial as well as the statements of the abused boy. (After writing “The Hungry Boy”, I obtained the transcript of the original trial, which does not counter in any way the statements in the COA opinion.)

Shortly after the publication of “The Hungry Boy”, Federici complained to and filed suit against me, Psychology Today, and other persons. Psychology Today took down “The Hungry Boy” and told me not to mention Federici’s name again. Although Psychology Today was served with a summons to appear in Fairfax, VA to answer the suit, and although I warned them that they should not default, they did not send a representative to appear in court and as a result a judgment for $5000 was given against them. I appeared and had a chance to see that Federici did not present evidence that he had been harmed by what I wrote nor that what I wrote was untrue (both necessary for a successful defamation case in the United States). As a result, the judge found for me.

Over the following several weeks, I did not mention Federici’s name on my blog, as instructed, but I did mention that I had been in court in a defamation case. Psychology Today responded to this by freezing my account on the grounds that I had broken an agreement with them, and I moved my blogging to http://www.childmyths.blogspot.com/.

Having lost his case in Small Claims Court, Federici had the option of an appeal to a higher court, and he filed this appeal against me and some other people. (He apparently came to some agreement with Psychology Today.) However, after some weeks, he decided on a “non-suit”-- to drop the case for the time being but to keep the option of reviving it. This revival is what he has apparently done as of Nov. 24, 2010.

What did “The Hungry Boy” say that was so disturbing to Federici? I’ll show you by posting the piece below.



The Hungry Boy: An Adoption Story, With Comments

Is starvation the key to good discipline and loving relationships in adoptive families?

In several posts on this blog, and in print publications over the last ten years, I have alluded to the suggestion by unconventional therapists that withholding food from adopted children is an effective way to shape desirable attitudes and behavior. Today, I’d like to tell some of the story of adoptive parents who took this advice, the consequences for themselves and their adopted child--- and the absence of consequences for the therapist who acknowledged in court that he had provided the treatment plan. I draw my information about this case from a document of the North Carolina Court of Appeals, issued Jan.19, 2010, and available at http://www.aoc.state.nc.us/ , as well as from a document prepared for the defense in this appeal and available at http://www.ncids.org/.

Here is the basic story. Paul and Leslie Salvetti adopted in the 1990s a little boy who had been born in Russia in 1993. Leslie later died, Paul re-married, and the new wife, Debbie, became mother to the boy, known as “Pesha”. At some point, the family’s functioning became less than ideal; “Pesha” reported to social services that Debbie had hit him with a frying pan and baseball bat, among other complaints, but it is not clear whether this was investigated.

According to the appeals court documents, Paul and Debbie felt that “Pesha” was “umanageable” by the time he was 13. In about February, 2007, the Salvettis consulted Ronald Federici, a clinical psychologist with a Psy.D. degree, licensed in Virginia, about their problems with “Pesha”. (The fee for this consultation was $5200 for three days of work.) Federici made a number of recommendations about appropriate treatment of “Pesha”, including the suggestion that ordinary meals should be contingent on improved behavior, but that “Pesha” should be provided with bologna sandwiches and fruit in any case.

The Salvettis also confined “Pesha” to his bedroom, where they covered the windows and removed most furniture , and these were the circumstances of his life for three months. “Pesha” later described himself as “cold and hungry” during this time. “Pesha” eventually escaped from the house and made his way to the authorities; at this time he was hospitalized for a week, during which time he gained 10 pounds. The Salvettis pled guilty to felony child abuse (intentionally inflicting physical injury, starvation) and in 2008 were sentenced to a period of imprisonment.

During the Salvettis’ trial, Ronald Federici testified on their behalf, and, unusually for a psychologist, commented on medical and genetic issues as well as psychological concerns; expert witnesses are generally expected to speak within their area of professional expertise. It is of particular interest that Federici testified to his belief that “Pesha” had not been substantially deprived of food. Federici and the defense attorney appear to have taken refuge in the ambiguity of the English language and to have interpreted the term “withheld food” to mean “withheld all food and liquid” rather than “reduced the amount and type of food available”. The defense argued that because some food had been provided, food had therefore not been withheld.

In addition, Federici testified to his opinion that children’s rage could cause them to lose weight, and that this, rather than food deprivation, was the cause of “Pesha”s” condition. (Although the implications of this statement were not discussed in the court documents that are available, I should point out that there is no known evidence to support Federici’s opinion.)
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So, what can we conclude from this case? Is starvation the key to good discipline and loving relationships? If not, what are its consequences? In this case, the consequence for “Pesha” was a terrifying experience and the loss of the home he knew. For Paul and Debbie Salvetti, the consequence was a period of imprisonment. For Ronald Federici , the consequence of his many activities has been popularity with the media, including a recent interview with National Public Radio in which he commented on the latest Russian adoptee scandal. Others who give similar recommendations have also found them lucrative.

If you are a member of an adoptive family, please note that you are not one of the people likely to benefit from using the withholding of food as a child-rearing technique.


*** That’s the end of “The Hungry Boy”. If you’re not sure whether my statements were accurate, you can read the North Carolina Court of Appeals opinion on line. Incidentally, the appeal in this case had nothing to do with any facts about what had actually happened, or any discussion of the appropriateness of Federici’s advice to the parents. The appeal had to do with the type of plea made by the parents in order to avoid trial, and whether they had actually understood that they would go to prison.

45 comments:

  1. Jean, I came over from O Solo Mama's site and am sorry to see this.

    Also wanted to let you know that the NC Appeals Court link isn't working--it looks like the website was updated and things moved around.

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  2. Thanks, Julia-- sorry about the link, it worked for me this morning! But try
    http://appellate.nccourts.org/opinions/
    ?c=2&pdf=2010/09-504-1.pdf. That's working at this minute.

    Jean

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  3. Well, no, it isn't working! But if you follow the link I gave, click on 2010 for the Court of Appeals, and scroll back to January, you'll see State vs. Salvetti and that's the one.

    They certainly didn't make matters easier by whatever they did.

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  4. http://appellate.nccourts.org/opinions/
    ?c=2&pdf=2010/09-504-1.pdf
    (without the period at the end) works O.K for me.

    Deliberately denying someone a balanced and nutritious diet IS withholding, as well as abusive. Bologna sandwiches and fruit just don't cut it. It's just plain unhealthy.
    I do not think anyone who supports, defends or recommends such treatment is credible.

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  5. In reading the the above transcript I find it interesting that such serious psychological and developmental problems would be treated with a plan that included a "fixed price" menu in which the child would have to earn his food through reformed behavior. That in itself seems negligent, bordering on malpractice.

    I too am sorry to see this happening to you Dr Mercer and cannot understand what in your blog piece, The Hungry Boy, could warrant legal action. People have the right to review these types of incidents, and perhaps even an obligation to do so.

    You would think continued pursuit of legal action against you, if deemed to be unfounded once again in appeal, could be considered harmful to you.

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  6. Jean, you will prevail. Your fastidious reliance on the public record and the conclusions that can be drawn from it must be maddening to some.

    I am still very PO'd about Psych Today.

    J.

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  7. Thanks for the kind and supportive comments, everybody!

    If you want to see other goings-on that are harder to deal with through the courts, have a glance at www.larrysarner.com, which in fact has nothing to do with the real Larry Sarner or anyone else mentioned there.

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  8. Oh yeah, me too regarding Psychology Today. I went there in the first place because of Jean's blog and found myself reading other blogs. Haven't been back since and won't ever since I heard they'd not supported one of their contributors.

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  9. They compared you to Fred Phelps. Oh, puh-lease.

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  10. See:

    http://wp.me/pRMnH-91

    http://wp.me/pRiaK-aN

    http://phtherapies.wordpress.com/

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  11. Thanks for the new link, Jean. Got it. Ugh.

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  12. I find it curious that none of the links in your post work. Not having as much time on my hands as you apparently have on your hands, I will take your accounting of the case on face value only.

    I have known Dr. Federici for five years and have two children in the behavioral program. The first very important detail is that a bologna sandwich with fruit is an adequate meal for a child. It has protein, fat, starch, and fiber. The only thing missing is the vegetable which many kids don't eat anyways. Dr. Federici would absolutely NEVER tell a parent to stop feeding a child. He may tell the parent to not feed the child their favorite foods and save them for treats. My child often would throw away his lunch and go to the front office of the school and claim that I didn't feed him. This is typical behavior for these children in their attempts at splitting authority and getting what they want from the other person. If you had more experience with this type of child, you would have known that.

    Another item of interest is the weight loss. These children tend to have rather prolonged violent temper tantrums making it difficult to keep weight on. They also frequently will go on hunger strikes and refuse to eat because they know it is important to the parents that they do eat.

    Also of interest, ten pounds in a week? Really??? I don't think so. That would be over five thousand calories a day and that amount of food would make the child ill if the child had truly been malnourished. If the child had intravenous lines, I can see the temporary water gain as the type of fluid given would hydrate the intracellular spaces and would soon be circulated in the venous system when normal fluid and food is ingested which would result in weight loss of the excess fluids.

    The supposed beatings, well, no one was there except the child and the parent. Again, these kids often split authority. My child went to school and complained that I locked him up in a basement. He left out a very important fact: we DON'T have a basement or anywhere else that he can be locked up. He also complained that I fed him dog food: so totally false.

    Did the parents do these things? I don't know. Only they and the child know. A guilty plea with our legal system means nothing to me because it may have been part of a deal.

    I suggest that you gain more knowledge into the difficulties these children bring to the families prior to indicting anyone on your own, "opinion" based on facts of a legal case that may have been made up by a lying child. You and I both know that attorneys can present things they want others to see them in order to win the case.

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  13. You may find it curious, but perhaps you're not accustomed to the ways states and courts change their on line documentation. You can find the document at http://appellate.nccourts.org/opinions/
    Go to 2010, scroll down to January, look for State v. Salvetti.

    I understand that Federici and others have responded to children's allegations of abuse by stating that the child is lying (see the Salvetti document). You also claim that the lawyers are lying. How about the hospital staff, school staff who reported, and social services representatives? All lying? Ya just can't trust anybody these days.

    Please note that no one has claimed that the parents were told to stop feeding the child.That is an absurd interpretation, and if it had been the case the child would have died within the period of time in question. The parents limited the child's diet beyond normal limits. Federici advises limitation of food in his self-published material. You yourself suggest that it is appropriate to limit the types of food available to the child, beyond what nutritionists would advise.

    Nancy Thomas states that peanut butter-and-jelly sandwiches and milk provide a child with a perfectly balanced diet for weeks. This seems to me to be a position closely resembling your own.

    If you would read the court of appeals document, you would know that the Salvettis took an Alford plea, by which they avoided going to trial but risked a prison sentence (which they received). The appeal was not on the basis of any queries about the accuracy of the evidence or counterclaims about what had happened, but involved the Salvettis' argument that they had not understood the Alford plea or that they might go to prison.

    Perhaps you and Federici could persuade the Salvettis to tell me their story, now that they are out of prison. It would be very interesting to know what they believe they did, and how they got the ideas for their treatment of the child.

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  14. The document referenced is a summary and not a transcript. Based on that, I give it little credence. The transcript would be valuable because as you know, people are often misquoted and misinterpreted based on the context of the conversation and their own belief system. Again, I doubt very much that Dr. Federici said exactly that the child had to earn food. In the program, there are food rewards that can be given in the form of food/candy that the child can earn for good behavior. That food reward that I just spoke of is in ADDITION to the regular diet. What I just spoke of is NOT child abuse, neglect, or maltreatment. It is a behavioral modification technique. I never once stated that it was appropriate to limit a child's food beyond what nutritionists advise; however, I did state that food can be used as part of a reward system in the form of treats as above in this paragraph.

    Also of note is that the program from Dr. Federici does NOT include being locked up in a room with boarded up windows. The room is stripped of all unneccessary items that are earned back. A bed, clothes, and food are NOT taken away from the child and the child is NOT locked up. The program calls for the child to be in close proximity of the parent at all times. The child cannot be in close proximity if the child is locked in their room.

    Another note of your response is that I stated the attorneys were, "lying". No, I did not say that the attorneys were, "lying". I stated that the child was probably lying and based on the information the child gave, the attorney presented what they felt would win their case.

    Nowhere in the document did I see the investigation that DSS had on the home. In cases of Immediate Jeopardy, they are required to investigate all of the complaints within a certain time-frame. Depending on the state, it is usually around 72 hours after the complaint comes in. The documentation that the DSS worker would have presented would have shown the conditions in the home. And, in cases of Immediate Jeopardy, the DSS worker can get a warrant to enter the home with the assistance of a Judge and Police.

    I would never state that everyone is lying, but, I would anticipate based on my experience with my two children, that the child was probably lying as I stated prior. I can also tell you that based on my experiences, the DSS worker sometimes misinterprets what is stated and what they see. Like the basement story I mentioned above, the DSS worker substantiated it. I got an attorney involved because I have NO basement or anywhere else like that that can be locked and it was overturned and records expunged. These kids lie all of the time and I would not doubt that the child was lying as being, "locked in a room with sealed doors and windows, absent of appropriate sleeping quarters" is NOT part of Dr. Federici' program. Giving treats and food rewards in ADDITION to the normal diet is part of the program for behavioral modification.

    The Alford plea as described in the document I place little credence to because that is part of working the system, so to speak. Personally, I would never enter a guilty plea, but I am different than they in my thinking. Again, the actual documents and not a summary would be very beneficial in determining whether or not this child was actually abused. And again, these kids often go on hunger strikes in order to manipulate the parents because they know nutrition is important to the parents. We don't know if that was the case either, or the amount of tantrums, severity, or any other information because we only have a summary and not the actual documentation. Making a verdict or judgement when we don't have all of the facts is an erroneous way to behave. My humble opinion.

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  15. The document is an opinion of the North Carolina Court of Appeals. As such, it summarizes material submitted by the appellant, including statements from the original trial. I have the transcript of the original trial, and you can get it too if you want to spend the time and money. Except for a lengthy discussion of what an Alford plea is, it does not contain much that's factual beyond what's given in the COA opinion. These people did not go through a full-scale trial, so many points that one would like to hear about are neither in the transcript nor in the opinion.

    In addition, because this case involves a child, many of the findings are confidential and will not be part of the public record.

    Of course, I have no idea what Federici told the Salvettis to do, but if he did not give them instructions to lock up the child, etc., he does seem to have neglected to make sure that they were following directions. I notice that in the transcript and in the parts quoted in the COA opinion, Federici did not state that he had not given such instructions or advised limitation of diet; he simply said that the child was lying, that the medical records were misinterpreted (a point outside his expertise, by the way), and that the social services staff had mishandled the case.

    It seems clear that you reject the NCCOA opinion as a source of accurate information, If you believe mistakes were made by the NC courts, perhaps you should help the Salvettis seek redress.

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  16. Trust me on this: Dr. Federici would not tell anyone to lock up a child. He specifically states in his book that, " Twelve to seventeen years old: This is likely the most difficult age to work with as it (the program) requires a tremendous amount of close physical proximity and a great deal of conversation between parent and child. Here, there still needs to be behavioral rehearsal (practicing appropriate behavior and communication patterns) but also, include written assignments. It also needs to be anticipated that the older child/teenager may be very resistant and hostile". I don't know how anyone can see this as locking the child up. Again, I saw no mention of the condition of the home and the said, "room" that the child claimed he was locked up in in the court summary.

    I also have no interest in obtaining the original documents as you suggest. I am also sure the Salvettis' are fully capable of fighting their own battles. I see those statements as an attempt to turn the tables on my opinions and turn the topic.

    I do however take issue at outsiders that have zero experience with this particular type of child berating anyone for actions that may or may not be a little out of the mainstream. I am speaking particularly about your issues with Dr. Federici and not any particular case or client of his or the many truly abusive cases mentioned on any site including yours or your friend Ms. Pignotti.

    I will state again that rewarding kids with treats and foods in ADDITION to a normal diet is what is supposed to happen. Kids are not entitled to junk food or any treats, but using them as a reward is what the behavior program suggests in the book. The book states to remove food from the child's room; that statement does not in any way suggest to starve a child.

    Proper interpretation of the book and any statements is the key to proper treatment of children that have come from institutional settings.

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  17. I'm afraid I trust the appeals court more than I trust your comments, especially since you're ready to carry on an argument without having availed yourself of existing information.

    Your point is a good one-- that Federici does say in his book that constant proximity is necessary. This obviously contradicts the use of seclusion. Again,I don't know what he told the Salvettis to do, but I would have thought he would have paid some attention to their treatment of a child they found extremely difficult, and that he would have referred to this in court. Surely we all know by now that these family situations-- especially this one, where the original adoptive mother had died and a new and inexperienced stepmother entered the picture-- can easily lead to abusive treatment.

    But of course, if your position is that there was no abuse-- the child did it all on purpose and then lied-- none of that is an issue, any more than would be the case for the therapist who was involved with Nathaniel Craver's family.

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  18. By the way, Valle, when Federici sued me and the others for conspiracy to defame him, he did not cite my comments on this case or indeed anything else written by me in support of his suit.

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  19. The mention of Nathaniel Craver brought a little research. My you must have a lot of time on your hands. This is what it said about Dr. Federici, "A developmental neuropsychologist told The Patriot-News of Harrisburg that it was possible that Nathaniel unwittingly injured himself to the point of death, but cautioned against speculation without a full evaluation of his development.
    "I've had a kid who chewed his hand off," said Dr. Ron Federici. "I had a kid who poked an eye out. Kids who cut themselves with no pain."".

    I find it difficult to locate information on the child's therapist, who is required to report any child abuse or suspected child abuse. I did find Dr. Federici's half quote on Ms. Pignotti's site. The important part of the quote in my opinion was missing.

    In my personal experience, yes these children do cause self-harm. My daughter used to pull her hair right out of her head leaving bald spots, cut herself with kid kitchen sets, and apparently suffered no pain that I could see. I would take her hands and hold her and explain to her that type behavior was not acceptable and remove any items she caused self-harm with. The only thing that stopped the self-injurious type of behavior in my kids was Dr. Federici's program. That being said, if my child did as the parents claim in the Craver case, I would have put a bicycle helmet on the kid and hold him so that he did not self injure so seriously. Based on the video interview by the news of the coroner, it certainly appears that the child suffered injuries beyond his physical capability, i.e. injuries on the back with the same shaped tool and muscular tears at the larger joints. The eye injuries may have been self-inflicted as my kids used to pick at their eyes also. My son used to head bang against the concrete floor and walls, again I would hold him so that he caused no harm and sit him right beside me so I could stop him before he harmed himself. Once he caused a small bruise on his forehead before I could get to him. This is typical behavior of the post-institutionalized child.

    This case I see a bit differently that the Salvetti case because there is video of the coroner stating his opinion of the injuries, which is different than a summary document. If the cauliflower ear was as the news said, I cannot see the parents not taking that child directly to an Emergency Room as that is a major change and life threatening.

    Another thought is that the child was removed from the home for two weeks some time prior to his death. Removal from the home indicates that DSS found substantial evidence of some type of problem with the treatment of the children. And yes, that definitely would exacerbate any Reactive Attachment Disorder.

    I cannot comment on the case between Dr. Federici and you. I know nothing about it except that it does appear that you and Ms. Pignotti take issue with his style of treatment; which works by the way. It would be nice if you two would not twist statements and would gain more experience with the post-institutionalized child in my humble opinion.

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  20. I'm wondering which children you mean when you say "these children".

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  21. It is not mere "style" that I disagree with, Ms. Oberg. I see no objective evidence that the treatment is safe and effective and no, testimonials are not evidence. Scientology can give testimonials too and they don't mean a thing. I continue to have and express serious concerns about Dr. Federici's intervention as described in his self-published book. There has been no twisting. The diagrams and instructions are there for all to read and speak for themselves. One does not have to have "experience" to criticize these methods. In my opinion, a grain of common sense will do, accompanied by the need to see actual evidence versus testimonials and self-promotional blogs and websites.

    Fortunately, the lawsuit Dr. Federici filed against us was dismissed and thus, we continue to have the right to express our opinions and the facts, as we understand them, about his work. He gave it his best shot, but the bottom line is that the Federal judge ruled that he failed to state a claim upon which relief can be granted. As Dr. Mercer mentioned, he failed to cite one specific statement written by Dr. Mercer and the material he cited that I posted, the judge ruled did not constitute defamation, nor was there any valid claim for conspiracy contained in his complaint.

    What I find of particular concern is the way in which you and other proponents of Dr. Federici's intervention continue to blame the child as a rationalization for what you do. I just don't buy it. I watched the video Saving Dane more than once and quite frankly I have worked with children who had much worse behaviors than those displayed by Dane on the video and those children were helped by standard behavior management, no need for hours of prone holds, isolation from everyone but parents or any of the other controversial methods described by Dr. Federici in his book.

    Here's what the Russian Commissioner of Children's Rights had to say about people who have been in trouble withe law for child abuse, blaming the child;

    http://rt.com/politics/press/rossijskaya-gazeta/punishment-couple-edelwina-leschinsky/en/

    Oh and one more thing, Ms. Oberg, regarding your propensity to jump to unwarranted conclusions about me elsewhere -- in response to a remark you made about me on another blog about the unfounded conclusion you jumped to regarding my ability to support myself -- I have a very strong work ethic as anyone who actually has worked with me can attest and I have supported myself doing completely legal, honest work since 1980. Furthermore, regarding the postings that publishing material from my dissertation was a bad thing and somehow dishonest or fraudulent, it is not. Publication of dissertation material in a peer reviewed journal is an accepted, highly encouraged and desirable practice. Just FYI. I post this response here because the anonymous blog owner in question does not post my responses. He or she only posts responses of those who malign me and other critics. Interesting how both Jean and I have posted your responses on our blogs and those of others with whom we disagree, but not vice versa.

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  22. PS: For those interested in reading the actual documents of Ronald Federici's lawsuit, they can be obtained here:

    http://www.citmedialaw.org/threats/federici-v-pignotti-et-al

    Federici's complaint:

    http://www.citmedialaw.org/sites/citmedialaw.org/files/2010-11-24-Federici's%20Complaint.pdf

    Dismissal Hearing Transcript:

    http://www.citmedialaw.org/sites/citmedialaw.org/files/2011-03-04-Dismissal%20Hearing%20Transcript.pdf

    and there are others at that site, if you scroll down to "Court Information and Documents"

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  23. Ms. Pignotti, what in the world are you talking about in this, "Furthermore, regarding the postings that publishing material from my dissertation was a bad thing and somehow dishonest or fraudulent, it is not. Publication of dissertation material in a peer reviewed journal is an accepted, highly encouraged and desirable practice"? Where did that come from in this conversation?

    The statements you are making have absolutely nothing to do with my conversation with Ms. Mercer. Team tagging me again I see....

    And just what does your Scientology have to do with the conversation between me and Ms. Mercer? If I recall, I didn't ask you about that cult.

    And since we are completely off the subject at hand, I don't remember which one of you is concerned about who makes what searches to land on your website, who cares? People make all kinds of searches to land on one of mine. I look at it so that I can perhaps anticipate what people want to know so I can write the next post. But to go on and on about someone using search terms in the middle of the night, I think maybe you need a different hobby.

    I do say that you seem to be fair about your comments and posting the comments, that is much appreciated; however, to discredit a method of treatment when you have no experience with the post-institutionalized child is in my opinion a bit negligent. Dr. Federici's treatment is a bit out of the mainstream; however, it is the only treatment that has been successful with my children.

    Let me tell you the treatments attempted on my children: AMEN clinic, local neuropsychologist, four psychiatrists (one of which told me to LOCK UP my three year old for good that, "the prisons are full of them"), four psychologists, one MFT, head scans, all various classes of antipsychotics, anti-epileptics, mood stabilizers, anti-depressants, behavioral therapy, computerized biofeedback for kids and more.

    Let me tell you their behaviors: self-mutilation, indiscriminate affection, severe separation anxiety, severe fears of all types, violent tantrums (my three year old would attempt to break windows and did pull a door jamb off the door frame during a tantrum when put to bed and he didn't want to go to bed), enuresis, encopresis (including pulling it out of his diaper and throwing at me while having a tantrum), lack of sleeping, hoarding food and water, lying, stealing, homicidal,assaultive to other kids (I was called to get the kid out of school), expelled from two schools (at ages 5,6), autistic behavior patterns, urinating on walls and floors when angry, and many more severe behaviors.

    Every single one of those behaviors is gone thanks to the innovative treatment of Dr. Federici. And as stated earlier, the holds are for safety and security of the child and others and are in no way abusive. That is a fact.

    I am truly not interested in reading about the suit between yourselves and Dr. Federici. Based on my interactions with you, I can understand why he would attempt to sue you in order to stop this degradation of his treatment and character.

    I will say this again: Dr. Federici does NOT recommend withholding food in any shape, manner, or form. The treats are in ADDITION to the normal diet. The holds are for the safety of the child and others (I know you disagree with the prone positioning). He teaches in his office how to perform the holds, when to release, and what to look for. His book states to get the children evaluated by a professional. And his diplomas, being that I have seen them with my own two eyes in his office in 2006, YES...he has all of those degrees. Maybe you are jealous of his accomplishments?

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  24. Another question that has occurred to me is if this child was on a "hunger strike" of some sort and refusing to eat in spite of the parent's efforts, why didn't the parents seek medical help? Someone refusing to eat for days on end is in a dangerous situation and in the case of a child, it would seem to me that failing to seek help would constitute at the very least, neglect on the part of the parents. After escaping, the hospital found that the 13 year old boy weighed 85 pounds.

    It seems to me that this has similarities to Lisa McPherson, who died at the hands of Scientologists after being isolated in a room and refusing to eat or drink for an extended period of time. The difference is that Lisa was an adult. Also, Lisa did not escape, she died. Thankfully, the Salvetti boy did manage to escape.

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  25. Ms. Oberg: You know very well what I was responding to: Your response to another blog that would not allow me to respond where you were doing precisely what you accuse me of, tag teaming and attacking me. Since I was not allowed to respond on that forum, I have every right to respond to you when you pop up elsewhere and as long as Dr. (she's a PhD, so it's not Ms.) Mercer agrees to post my comments, I shall comment as I see fit. I have every right to defend myself from the smear campaign you have participated in. You don't get to call the shots here.

    As for your statement "I will say this again: Dr. Federici does NOT recommend withholding food in any shape, manner, or form." I never said he did, nor have I said anything about his degrees and no, I am not jealous. I have a PhD myself, so have no reason to be jealous of someone who has a PsyD.

    Once again, you are creating a straw man argument, maintaining arguments I never made. If you go back and read what I wrote, I clearly have stated the problems I have with Dr. Federici's recommendations in his self-published book and to the media.

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  26. Actually, Federici's book does say that parents should have complete control over food, and it's hard to see why that would be necessary unless limitations on the amount or types of food available were to be enforced. I believe that part of the issue here has to do with the definition of a "normal diet" by people who are not professionally trained to recognize such a diet for children indifferent age groups. Perhaps the question should really be about an adequate diet rather than a normal diet.

    According to Tanner's weight tables, the Salvetti child was below the 5th percentile for weight for his age. If he was undergrown all along, it would seem advisable to have any food limitations superintended by a pediatrician. Perhaps someone knows more about this than I do-- because the case did not go to a full-scale trial, the medical history was not revealed.

    Ms. Oberg has still not said what she means by "these children". I would be interested in having this specified.

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  27. I'd be curious to know that as well. Maybe she's referring to kids with RAD. I believe this is her blog and it recycles the usual myths about RAD by listing symptoms such as lack of a conscience, lying, cheating, stealing, hoarding food, etc. that are not in the DSM.

    http://adoption-issues.com/reactive-attachment-treatment

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  28. Is that correct, Ms. Oberg? Is that your blog?

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  29. If you go to any of her responses to this blog and click on her name, it goes to that link, http://adoption-issues.com/

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  30. Looks like she's responded to us further on her blog:
    http://adoption-issues.com/ongoing-dialogue-dr-mercer

    Ms. Oberg asked which comment I was referring to. Here it is:

    http://practitionersofquackery.wordpress.com/2011/09/11/monica-pignotti-environmentalist/#comments

    Since the name of the author of that comment was Valle Oberg and it links to her blog, I assume this is the same Valle Oberg who has commented here.

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  31. I see on Valle's blog that she has made some comments and has noted that she cannot post here today. I checked the spam box and see nothing there, so I don't know what the problem is. People who want to know what she said, especially about the food-restriction issue, can look at her blog, as indicated above.

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  32. Here's a link for Valle, a review by Charles Zeanah (who has made it his life's work to study the post institutionalized child) and his proposed revisions for the latest forthcoming edition of the DSM, DSM V. Based on the latest research, still no evidence of behaviors such as lying, stealing, cheating, food hoarding, etc. Of course, DSM V is based on actual research, not anecdotes from blogs. See:

    http://www.dsm5.org/Proposed%20Revision%20Attachments/APA%20DSM-5%20Reactive%20Attachment%20Disorder%20Review.pdf

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  33. Dr. Pignotti, http://www.aacap.org/galleries/PracticeParameters/rad.pdf
    In your document it states under table 2 ICD 10 thatpoor social interaction with peers is typical, aggression towards the self and other is very frequent, misery is usual, and growth failure occurs in some cases. And the most important is that it states the existence of this behavioral pattern is well recognized and accepted, but there is continuing uncertainty regarding the diagnostic criteria to be applied, the BOUNDARIES of the syndrome, and whether the syndrome constitutes a valid nosological entity. Also in table 3 ICD-10 it states in middle and later childhood, individuals may or may not develop selective attachments but attention seeking behavior often persists, and poorly modulated peer interactions are usual; depending on circumstances, there may also be associated or BEHAVIORAL DISTURBANCE.

    Also, in the link I provided it also states that other symptomatology can be present and it is difficult to discern an overlapping of disorders and behaviors. The food hoarding is very common in children that have been deprived and is not necessarily associated with RAD; however, the general public may associate the two.

    My statement on your blog refers to the instances that I see on the Internet such as that man that said his child was a psychopath etc. This man was clearly overwhelmed; however, instead of helping him, I saw that your reponse was to berate him. No, I don't remember exactly which blog it was on, I am sure you have a recollection. This is the type of thing I object to, berating instead of helping.

    And as far as this blog, at times I have to submit four or five times before it will take and last night it would not accept it at all. Probably a bit of a glitch in the system.

    My humble opinion.

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  34. ICD-10 says that one of the criteria for Reactive Attachment Disorder is "lack of emotional responsiveness, withdrawal reactions, aggressive responses to one's own or another's distress,

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  35. (oops--) and/or fearful hypervigilance." Is this what you meant by aggression toward the self and other?

    Children who have been maltreated or who have emotional problems other than RAD may be aggressive etc., of course. The point is that aggression is not one of the diagnostic criteria for RAD or for the disinhibited version as described by ICD-10. Neither is food hoarding part of the syndrome, as you point out, and in both cases I'm hoping to get beyond what the general public thinks-- even to give the general public some more accurate information.

    As for berating people, my concern is about the child's position. As I recall, that man was busy collecting proof that the child was just bad. I am sure he could not have "heard" me no matter what I said, so I addressed myself to other people who had shown interest in the situation. Sometimes, someone must say that a person or an action is wrong, even though it's "not nice" and may be uncomfortable for the person who states that the Emperor has no clothes on.

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  36. The description you quote from doesn't even come close to the kinds of descriptions that you and others have given of children with RAD. Attention seeking behavior and "poorly modulated peer interactions" and "behavioral disturbance" are not the same as the very extreme claims that these children lie, cheat, steal and will grow up to be sociopaths if some kind of extreme intervention is not done. With RAD per the DSM the attention seeking behavior consists of indiscriminate friendliness.

    If you check out p. 11 of your document, they are arguing against the AT position of Levy and Orleans. The severe behavior problems are a separate diagnosis, not RAD and they are not a large percentage of children with RAD. Also, there are plenty of children who do not have any kind of attachment problem who are not even adopted that have very serious behavior problems.

    I also see nothing in those practice parameters that condones the use of so-called therapeutic holds or the kinds of extreme measures outlined in Federici's intervention.

    See Recommendation #9 on p. 20:

    "Interventions designed to enhance attachment that involve noncontingent physical restraint or coercion (e.g., “therapeutic holding” or “compression holding”), “reworking” of trauma (e.g., “rebirthing therapy”), or promotion of regression for “reattachment” have no empirical support and have been associated with serious harm, including death [NE]. "

    Jean Mercer's work is cited in the paragraph below that statement. And yes, I know Federici writes that his approach is different from this but he still is recommending using prone holds even if there is not an immediate threat to harm (e.g. if the child backs down and promises to be good) and he recommends using it when the child doesn't follow the very strict rules set out in "adults only".

    The paper recommends restraint only "for extreme aggression and uncontrolled behavior is sometimes necessary for protection of the child or family members" and it states "Children who are so aggressive that they are unmanageable in the family setting may require referral for more intensive treatment, such as residential placement. Even in these cases,
    physical restraint should be used judiciously and attempts to work with the family promoted."

    And no, I have no such "recollection" of "berating" anyone and since you are unable to provide an exact citation of exactly what I wrote, I have to assume that you are reading things into what I wrote. Providing parents with information is helping them. Using therapies that have not been properly tested is not "help" in my opinion.

    Even if you did perceive my well-founded criticism of certain practices as 'berating' your jumping to the conclusion that you don't see how I could support myself is completely unwarranted and does not follow. People who work full time commonly find time to do all kinds of things during the time in which they are not working.

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  37. An important issue here is that strolling through the cherry orchard does not substitute for a thorough reading of diagnostic criteria and commentaries discussing them. An anonymous reader recently mentioned web sites and on line support groups-- although these have their uses, they are not likely to provide any more complete information than Ms. Oberg seems to be offering.

    Just because an issue involves children, that's no reason to think that the matter can be simplified beyond a certain point.

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  38. Here's the nutritional status of bolonga (at least one brand):

    http://www.nutrientfacts.com/FoodPages/NutritionFacts/NutritionFacts_Bologna.htm

    Lots of salt and fat, little protein or other nutrients. Even the healthiest bread and fruit wouldn't make it a balanced diet. Nor peanut butter and jelly, although the nutrient profile would be better.

    To me, feeding someone the same thing again and again and telling them they get regular meals if they behave is not a good tactic. If it's really about keeping away treats, why doesn't the child get what's ordinarily served for breakfast, lunch, and dinner? You can't seriously argue every single thing but sandwiches, fruit, and milk should be considered "treats."

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  39. Dr. Mercer and Dr. Pignotti,

    Maybe the Mayo Clinic describes what all of us parents with children that have been appropriately diagnosed with RAD state at: http://www.mayoclinic.com/health/reactive-attachment-disorder/DS00988/DSECTION=complications. Us parents are describing what we see as a commonality with children that have this disorder in what we describe as symptoms and Mayo Clinic describes as complications. The behaviors that are so common can be under any one of these, "complications" of RAD.

    In reviewing my particular childrens records, only one was diagnosed with RAD, the other has the same symptomatology but was not diagnosed with RAD; however, spent as many years in the orphanage. The food issues I have seen from my experience and reading are common with children adopted from foreign orphanages that were deprived of food.

    Nutrition: there again, we all can argue whether bologna sandwiches consitute a healthy diet. Of course not if they are eaten all of the time for months on end. Remember, we don't have the Salvetti child's medical records. I only stated that three food groups were included and they do have protein as items like hotdogs do. Yes they are full of fat and sodium; kids eat this junk all of the time.

    Residential treatment and restraints: Yes, the more violent kids may benefit from residential treatment; however, my son was in residential treatment for six weeks and came home worse than how I sent him. Not only that, he held it together there because there were big men around, which I don't have at home. So he came home more violent, had a tantrum as I was cooking and I was the one that was injured with a permanent scarring burn and he had no injuries at all. Yes, I did hold him down prone and he is alive today and thriving. It is tougher nowadays to hold him because he is only about four inches shorter than I. Even with his adrenaline rush, I can still hold him down and I did. What choice do I have? No choice with no assistance from the school district, psychiatric community, or anyone else. And that is the position many parents find themselves in. Isolated, grasping at any glimmer of hope that they can save their child.

    So as a parent, I really don't care what the DSM or ICD codes say because they are paperwork necessary for insurance companies and to put some sort of structure to the psychiatric problems that appear.

    What do I care about? I care that there are some programs that work that do not involve what I see as weird stuff like rebirthing, holding therapy, thought therapy, and any of that type of non-mainstream therapy. I know that Dr. Federici's program works because it has saved thousands of children, including mine.

    I didn't have time to respond immediately as my son was presenting a few regressive behaviors, but I did see another blog entry on this issue.

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  40. It isn't about what kids eat, it's about artificial restriciton of diet. According to Federici, the boy had to earn meals of anything other than bolonga sandwiches and fruit. Kids like things that aren't nutritious, but that's not the entire diet.

    Browsing the Mayo Clinic site, I see quite a few treatment modalitites of dubious merit, at best. They may be well known but that does not mean they are always right.

    You also say his program is not "holding therapy" but it involves prone restraint for misbehavior. What do you consider the difference?

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  41. I'd be interested to know how thousands of children were even treated, much less "saved". Let's suppose it's only one thousand and Federici has been doing this for 20 years. That's 50 a year, and I would suppose treatment would take a year at least, with a minimum of one contact hour a week, whether with the child or just in consultation with the parents. There we have 50 hours of work per week, without even counting paperwork, discussion with his own therapist of personal issues that arise, or travel in cases like the Salvettis.

    I'd like to know the evidence that there have been even one thousand children treated in this way. Federici has never published anything about his treatment methods or outcomes in any peer-reviewed publication. The published articles he has on his CV were not about behavioral issues.

    So, what are the sources either for the statement that the methods are successful, or for any statement of the numbers treated?

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  42. Holding therapy is commonly referred to when practitioners are speaking of holding calm children often with questioning, yelling, waiting until the child is angry and screaming and sometimes tickling and other weird actions.

    Restraint as I referred it is the external control on the child to prevent the child from injuring themself or others. Restraint is only for immediate safety and security.

    Although both definitions involve some form of holding the child down, holding therapy is very much different from restraining the dangerous and violent child from causing harm to self and others.

    Being that I have had contact and advice and my kids have been treated by Dr. Federici, I can comment with knowledge on the techniques. That being said, Dr. Federici does not just treat or evaluate the child once and that is it except for rare contact. What is involved is coordination with schools, special education teachers, psychologists, psychiatrists, and any other discipline necessary to treat the child. He doesn't need to produce any evidence as to the number of children treated as you don't need to produce the evidence of your teaching experience. The publishing in a psychology journal is also not indicative of education and experience. He has testified before the Senate. For exact numbers of successful cases, I suggest you contact him directly as I am not his associate and do not have access to that type of informational, "proof" that you seem to require.

    I can tell you that as a parent of the post-institutionalized child that has been appropriately diagnosed with RAD among a myriad of other disorders, his treatment works. If there is question on if the treatment works, contact him and he will provide what you need in statistical numbers, or he may not since there is much dedication on your site to discrediting his methods.

    My humble opinion and I am guessing this is the question you were referring to.

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  43. If Federici wants people to think that he uses effective methods, it's up to him to demonstrate this by publication of outcome research in peer-reviewed journals. It may be okay with you that he doesn't do this, but it won't be okay with me or with any other professional. Talking to the Senate is neither here nor there-- they've had Jenny McCarthy too, I believe.

    As for holding therapy, I agree with your definition. However, Federici's self-published book does not say that restraint is limited to immediate safety and security. He advises it for disobedience that has no immediate safety or security implications, as well as suggesting holding the child and gazing into his eyes for attachment purposes. Federici's friend David Ziegler maintains that restraining a distressed child leads to a change in emotional state that makes the child especially susceptible to therapeutic interventions; Ziegler also cited a number of publications supporting holding therapy when he argued for this position.

    When you say that Federici does not just evaluate and then reduce his involvement to rare contact, are you suggesting that he was well aware of the child's situation in the Salvetti case?

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  44. Valle, I don't understand how you can say the Dr. Federici does not need to produce evidence that his therapy is effective just as Dr. Mercer would not need to produce evidence of teaching experience. If she were applying for a teaching position, indeed she would, regardless of how many previous years of experience she had. In most universities, even tenured faculty have to provide, on a regular basis to their institution, evidence of their scholarly productivity. Nothing is taken for granted. This should be even more the case for people who are doing clinical work with vulnerable children. In this age of evidence based practice, professionals are indeed held accountable to provide evidence for what they do and more and more consumers are being educated to ask that question. That is what I meant when I wrote that the days of therapy gurus who believe they are immune to such questioning are coming to an end, meaning that they are now expected to respond to questions asking for evidence.

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