Concerned About Unconventional Mental Health Interventions?

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

Tuesday, August 23, 2011

A Russian Adoptee, Child Abuse, RAD, and MAD

In an all too common scenario, the Alaskan adoptive mother of a Russian child is on trial for child abuse, and her defense argues that the child is so awful that it was suitable to punish him by putting hot sauce in his mouth and by forcing him into a cold shower. (See http://articles.ktuu.com/2011-08-19/hot-sauce_29907825 and http://www.ktuu.com/news/ktuu-jessica-beagley-child-abuse-trial-closing-statements-082211,0,2078692.story for information about this.) Jessica Beagley’s actions toward her adopted son might never have been detected, or if detected might not have “made news”, except for the fact that she wrote to “Dr. Phil” and made a tape for the show, describing her anger and frustration and the use of worrisome disciplinary methods.

During Beagley’s child abuse trial, her attorney argued that she had done nothing wrong. Her family therapist, Chantal Cohen, and others stated that the 7-year-old was difficult because he suffered from Reactive Attachment Disorder as a result of his early life in a Russian orphanage. Cohen stated that such children can be “sweethearts at school and monsters at home.” Other testimony said that children with Reactive Attachment Disorder “are uncontrollable and don’t show empathy”. Cohen also testified that the children “intuitively find the one button that’s intolerable to you and then they smack it really hard.”

This all seems pretty inconsistent; how can a person without empathy, the capacity to know what others feel, also have a capacity to figure out what someone else’s concerns are? But, be that inconsistency as it may, there’s a much bigger issue to consider about these statements regarding Reactive Attachment Disorder. My question is, what did Chantal Cohen and others think they were talking about when they referred to Reactive Attachment Disorder? The characteristics they referred to and attributed to Beagley’s adopted 7-year-old form no part of Reactive Attachment Disorder as it is defined by the official source, the Diagnostic and Statistical Manual of the American Psychiatric Association (often called just DSM).

Here is how DSM describes the characteristics of Reactive Attachment Disorder (code 313.89):

Markedly disturbed and developmentally inappropriate social relatedness in most contexts [not just at home-- J.M.], as evidenced by either (1) or (2):

Persistent failure to initiate or respond in a developmentally appropriate fashion to most social interactions [again, not just at home-- J.M.], as manifest by excessively inhibited, hypervigilant, or highly ambivalent and contradictory responses…
Diffuse attachments as manifest by indiscriminate sociability with marked inability to exhibit appropriate selective attachments (e.g., excessive familiarity with relative strangers…).
[The DSM description goes on to cite other points that are irrelevant here but can easily be found by interested readers. ]

There is nothing in this description about being a “monster at home”, about lacking empathy, or about intuitively finding and pushing a parent’s most sensitive button. What, then, is Chantal Cohen talking about? Chances are that she misunderstands Reactive Attachment Disorder because she has been “trained” in an alternative view, put about by quasi-professional family therapists and life coaches, that describes either Reactive Attachment Disorder or something called just “Attachment Disorder” in a way completely different from the DSM description. They sometimes call it RAD, sometimes AD; I’d like to call it MAD for Misunderstood Attachment Disorder (and because it makes me mad to see this deception practiced).

Here are the characteristics of this MAD/RAD as stated at http://www.attachment.org/pages_what_is_rad.php:


Superficially engaging and charming.
Lack of eye contact on parent’s terms [this does not seem to preclude the existence of normal eye contact most of the time-- J.M.]
Indiscriminately affectionate with strangers.
Not affectionate on parent’s terms (not cuddly).
Destructive to self, others, and material things (accident prone).
Cruelty to animals.
Lying about the obvious (crazy lying).
Stealing.
No impulse controls (frequently acts hyperactive).
Learning lags.
Lack of cause and effect thinking.
Lack of conscience.
Abnormal eating patterns.
Poor peer relationships.
Preoccupation with fire.
Preoccupation with blood and gore.
Persistent nonsense questions and chatter.
Inappropriately demanding and clingy.
Abnormal speech patterns.
Triangulation of adults [might be difficult to do without empathy-- J.M.].
False allegations of abuse.
Presumptive entitlement issues.
Parents appear hostile and angry.

This list is on a web site belonging to Nancy Thomas, a foster parent and advocate of Holding Therapy, as well as in print and Internet publications by similar authors. In no case is evidence provided that such a group of characteristics is in any way associated with emotional attachment of children to caregivers, or that these characteristics tend to be shared in the form of an identifiable syndrome. Only two of these characteristics (“indiscriminately affectionate with strangers” and “inappropriately demanding and clinging”) overlap conceptually with the description of Reactive Attachment Disorder in DSM.

It appears that Jessica Beagley’s defense is arguing that she has been abusive in the course of her well-intentioned efforts to deal with a child with Reactive Attachment Disorder. However, nothing reported about the testimony suggests that the child has been professionally diagnosed with Reactive Attachment Disorder as it is properly defined. On the contrary, the testimony suggests that the witnesses wish to use the established term Reactive Attachment Disorder as a way of normalizing their unconventional diagnosis, the MAD/RAD concept. Assigning a child to the MAD/RAD category, with the characteristics listed above, enables the defense to argue that the child is lying and making false allegations of abuse, that the mother’s hostility toward him is in response to his personality disorder, and that the mother’s escalation of unacceptable punishments was entirely an effort to control the uncontrollable.

The RAD defense is regrettably becoming more common as a way to extricate abusive, even homicidal, parents from legal difficulties. In the Salvetti case which I discussed some months ago on this blog, the defense argued that another Russian adoptee had refused to eat until his weight dropped noticeably, rather than having his food limited by his parents as a disciplinary measure. The Salvetti defense stressed the idea that as a RAD sufferer, the boy was a persistent liar.

Prosecutors and judges need to be aware of the real and the false Reactive Attachment Disorder descriptions so they can respond appropriately when the RAD defense is mounted during child abuse trials. It’s time to stop the repetition of this scenario, with its tendency not only to do injustice, but to spread disinformation and encourage mistreatment of adopted children.

P.S. Aug.24-- Jessica Beagley has been found guilty, and SLATE, in commenting on this, has invented something called Radical Attachment Disorder!


6 comments:

  1. Once these myths get out there, they keep getting repeated. If ever there was a case for the Daubert standard, this is it. We can keep trying, though, to dispel them. Here is my contribution, which includes a table from a recent publication that demonstrates the difference between the legitimate DSM definition of RAD and the misunderstood one.

    http://wp.me/pRMnH-pO

    ReplyDelete
  2. Thanks, this will be very useful for interested professionals.

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  3. "It’s time to stop the repetition of this scenario, with its tendency not only to do injustice, but to spread disinformation and encourage mistreatment of adopted children."

    Yes! Yes! Yes!

    It seems like all a parent has to do is say their kid has RAD and they think they have a free pass to treat their kids any way they want. It is really sickening!

    ReplyDelete
    Replies
    1. Your remarks are rooted in dangerous miscalculation of the parent's intention and response of a child's preexisting volatile characteristics following his or her post-institutionalization adjustment. Whatever ones calls it, a high incidence of psychological and neurological conditions are present when many of these children are adopted. The adoptive parents are far too often blamed for FAD and FAS due to the birth mother, as well as executive function delays. It is much more serious that labeling their preexisting conditions, as RAD or stereotyping and blaming adoptive parents, based on presumption. One need only walk in the shoes of discrimination to understand its vile inequity for facing the hardship of trying to parent and help a child in post-institutionalized crisis.

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    2. I'm not at all sure what you're getting at, but nobody was blaming anybody. The point here was that correct assessments of childhood problems are needed, not a focus on what either adoptive or birth parents did wrong.

      Delete
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