Concerned About Unconventional Mental Health Interventions?

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

Friday, November 11, 2011

RAD Foolishness at Huffington Post

The Huffington Post columnist Lisa Belkin deplores the deadly results of child abuse, and well she may. But in her remarks at www.huffingtonpost.com/lisa-belkin/adoption-spanking-childabuse_b_1081617.html , she falls heavily for an idea associated with an eccentric view of child mental health--- the belief that emotional disturbance can cause an inability to feel pain. Belkin says that Reactive Attachment Disorder is “essentially the inability not only to bond, but to feel… these children can have elevated levels of the hormone cortisol, which increases their tolerance for pain… Some speculate that … spanking can spiral out of control” because the children do not respond to normal levels of painful stimulation.

Let’s parse this remarkable statement.

Do “some” speculate on this idea and claim that children with Reactive Attachment Disorder (or adopted children-- the two are sometimes spoken of in the same breath) are not very responsive to pain? Yes, “some” certainly do. Here are a couple of examples. At www.attachmentdisorder.net?Letter_to_Teacher.htm, we are told that “RAD kids can walk around in significant physical pain from real injuries”. At www.adopting.org/DrArt/diagnosisrad.html, the social worker Arthur Becker-Weidman, the soi-disant “Dr. Art”, provides one of those do-it-yourself RAD checklists, including the item “My child ‘shakes off’ pain when hurt, refusing to let anyone provide comfort”.

These statements confuse the actual response to pain with the seeking of comfort from the “right” people, and ignore the possibility that the child does not find particular adults (or adults in general) to be very comforting people. Belkin, however, accepts the idea that children diagnosed with Reactive Attachment Disorder may have an increased tolerance for pain-- by which I assume she means a raised threshold, requiring a higher level of painful stimulation before the child experiences pain.

Is it possible for this to happen? Yes, as Belkin states, changes in stress hormone levels can make a difference to pain tolerance. Physical stimulation can result in changes in pain threshold called stimulus-induced analgesia. People with diseases of the peripheral or central nervous systems such as leprosy can lose skin sensitivity of all kinds in some parts of the body. Studies of soldiers during World War II showed that wounds treated at front-line dressing stations required much less morphine than similar injuries due to surgery. A very few people are congenitally insensitive to pain and are frequently injured as a result (for example, being unaware that a hand is on a hot stove until they smell charred flesh). A few others, afflicted by harmful genetic factors, mutilate themselves by chewing their lips and tongues and do not seem to find this painful-- but can learn not to do it when subjected to painful electric shocks.

Is there any documentation of the claim that children who have been given the RAD diagnosis are in fact less responsive to pain than other children? This could be ascertained through standard laboratory tests of pain thresholds, or by systematic observation of toleration of dental work or medical procedures like immunization. No one has done this, so in fact the idea of higher pain thresholds (better pain tolerance) remains entirely hypothetical. The DSM description of Reactive Attachment Disorder certainly mentions no such symptom.

Let’s look at Belkin’s suggestion in another way. Does ordinary child guidance depend on experiences of pain? If a child felt little or no pain, would he or she then be untrainable? Although many parents do use spanking (a few blows with the open hand, no weapon) as a disciplinary method for preschool children, it is also common and effective to use timeout, isolation in the child’s room, scolding, or deprivation of treats-- all useful methods without physical pain. An ordinary spanking itself, when applied through a layer or two of clothing, involves intimidation much more than pain. In fact, it is not necessary for punishment to be painful in order to be effective . (The use of aversive treatments like electric shock-- certainly a painful experience-- is ethically limited to situations when a child will put himself in danger of real harm if he does not comply with instructions. ) If indeed children with Reactive Attachment Disorder had high tolerance for pain, there is no reason to think that this would affect their response to ordinary discipline one iota.

This line of discussion leads to another claim, one not made by Belkin but common among the people whose work she seems to have been reading. This is the idea that children with Reactive Attachment Disorder are unable to learn cause and effect connections, as stated by the “Evergreen Consultants in Human Behavior” at http://attachmenttherapy.com/ad.htm and many others. This bizarre belief appears to have come from someone being frightened by Piaget at an early age. In fact, learning to associate cause and effect begins in the first months of life, and is shown in thousands of daily behaviors such as becoming toilet-trained and using a spoon to eat with. The belief that Reactive Attachment Disorder necessitates severe parenting methods and high levels of child discomfort appears to be based on this entirely hypothetical inability to associate cause and effect. Children who attend school, dress and feed themselves, and do household chores all are demonstrating evidence of cause and effect learning, but they may for quite other reasons fail to learn to display affection or gratitude to their caregivers, or to make the caregivers feel that they have achieved the family relations they wanted.

Belkin associates Reactive Attachment Disorder with an “inability to feel”-- perhaps deriving this idea from the claimed lack of responsiveness to pain. Yet even the attachment therapists from whom she seems to have adopted ideas would point to the children’s rage and grief about separation from their original caregivers, even in cases where there was not enough time for an attachment to have occurred. The real issue appears to be that the children do not feel what their adoptive families want them to feel, or if they do, they do not display their feelings as is expected of them.

Belkin’s suggestion that children are abused because they are insensitive to pain and do not “feel” emotions is simply not tenable. This is not a matter of parents who must escalate physical punishment because without pain the children will not learn; it’s clear that children, adopted or not, do learn without pain. There was something else going on in the child deaths associated with “To Train Up a Child”. What was it? There were undoubtedly different factors and combinations of factors in the three known cases, but here’s a short list of possibilities:

The belief that the child’s eternal damnation or salvation rests on present obedience.

The belief that physical punishment is traditional, Christian, or in some way linked to a set of “family” values.

The belief that it’s a child’s job to make a family happy.

The belief that isolation of the family from the surrounding community is desirable.

The belief that adopted children are different from others in essential ways (a belief, by the way, fostered by Belkin’s comments on this subject).

The belief that there is an undefined process called “bonding” that may be undertaken by children and which is different in its nature from emotional attachment.


These factors could all be part of the lives of fairly ordinary adoptive parents. When we add in the possibility of serious mental illness in parents or in children (sorry, RAD doesn’t count), we multiply enormously the possibility of child abuse, injury, even death. The hypothesis that adopted children have a high tolerance for pain is not only unsupported, but an unnecessary addition to the discussion. Stressing that hypothetical factor is just another way to say, “the child made me do it.”

2 comments:

  1. Something else that this article misses is how prevalent it is that children (or even adults) who have been given a R.A.D diagnosis may actually be misdiagnosed and the correct diagnosis should have been Fetal Alcohol Spectrum Disorder. There are a range of impacts that can be experienced under the umbrella term FASD all linking back to Central Nervous System damage resulting from maternal alcohol consumption while pregnant. The damage that occurs is vastly different from person to person yet (though the first and foremost organ impacted is always the brain). It depends on the mother's genes, the child's genes, when the alcohol was consumed in the pregnancy and how MUCH was consumed. These aren't things that are easily documented, and the challenges someone with FASD faces range from the subtle (e.g. missed social cues, easily overwhelmed by sensory stimuli, hearing/vision impairment) to the obvious (e.g. FAS, the official medical diagnosis, is the leading cause of mental retardation). The issues for someone with this life-long damage may differ drastically for someone who did not incur brain damage in utero. Certainly, the discipline that is given to a child with FASD will need to be adjusted to fit the child's needs. For instance, a "token-economy" rewards system wouldn't work too well for someone who genuinely has terrible short term memory! You remarked, "Does ordinary child guidance depend on experiences of pain? If a child felt little or no pain, would he or she then be untrainable?" I would like to say: Is a person with FASD untrainable? Of course not! In fact, it is of utmost importance that caregivers create an environment in which the child is supported in the way that specifically works for them. The indirect conclusion that child abuse is somehow the child's fault is as outlandish as saying it is their fault that alcohol gave them brain damage in the womb! I find that to not only be untruthful but also offensive. Thanks for your blog.

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  2. Excellent points-- thank you. The common claim that children diagnosed with attachment disorders are incapable of learning certainly suggests the memory problems you cite.

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