Concerned About Unconventional Mental Health Interventions?

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

Wednesday, July 27, 2011

Adoption, Trust, Complacency, and the Barahona Case

While most of the nation was intensely involved with the trial of Casey Anthony in Florida, another case in the same state got much less attention in spite of its seriously disturbing nature. In that case, a grand jury investigated the death of Nubia Barahona and the serious injury of her twin, Victor, apparently at the hands of their adoptive parents, Carmen and Jorge Barahona. The death and injury followed a series of reports of child abuse, including complaints from Nubia’s teachers that she seemed to be very hungry and that she was nervous and afraid to go home. Other complaints stated that the twins were bound with duct tape, locked in the bathroom, left to sleep in the bathtub, and fed on bread and milk once a day. The Barahonas took the children out of school and said they were homeschooling them. Following the pattern of the all-too-familiar-story, caseworkers had not succeeded in seeing the children, but had accepted Carmen Barahona’s statement that they were fine. Then, on Feb. 14, 2011, Nubia was discovered dead and rolled up in a carpet in Mr. Barahona’s truck; her brother was there too, badly hurt.

The Miami-Dade County grand jury that indicted Carmen and Jorge Barahona filed a final report that is of great interest ( In this report, while acknowledging all the many problems of caseworkers, including poor training and heavy caseloads, the jury members emphasized a problem that is prevalent but rarely mentioned. They referred to it as a bias of trust and complacency.

The bias of trust stressed by the grand jury report is the assumption on the part of the social work profession that adoptive parents are by definition good people, and that they cannot be the source of harm to the children in their care. Without wishing to accuse an entire professional group, I must agree strongly that this belief characterizes many adoption caseworkers and the staffs of adoption agencies. All adoptive homes are described as loving and nurturing, as if adoption were synonymous with excellent child-rearing. Adoption-oriented web sites describe adoptive parents as “awesome moms”. When adoptive families are functioning poorly, there is haste to say that someone, somewhere, did not tell the truth about the children, who are considered the causes of any trouble. These common beliefs may be the basis for the caseworkers’ bias of trust in adoptive parents which the grand jury report points to so explicitly.

Come, let us reason together about this. Why should adoptive parents be uniformly “awesome”, wholly loving and nurturing, and worthy of the unquestioning trust of society, when birth parents as a group do not meet these standards? Some would assume that adoptive parents must be excellent because they must have wanted the children; these people attribute child abuse to being saddled with unwanted offspring and resenting them. But, in fact, birth parents too may abuse children whom they wanted and even planned. (Shockingly, the grand jury report suggested that the investigation of the Barahona case would have been more careful if the children had been with their birth parents.)

Others who think adoptive parents are always good rely on screening and evaluation of adoptive parents to mean that only those who can do a good job are allowed to adopt. It’s true that screening makes it much less likely that people who are physically ill will be allowed to adopt, or that those living in poverty or substandard housing will become adoptive parents. Those with florid mental illnesses are also likely to be screened out. But in actuality there is no screening that will allow us to know exactly how a person will behave toward a particular child, and that is why post-adoption monitoring by an independent observer should be an essential part of the adoption process.

It would be a grave mistake to attribute cruelty and abuse to all adoptive parents, most of whom manage their families’ relationships in such a way that their children grow up as healthy, competent, successful contributors to society. It is an equally grave mistake, however, to assume that adoptive parents must not be the cause of evident problems in their children-- problems as serious as constant hunger, bruising, and fearfulness of going home. Adoptive parents are human beings; human beings can do wrong. If we are to do right by vulnerable children, we cannot let this be forgotten.

Is it too difficult for caseworkers who have known adoptive and foster parents for years, who may have been involved in the placement of children with them, to approach these families without bias? Is it too important to some caseworkers to be the friends of adoptive parents and to feel their approval? We can hardly blame the caseworkers if these things are true. Human beings trust people they have known for a long time, and human beings don’t enjoy being disliked by the people they work with. So, can we trust caseworkers to avoid that “bias of trust” when they have been involved with screening parents or placing children? It may well be that we cannot, and that the solution is to change the system so that strangers do the monitoring.

The Miami-Dade County grand jury report is a remarkable document. I congratulate the grand jury members for their ability to cut through the bureaucracy and to suppress temporarily the distress they must have experienced at the details of the Barahona story. By homing in on the trust issue, they have pointed out an essential flaw in our efforts to prevent abuse of adopted children in the United States. I would hope that this report will become required reading for all social work students and social services staff.

Monday, July 25, 2011

Behind the Norwegian Terrorist: The Grande Dame of Conspiracy Theory

I really don’t believe in “synchronicity”, but I made a find that startled me yesterday. I turned on my laptop and saw headlines about the Norwegian domestic terrorist Anders Breivik. Then, sighing and shaking my head, I turned to EBSCOhost to continue the work I had been doing, which involved reading articles about some unconventional belief systems.

The first thing I saw was a small number of articles discussing the life and work of one Nesta Helen Webster (1876-1960), an Englishwoman whose writings were a powerful influence on the John Birch Society, the Patriot movement, Pat Robertson-- and now, believe it or not, even radical Islamist groups. Her 1924 book “Secret Societies and Subversive Movements” told of organizations “gathering strength for an onslaught not only on Christianity, but on all social and moral orders”. It’s very likely that Nesta Webster’s views helped form the framework for Breivik’s fears and actions.

Mrs. Webster believed that subversive groups, initially in the form of the Illuminati, had conspired to bring about the French Revolution in an effort to destroy the aristocracy and break down class barriers so they could rule the world. In her own time, she thought, this work was being done by Communists, Freemasons(!), and “international finance” (read: secular Jews). She had a general admiration for the Nazis, but felt that they were not Christian enough and was concerned about their treaties with Russia.

According to some commentators (Ruotsila, M. [2004]. Mrs. Webster’s religion: Conspiricist extremism on the Christian far right. Patterns of Prejudice, 38, 109-126), Mrs. Webster’s beliefs about international and multicultural conspiracies were based on her own upbringing as a member of the Plymouth Brethren, a dissenting group whose “existential gloom” was matched only by a few members of the Church of England. Like some fundamentalist Christian groups in the modern United States, the Plymouth Brethren were premillenialists, believing that the “end times” would soon arrive and would involve a battle for souls between the forces of good (basically, themselves) and those of evil (everybody else). Premillenialism usually includes a concept of an Antichrist as the incarnation of evil, although the specific identity of the Antichrist is left unclear, enabling groups to fill in the blank with the name of their most concerning enemy. Of course, non-Christian groups can readily adapt the story to their own needs by using some term other than Antichrist but keeping the rest of the narrative.

Mrs. Webster’s conspiracy theory seems to have done little but insert the names of her particular feared people into the Antichrist blank. The rest of her concerns (and those of modern complex conspiracy theorists) mirror the premillenialist narrative. The basic story is as follows: there is a battle that has been going on for a long time; many enemies conspire against us; they want to destroy our cherished ways and replace them with an immoral and disgusting society; they operate secretly and unfairly; the end of the battle is near, and we must counterattack if we are to survive; no compromise is possible; they hate us, and we are right to hate them.

It was just as simple for Anders Breivik and many others to make use of this narrative as it was for Mrs. Webster. Breivik easily inserted Islam and multiculturalism into the Antichrist blank-- just as radical Islamists can insert the names of European and North American people and institutions into the same opening. It’s a terrific story, very exciting and engaging, and even contains some partial truths. How difficult, then, for many people to question or resist it!

Whether Anders Breivik is “crazy” is already being debated, as happens every time there is violence committed by one of these true believers in conspiracy. Even Mrs. Webster had some personal beliefs and assumptions that are likely to raise some eyebrows-- she thought she might be the reincarnation of an aristocrat who died in the French Revolution, she believed in ESP , “ancestral memory”, and the influence of “spirit presences” (see Lee, M.F. [2005]. Nesta Webster: The voice of conspiracy.Journal of Women's History, 17, 81-104). Yet having unusual beliefs is not clear evidence of “craziness”, and neither is killing a lot of people, an action for which we reward soldiers with high praise.

In fact, it may not be particularly relevant whether Breivik is “crazy” or not. Focusing on this issue may be important for the making of legal decisions about him, but it can also have the effect of distracting us from the much larger problem shown by Internet sites like “Gates of Vienna”. In fact, to declare Breivik “crazy” may have the unfortunate effect of hiding the power of the basic Antichrist story which motivates modern conspiracy theories of the kind Breivik acted out. Christians, Muslims, and other religionists, can you recognize this dangerous narrative, this self-fulfilling prophesy, and speak out against it before it creates more mini-Armageddons?

[Incidentally, I fully expect a number of attachment therapists to declare that Breivik was suffering from Reactive Attachment Disorder. Let me point out that there is no reason whatever to think that this was the case, or that if it had been, that this would have offered an explanation for his actions.]

Monday, July 18, 2011

What About the Fathers? The Anthony Case and Danieal Kelly

I confess that I winced away from watching the Casey Anthony trial and only inadvertently picked up information from people who wanted to tell me about it. Now that the trial is over, though, I find myself thinking about an aspect that rated some sidebars: what about the father?

The Internet remains full of discussion of who the child’s father might have been, whether he’s alive, why he hasn’t come forward. A woman in New England has even declared that her son is the father, carrying family solidarity and maternal pride (?) to unheard-of levels. The comments on this issue are a melange of different types of disapproval, ranging from the idea that the father might have saved the little girl’s life if he had been paying attention, to the concern that anyone putting himself forward at this juncture is merely acting in hopes of cashing in on the selling of the Anthony story.

Not many people have mentioned the possibility that an identified biological father may have some legal responsibility in the child’s death and the mother’s subsequent ill-judged actions. I don’t know what the Florida law is, or what prosecutorial intentions might be, but a somewhat parallel case in Philadelphia shows that a father may be found guilty of various offenses in connection with the death of a child with whom he has no contact.

A lengthy legal process has tried several people for their culpability in the 2006 death of Danieal Kelly (see Danieal, who was physically very much impaired by cerebral palsy, died at age 14, weighing 42 pounds and covered with bedsores. She essentially starved to death. Her mother, Andrea Kelly, is already serving a prison term, but a few days ago, after trial, the social workers who had failed to respond to the child’s condition, and Daniel Kelly, Sr., Danieal’s father, were convicted of charges in this case. Daniel Kelly, who had at one time had custody of his children, returned them to their mother, who, he claimed, denied him access to Danieal. He did not report the matter to authorities or make any effort to be sure that Danieal’s special needs were met. He has been convicted of child endangerment and may be sentenced to as much as 7 years in prison.

Would Daniel Kelly have been convicted if he had never seen Danieal, or if he did not know he was her biological father? It’s possible-- even likely-- that he would not even have been tried under those circumstances. As it was, having spent some time living with Danieal, he was well aware of her physical incapacity and her special needs for physical care and for educational services. He must have had some idea of the degree of danger involved in leaving her to the sole care of her mother, although he also may have legitimately assumed that the social work service would oversee what was happening to Danieal. Nevertheless, some will object to his conviction for events that occurred when he wasn’t fully aware of the situation, and might well argue that if he had never known there was a baby, he would not have been at all responsible for Danieal’s death.

Daniel Kelly’s conviction is a message to some disengaged fathers of their minimal responsibility toward their children; even if they never provide a meal or pay child support, they must be sure that their children are receiving the basic care they need. But what is the message to those who never saw the baby, or even paid enough attention to know there was a pregnancy? What are the legal implications for those men of coming forward at a later time? Generally, unknown fathers are thought to lie low in order to avoid paying child support, but where a child has been harmed or killed, such men might also have possible concerns about charges of child endangerment.

This situation is fraught with ethical and practical dilemmas. On the one hand, it seems completely unfair to bring serious charges against someone who didn’t know what was going on-- but is Daniel Kelly’s “failure to know” any more or less culpable than the failure of a man to know that he impregnated a woman? And what would happen if unknown (but later identified) fathers of abused children were charged with endangerment? Would this encourage such men to take responsibility for their children’s well-being-- or would it encourage them to withhold their identities from partners and avoid serious relationships?

Perhaps the various candidates for Casey Anthony’s impregnator should think over their positions before they rush to declare themselves and sell their stories.

Sunday, July 17, 2011

Eye Contact With Babies: What, When, Why, and How





When I look at the statistics Blogspot gives me, I see that day after day, large numbers of people end up at this blog when they Google questions about babies and eye contact. Parents are obviously worried about this issue, and that fact is confirmed by the existence of quite a few websites that give instructions about how to get your child to make eye contact more often. But what are the facts about all this? Can you get your child to increase eye contact? Do you need to? Why are we concerned about this matter at all?

What is eye contact? The term “eye contact” might be better replaced by “mutual gaze”, because of course there is no real “contact” about this common human action. In mutual gaze, two people’s faces and eyes are aligned so that each set of eyes is gazing at the other set. This is often very brief, although it can also be maintained for seconds at a time. Mutual gaze may also be performed in a sequence of episodes, for example as two friends approach each other, joining and breaking gaze along the way, stop and briefly engage in mutual gaze, and finally avert their gazes slightly while talking. Prolonged mutual gaze may indicate deep emotional involvement-- but it can be either a loving look or a hostile or frightened stare, depending on the context and the rest of the facial expression. Mutual gaze has a terrific communicative power for human beings, but it can have more than one meaning.

When does eye contact happen? From birth, babies are interested in looking at faces and especially eyes, and do this so carefully that they can and do accurately imitate facial expressions in the early days of life. Nevertheless, most new parents find that it is quite difficult to get a sense of mutual gaze until some weeks have passed. At about 4 to 6 weeks, as babies begin to do what used to be called “taking notice”, they start to look more responsively at people who are looking at them-- especially if the adult does something attention-getting like opening eyes and mouth wide and “looming” closer to the baby’s face. Soon, the baby smiles in response to a smile, and maintains a mutual gaze with a friendly adult (familiar or unfamiliar). If the adult looks blank or “stares through” the baby, though, the latter will avert the gaze, appear uncomfortable, and begin to cry. The baby expects the adult to “manage” his or her gaze in a way that coordinates with the baby’s gaze.

By about 6 months, babies begin to look toward an adult’s face and eyes for “social referencing” purposes, not for eye contact in and of itself, but to get information from the facial expression and the direction of the adult’s gaze. This information guides the baby in understanding the environment and knowing whether unfamiliar things are worrisome, neutral, or pleasant. The baby continues to pay attention to the direction of people’s gazes and between 9 and 12 months begins to show “joint attention”-- using the gaze as a “pointer” to show someone else where to look, and following another person’s gaze to see an interesting sight. These are not examples of mutual gaze, but they are other forms of communication that may emerge from mutual gaze.

It can be hard for an inexperienced parent to know whether a baby makes eye contact soon enough, long enough, or often enough. Anyone who expects prolonged mutual gaze many times a day from the time of birth is bound to be disappointed and frightened. The earliest eye contact events are fleeting, and even at 2 months the baby may not pay much attention without a good deal of adult effort. Mutual gaze during breastfeeding is not likely until the child is old enough to pause in sucking and look around, or let go the nipple temporarily and move the head-- perhaps 5 or 6 months of age.

Why is eye contact important? Mutual gaze is an important form of communication that conveys information both to the baby (“hey, people are quite interesting and pleasing”) and to the adult caregiver (“oh, my baby’s looking at me-- this feels so good-- he thinks I’m important and interesting”). It may be the foundation of other uses of gaze and other gestures for communication.

Looking at whether young children engage in mutual gaze can be a helpful way of understanding whether their development is typical or whether they have certain special needs. One of the best-known aspects of autism is the infrequency of eye contact. Individuals with Asperger’s syndrome, a disorder related to autism, may say that they dislike being looked at and find mutual gaze very uncomfortable. Persons with Fragile X syndrome are also known for their poor use of the gaze in social communication.

When people avoid looking at other’s eyes, or when they are simply inattentive to gaze information, they can miss much other information too. If an adult uses a word a child does not know, for instance, the child can often make a good guess by watching the adult’s gaze, to see what he or she is looking at. When a child also has poor language development, as is common in autism, the combination of underdeveloped language and of lack of gaze communication can make for serious difficulties, the appearance of deliberate noncompliance, and frustration for both child and adult. These facts all suggest that if a child is really not using mutual gaze or other gaze information, helping him or her gain those skills would be a valuable achievement.

However, it’s important to realize that increasing mutual gaze is not a way of increasing the child’s emotional attachment. Toddlers are more likely to engage in mutual gaze with people they are attached to, but increasing gaze episodes does not make them attached. Blind children become strongly attached to their familiar caregivers just as sighted children do; attachment is a very robust developmental phenomenon that involves hearing and touch as much as, or instead of, sight. Mutual gaze may have its strongest effect on adults, who are much influenced by the child’s gaze and feel a sense of emotional contact when exchanging gazes, so it’s possible that increasing mutual gaze can have an indirect effect on children through its influence on their caregivers. However, of course, blind parents also have strong emotional involvements with their children; they too can use other sources of communication to develop these intense relationships.

How to increase mutual gaze? I notice on several websites a variety of instructions for improving eye contact with children. These include wearing funny glasses (something like this was suggested by Nikolaas Tinbergen 40 years ago), playing games based on prolonging eye contact, and giving the child sweets while maintaining mutual gaze.

Whether these methods are a good idea depends in part on whether the child really does show too little eye contact for his age and situation. This is a point on which most parents need professional guidance. If the parent’s motivation comes from the belief that more eye contact would cause better attachment, and especially if the parent believes the child is poorly attached because he or she is disobedient, there is certainly little point in doing any of these things.

However, if the child is being treated for a developmental problem that is characterized by poor mutual gaze, the parent may already have received some training in rewarding eye contact or may at least be aware of how the behavior therapist works with this. An article that describes one method is to be found at (Hall, S.S., Maynes, N.P., & Reiss, A.L. [2009]. Using percentile schedules to increase eye contact in children with Fragile X syndrome. Journal of Applied Behavior Analysis, 42, 171-176). Similar work can be done at home, but it needs to be carefully thought out beforehand.

**** Readers, if you accessed this post in a search for current work on eye contact and autism, please look at my post for Nov. 7, 2013, which discusses the Nature article by Warren Jones and Ami Klin.****

!!!!!!                                                                                                                                       !!!!!

Thursday, July 14, 2011

The Russian-U.S. Adoption Treaty: The Psychological Evaluation Issue

After a considerable period of discord, and a history of disasters for children adopted to the United States from Russian institutions, Russia and the U.S. have signed a treaty intended to address problems that have caused harm to adopted children (M. Schwirtz, “Pact on adoptions ends a U.S. Russian dispute”, NY Times, July 14, 2011, p. A12). In addition to improving the mechanisms for monitoring families after adoption, this treaty requires improved screening of potential adoptive parents and better information about the children’s medical and psychological histories.

How are people evaluated before they are accepted as adoptive parents? Psychological evaluations, often done through private sources or as recommended by the adoption agency, generally involve an open-ended interview less than an hour long, and may include a paper-and-pencil psychological test, usually the Minnesota Multiphasic Personality Inventory (MMPI). The MMPI provides an assessment of the individual on a number of scales (including whether they are so inconsistent that they are probably lying) as well as on some combinations of scales.

The MMPI does a good job of identifying individuals who are seriously mentally ill-- schizophrenics, for example. But most adoptive parents who harm or reject their children are not actually mentally ill. Instead, they have other personality characteristics, beliefs, habits, or social circumstances that culminate in child abuse or neglect, or even in the child’s death.

Can the MMPI identify those concerning personality characteristics and help to prevent adoptions that may lead to harm? Regrettably (considering how much people rely on this test), the answer is probably that it cannot. Of the thousands of studies done on the MMPI, very few have focused on the success or failure of adoptive parents, nor have most considered whether the responses of potential adoptive parents to the MMPI should be interpreted in any special way.

Almost 20 years ago, one researcher, J.E. Dalton, looked at a group of prospective adoptive parents and analyzed their scores on MMPI scales and on other personality tests (“MMPI-168 and Marlowe-Crowne profiles of adoption applicants.” Journal of Clinical Psychology, Vol. 50, 863-866). Dalton noted that there was a serious lack of normative data that would allow adoption applicants to be compared to other adoption applicants rather than to people who were free of the stresses peculiar to the adoption situation. He noted that the typical MMPI profile for the applicants he tested was “characterized by a high degree of defensiveness, particularly among females… the [average] female profile on the validity scale would be interpreted as follows: “This is a valid profile. Persons who obtain similar scores are often seen as naively defensive individuals who have a strong need to present an image of virtuousness or perhaps strong moral character. They tend to have little insight or awareness of their own stimulus value… “(p. 865). Dalton then went on to say-- and this is the significant part--- “Although it is possible that defensive people are more likely to apply to adopt children a more likely interpretation is that the [preadoption] screening process creates a defensive attitude” (p. 865). Dalton strongly advises comparing the MMPI scores of potential adoptive parents to those of other such people rather than interpreting them in terms of the larger population, in comparison to which the adoption applicants may appear to have some undesirable personality traits.

It is doubtful that preadoption psychological evaluations often do follow Dalton’s suggestion. Even if they did, however, there is little or no information to show us whether successful adoptive parents have different MMPI profiles than those involved in serious failures. Few evaluators who specialize in preadoption screening are research-oriented, and few potential adoptive parents would give permission to include their data in research reports. As a result of this lack of information, we may have a situation in which psychological evaluation can screen out seriously mentally-ill applicants, but fails to determine characteristics that may or may not fit a potential adoptive parent to do a successful job with a child.

I suggest that preadoption evaluators may do better to focus on certain personality and social characteristics that are not assessed by the MMPI but may be highly relevant to adoptive parenting. One of these is authoritarianism, a personality characteristic focusing on the issue of obedience to authority. Authoritarian persons are concerned with the obedience children owe to their parents and are simultaneously concerned with the obedience they, the parents, owe to persons in authority over them. Authoritarianism values obedience in and of itself, not simply as a means to an end; a nonauthoritarian parent may work to instill obedience in children so they will come out of the street or away from a hot stove when told, but the authoritarian parent sees child obedience as a goal in itself, independent of child safety or health outcomes. Some authoritarian parents consider child obedience to have special value in a religious context and consider obedience to a parent to be the foundation of obedience to God, while others want obedience as part of a secular value system.

A high degree of authoritarianism motivates a parent to require obedience of children even if they cannot do what is required of them or do not understand what is being ordered. When there are cultural differences which the parent does not understand or accept and which the child cannot articulate, there may be apparent intentional disobedience that an authoritarian parent finds unbearable. An example here might be the conflicts over pet animals so often noted in adoption blogs; poor or post-institutionalized children or those from the Third World may have had no contact with pets and may regard them as predators or vermin that should be killed, whereas an authoritarian adoptive parent may demand what he or she sees as appropriate affectionate behavior toward animals. More and more severe punishment may follow the child’s failure to comply.

Authoritarianism may also make adoptive parents especially susceptible to adoption counselors or therapists who focus on child obedience and parental control as the sole route to family success. Such semi-professional or professional advisors may advise physical restraint and control over food intake as appropriate means to achieve the obedience they have claimed as the key to positive development. These methods, or similar techniques like exposing the child to heat or cold or forced drinking or eating, all have very real potential for causing injury and even death.

Psychological evaluators, do your assessments consider authoritarian personalities as matters of concern for preadoption psychological evaluations? Do your interviews explore adoption applicants’ connections with advisors who may suggest potentially harmful paths to inappropriate goals? The U.S.- Russian adoption treaty will not tell you to do these things, but you may find them more genuinely useful in preventing adoption disasters than the MMPI’s standard textbook interpretation. The same goes for the post-adoption monitors required by the treaty.

Wednesday, July 13, 2011

RAD on Youtube; or, Caveat Spectator

“Open source” mental health information on Wikipedia is problematic enough, as I’ve written elsewhere, but at least it tends to be watched and corrected (or perhaps just edited) by interested editors and Wiki admins, and citation of sources is supposed to be required. Youtube productions can present a more serious problem, because no one can make corrections by editing within a video; the best they can do is to make their own video and strive to correct any misconceptions that may have been caused by the original presentation. In addition, it’s up to the contributor to decide whether any source of information should be cited-- and often none is given

I’ve been looking at Youtube material that purports to discuss Reactive Attachment Disorder, and a depressing job it’s been. I can’t possibly talk about everything I’ve seen that’s wrong, especially that old TV melodrama “Child of Rage”! However, I do want to comment on two of these gems,, whose authorship is not clear, and, created by the Association for Treatment and Training of Attachment in Children (ATTACh). Each of these is full of inaccuracies, inconsistencies, and downright errors (it’s a trivial point, but the creator of the anonymous video apparently believes that Mary Salter Ainsworth was a man).

The anonymous video (uploaded by one vsulley) commits the very worrisome error of conflating Reactive Attachment Disorder (RAD) as described in the Diagnostic and Statistical Manual of the American Psychiatric Association with the notional problem sometimes called just “Attachment Disorder” (AD for short). Reactive Attachment Disorder is characterized by age-inappropriate social behavior, especially with respect to familiar caregivers. Children may be unusually aloof, independent, and willing to interact with strangers for their age, or unusually clingy and demanding of adult attention for their age. The RAD diagnosis can be given in either of these cases, but only if the behavior began before age 5 years and if there is a history of poor care. AD has nothing to do with symptoms of RAD, and the manual for the Randolph Attachment Disorder Questionnaire, a test intended to detect AD and cited in this video, actually states that it is not intended to diagnose RAD. Speculative discussion of AD, whose existence is not supported by systematic evidence, claims that symptoms of the disorder include a fascination with blood and gore, cruelty to animals and younger children, refusal to make eye contact on adult terms, “crazy lying”, and so on. These are obviously very different symptoms than those associated with RAD (not to mention the lack of evidence that such a disorder exists or is related to attachment in any way). But the anonymous video treats RAD and AD as equivalent and cites a very weak 2003 Journal of Psychology article by Hall and Geher as a major source. On the positive side, this video does not support the use of holding therapy and notes the lack of evidence that HT is effective, neglecting, however, to state its potential harmfulness.

The ATTACh video, posted by the parent-professional organization that has for many years promulgated the idea that adopted children are likely to suffer from mental health problems associated with attachment, takes a different approach. It rejects the DSM description of Reactive Attachment Disorder as an insufficient diagnosis for the posited problems of adopted children, but rather than referring to AD (once a major tenet of ATTACh’s belief system), the video emphasizes the Developmental Trauma Disorder proposed by Bessell van der Kolk but not included as a diagnostic category in the work on the upcoming DSM-V edition. The ATTACh video fails to state that a lack of systematic evidence for the disorder suggested by van der Kolk is the reason why DTD will not be included in the new revision.

The ATTACh video re-emphasizes a position long taken by the organization-- that Reactive Attachment Disorder in childhood develops into serious personality disorders, antisocial personality, depression, anxiety, and suicidal thinking. The video completely omits any discussion of longitudinal research by Michael Rutter and his colleagues, showing how few children adopted from Romania had later mental health problems. I’ve discussed this research at and included the comment of the developmental scientist Megan Gunnar that so-called attachment problems may not be associated with attachment at all.

There are two other interesting points about the ATTACh video, and both of them require some explanation for those who cannot “read between the lines”. One is a startling acknowledgement of the influence of Foster Cline on the organization and the continuing importance of his views of attachment and related disorders. Foster Cline is an M.D. who was strongly influenced by Robert Zaslow, a psychologist who developed an intense and intrusive form of holding therapy in the 1970s. Cline learned Zaslow’s methods and applied them during the ‘80s and ‘90s, during which time he compared holding therapy to chemotherapy as a painful and frightening but necessary treatment that should not be avoided in spite of its dangers (it was eventually associated with a number of child deaths). Cline stated that “all bonding is trauma bonding”. Both Zaslow and Cline surrendered their professional licenses after disciplinary actions following injuries to patients. It is quite remarkable to me that ATTACh continues to state its Cline connection in contradiction to its efforts to become a kinder, gentler organization following the 2000 death of Candace Newmaker during a therapy session.

A second point, and one surprising to me, is the appearance in this video of the psychologist Michael Trout. Trout, at one time a highly-respected clinician, has in the last 15 years become greatly involved with the Association for Pre- and Perinatal Psychology and Health (APPPAH), a group committed to the idea that babies remember their gestations (perhaps even conceptions) and births and will sometimes spontaneously report on these. APPPAH attributes much emotional disturbance to prenatal and birth trauma and supports massage of neonates by individuals like William Emerson, who claims to release birth trauma by pressure on infants’ heads and necks. In the video, Trout specifically refers to the mantra “baby can remember” on which much APPPAH thinking is based.

Rather than providing reliable facts about childhood mental health issues, the ATTACh video gives some revealing information about the direction ATTACh seems to be going. A connection with APPPAH is a remarkable step away from the “mainstream” status once aspired to by this group. The ATTACh video is thus remarkably informative about ATTACh-- but not so much about Reactive Attachment Disorder.

Thursday, July 7, 2011

Monkeys or Mamas? It's a Toss-Up for Newborns

There’s been a lot of discussion about whether newborn humans recognize their mothers’ voices, or anything else about them, The voice issue has received a great deal of emphasis because babies can hear speech sounds before birth. Even though the sounds are somewhat muffled by the mother’s skin, muscles, viscera, and amniotic fluid, they can be heard and are apparently recognized, as babies after birth have been shown to prefer familiar speech sounds to unfamiliar ones.

In addition to preferring the familiar, newborns prefer voices over other kinds of sounds from inanimate sources. They show this when they have learned that by sucking frequently on a pacifier-like object they can control whether they get to listen to voices or other sounds, or to familiar or unfamiliar voices.

Most researchers working on this topic have not thought about the effect of sounds that are not only unfamiliar, but not likely to be heard at all by most infants in the industrialized world. However, one group looked at whether babies were attentive to hearing rhesus monkey vocalizations (Vouloumanos, A., Hauser, M.D., Werker, J.F., & Martin, A. [2010]. The tuning of human neonates’ preference for speech. Child Development,81, 517-527). They were interested in learning whether newborns were really especially attentive to speech, or whether they preferred all sounds with characteristics they share with human speech-- like the sounds of monkey vocalization. These researchers let newborn babies hear nonsense speech and also recorded vocalizations of rhesus monkeys. The neonates were equally likely to choose (by sucking at the right time) to hear human nonsense speech or to hear monkey sounds. They chose both of these over synthetic sounds.

It seems that the newborn humans could not, or at least did not, tell the difference between humans speaking and monkeys vocalizing. But adults and even older children can readily make that discrimination. How and when do they manage this? Vouloumanos and her colleagues tested 3-month-old babies, using a different technique than the one they had used with the newborns. The 3-month-olds could keep a sound playing by looking at a black-and-white checked screen for a long time; if they looked away, the sound stopped; when they looked back again, one or another sound occurred at random. Unlike the newborns, the 3-month-olds spent more time looking in a way that would allow them to hear human speech sounds. They not only could, but did, tell the difference between human and monkey sounds.

How does this work compare with the research (by DeCasper, for instance) suggesting that newborns can make very careful discriminations, not only recognizing their mothers’ voices but even telling the difference between stories that were read? How could they tell these rather subtle differences, but not discriminate human and monkey vocalizations? Is a puzzlement, yes?

Vouloumanos and her colleagues suggested that this peculiar difference might result from the fact that the nonsense speech they used was quite brief and was not the connected speech of ordinary use. It may be that spoken sentences make available to babies a good deal more of the distinctively human speech characteristics that differ from those of monkey vocalization. Connected speech contains a variety of information in the form of syllable length, intonation and emphasis, rhythm, and so on. This rich, variable material may be much more effective in catching infants’ attention than brief nonsense words. In other words, the researchers speculated that the newborns actually could tell the difference between human and monkey sounds, but did not pay much attention to what they did not find very interesting.

Whether or not newborn babies can tell monkeys’ voices from mamas’ voices-- and a definitive answer is not yet available-- it’s clear that they do discriminate between voice sounds and synthetic sounds, and spend more time listening to voices when they get the chance. They are born with a positive bias, an interest in the sounds voices make. Is this because of prenatal experience with voices, because of a built-in “tuning” of the auditory system for those important sounds, or because of a combination of the two? That isn’t clear yet, but it is clear that newborns are still very much in the process of development, and adults should not jump to any conclusions about resemblances between the very young and the older human being.

Just a little addendum: when Vouloumanos and her colleagues did one of these experiments, they tested 30 babies. Another 44 babies were available but were excluded from the study because they fussed or fell asleep or because they did not suck often enough. If you ever wonder why research on young infants is not done more often and with larger numbers of babies,do remember this: just as you can’t make a turtle come out, you can’t make a baby participate if it doesn’t feel like it.