Concerned About Unconventional Mental Health Interventions?

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

Sunday, July 29, 2012

It Ain't Necessarily So: Mistaken Conclusions From Adoption Anecdotes


Why do people continue to espouse mistaken understandings of adoptees’ relationships with their birth mothers? Why do they seek information that they think confirms some special relationship they had and then lost when they were adopted as tiny infants? In much of western culture (although, not, by the way, in traditional Hawaiian society), there is a myth of the birth mother’s stamp on her infant, and the longing of the adopted child for reunion with a person for whom there is no conscious memory.

(Curiously, in spite of this myth, modern literary representations from drama to comic books have focused on the search for the lost father--  although the little girl Hushpuppy in the wonderful movie “Beasts of the Southern Wild” is shown as searching for her mother, now that her father is dying.)

Part of the birth mother myth may be a remnant of the old conviction that a pregnant woman’s wishes and feelings would mark her baby both mentally and physically. A “strawberry mark” might be explained as caused by the mother either eating too many strawberries, or by wanting some and not having them. If a pregnant woman saw something she wanted to eat, she might be advised to have some, because if she didn’t, her baby would “want”. It’s only a step from those beliefs to the idea that something happened during pregnancy that irrevocably connected the baby to the birth mother.

Beyond the influence of old tales on people’s beliefs about birth mothers and babies, though, there’s the fact that some individuals and groups make a point of insisting on a deep connection—in spite of the fact that no systematic evidence supports their beliefs. One organization well-known for this activity is the Association for Pre- and Perinatal Psychology and Health (APPPAH), which advocates the beliefs of authors like Francis Mott, Frank Lake,and Stanislav Grof that dreams and experiences under the influence of LSD are accurate depictions of what a baby experiences prenatally and during birth. The APPPAH web site, http://birthpsychology.com, posts a variety of articles arguing for or building on the claims of Mott, Lake, Grof, and others. One of these is a paper by Lavonne Stiffler  stating that “synchronicity”  (related events that reflect an underlying spiritual framework of causes) characterizes reunions between adoptees and their birth parents.

You have to pay to read Stiffler’s paper, but you can get a good idea of the contents with the “look inside” feature of her book of the same title on Amazon. Published in 1992, Synchronicity and Reunion: The Genetic Connection of Adoptees and Birthparents recounts a number of personal narratives as evidence that genetic factors connect separated parents and children and cause them to look for each other. She suggests that such a wish may involve a form of “homing instinct” that drives humans to look for people in the same way that migratory animals search for their territories and flight paths. As a mechanism for such searching, Stiffler refers to magnetite crystals in human brains.

Now, I am not about to say that it is impossible that genetically related people would seek each other. It’s a world of wonders, there are more things under heaven and earth than are dreamt of , and they laughed at the Wright brothers (or was it the Marx brothers?). It could be, right? But the point that concerns me is this: how would we go about discovering that it was right, and how would that method compare with what Stiffler did in her dissertation at the Oxford Graduate School (no connection with the real thing) in Dayton, TN?

Stiffler herself notes that her set of stories comes entirely from reunited adoptees and birth parents. Having found each other successfully, and being happy about the fact, these people were asked to tell the stories of their searches for each other, what they thought, what they felt, and so on. Stiffler concedes handsomely that she has no idea what would be the stories told by people who searched without finding, did not search at all, or were reunited and did not care for each other. And despite this concession, she goes right on to say that a synchronicity or coincidence of events is meaningful in that it is a unique subjective experience for the participants--  in other words, it would appear, that it does not really matter whether a phenomenon can be observed objectively.

From my point of view, which I think I share with other children of the Enlightenment and admirers of critical thinking, the subjective aspect is interesting and useful to know about, but if there is no objective evidence for a phenomenon, we can’t build our understanding of the world on a mere assumption that the phenomenon exists. So, if we want to understand whether there are special links between  birth mothers and their separated babies, we need to look at a large group of such people and examine the experiences and narratives of all of them, not just those who have been reunited and are volunteering to tell us about themselves.

I don’t reject the stories collected by Stiffler. But I do say that they can be understood only in the context of other stories by people who have had the same experiences of separation. Why? Well, there’s the statistical part about small and large samples, but let’s leave that out. A more important issue is that investigations like this depend on retrospective approaches and therefore on memory. All the interviewees can do is to tell us what they remember and how things seemed and seem to them. And human memory, of course, is not a matter of neural videorecording, but a matter of reconstruction of pieces of information so that they make sense to the rememberer. That reconstruction is what makes us say that we were always suspicious of the investment counselor who turned out to be a fraud (when in fact we always had complete confidence in him before), or that a son- or daughter-in-law with whom we got along well suddenly “never seemed like the right kind of person” after  splitting up with our child.

 We are always looking for patterns, patterns that make us feel safe and help us conceal from ourselves the unpredictable risks and traps of the real world. If we can think that we felt in our bones that our relinquished child lived in Chicago, that’s comforting. If we can think that a person lost to us is not really lost but will be drawn to us by magnetite crystals, that’s even more comforting. Stiffler’s book and article play on this desire we all feel for comfort in a dangerous and random world.

Stiffler and other authors honored by APPPAH have not shown that their beliefs are more than comforting patterns. It ain’t necessarily so--  until some serious evidence is brought forward, and that has certainly not happened yet, in spite of the claims of Verny, Verrier, and other APPPAH stalwarts.



Monday, July 23, 2012

The Colorado Shootings and Young Children


Some years ago, it used to be possible to keep news of disasters from young children. If they couldn’t read, they could remain unaware of newspaper headlines, and even TV news was much less graphic than it is today. Children might overhear adults talking and realize something had happened, but they were not exposed to every detail, unless they themselves were present at the event.

The recent shootings in Colorado remind us that today it’s much more difficult to protect young children from frightening awareness of terrible events. Excited news reports are seen and heard on the radio, on the computer screen, on television in the home and in public places (where it can’t be turned off or avoided). Tweets can keep parents constantly aware of ongoing situations which they find difficult to ignore.

If your child is with you when news of disaster comes, your very nearness creates a feeling of safety and security that can help override the impact of the event. But what if the child doesn’t seem to feel safe—or what if you are a friend, a relative, or a teacher or day care provider with temporary responsibility for the child?

A handout provided by Dr. Gerard Costa of Montclair State University gives some outstanding guidance for adults trying to help young children cope with frightening news.  I’m going to quote some of his suggestions directly and then add a few comments to each.

“1. Ask children what they know and have heard. Correct the accounts and give permission for many different feelings: scared, angry, worried, etc. Monitor your own emotion and tone of voice.”

  • Of course, what you ask or tell depends on the child’s age. Some may know no more than that someone got hurt, and they don’t need to know more than that, or to be corrected by being given additional information. If they are really mistaken, and if the mistake is an additionally frightening one--  for example, that a building fell down by itself (so the building the child is in could do the same), a correction is helpful. As to how they are feeling, the youngest children may have very little vocabulary to describe this, but they may be able to tell you what they want to do--  stay close, sit on your lap, have a story, perhaps.  Although adults will feel distressed, they need to try to be calm and to pay attention to how they sound or look to the children.
“2. It is okay, even important, for children to know that the adults in their lives have the same feelings when bad things happen: sadness, fear, worry, anger. Let children know you feel these things and that you are there for them. It is important, however, that you remain in control. If your own reaction is difficult to manage, enlist another adult to help you with the children.”

  • It can be very helpful to have another adult present to help. What can be hard, though, is for both adults to concentrate on the children’s needs rather than talking to each other. People who have worked closely together and thought about or practiced what to do ahead of time are probably more likely to be able to resist the temptation to turn to each other, which might be harder for adults who don’t know each other well and find themselves together entirely because of a catastrophe. For teachers and caregivers, occasionally practicing a “psychological disaster drill” might be helpful when the real thing happens.

“3. Limit repeated exposure to images and reports of the events. Follow the child’s lead, talk about what happened, be reassuring about the ways that you, the adults, will take care of them. Turn the TV off, read a book, interact in play, talk. Typical and normal routines are comforting and   reassuring to children.”

  • This excellent advice goes directly against the impulses of the adults, who feel as if they are safer when they know more about something, and would like to be glued to the news even though the same scenes are being shown over and over. When a disaster occurs, adults tend to lose their appetites, forget about meals, and be unable to sleep, abandoning the routines that are so important to young children’s sense of security. Adults who are responsible for children need to recognize the difference between their adult motives and those of young children, and consciously choose to do what the children need.

“4. At each developmental period, the availability and empathic response of a caring, familiar, adult begins the process of remediation.”

  • Although preschoolers and young school-age children may appear extremely independent when all is going smoothly, they are as much in need of adult support in times of fear as infants and toddlers are. But preschoolers and kindergarteners are much more likely than babies to find themselves with an adult who is not very familiar when news of frightening events comes. They are likely to be cared for or go to school in larger groups and therefore have less opportunity to develop relationships with caregiving adults. This does not mean that there is no help for them--  even a completely unfamiliar adult can provide stability and some comfort by staying near and being attentive to children’s signals. A familiar person can do this much more easily, but anyone who behaves appropriately can be a big help.
“5. When children do see images or reports of tragedies, Fred Rogers suggests that we help them ‘look for all the people who are helping’. Couple the sad tragedy with the comforting presence of others who are helping and taking care of others.”

  • Young children’s natural interest in firefighters, police, and medical personnel can help to turn worrisome news about an event into a familiar discussion. (“Mr. Rogers” knew a thing or two about how young children operate.)
“6. If the status of a child’s parent or relative is unknown, reassure the child that you will stay with him/her  and that you will be sure to contact someone they know who can come to be with them.”

  • Although an actual reunion with the missing person is the only thing that will really give the child peace of mind, it’s important that they be helped to know they are not alone. Remember that young children are often still functioning with a “desire psychology” in which they believe that whatever people do, it’s because they want to do it. Especially in stressful situations, they are likely to think in that way and to believe that Daddy isn’t picking them up because he doesn’t want to, not because he is hurt or because he doesn’t know where they are. They need to know that you, the adult, want to be with them and will be there.
To conclude with an essential message from Gerry Costa’s handout:
“While we as adults may feel unsure of the possibility of future tragedies, uncertainty is the province of adulthood. We must always let children know that we will take care of them and protect them.”

[And how about giving children that assurance by demanding that the two presidential candidates state how they propose to regulate not only guns but ammunition purchase?]

Friday, July 20, 2012

Attachment and Day Care, Part 3


In the last two posts, I’ve been discussing some issues brought up by Elisa B., the mother of a two-year-old who has been having difficulty in his day care since he was separated from a favorite teacher. Elisa has found that the separation was intentional and that the day care staff believes that Billy should be developing more casual affectionate relationships with more child care providers rather than having a strong relationship with one. She also found that the plan is to move Billy to yet another classroom in about 6 weeks.

I mentioned in the last post that Developmentally Appropriate Practice requires attention to the needs and abilities characteristic of a particular age group (and I might point out that children are generally thought to do better with a small number of familiar people until at least 36 months of age, so I don’t think the day care center is aware of relevant appropriate practice). In addition, because children do not all develop along exactly the same schedule, or even develop all their abilities at the same rate, individually appropriate practice is also needed.

An essential part of individualization is attention to temperament. This term refers to the biological, constitutional characteristics unique to each person, which determine the ways each of us reacts to the world. There are several ways of looking at temperament, but they all assume that people have characteristics at birth which continue to be expressed throughout their lives. Naturally, because each person changes with age, the behaviors that express temperamental characteristics change over time, but the temperament remains the same. For example, the 6-month-old who eagerly tries new foods may become the ten-year-old who likes some foods much better than others but is enthusiastic about new games or people. All temperamental differences are by definition within the normal range of development, but some temperamental patterns take more support and guidance than others.  

Elisa  describes Billy as always having cried a lot, being shy around other people even if his mother and father were there, and having a lot of trouble adjusting when he first attended day care at 13 months.  Without having any other information, I’m guessing that Billy has three important temperamental characteristics. He has negative mood quality, so that even if there is nothing much happening his tendency is to be sad rather than cheerful. He withdraws  from new events and people rather than approaching them eagerly. And he is slow to adapt to situations.

These “difficult” temperamental characteristics have their advantages. A child like this does not wander off with strangers, drink liquids the painters left sitting around, or approach stray dogs. At the beach, he won’t go into the water when his mother isn’t watching (in fact, lots of luck getting him in there before Labor Day). But, in modern life, adults are not likely to see this as an ideal temperament. Families are all scheduled up and feel they should be able to rush hither and thither without pausing for adjustment. However, a child with this sort of “difficult” temperament just can’t be forced to accept rapid changes without responding with many tears and fears.

“Difficult” children can do very well if they are given plenty of affectionate guidance and if their reactions are anticipated. It would certainly be a big surprise if a child like Billy took happily to day care at 13 months. What he needed, and still needs, is plenty of time for adjustment to any new person or situation. What--  does somebody say he’ll have to do better eventually, so why not make him do it now? First of all, he can’t do it now. He doesn’t have the skills. Second, he will be able to do a good job later, and be his best mental and emotional self, if he now learns from adults how to cope. Doing new things a little at a time, having a chance to watch other children do them, and knowing that a familiar adult is nearby--  these are all factors that can make a new situation be, as one of my sons used to say, “funner than I thought!” Interestingly, we have no problem with letting adults or even older children handle their introduction to new things as they see fit, but some of us still believe that to allow  “difficult” toddlers to take their time is spoiling or babying them. On the contrary, it’s providing what teachers call scaffolding to help them master the situation.

Although it’s not well understood how temperament is determined, it probably has at least some genetic causes. One of the things Elisa B. said about herself was that she tended to be anxious and depressed. This makes me wonder whether she shares Billy’s temperament to some extent, which may help her have some insight into his feelings. Whatever day care arrangement Elisa finally makes, I hope it will be one where the caregivers are able to recognize the accuracy of her statements about Billy.

One more issue needs to be discussed. Elisa has asked me whether it would be good to have Billy tested for his attachment to her and to seek treatment for any problems that showed up. I have to say that I would see no point to doing this. First of all, the major way of evaluating attachment, the Strange Situation, was developed as a way of looking at differences between groups, not differences between individuals. The Strange Situation does not offer a clear assessment of individual attachment, and although it might provide guidance for clinical work with a family, very few clinicians are trained to do it or have in their offices the physical arrangements it requires. In any case, there is no question in my mind that the reported behavior shows that Billy is much attached to his mother and also quite able to form attachments to other caregivers when given time and opportunity. He does not need help or guidance in attachment--  just a chance to do it. However, if Elisa feels that the situation is too difficult to deal with, she and Billy might benefit from one of the treatments (like DIR) that works with parents and children together to improve their emotional communication.

A while ago, I came across a parent education pamphlet, put out by a major infant mental health group, that made a remarkable error about attachment. It stated that if children are securely attached, they will not cry when left at day care. This is absolute nonsense, and I hope that Elisa has not been thinking that it’s true. Secure attachment means that when the young child is distressed, he or she can be comforted by a familiar caregiver, and that the child can use that caregiver as a secure base for exploration. Infants over about 8 months of age, toddlers, and even young preschoolers are quite likely to cry at least briefly when left by a familiar person--  unless another familiar attachment figure has received them and begun to talk to and hold them. Young children who do not react to separation are much more likely to need some form of intervention, convenient though their behavior may seem to parents and caregivers.

I hope Elisa and Billy are able to find a day care arrangement where caregivers understand some of the points I’ve been making and are aware of appropriate practice with different developmental stages and different personalities. Finding such a place would make the next few years of Billy’s life far more pleasant for the whole family.

   

Wednesday, July 18, 2012

Attachment and Day Care, Part 2


In yesterday’s post, I commented on the concerns of Elisa B., the mother of two-year-old Billy, about his distress in day care after he was moved to a new classroom and separated from his favorite teacher. Elisa said Billy had been in day care since he was 13 months old and had adjusted slowly, but now cried when being dropped off and cried when he saw the favorite teacher in the hall.

Elisa has now told me that she talked to Billy’s teachers and they stated that the separation from the favorite teacher had been intentional. The day care staff felt that by age 2 ½ children should be discouraged from attachments to a few people and encouraged to be friendly with many caregivers. They also told Elisa that the plan is to move Billy to yet another classroom six weeks from now.

As I pointed out yesterday, the National Association for the Education of Young Children and other early childhood groups like Zero to Three favor limiting children’s caregivers to a small number of familiar people until at least 36 months of age. One of the reasons for this guideline is that familiar attachment figures can serve as “secure bases” for young children. In the presence of the attachment figure, the child can explore new territory, checking back or going back to the adult for reassurance from time to time. Without an adult who can be a secure base (and unfamiliar people cannot do much of a job on this), young children are often reluctant to explore and may appear withdrawn or even go into a tantrum of protest. Their ability to learn under these circumstances is limited, in comparison with that of children who can draw on a secure base person for support. As they move into the preschool (age 3 to 5) period, children become more self-reliant and more skilled at dealing with strangers and depending on friends of their own age. They can then cope reasonably well with larger groups, larger staff to child ratios, and staff changes--  except that even these older children will handle injuries, illness, or fear much better when they can be with familiar, sensitive, responsive caregivers

Organizing day care around the characteristics of infants and toddlers is one aspect of Developmentally Appropriate Practice (DAP). DAP is a central theme of all current professional guidelines about child care and early childhood education and is essential to NAEYC accreditation.  It’s not at all clear to me why Elisa’s day care center staff seem to reject standard DAP guidelines, but it should not be forgotten that high-quality, DAP-oriented care is expensive, and that a center can be much more profitable if it embraces a philosophy claiming that it is good for young children to be forced into unfamiliar situations and discouraged from using a secure base created by an attachment relationship. This is one reason why not-for-profit day care centers tend to be of higher quality than the for-profit kind.

It’s often easiest to think of DAP in terms of children’s chronological ages, but in fact age is not the only factor determining a child’s needs. Development in different areas--  like physical and social abilities—can be quite different in a given individual, and development in any area may move rapidly and then take a long pause on a developmental plateau. This means that understanding what is developmentally appropriate for a given child depends on knowing that child as a unique person. Day care providers cannot do this effectively unless they have plenty of time with each child, so they can work with individuals rather than with groups most of the time. (Large amounts of the day spent in group work are a sign of poor-quality care for infants and toddlers; what might be acceptable for a 5- or 6-year-old does not work well for young children.) One of the problems created by concentrating on group work is the making of arbitrary decisions like the one Elisa reports as a plan to put Billy through another change of classrooms soon, even though he has clearly not yet adjusted to the last change.

Knowing a child as an individual involves more than being able to assess his or her skill levels. A critical aspect of individualization is understanding a child’s temperament, the personality characteristics created by biological factors. I will be talking about those tomorrow and showing how relevant they are to Elisa’s and Billy’s situation.

Tuesday, July 17, 2012

Attachment and Day Care, Part 1


A few days ago I had an e-mail from a young mother who is concerned about her toddler and his behavior at day care. She commented correctly I think, that many parents have concerns similar to hers but don’t know how to find answers to their questions. I told her I would answer her by means of blog posts--  and there are so many issues to be considered that I think this will require several posts.

I should point out, by the way that I have never met this lady whom I will call Elisa B., or her child. I am not a clinical psychologist, but a developmentalist, in any case, so I can’t offer clinical suggestions--  but even if I were trained in that way, it would be against professional ethics for me to comment on individuals I have never worked with. Elisa also kindly offered to pay me for my time, but it would be inappropriate for me to accept payment.

I’ll summarize some elements of Elisa’s story. Her little boy, whom we can call Billy because as far as I know that isn’t his name, is two years and three months old. He has been attending a day care center since he was 13 months old. Billy was very attached to one teacher, but several weeks ago his group of children was moved to a different level. His favorite friend is now in a different group, and he rarely sees the favorite teacher. He cries when his mother leaves and when he sees the favorite teacher in the hall. The new teachers say he is adjusting, but Elisa says he gets quiet when she asks about the new people.

Elisa says Billy has always been shy around other people, even if his parents are there, and she describes him as always having cried a lot. She also says of herself that she is inclined to be anxious and depressed and that she decided on day care for Billy because she was worried that being at home with a depressed mother was not good for him. (Incidentally, I would like to point out how important it is that Elisa is considering her own possible contribution to the situation—this is a difficult step for most people to take.)

Elisa wants to know what the day care center might do to help and how she can communicate with the staff without making them get defensive. She also asked whether it would be good to have Billy’s attachment status evaluated and whether some intervention might be possible.

Like most real-life situations, this is a complicated one. Some factors at work are the day care center’s practices, Billy’s temperament and why he cries when he sees his favorite teacher, Elisa’s own personality, and the advisability of evaluation and treatment. I know there is a lot to say about each of these, so I’m going to give each topic a post of its own, starting with day care practices today.

High-quality child care centers comply with the standards for voluntary accreditation set by the National Association for the Education of Young Children and administered by its state affiliates. Important among the NAEYC standards are staff to child ratio and group size. NAEYC recommends that for children in Billy’s toddler age group the ratio of adult caregivers to children should be no higher than one adult to six children, and that the whole group of children together in a room should be no more than 12. NAEYC also recommends “assigned caregivers”--  adults whose responsibilities are for particular children and who do not “float” or look after children no one else is dealing with, unless there is a real emergency. These rules are aimed at providing a comfortable, familiar social setting in which each caregiver can genuinely learn to know each child, and each child will feel at home with his or her caregivers. Because children are often at a center for periods that overlap two caregiver shifts, the rules emphasize assuring that all the caregivers are familiar to the children they will meet--  even when there is a “substitute” (which there often must be, because people who work with young children catch colds often).  Without specifically addressing attachment issues, these rules attempt to create a supportive, responsive social environment for young children and to help them respond with resilience to any disturbing events. Standards for NAEYC accreditation also include center rules that allow parents to drop in at any time and that name support of the family as a center goal.

About 20 years ago, incidentally, there was a serious proposal in early childhood circles that young children not be moved from one room and teacher to another, as Billy was moved. The idea was that a caregiver would begin with a group of young children and continue with them from infancy right up to kindergarten entry. This excellent proposal, which would have allowed teachers and children to know each other very well, never developed any traction, in part because it was rejected by many teachers. When I asked day care staff and preschool teachers about it at the time, almost every one declared that she was a “two-year-old teacher” (or three-  , or four--) and that she wanted to go on doing the things she did to teach children in that age group; the group was more important to the caregiver than the individuals within it, in many cases. For whatever reason, the proposal was never widely accepted and is not part of accreditation standards--  but how much difficulty for children could be prevented if it were!

If Billy’s day care center is NAEYC accredited, Elisa’s problem about consulting with the staff is much simplified. The accreditation standards require that this be done (although not necessarily without a planned appointment), and specifically require compliance with standards that help give children a familiar social group. But accreditation is not the same as licensure, and state-licensed, unaccredited day care centers may stay within the law without meeting the high standards mentioned earlier. Those centers may be much less available for consultation than Elisa would like, and especially if they are for-profit franchises of national companies, they may be under great pressure to maintain the “bottom line” by reducing the staff expenses that are the major cost of running a day care center. For-profit centers may turn a higher profit by hiring staff part-time or even by failing to provide a substitute for a sick caregiver, thus reducing for all practical purposes the staff to child ratio they advertise. Under those circumstances, Elisa’s concerns would not be likely to be heard.

What if  Billy’s center will not cooperate, or if Elisa goes on feeling that she cannot make herself heard without making staff members angry? With a sensitive child like Billy, of course, one dreads the idea of changing to a new care setting. However, if the present situation is too difficult, it may be best to make a change to a place that will help him feel secure over the next several years. I would suggest that Elisa and her husband look into family day care rather than center-based care. The small group and consistent caregiving of this form of care can be much more comforting for some children than the experience of a large day care center. A family day care program is ideally part of a day care network that offers support and education to care providers and often helps them with business insurance and benefits like health care. Parents who perceive nonparental care as “school” may turn up their noses at family day care, but for a young and anxious child like Billy, it’s probable that much more learning will go on when he feels comfortable than can possibly happen in a highly academic but emotionally uncomfortable day care center.

   

Thursday, July 12, 2012

The Russia-U.S. Adoption Agreement: Some Supernatural Entity is in the Details



Is it “God is in the details” or “the devil is in the details”? And what does either of them really mean? I never know, but I do know vague generalities when I see them and understand that their portents may seem very different when the Ts are crossed and the Is dotted.

This level of vagueness is present in the agreement between the United States and Russia about handling of intercountry adoption, signed a year ago but taking effect only upon an exchange of diplomatic notes between the countries. Some information about the agreement is available at www.adoption.state.gov/content/PDF/FAQs_re_Agreement_07_13_2011_FINAL2.pdf , but as you will see, some of the important things had yet to be outlined at the time that document was written.

Here are some important things to keep in mind:
  1. Although the agreement contains a number of elements of the Hague Intercountry Adoption Convention, it does not require Russia to sign onto the Hague guidelines.

  1. The agreement forbids individual, private adoptions without the involvement of an adoption agency, unless the adopting family is related to the child.

  1. Adoption agencies involved in adoption to the U.S. from Russia must be authorized by Russia. All authorized agencies must first have been approved under the Hague Convention in the U.S., but Hague authorization does not guarantee Russia’s approval of the agency. Agencies currently operating are not grandfathered--  they must apply for authorization within 60 days after the agreement goes into effect. If they do not do so, they may apply one year later.

  1. There are new requirements for adoption service providers, and they must provide documentation of their capacity to meet these requirements in order to be authorized by Russia. Some of these requirements relate to both pre- and post-adoption services, as well as to the handling of adoption dissolution and the placement of the child with a new adoptive family. I’ve put asterisks * by the points where I think the details will be most significant.

“D” is the topic where the details are going to make the greatest difference, and those details are not yet available to most of us. Russia has committed to providing all medical and other background information for each child, so that appropriate matches between children and the capacities of adoptive families can be made. Prospective adopters may be required to receive special training to prepare them to care for certain children *1. When the adoption has taken place and the family returns to the U.S., adoptive parents are expected to register the child with the Russian Embassy or local consulate as soon as possible and to work with their adoption agencies to satisfy post-adoption requirements including reporting requirements.  

Following placement, the living conditions and upbringing of adopted children are to be monitored as Russia has instructed. This would be done in the home by the authorized agency’s caseworker, or by another person licensed to conduct such an evaluation. * 2 Periodic reports would be supplied to the Russian authorities, giving reliable descriptions of the child’s development and adaptation. *3

In the case of adoption disruption, Russian authorities would be notified as soon as possible, as would the U.S. State Department Office of Children’s Issues. Information about a new adoptive family would be provided to these authorities, and the consent or non-consent of Russia to the change might be required. *4 This would be true even of adoptions that occurred before the agreement went into force. *5

The agreement covers only adoptions where the adopting parent or parents have seen the child in person before the adoption and have participated in the Russian court procedures. *6

Now, all those asterisks— what are some of the details that will make a difference?

1*  Who provides the training? Considering how many misunderstandings about adoption are posted on the Internet by various groups, the quality of the trainer is a legitimate concern and one of obvious significance for the outcome.

2* What is the background of the evaluator, and what is the assurance that this even happened? The report of the Barahona grand jury, and innumerable other tragic situations, show that we can make no assumptions on these matters.

3*  Who writes the reports, and who reads them? If either writer or reader is poorly qualified, this will be only a ritual bow to the nature of the agreement.

4* What happens if Russia does not consent? How would the all-too-common informal exchanges of children be monitored?

5* How are these existing adoptions to be traced?

6* How much seeing in person would be required? In one case I’m familiar with, an adopting couple were told that they must take a boy’s sister if they wanted the boy they had spent time with. They had seen her, they were there and participated in the court procedures--  but they didn’t like her and several years later handed her off to another family (a judge signed off on this after the caseworkers recommended it). …. Presumably, this requirement means that trafficked children are protected under a different law.

For myself, I’m deeply embarrassed that my country has had to have its feet held to the fire before moving to protect internationally-adopted children. I look forward to the release of more information on the details of this agreement, and hope for the best.


If You See Something, Say Something, But Don't Expect to Be Thanked


Since 9/11, we’ve been cautioned repeatedly with respect to potentially criminal or terrorist acts: If you see something, say something. And very wise this is, because there are many more eyes of ordinary citizens to see problems than there are of “authorities”.

More recently, I’ve seen that catch-phrase used with respect to the Sandusky child molestation case. According to trial testimony, Sandusky was seen molesting boys, but the people who saw him didn’t mention it, or spoke only to others who in turn failed to report the facts to anyone who might have intervened. Now various sports journalists are trying to encourage those who see evidence of child abuse to take their observations to someone in a position to enforce the law.

This is all good advice, but it fails to take into account the retaliation of those whose plans are disturbed by a report of “something seen”. (And of course some of those people may be completely innocent of any wrongdoing.) While that retaliation may not go as far as the anti-snitch culture in which you can get shot for reporting, nevertheless it is severe enough that even whistleblower-protection laws are not perfectly effective.

“If you see something” is also at odds with the cultures of mental health and social services professionals, as I mentioned at http://childmyths.blogspot.com/2012/06/mental-health-mantras-versus-evidence.html. Most of those professionals would not dream of failing to report child abuse (although as the Barahona case showed, being friendly with parents may make caseworkers too comfortable with missed observations and appointments), but they are most reluctant to offer criticisms of other professionals’ work or belief systems. It’s not nice, especially if the criticism is offered in a public way. Ethics guidelines for both psychologists and social workers recommend that any concern about a colleague should be taken privately to that person and worked out, with complaints to a state organization or licensing board reserved for desperate problems. My own experience, in reporting a mental health professional whose online advertising was not truthful and who had attempted to self-plagiarize in a professional publication, was that the problems were said not to meet the threshold for an ethics complaint--  even though the lack of truth in advertising was misleading to clients. One blog, at www.goodtherapy.org, contains repeated complaints of therapy clients whose therapists have failed to provide appropriate services and who have been turned away when they filed complaints. (For full disclosure, by the way, this blog kicked me off several years ago when I criticized the claims of a therapist who was at that time a major player on the blog!)

A recent case of retaliation against a professional critic is told at http://jamescoynequickthoughts.posterous.com. Jim Coyne, a clinical psychologist and professor in the University of Pennsylvania Department of Psychiatry, wrote a post for his Psychology Today blog that questioned the research of pharmaceutical companies on antidepressants used to make cancer patients feel more comfortable psychologically during treatment. In short order, he found that his post and his picture were taken down by Psychology Today and his post was replaced with a new title. He was also told that in future his posts would need preapproval. This experience with Psychology Today echoes my own story at http://childmyths.blogspot.com/2010/12/federici-v-mercer-story-behind-lawsuit.html. Interestingly, in both cases, the criticism had not been directed against Psychology Today itself, but the retaliation was by the magazine, presumably in preemptive strike against litigation or removal of advertising. The intention, wherever it was framed, was clearly to have a chilling effect on professional criticism and to uphold marketing strategies.

In an article published some years ago (Kennedy, Mercer, Mohr, & Huffine [2002]. Snake oil, ethics, and the First Amendment: What’s a profession to do? American Journal of Orthopsychiatry, 72, 5-15), some colleagues and I argued that professional ethics, as well as personal ones, should require us to say something if we see something. In the personal arena, we would be concerned with  individuals or small groups harming others. In the professional area, our obligation should be to speak up when we see what we consider to be systematic professional errors; this does not mean jumping on every colleague who makes a mistake, but it does mean responding to genuine misrepresentation or clearly misguided treatment strategies.

Between the pressures of the marketplace and the cultural demands of mental health and social services professions, few of those who see something now feel ready to say something. This means that much that needs saying is going unsaid—in the professional world as well as in reporting of child abuse.  Isn’t it time that we stood up against the anti-snitch culture? If enough of us do it, we may be able to create a culture of responsible criticism.

I’ll say “thank you” to anyone who stands up--   but at this point very few other people will, unless our criticisms speak to their personal conditions.  



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Tuesday, July 10, 2012

Evolution, Attachment, and Megafamilies


Like almost everybody else except possibly creationists, I love to speculate about evolutionary psychology. (Is there creationist psychology, by the way? It might be even more interesting.) What fun, thinking about our remote ancestors wandering the Serengeti or painting horses in caves. I think it was in “Reindeer Moon” that Elizabeth Marshall Thomas described women marrying men from a different group and teaching them to have sex face to face—talk about your paradigm shifts!

On the other hand, even while having fun, I acknowledge that a lot of evolutionary psychology is along the same lines as the Just So Stories. It’s only a step from How the Elephant Got His Trunk to How the Human Babies Got to Be Attached to Familiar People. You can’t always work backwards from the present to past causes, because the same cause can sometimes have different outcomes, and a single outcome can have a variety of causes.

All the same, the evolutionary lens provides interesting images when applied to certain topics. Let’s think about emotional attachment of babies to caregivers. It’s easy to see the evolutionary advantage of having toddlers emotionally attached to familiar people--  the attachment works like an invisible playpen. When mothers gathered food in the wild, or cooked on a campfire, or carried water from a distance (as they still do in the developing world), a toddler who ran off or who approached unfamiliar people or animals might well not survive to reproduce. Those who were attached, who stayed near without being supervised closely, and who scurried back to mama when anything strange or startling happened--  they were the ones most likely to survive, and, given that their behavior was genetically determined, the ones likely to pass their traits along to their own offspring, who in turn would survive better  than cousins who were bolder.

But what about the claim that babies are really already attached at the time of birth, when they can’t yet get around on their own? In the environment of early adaptation, that would have been a problem, if it had been true. Maternal death rates were high. Even today, in Sierra Leone, the rate of maternal deaths within the 6 weeks after birth is 2000 per 100,000 births, or 2 maternal deaths per 100 births. Deaths of mothers for reasons unassociated with birth were also common, and probably more so for women who had been weakened by childbirth. This meant that by no means all babies could count on being cared for at age 12 months by the same woman who had given birth to them. For those who were orphaned, it was not necessarily easy even to find in a small band another nursing mother who could feed another child. Caring for an orphaned infant would have been made much more difficult if a young baby had experienced grief over separation from the dead birth mother, because grief interferes with feeding as well as sleep and play. The best arrangement from an evolutionary point of view would have been for infants to develop emotional attachments only after months of experience and familiarity with caregivers--  not that caregivers might not die later on, but they would be less likely to do so if they were not experiencing the risks of childbirth--  and this is how things turned out.

Then there are the megafamilies, adoptive and otherwise. Is it likely that human beings would have evolved to care effectively for many young children at the same time? If we’re talking about adoption, there could be two or more children who are actually about the same age--  would this have occurred in the distant past? Is it likely that any family would have, as well as a lot of young children, many older children who could be put to work at child care? The answers to all these questions are probably in the negative.

Poor diets delay puberty, so it may well be that many of our remote ancestors became sexually mature relatively late and therefore had fewer children than they might have had with early maturation. In addition, regular ovulation depends on having quite a high fat level (24% of the body, believe it or not), which would be less likely with limited food supply and high energy demands from exercise. Of children who were born alive, a high infant mortality rate would have carried off large numbers; even in the 19th century in some European countries, the infant mortality rate (proportion of deaths before the first birthday) was as high as 250 per thousand births--  one quarter of the children born. These facts mean that few, if any, of our remote ancestors--  the people from whom we presumably receive our genetic heritage--  ever had a baby every year and saw all those babies live. If they had twins or triplets, or babies with any handicapping conditions, chances are that they exposed some of  those babies to the elements and wild beasts, just as many of our less remote ancestors have done. Giving birth to a small number of children, and rearing relatively few of those, was the situation in the environment of early adaptation.

Assuming that human caregiving behavior evolved to suit that early environment (which it may or may not have done), it would seem that we are not likely to have inherited much ability to care for and respond to large numbers of children. Interestingly, some of the research of Mary Dozier of the University of Delaware has suggested that foster parents who have cared for many children in succession are in fact less capable of developing attachment relationships with children than are those who have cared for fewer foster children. The glamorization of large families by the media (and even those are usually 12 or less) does not reflect reality. Even the originals of “Cheaper by the Dozen”, the Gilbreth family, depended on affluence and faithful servants to achieve their good child-rearing outcomes. It is no wonder that when megafamilies meet real challenges in the form of special-needs children the results may be disastrous; it may not be “natural” for humans to have so many children.

These things said, I should point out that different species have different amounts of genetic variability. Look at cats and dogs--  there are small numbers of cat breeds, and only minor differences among them. Dogs, on the other hand, are highly variable, and that variability has made it possible to breed for many different sizes, appearances, and behaviors.How about humans? Are we invariable enough that reasoning based on “our remote ancestors” applies equally to all of us? It’s hard to say, because we’re so cross-bred, even the few groups who pride themselves on their “racial purity”. But in the 1970s Daniel Freedman put together a fascinating short film on behaviors of newborn infants of a number of different ethnic backgrounds, including Native Americans, Japanese, and people of sub-Saharan Africa. These babies during the first 48 hours of their lives showed behavioral differences in their reflexive responses to stimulation--  some of them, in perfect health, showing behaviors that would have been considered abnormal in Caucasian babies. The idea that there might be some basic differences between groups belonging to the human species did not sit well at that time and is rarely mentioned today--  but perhaps it should remind us that all human evolution may not have taken place in the same environment, and all our traits may not be subject to the same explanation.

Thursday, July 5, 2012

Abusive Adoptive Megafamilies and Child Hoarding: A HIGHLY Speculative Post


Periodically, newspaper reports emerge of adoptive “megafamilies” who neglect and abuse their children and who isolate themselves or move from location to location in order to avoid detection. One example is the Schmitz family, reported to authorities in Tennessee, who had 11 children, some with special needs; the parents had children “dig their own graves” for punishment, and took away needed spectacles and walkers as discipline of some special needs children. Another such family was the Gravelles of Ohio, also adoptive parents of 11 children, who used cages as disciplinary techniques. (The USA Today reporter Wendy Koch gave details of these cases at www.usatoday.com/news/nation/2006-01-18-swapping-children_x.htm and www.caica.org/NEWS%20Enclosed%20beds.htm.)

It seems unlikely that having a lot of adopted children is in itself the cause of the parental abuse and neglect, although these megafamilies are actually larger than most that research has investigated so far. It seems more likely that pre-existing characteristics of the adoptive parents led both to adopting many children and to abusive and neglectful treatment. If that’s the case, it would be very advantageous for adoption agencies to be aware of those characteristics.

But how to find out the characteristics? Most parents of large families, special needs or otherwise, adoptive or otherwise, do an adequate job of caring for their children. Although it happens too often that megafamilies are abusive, it’s nevertheless actually quite infrequent when you consider all such families.  Here’s where the speculation comes in: what if we could find a similar kind of behavior that would be more frequent and easier to study?

It turns out that there is such a similar behavior, and I’d like to propose it as potentially comparable to megafamily child abuse, and as a possible window into that kind of abusive treatment. I refer to the behavior often called animal hoarding—possession of dozens, even hundreds, of  cats and dogs, none of which are properly fed or cared for. These animal hoarding cases crop up often in the news, generally when revolted neighbors have demanded that the authorities at last do something about a house that turns out to have its floors six inches deep in garbage and animal feces. Animal rescue personnel carry out dead and dying animals, some of which have been partially eaten by others, and take away the living, often to be euthanized. The owner is heartbroken, denies that there was any problem, and just wants the pets back. The animals’ suffering, so obvious to anyone else, seems invisible to the animal hoarder.

Many people have a lot of pets, but until those pets are neglected, nobody would call them animal hoarders. When they become animal hoarders, however, it appears that elements of mental illness are as important as their love for their pets. Animal hoarders have been compared to people who hoard objects and go beyond a nice collection to the point where their homes and lives deteriorate because of their hoarding (see Frost, R.O., Patronek, G., & Rosenfield, E. [2011]. Comparison of object and animal hoarding. Depression and Anxiety, 28(10), 885-891). Hoarding disorder has actually been proposed as a syndrome to be included in DSM-5, and it has been discussed as related to anxiety and obsessive-compulsive behavior.

One student of animal hoarding, Gary Patronek, has discussed ways in which animal hoarders might be grouped in terms of their behavior and motivations (Veterinary Medicine, 101(8), 520-530). It’s interesting to think how these categories might apply to abusive megafamilies (although it wasn’t clear to me exactly how the types were arrived at).

Patronek began with an “overwhelmed” group. These were people who did not seek out more animals and who were somewhat concerned about their pets’ conditions, but because of factors like their own age or illness the owners had become less and less capable of caring for the animals. This does not seem very parallel to megafamilies, who have generally made some effort to collect a large number of children, and who if abusive may need to work to avoid attracting attention to their homes. Patronek’s other two categories seem much more relevant to abusive megafamilies, though.

He identified one group of animal hoarders as “rescuers”. These people were afraid of death and so worried about euthanasia that their pets’ present suffering seemed irrelevant or invisible to them. They felt that only they could provide the needed care, and thus avoided authorities or prevented their access to the home. They worked with a “network of enablers” who protected each other and passed pets along. These animal hoarders felt they had a mission to save the animals, and that mission led them to a compulsive need to acquire and control pets.

The second group Patronek referred to as “exploiters”.  These people denied any harm to the animals from the time they were acquired and were indifferent to suffering. Their interest was in achieving control, and the hoarded animals were tools for this purpose.   They rejected authority, and behaved toward others in manipulative, exploitive, and charming ways. They felt no guilt about what they were doing and had little empathy for people or animals. (Remember, these are not people who have directly harmed the animals--- no torture or dog-fighting is involved.)

Although typologies always raise some questions, I find these categories of animal hoarders strikingly similar to the abusive parents of adoptive megafamilies like the Schmitz and Gravelle couples. The compulsive missions, the drive for control, the network of enablers--  some of these factors do seem to characterize such people.

Are abusive parents of adoptive megafamilies actually what we might call child hoarders? Do they play out their own anxieties by collecting and controlling children--  an easy thing to do when there is popular admiration and nostalgia for the “old-fashioned” big family? (And might it even be that abusive adoptive parents in general are following some version of this scenario?)

Once again, I am speculating freely here. However, I think it’s time we considered more of the background of abuse of adopted children. Yes, certainly, those abusive parents are bad guys--  but why? Is there anything about them that we might detect beforehand, so that we could screen them out of the adoption process? They don’t seem bad to other adults, or they would never have been able to adopt, so it’s background material that’s needed. We need to go much farther than blah-bah-blah, they were abused as children, blah-blah. And adoption agencies need to drop the assumption that if adults are “nice people” they will make good parents. Screening out potential “child hoarders” --  if there are such, and I can’t prove that there are--- may seem unfair to the adoption candidates--  but it would certainly be more than fair to the children.    

Wednesday, July 4, 2012

Food Pouches, or, Bringing Up Mama


The topic of the week seems to be “food pouches”--  containers of pureed food that can be held and squeezed out by toddlers and even older children--  providing some nutritious food without any of the hassle of utensils, sitting at the table, being careful not to spill, etc., etc. They’re available at considerable cost, filled with elite foods like quinoa. A recent New York Times article discussed the use of these pouches by parents who are too busy to supervise their children’s meals and who want to make sure that foods their children eat are not just junk (also, presumably, who can afford the expense).

Food pouches would seem to be ideal for traveling families who can’t be sure of getting appropriate food for older babies and toddlers, or for situations where a sick or injured child has a poor appetite and may be intrigued by the container. But, for all the kids, a lot of the time? No, and for several reasons.

When babies don’t have any teeth--  or just the front ones—they obviously are not ready for corn on the cob or steak frites. But they do want to chomp on things (“how sharper than a child’s tooth”, as Pogo used to say), and they like to practice that chomping. Given a spoonful of applesauce, they slurp off the applesauce and then bite the spoon too. Bottlefed babies can be seen biting on to the bottle nipple and then yanking it out between their closed teeth.  

What’s the advantage? Part of it is that when teeth are being cut and gums are itchy, biting on things relieves some of the discomfort. But there’s more to it than that. When older babies negotiate lumpy foods, they develop skills in controlling how hard they bite and in using the tongue to chase lumps around the mouth. These skills help prevent choking and gagging, and toddlers who have not had this experience are all too prone to gag on any lumpy foods, like vegetable soup or rice pudding with raisins in it.

In addition, learning to control the tongue and biting pressure also contributes to well-articulated speech, because producing an exact speech sound involves using the positions of the jaw and the tongue to shape the sound-producing air stream coming up from the lungs. Many speech sounds, even though we hear them as the same sound throughout, actually involve exceedingly quick movements of tongue and jaws with changes right in the middle of the sound, so a nimble mouth is required in order to speak clearly. A diet stressing pureed foods after 8 or 9 months may not give the right kind of exercise.

Although the growth of the upper jaw is largely genetically determined, the growth of the lower jaw is guided by exercise and experience of pressure. This enables the growing child’s upper and lower teeth to fit together perfectly in spite of factors like preferring to sleep on one side, which may slightly change face shape. Without exercise and pressure, the lower jaw may not grow adequately, may have an unusual appearance, and may not provide for good speech articulation. (This is a problem for some individuals with cerebral palsy, whose difficulties in swallowing and tongue control have required a soft diet.)  One “evolutionary dentist” writing recently in the magazine Science, even suggested that foods like beef jerky might be important ways to get children enough jaw exercise in this time of soft processed foods. (Bubble gum, I wonder?)  Certainly pouches of puree are not going to do the job, not after the point when teeth are coming in quickly.

There’s more to this issue, too. Let’s think about parent-child communication (which is, by the way, a foundation of attachment as well as of language). Spoon-feeding is an excellent situation for practicing communication. Face-to-face, caregiver and child are ideally arranged for seeing each other’s facial expressions and gestures. They imitate each other--  can any adult offer a spoonful of food to a baby without opening his or her own mouth? For successful spoon-feeding, parents are forced to be sensitive and responsive to the baby’s cues. They can’t just keep shoving food in when the baby doesn’t want it, because baby will just spit it out, close the mouth and turn the head away. If the baby wants more, she will signal more and more clearly and loudly. When enough is enough, everybody slows down and sees that the meal is over. The spoon-feeding set-up is also ideal for practicing hand-to-mouth control. The hungry baby can pick up bits of finger food or hold an empty spoon in one hand and manage a full one with the other. (For some reason, both hands have to be occupied in this task.) As appetite is sated--   which the caregiver has to notice, thus practicing sensitivity and responsiveness-- the caregiver can offer more spoonsful  until no more is wanted.

What I’m saying here is that being spoon-fed, and eating lumpy or chewy foods, is beneficial for the baby’s development. But it’s also beneficial for the growth of the parent as a parent. Experience with babies teaches us to be parents, and the skills we learn at that time will benefit us right through their childhood and adolescent years--  not that we’ll still feed them, but we’ll be skilled in adapting to their changing needs.

[By the way--  wondering about the baby dumping food out of the spoon? Until he or she can rotate the hand on the wrist, it’s awfully hard for the baby to keep any runny food in the spoon. But something stickier will stay in even when the spoon is upside down. ]


On Babywearing


Everywhere I turn these days, I see something about William Sears, “attachment parenting”, and babywearing (carrying babies a lot of the time in various kinds of slings and carriers). It all seems to have to do with the fear that attachment just won’t happen properly, and that if it doesn’t a whole cascade of bad outcomes will occur.

Obviously this isn’t something we can do randomized controlled trials on. Even if there weren’t ethical issues about any possible harm to babies (either of being “baby-worn” or of not having this experience), there’s no way to be sure that parents would follow the routine they were assigned--  and why on earth should they, after all?

What we can do, though, is taking an anthropological approach and look at ways different groups of people have cared for their babies. Much of the decision has been based on the physical and social environment--  did they need to keep babies warm? Did they need to keep them from falling into the fire? Were there lots of other people around, or was the family pretty isolated?  Was it customary to space babies by prohibiting sexual relations until the child was weaned at age 2 or 3? Was there a high infant mortality rate so that most families would not have living children close together in age?

Thousands of ways have been used to care for babies under different sets of conditions. Margaret Mead and Gregory Bateson did a wonderful book of photographs of Balinese life, including babies being carried at all waking times until they could walk , because as creatures who had come recently from the divine they should not go on all fours like animals (by the way--  so much for having to crawl, right?). In the Middle Ages in Europe, and in Russia perhaps even until the present day, babies were swaddled by wrapping in cloths from foot to head until they could be picked up by the ankles and not bend. In cold countries where people stayed indoors much of the time in the winter, babies were kept in cradles where they could be wrapped warmly and rocked to sleep while their mothers did other tasks. In Polynesia, babies could be wrapped into a container and hung from a hut roof, away from animals and adult activity. Some Native Americans bound the child to a cradleboard, so the baby got a handsome flattened head and could be carried easily on the mother’s back. (On the whole, fathers didn’t do these things, although they might be very fond of their children.) In parts of Africa today, although mothers may carry babies in slings as they work in the fields, if they have any 5- or 6-year-old girls around, those girls become “child nurses” and are in big trouble if they let the babies cry.

Let’s not forget an interesting one: in traditional Israeli kibbutz life, babies lived in the babies’ room, where the group was cared for by one or two caregivers who might or might not have much interest in the task. The mothers came in periodically to breastfeed but were encouraged to wean soon and put their energy into the communal organization. The whole point was that there should not be intense emotional connections between family members, but that instead that emotion should go into loyalty to the group.  

And, you know what? All those babies formed emotional attachments to familiar people in pretty much the same way, no matter what their experience had been. Most were securely attached, some were insecurely attached, but the great majority in every group grew up to have ordinary cognitive abilities, social skills, and relationships with others.

The moral of this story is that just as human beings can thrive on a lot of different kinds of food, emotional attachment can grow robustly on many different social diets. If everybody in the family wants to go with babywearing, it isn’t going to do any harm, but it isn’t going to do any special good either. Babies need caregivers who are sensitive and responsive to the babies’ communications. Exactly how they go about being sensitive and responsive can vary enormously depending on the family situation and individual personalities, and they don’t have to be sensitive and responsive every minute. There are limits to tolerance for unresponsiveness, of course, and caregivers who change frequently or are otherwise unable to figure out a given baby’s cues do not provide the ideal situation for secure attachment or other important parts of development.

Having read some of Sears’ work, I have to say that I’m not clear on what he thinks attachment is, or bonding either (and he does seem to use the terms interchangeably). I remember one statement he made some years ago, to the effect that a baby separated from its mother in the hospital was “bonding to the bassinet”. I have no idea what this could possibly mean, unless Sears thinks that human beings, like ducklings, become imprinted on whatever they see in the first hours of life.

So-- Do what works for you and your family. If you have time and energy and want to wear your baby, that’s fine. If you work full time and hand off the baby with your spouse or another caregiver, and nobody wears that baby, that’s fine too. Neither family is going to guarantee a child with no problems, or a child with a lot of problems, by taking one route or another. And don’t snub people who don’t do what you do. It really isn’t a competition.

One thing, though--  babywearers and non-babywearers both, watch it with the cellphones! Don’t imagine that you’re being sensitive and responsive to your baby if you stare toward the baby and talk at length in an adult voice. What do you think this conveys to the baby? It certainly must be confusing to see what appears to be “eye contact” but no response to facial expressions, and the wrong kind of talk for someone looking at a baby. Get a look at a baby’s face some time when Mom is yakking away on the phone and looking vaguely toward the baby. Talk to your friends some other time! For the baby’s sake, Be Here Now.