Concerned About Unconventional Mental Health Interventions?

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

Friday, September 20, 2013

In the Wake of the Reuters Report, A Scientifically Questionable Legislative Proposal

You would think that the Reuters investigation of “re-homing” of unsatisfactory adopted children would be followed by legislation that would protect all adoptees, foreign or domestic, in the United States. Instead, we see introduced in the Senate a bill called the Children in Families First Act of 2013 (CHIFF). Senators introducing this bill were Landrieu, Blunt, Burr, Inhofe, Kirk, Klobuchar, Shaheen, Warren, and Wicker. If any of these are your senators, I hope you will try to make them understand what they are doing. If not, please join me in contacting your own senators and representatives and cautioning them about giving support to CHIFF.

A summary of talking points about this bill can be seen at www.childreninfamiliesfirst.org/wp-content/uploads/2013/08/CHIFF-Messaging-Points.pdf.  According to this summary, “CHIFF fixes the functional problems without (sic) our government bureaucracy with a smarter, not bigger, approach that will allow international adoptions to become a strong and important part of how we protect children”. The bill itself, at www.childreninfamiliesfirst.org/wp-content/uploads/2013/09/CHIFFBill.pdf, is worth the attention of everyone with an interest in children’s welfare.

The bill begins with a statement about “the core American belief that families are the best protection for children and the bedrock of any society” and proposes “ensuring that every child can grow up in a permanent, safe, nurturing, and loving family”. What is not revealed at this point is that the bill has less to do with children living in the United States than with other countries that rely on institutional settings to care for children without responsible parents or other kin. As most societies assign child-rearing tasks to near kin whenever possible, it seems hard to consider this an exclusively “core American” position. It is also difficult to envisage how family love can be legislated. (As for the geological metaphor, I am puzzled, but suspect that bedrock and apple pie are in some way related.)

The issue I would like to address with respect to this bill is its effort to call in some science to support its proposals. This is seen in the talking points mentioned earlier, which state: “Today’s science shows that children cannot are terribly damaged, often irreparably, by living in institutions or without any parental care (again, sic)”. The bill itself says, “Science now proves conclusively that children suffer immediate, lasting, and in many cases irreversible damage from time spent living in institutions or outside families, including reduced brain activity, reduced IQ, smaller brain size, and inability to form emotional bonds with others.”

Let’s look at these points under a strong light.

  1. Who are the children? Parts of the bill refer to children as persons under 18 years of age. Do all children from birth to the 18th birthday experience the same effects from group care? No, certainly not, and to claim that they do is to fly in the face of the well-established principle of developmentally appropriate practice, a guideline based on both common sense and observation of different care needs at different stages of development. The children to whom the bill’s statements might apply are infants and toddlers, who are far more vulnerable to the effects of caregiving quality than are older children--  and certainly than adolescents.
  2. Does the science now show that children suffer the stated damage from living in all institutions, by virtue of their being institutions? No; the evidence is that neglect by caregivers distorts developmental trajectories in early life. Institutions may be highly neglectful, and no one has forgotten the ghastly Romanian warehouses (incidentally, these throve where abortion and contraception were prohibited). “Natural experiments”, like the Hampstead nurseries administered by Anna Freud during World War II, the Bulldogs Bank children who came as a small group of toddlers from a concentration camp, and the “children’s house” residents of the traditional kibbutz, have all shown that excellent care and development can be achieved in a non-family setting.
      When institutional staff are neglectful, and developmental problems result, a major  reason may have to do with the poor nutrition that results when caregivers feed  insensitively and unresponsively, failing to work with a child’s eating rhythm or state of    arousal.  Family caregivers may also present these problems and cause unwanted outcomes; children adopted into “mega-families” may experience neglect in this way.All caregivers can be trained to do a better job of feeding and to reduce the           possible effects of neglect.

  1. Does the science show immediate effects of institutional life? No, certainly not. Length of time spent in even the worst institution will have a significant effect on the developmental trajectory for most children, and none are instantaneously affected. (The reasoning behind this exaggeration is not at all clear to me.)
  2. Does the science show lasting and possibly irreparable damage from institutional life for all children? No, it does not. The English-Romanian Adoption study followed over 300 adopted children into adolescence (Rutter et al, Deprivation-Specific Psychological Patterns: Effects of Institutional Deprivation [Monographs of the Society for Research in Child Development, Serial No. 295, Vol. 75, No. 1, 2010). Rutter’s study concluded that “A striking finding at all ages was the heterogeneity in outcome. Thus, even with the children who had the most prolonged experience of institutional care, there were some who at age 11 showed no sign of abnormal functioning on any of the domains we assessed. Conversely, there was a substantial proportion of children who showed impairments in multiple domains of functioning” (p. 14). This heterogeneity suggests that institutional care may be only one of many factors that interact with genetic background and post-adoptive care to determine a child’s development.
  3. Does the science show an inability to form emotional bonds with others? This is difficult to answer, because the bill does not define “emotional bonds” in any way. However, if we consider this in term of age-appropriate attachment behavior: No, it does not. Of the children Rutter’s group studied, there were cases where children were unusually friendly to people outside the adoptive family, but by the time they reached adolescence most of these children were viewed positively as outgoing and socially engaging. Megan Gunnar, writing in the Deprivation-Specific volume, proposed that these behaviors, sometimes defined as “attachment disorders”, were not in fact caused by differences in attachment.
      However, it may well be true that the children’s ways of communicating their need for parental care may be difficult for adoptive parents to “read”, and this may be the basis of  some of the Reuters reports’ quotations from parents who said they could not “bond  with” an adopted child.

It seems, then, that the scientific basis presented by the authors of CHIFF does not provide any reason to accept the proposed bill. But does the bill in itself contain any desirable plans? Much of the bill, with its concerns about whether UNICEF has a more powerful effect on international policy about children than the U.S. does, is clearly driven by ideological motors. This is made plain when the bill and the talking points are walked back to the organization Children in Families First, and we see the involvement of the Christian Alliance for Orphans (see Kathryn Joyce’s The child catchers) and Saddleback Church. These contributors may be the source of concerns mentioned in the bill about Muslim fostering practices and attitudes toward adoption in the Western sense.

However, the bill does contain a highly desirable repetition of a previously agreed-upon change: that administrators shall “establish and operate a database containing data respecting children involved in intercountry adoption cases who have immigrated to the United States.” This would be a helpful and appropriate move toward protection of adopted children--  especially if it were written to include domestically-adopted children as well, and either to remove from the States to the Federal government the role of overseer, or to require States to do this job properly. Enforcement of data collection through adoption tax credits and adoption assistance programs could help to establish the proposed database.  


ADDENDUM: An article by McCall et al in the most recent issue of Child Development ("Maintaining a social-emotional intervention and its benefits for institutionalized children", Vol. 84 (5), 1734-1749) reports a comparison of a Russian Baby Home that maintained its usual practices with another that gave staff additional training and a third that used staff training plus structural changes (reduced group size, assigned caregivers, fewer caregivers, and elimination of graduations to other wards). Developmental scores improved significantly for the third group of infants, and were maintained over the next 6 years. This finding contradicts the assumption of the CHIFF initiators that institutions of all kinds have equally ill effects.

FURTHER ADDENDUM: https://www.facebook.com/StopCHIFF lets you state your opinion of this bill.


  

4 comments:

  1. Thank you for this great posting. I would like to add that the so-called scientific proof of the bad effects of 'institutionalisation' are primarily based on the Bucharest Early Intervention Project. That project was based on research in ONE institution, a Romanian children's home for children 0-3 years. I would not call that representative. And at the heart of it was Federici. But he could not formally be part of it, as he is not a scientist - I was told.

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    1. I don't suppose you can explain further about RSF-- or can you, I hope?

      I see two major publications about this work: Fox et al.,(2011). The effects of severe psychosocial deprivation and foster care intervention on cognitive development at 8 years of age: Findings from the Bucharest Early intervention Project, Journal of Child Psychology and Psychiatry, 52, 919-928

      and

      Zeanah et al (2006). Ethical considerations in international research collaboration: The Bucharest Early Intervention Project. Infant Mental Health Journal, 27, 559-576

      and OMG, you're right, I just noticed, Zeanah or somebody actually cited the horrible RSF book in the 2006 one! And this after publicly rejecting holding therapy a year or two before!

      How depressing.

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  2. Well, the infamous ATTACh was able to buy Zeanah to do their key note speech one year. Is the guy careless or what?

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    1. I have no idea what he and other mainstream persons were thinking. Hope to be finding out, though--

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