Concerned About Unconventional Mental Health Interventions?

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

Tuesday, September 17, 2013

The Reuters Investigation into "Re-Homing" Adopted Children (Part II)


The recently released Reuters investigation of “re-homing”, or offering adopted children to be taken by another family (http://www.reuters.com/investigates/adoption/#article/about) provides a helpful interactive table with links to the ads written about particular children. The report provides a limited analysis of the ads, with indications of the children’s age range, gender proportions, and special needs. With the help of Linda Rosa of www.childrenintherapy.org and www.scienceinmedicine.org, I’ve been trying to see what further information can be extracted from the ads Reuters found on an Internet bulletin board (now taken down).

Several points need to be kept in mind about the Reuters data. One is that the ads considered had been posted over a period of five years, so without at all minimizing the importance of these findings it’s wise to understand that this number of new ads did not run every week. It’s also hard to know how many of the children who are “re-homed” are advertised in this way, or indeed how many of the ads were successful in transferring children. There seem to have been some clerical errors in the graphic representation as well, because whereas one child figure icon usually represented one child, there are cases where there is one icon but reading the ad shows that there were two children being offered, and one case where there are two icons but only one child described. There are also some ads duplicated verbatim and one or two where the same child may be being described in different words. Trying to figure this out, we came to a count of about 276 children.

We also had to consider that we knew nothing about the children themselves, but could only examine the statements in the ads, and were thus best advised to look at the ads’ statements without considering whether or not they were accurate. The ads could be considered to reflect what their writers (sometimes, but not always, adoptive parents) thought were important things to say about the children. (However, by no means all the ads described the children or gave reasons for the decision, and a few were asking for respite care rather than a new adoptive family.)

Because Linda and I have both been working for a long time on alternative beliefs about and treatments for child mental health disorders attributed to attachment problems, we wanted to see to what extent the ads referred to attachment disorders as important reasons for disrupting or dissolving an adoption. We read all the ads and counted 77 cases in which the reason for “re-homing” was specifically stated to be Reactive Attachment Disorder (RAD). Some of these ads said there was a diagnosis of RAD, while others simply said the child “had RAD” or was thought to have the disorder. In 45 other cases, the writers referred to attachment issues, a failure of bonding on the child’s or adult’s part, or simply not loving the child.

It was difficult to tell what was meant when a child was described as having Reactive Attachment Disorder. Where specifics were given, there were many references to aggressive behavior, lying, stealing, and manipulation of other people---  none of these part of RAD by the official DSM description, but problems often named by attachment therapists and included on checklists that purport to allow diagnosis of RAD or its alternative model, Attachment Disorder (AD). The majority of the children were of school age, and no evidence-based method exists for  diagnosing RAD in children past preschool age, so unless the ad writers meant that the children were diagnosed years ago, it seems that they must have meant that the diagnosis was by an alternative therapist using the alternative model. One child was said to have Reactive Attachment Disorder  many years after being adopted at 3 weeks of age—not a possibility from the conventional viewpoint.

Some of the ads that did not mention RAD by name were difficult to understand. One, for example, said a child was “reactive in her behavior”--  a new concept for me, unless it means “impulsive”, and a usage that made me wonder whether the first word in Reactive Attachment Disorder is being used independently to describe some aspect of behavior.

The term “bonding” was used frequently, and again it was not clear what people meant by it unless they described the situation. In many cases, it was the child who did not “bond”: “she will not allow herself to be close to my husband and I”; “she has never bonded in 9 years with us”; “people begin to blame us for the lack of a bond”.  In other case, though, the parents feel no bond to the child: “I’m not bonded to this child, nor is she bonded to me”; “I don’t like him very much”. One adoptive mother said “I just cannot bond with him” after she saw her preschool son touch a younger sister’s genitals. Another couple stated about their 4-year-old adopted son: “We do not love this child and know that he deserves to have truly loving and committed parent(s). He has attached very well to us…”.  In several cases, it was the decision of the adoptive mother that the child had to go.

Presumably, most or all of these adoptive parents had undergone home studies and had had to make some efforts to adopt these children, including some hours of training as required under the Hague Convention. The frequency with which they spoke of attachment and bonding suggests that they had what they believed to be some accurate knowledge about these events. But did they? I am not simply splitting hairs when I ask what they meant, or thought they meant, by attachment or bonding. Had these people succumbed to the idea that attachment is not only intense and lasting, but that it lasts in the same intense form throughout life? Did they also believe that the mutuality of attachment meant that they, the parents, must have intense positive emotions toward the child at all times, or something was wrong?  Was their goal in adopting to achieve the high of a love affair, but asexual, and sustained for many years?

There is no question that we adults are thrilled when a child seems to like us and discouraged or bored by a child who seems uninterested in us. That’s one of the reasons why parents in Mary Dozier’s ABC program are helped to see the subtle signals by which fostered toddlers communicate their need and desire for nurturing. Could the adoptive parents who wrote the ads not detect the children’s signals, or could they not tolerate the times when the children were not interested in them? Did they not understand that anger on both sides is part of an attachment relationship at times?

I do not want to ignore the facts that a number of the children had special needs that overwhelmed their adoptive families, or that some were dangerous to themselves and others. In a couple of cases, serious illness or death of a parent made care of an adopted child very difficult. These are situations that can also affect birth families and that can never be completely planned for.

My concern, however, is with the number of adoptive parents who may have obtained their beliefs about attachment and attachment disorders from unconventional “attachment therapists”. (Two children were said to be receiving horse riding therapy, an approach that makes sense for cerebral palsy but not for mental health problems.) An overemphasis on attachment can prevent parents, therapists, and educators from identifying and working on treatable problems, as Matt Woolgar and Stephen Scott have pointed out (“The negative consequences of over-diagnosing attachment disorders in adopted children: The importance of comprehensive formulations.” Clinical Child Psychology and Psychiatry, http://ccp.sagepub.com/content/early/2013/04/08/1359104513478545). It’s possible that some adoptive parents who were less convinced that “it’s all about attachment” might have looked for more complete evaluations, have found appropriate help, and have avoided the “re-homing” bulletin board.
   



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