Concerned About Unconventional Mental Health Interventions?

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

Wednesday, January 30, 2013

Kafka Again: More on Capture of Child Custody Proceedings by Attachment Therapists


I have more to tell about “Eve Innocenti”, the mother whose struggles for contact with her children I discussed at http://childmyths.blogspot.com/2012/12/the-attachment-therapist-wears-two-hats.html and elsewhere. I think now I should have named her “Josefine K.”, because her situation is becoming more and more reminiscent of The Trial, with its unstated accusations, empty courtroom, and efforts to make the protagonist punish himself.

As some readers will remember, Eve had two sons while living in Colorado. The boys had different fathers, but only one of the fathers was in the picture, and he and a new partner offered occasional care to both boys. Several years ago, Eve left the children with that couple while traveling--  and when she returned found that they refused to let her take the boys home. (Note, by the way, that while the older boy was the son of the man caring for him, the  younger boy was not biologically related to either of the caregivers.) Eve remained in the state of Colorado for some time, during which period she sought legal and judicial help that would allow her contact with her children, and preferably physical custody--  but without much success.

Eve married and moved out of the state with her new husband. She continued to try to work with Colorado authorities and found that she was being accused of having neglected and abused the boys earlier. She was assigned an attorney to represent her interests, but found and still finds that this person does not return calls nor apprise her of court dates. Meanwhile, the children’s “stepmother” (not legally, but for all practical purposes) enlisted the help of a local practitioner of Attachment Therapy, who began to serve not only as the children’s therapist but as an evaluator communicating with the court—an ethically questionable combination.

In Attachment Therapy, a stated goal is to remove attachment to a previous caregiver, and to establish attachment to a new adult. The tenets of AT suggest that this is to be accomplished in part by requiring a child to agree with and repeat statements about the abusive or neglectful treatment of the early caregiver, and to express rage against that person as instructed. Through this procedure, any child cooperating with AT will say that a caregiver was abusive. Statements made in this way by Eve’s children were the apparent source of abuse accusations against her—the accusations that are being used as an argument in favor of preventing her from having contact with the children, and eventually of terminating her parental rights. (Eve has never been told what the accusations against her actually are, so she cannot defend herself; instead of telling her, Colorado authorities suggested that she make a list of all the bad things she had done, and they would check those against what the boys were reported to have said.)

Paradoxically, when AT practitioners wish to foster an attachment between a child and a new caregiver, one of their tools is to separate an uncooperative child from the current caregiver and to send him or her to “respite care”, where treatment is austere and minimally enjoyable. This treatment has been used with Eve’s older son, in contradiction to the conventional view that attachment is encouraged by increased pleasurable social interaction with an adult caregiver. He apparently disliked this treatment very much.

A month or so ago, Eve came to the conclusion that for her own sake and that of the children, since the termination of her parental rights seemed to be unavoidable,  she might do well to relinquish her rights. This action would make the children both adoptable by their stepmother, and enable the father of the older boy able to adopt the younger one. Eve and her husband have spent all their savings, but their income is too large to make them eligible for legal aid, and without counsel they have no idea how to pursue the matter any farther.  Relinquishment could reduce the difficulties the children are presently going through, Eve thought.

But no! A telephone call from the Colorado authorities has advised Eve that she cannot relinquish. To do so, she would have to be available for counseling about relinquishment, and as she lives in a different state, this is not possible. The children’s caseworker has said that it is only a matter of time until her parental rights are terminated, in any case. In addition to its Kafkaesque features, this makes the case take on aspects of the judgment of Solomon--  if Solomon had said, “All right, this mother gives up, but let’s cut the child in half anyway”, but instead of cutting, subjected the child to abusive practices labeled as psychotherapy.   

What does the law actually say about this situation? According to S.N. Katz’s book Family Law in America (Oxford University Press, 2011), “Federal guidelines [the Adoption and Safe Families Act of 1997] mandate that a state make reasonable efforts to prevent the removal of children from their families except in the most aggravated circumstances of abuse. The goal is to insure that parental rights are respected, on the one hand, and the best interest of the child is served, on the other.”

The law [Child Abuse Prevention and Treatment Act, amended 1996] also requires that in child protection proceedings the child must have independent counsel. An attorney representing the child is not the same as a guardian ad litem (GAL). As Katz notes, “The difference between an attorney for the child and a GAL is… that the attorney represents the child whereas the GAL represents the GAL’s opinion as to the child’s best interests.”

Neither of these two legal requirements has been met in Eve’s children’s case. Of course, it is an awkward case because of the different relationships of the two children to their present caregivers. In the case of the older boy, he is living with one biological parent, and the only question about the situation is how his relationship with his birth mother is to be handled. In the case of the younger boy, neither of the present caregivers is biological kin, so the roles of both of them, in addition to the connection with the birth mother, require legal examination.  

Eve and her children need legal counsel, but they appear to be captives of the Attachment Therapy belief system as it has taken over a county’s practices. They will not get the counsel they are entitled to from the county, nor will they get any explanations or opportunities to deal with accusations.  I have suggested that Eve contact the American Civil Liberties Union for help in a situation where government is interfering with citizens’ rights.




Friday, January 25, 2013

Russian Adoption: Letter to Senator Mary Landrieu


Dear Senator Landrieu:

I am writing to you because of your involvement with the congressional adoption coalition and because of your recent attempts to communicate with the Russian authorities about the adoption ban. I want to comment on some issues that have rarely been mentioned in connection with the ban. Sad though the Russian decision was for some American families and some waiting children, it may offer us an opportunity to examine factors affecting the success of  both foreign and domestic adoptions in this country.

The Russian legislation was named for Dima Yakovlev, a toddler adopted from Russia who died a tragic but purely accidental death. It would more appropriately have been named for children like Viktor Matthey and Nathan Craver, or others who died as a result of systematic maltreatment of a type advised or countenanced by some adoption caseworkers and educators.

Popular sources of information about adoption and Internet sites such as www.focusonthefamily.com  and www.attach-china.org have to a considerable extent been hijacked by an unconventional, non-evidence-based view of emotional attachment and treatment of mental illness. This perspective claims that all emotional disturbance derives from poor attachment experiences, and that adoptive parents can cause children to become attached to them by displaying their power and authority. In order to display authority, parents must make children completely dependent on them and obedient to them; children may eat and drink only as parents allow them, must not use the toilet without asking, and may be kept in cold or uncomfortable sleeping arrangements, including cages. Such treatment is physically as well as mentally unhealthy and accounts for the frequent findings of malnutrition in deaths of adopted children.  

Because Internet sources present these types of maltreatment as appropriate for adopted children, adoptive parents may have become convinced of this misinformation before they ever receive the pre-adoptive training required under the Hague Convention. Whether their pre-adoptive education contradicts or confirms their beliefs may make the difference between mistreatment of adoptive children and appropriate treatment. Unfortunately, evidence from education of social workers, CASAs, and GALs suggests that in some cases the mistaken beliefs may be confirmed rather than contradicted.

How can the U.S. alter this situation so that adopted children from all countries are safer? As I suggested in a letter to Pavel Astakhov two years ago, an important step would be to review pre-adoption training materials. I would like to see this done for all pre-adoption education, but in light of the Russian ban this may be the time to begin with materials from agencies that work with foreign adoptions. I don’t believe that such a process can constitutionally be created by Federal legislation, and I believe that state legislation would be strongly resisted by groups like the ones I mentioned earlier. However, it should be possible for a congressional committee to request co-operation from agencies that deal with foreign adoptions and to have their materials vetted by independent scholars.

What I suggest here would obviously be only a first step,  but it may be an essential one both toward improving the outlook for adopted children and toward convincing the Russians that the ban is unnecessary.

Sincerely yours,

Jean Mercer,Ph.D.
Professor Emerita of Psychology, Richard Stockton College

NOTE: Senator Landrieu's office answered this the day after it was sent, with a form letter in which the Senator deplored the conditions of children in Russia.

I was recently interviewed on this issue by the Russian magazine Za Rubezhom. Perhaps Senator Landrieu's staff will read about the matter there.    J.M.



Saturday, January 19, 2013

False Positives, False Negatives, and Standardized Testing for Reactive Attachment Disorder


When tests are developed for medical or psychological disorders, the idea is usually this: There is a disorder that can be identified. However, it may be difficult and complicated to identify it in the usual ways, or it may be desirable to identify it when only a few vague symptoms have appeared, in order to treat it early and keep it from getting worse. A medical or psychological test is a way of measuring a sample of behavior or biological functioning that will help predict whether a disorder is developing, or that can be an effective substitute for difficult, intrusive , and time-consuming examination of other kinds. Effective tests are very useful in ruling out problems that the symptoms might suggest but that are not really present, and thus allowing appropriate treatment to be chosen without waste of time.

But the tricky part about tests is that even the good ones are not always right. They may result in false positives and indicate the presence of a problem when there really is none. They may also result in false negatives and show that there is no disorder—but later events demonstrate that the disorder was actually there. Even the best tests show some false positives and some false negatives. The practical goal is not to get rid of all of these, but to be able to state how often they occur, and to interpret results in the light of that information.

Test development is a complicated and tedious matter in which small errors may ruin the value of extensive efforts. For example, an imprecise or erroneous definition of a disorder can result in an ineffective test. Test developers must work hard to exclude sources of bias, especially if diagnosis of the disorder has more than a small reliance on subjective opinions. Persons who perform or even know the diagnosis given to a participant must not also be the ones who perform or score the test, for fear that their beliefs will inadvertently influence the ways they administer or interpret the test. If a diagnosis depends on the examiner’s opinion rather than an objective measurement, it’s important to have several examiners make independent assessments, and to ascertain the extent to which they agree. If a test has not been developed following these and other guidelines, it cannot be trusted. Tests should be regarded with suspicion if they have not been published in peer-reviewed journals, whose expert reviewers will have done some of the work of assessing the test’s credentials. Transparency of reporting is the key to test selection; tests that are published privately by their developers, and whose background is not available to the reader, should be approached warily.

How does all this relate to the issue of testing for Reactive Attachment Disorder? There are presently no thoroughly-validated tests for this disorder--  and one reason is that the condition remains only incompletely defined, and has somewhat different descriptions in DSM (the standard U.S. listing of mental disorders) and ICD (the European manual).

Nonetheless, some American practitioners, especially those who advocate the use of “holding therapy” for children diagnosed with Reactive Attachment Disorder, choose as a diagnostic test the Randolph Attachment Disorder Questionnaire (RADQ), an instrument self-published by Elizabeth Randolph. The validating information claimed for the RADQ by Randolph has never been published in any peer-reviewed journal, and the one related article in a peer-reviewed journal (by Cappelletty et al) concluded that scores on the RADQ did not correlate with any validated test for childhood emotional disturbance. Beyond that, however, it is notable that Randolph herself stated plainly in her self-published work that the RADQ was not intended as a test for Reactive Attachment Disorder, but instead was an assessment of a different, suppositious disorder never described in any peer-reviewed publication. Whatever Randolph intended to test, in any case, she failed to guard against bias in her results by herself doing both the job of subjective diagnosis and that of performing and scoring the test. Although her publication includes a report of an analysis of variance on the test results, it does not state how many false positives or false negatives occurred. This raises the question whether there were no such false results, simply because both the original diagnosis and the test result were in each case formulated by Randolph, who agreed with herself strongly in her assessment of each child; this of course is a far cry from having test scores that are validated by their agreement with an independent diagnosis.

The RADQ should be excluded as a possible diagnostic tool for Reactive Attachment Disorder  first on the showing of its own developer, who did not intend it to do that job, and second on the basis of its complete lack of conformity to normal guidelines for test development. That neither false positives nor false negatives have been reported is a statement not of the effectiveness of the test, but of a failure to consider a basic testing issue.

What then? Are there any standardized tests for Reactive Attachment Disorder? Helen Minnis, a Scottish psychiatrist, has been working for a number of years to try to develop such an assessment, but although she has created evaluative methods, she has no standardized brief test. In a 2009 paper with a group of colleagues (An exploratory study of the association between reactive attachment disorder and attachment narratives in early school-age children. Journal of Child Psychology and Psychiatry, 50(8), 931-942), Minnis described the complications and difficulties of this work, beginning with the lack of clarity in descriptions of the disorder: “Although the concept of RAD is encapsulated in psychiatric classification systems… the research base is scant, particularly in relation to school-age children… In this paper, we use the term RAD as in DSM to cover both the ‘inhibited’ and the ‘disinhibited’ phenotypes… The DSM and ICD systems both define RAD as being associated with early maltreatment and characterized by disinhibited behavior (indiscriminate sociability) or inhibited (withdrawn, hypervigilant) behaviors.” Minnis goes on to point out that there is not much consensus about the effect of changes with age on RAD, and that one system includes attention-getting and aggression toward self and others among the symptoms. Minnis pointed out that research has indicated that children may show symptoms of RAD and also be evaluated as securely attached to caregivers. (Does this suggest that in fact Reactive Attachment Disorder has nothing to do with attachment? See below—J.M.)

Children in the Minnis study were referred because of symptoms noticed by social workers and mental health teams, but not because of evidence of pathogenic care. Thirty-three children  diagnosed with RAD on the basis of interviews and observations were compared to 37 children matched on age and sex but not diagnosed with RAD.  Working with an extensive protocol rather than a brief test like the RADQ, Minnis looked for shared characteristics of children diagnosed with RAD. Minnis and her colleagues concluded that their findings “reinforce the conclusions from other literature that RAD is a phenomenon different in kind from attachment specific behaviors…. RAD can perhaps be seen as one of the pervasive disorders of social impairment…”.  

Minnis’s work suggests that a brief test diagnosing RAD is not going to be possible in the near future. Beyond that, Minnis and her colleagues point out the possibility that RAD is not about attachment in any ordinary sense of the term. I would note that this finding implies that efforts to destroy or create attachments are essentially irrelevant to treatment of  RAD--  in contradiction to the belief systems of persons who currently use the RADQ.


Friday, January 18, 2013

Book Review: Eileen Gambrill's "Propaganda in the Helping Professions"


As you might expect, people in the helping professions want to help. Physicians, nurses, social workers, psychologists, occupational therapists—although they may have other motives too, they probably won’t stay in those professions long unless one of their goals is giving help. And because they really want to help others, they may be quite vulnerable to propaganda in the form of attempts to persuade them that certain methods are safe and effective. Even if there is no good evidence to support such claims, helping professionals may accept persuasive material  enthusiastically and unsuspiciously, to the unfortunate detriment of their clients’ conditions. This situation is especially problematic if propaganda is generated by pharmaceutical companies or by proponents of alternative methods, who stand to profit if they can persuade the helping professional to use their proffered techniques.


In Propaganda in the helping professions (Oxford University Press, 2012), Eileen Gambrill, a social worker with a long history of concern about methods in her own profession, warns patients and practitioners of the potential dangers of persuasive messages about treatments, and describes at length some necessary skills for identifying and resisting propaganda. Densely informative, with 500 closely-printed pages of information and argument, Gambrill’s book presents ideas and methods which most people in the helping professions have been exposed to--  but did not necessarily catch. Like many abstractions, these ideas are easily forgotten, and most of us benefit from periodic reviews of material we recognize but don’t easily recall. Gambrill’s almost encyclopedic book will not be read straight through by many, but can be dipped into frequently with benefit to professionals and to patients who want to take some control over their treatment. Readers will find the extensive bibliography helpful, the endnotes both entertaining and informative, and the entire publication characterized by personal, opinionated, and even pejorative views (Gambrill refers to the American Psychiatric Association as “fellow travelers” of the pharmaceutical industry, for example).

An important section is one that restates a point discussed frequently over the last several years: that both practitioners and patients understand risks and benefits of events better when statements are in “natural” terms (e.g., 3 cases of breast cancer out of 1123 women) rather than in proportions or percentages. The ratios are the same, however they are stated, but the medium influences the reception of the message. Gambrill works out several problems using natural statements of numbers and shows how intuitive responses to reports of percentages may be quite different from responses when specific numbers are provided, with possible effects on our conclusions about the effects of treatments.

Several sections of the book focus on rhetorical or logical factors as they influence a message’s persuasiveness. For example, Gambrill discusses fallacies of irrelevance and the frequency with which they are used in propaganda about medical and psychological treatments. Indeed, defense of statements with comments that are ad hominem (about a speaker) rather than ad rem (about the topic) is a technique that is almost diagnostic of propaganda in the helping professions and elsewhere. For myself, I find it useful to review types of fallacies from time to time--  remembering the names helps me to identify examples that I read or hear, and assures me that others would find the statements fallacious as well. Gambrill’s book presents a thorough review, and includes a warning against the possibility of “self-propaganda”, the tendency to persuade ourselves of beliefs that in fact we cannot support.

Propaganda in the helping professions is a book full of good things, but it is not precisely a “good book”; there is more to a good book than a series of good sections. Gambrill’s book would have benefited greatly from an experienced editor who could have tightened up the text and revealed an underlying structure that is presently obscured by details. In addition, the production phase seems to have been skimped, leaving the text sprinkled with puzzling uncorrected typos of the kind that spell-check either caused or failed to fix. These include sentences where punctuation seems to have gone agley, leaving the reader to figure out what happened to the shoots and leaves.

I was left with unresolved concern about a point in Gambrill’s book. As she has done elsewhere, she refers to the Citizens Commission on Human Rights as a “watchdog group”, together with  the American Civil Liberties Union and Advocacy (sic) for Children in Therapy. Overleaf (not her fault, of course), Gambrill notes that the CCHR was established in 1969 by the Church of Scientology. It can’t be denied that the CCHR is indeed a watchdog group---  but its Scientology affiliation surely raises questions about who should be watching the watchmen. Here, where I would have expected one of the references to “fellow travelers” found elsewhere in the text, I see no comments at all. Does Gambrill presently consider the CCHR and the ACLU to be equivalent in roles and purposes?  Or is this simply a result of cutting and pasting of an unwieldy mass of material? I’d like to know, and I’d like this flaw to be corrected, so it doesn’t steal attention from the rest of Gambrill’s valuable contribution.

Thursday, January 17, 2013

Focus on the Family Buys Into Attachment Myths



Attachment theory, as formulated decades ago by John Bowlby, is a framework for understanding how human social interactions and relationships develop from infancy onward. Any theory works to pull together observations or other data on a topic and to suggest how they are connected with each other. Attachment theory deals with observable aspects of social relationships such as the apparent indifference of infants in the first months to contact with strangers, the quickly-developing preference for familiar people and fear of separation or strangers as infants  reach the end of the first year, the use of contacts with familiar people to help toddlers explore and learn, and the associations between early social experiences and adult attitudes toward other people.

Attachment theory, as it is conventionally understood, has been tested and revised as thousands of empirical studies have examined it. This is not the case, however, for an “alternative” view of emotional development that also uses the term attachment, but is in fact a matter of attachment myths.

The organization “Focus on the Family” appears to have bought into prevalent attachment myths. Although materials on its web site reference John Bowlby and attachment theory, it is in fact the myths that are repeated. Advice to parents  given by “Focus on the Family” is based on attachment myths, not on attachment theory.

Here is one example, taken from http://www.focusonthefamily.com/parenting/adoptive_families/attachment_and_bonding/new_definition_of_attachment-regulation.aspx. . The FoF author, Debi Grebenik, says this: “Children (biological or adopted) who do not get their needs met as babies and small children typically do not form a strong attachment with their parents. Even when adopting a baby, it is important to consider that the removal of a child from his or her biological mother creates a traumatic event in the life of the child.” Grebenik provides a diagram of the so-called “attachment cycle” that is solely a part of the attachment myths system and in no way a part of attachment theory.

Grebenik’s statements vary between the deceptive and the false. Certainly, young children are helpless to feed and care for themselves, and for good development must have caregivers who will do these jobs and do them well. However, it is a mistake to conflate good caregiving with the social interactions that are the actual cause of emotional attachment to caregivers. This aspect of attachment mythology adopts Sigmund Freud’s belief that children become attached to familiar people because those people provide food, an idea that was contradicted by Bowlby’s report, and the position of attachment theory, that pleasant social interactions with an adult are the actual cause of a child’s attachment to that adult.

Ordinarily, of course, caregivers who are neglectful or abusive are also likely to fail in providing pleasurable social interactions, and those who are attentive, sensitive, and responsive are also likely to create pleasant social interactions with their babies. It is easy to confuse these issues and to jump from care experiences to the social events that create attachment. If Grebenik is going to write about these issues, however, she should realize that it is deceptive to focus on satisfaction of needs as a cause of attachment, when in fact social interactions are the important factor here. Although events depicted in the “attachment cycle” diagram are usually accompanied by the important social interactions (which go unmentioned), the two are not the same things. This may seem like nitpicking--  except for the fact that attachment mythologists often recommend treatment of older children by attempts to re-enact the notional attachment cycle, such as spoon- or bottle-feeding. Buying into attachment myths in this way encourages parents and practitioners to choose forms of treatment that are neither plausible nor demonstrably effective.

In referring to the removal of a child from the biological mother as traumatic, Grebenik is again deceptive in her omission of important details. Of course, separation from a familiar caregiver (biological relative or not) is likely to be traumatic when two circumstances are present. The first is that the child has already formed an attachment to a familiar person, an event that does not occur before 6 months of age at the earliest. The second is that the new caregiver is unavailable, insensitive, and unresponsive. (I should note, by the way, that Bowlby did not consider, the second factor to be important, but his colleague John Robertson demonstrated that it was.) If the child is under 6 months old and is moved to a situation where a small number of attentive adults give good care and are socially responsive, this does not appear to be traumatic. Even an older child who is given sensitive, comforting care will adjust well over time. However, a child old enough to have formed an attachment, but too young to have developed good cognitive and language skills, is likely to be traumatized if placed in the care of a busy, unavailable, insensitive, and unresponsive caregiver. Children between 6 months and two years of age are most likely to have the reaction that Grebenik appears to ascribe to all children.

Let’s look at another FoF statement, at http://www.focusonthefamily.com/parenting/adoptive_families/wait-no-more/attachment-problems-up-close-and-personal.aspx. Here, in a piece by Kelly and John Rosati, we see the advice that emerges (logically but incorrectly) from the attachment myths described by Grebenik. Here’s what they say about the advice given to adoptive parents of a baby, whose age is not stated, but who was at the crawling stage. The adviser (an adoptive parent, not a professional ) inquired whether the baby held his own bottle, and whether when crawling toward an interesting object he looked back “to show it to you”. When the parents replied Yes and No, respectively to these questions, their adviser looked grave and announced that they were “in for trouble” if they did not work to overcome these attachment deficits.

[Let me take a moment here to point out two things. The first is that because there is no evidence that the “attachment cycle” described earlier actually exists, there is no reason to think that holding or not holding a bottle has any relevance to attachment. As for the second, the adviser appears to be confusing two developmental steps. At about 10-12 months, well-developed babies display “joint attention” by looking back and forth from an interesting object to a caregiver, until they get the caregiver to look at the object “with them”.  This is not usually considered a measure of attachment. The step this seems to have been confused with is secure base behavior, in which a child exploring a strange place or situation will occasionally make contact with a familiar person, by coming back to the adult, by “checking back” with a look, or by calling to the adult.  Unless an interesting object was also frightening, no one would expect a baby in a familiar setting to do much secure base behavior as he or she explored. ]

What did the adviser then suggest? “…only John and I should hold Daniel, and only I should feed him (not even John!). She told us that we should never let him hold his own bottle; he needed to depend on me to provide him with what he needed. … And then came the kicker: I needed to hold him and be face-to-face with him for almost eight hours a day!”

This mother recognized the implausibility of the advice--  although she apparently did not think of the interference with Daniel’s normal mastery motivation and with the eight hours of normal activity he would be missing, or of the training in passivity that was being given here. Scared of the dire predictions of the adviser, she did as she was told. “After several months of this therapeutic parenting…Daniel began to make good eye contact… and was more engaged and more emotionally connected with us”. The mother attributed the change she perceived to the treatment given--  although in fact one might well expect several more months in an adoptive family to be accompanied by increasing maturity and attachment to the new caregivers. (Indeed, I would ask whether those changes were actually slowed by the “therapeutic parenting”!)

There you have it. “Focus on the Family”, an outfit that draws many readers because of its religious and social positions, has bought into a mythology of attachment that contradicts  conventional attachment theory and that culminates in diagnoses and treatment that are inaccurate and inappropriate. How about it, FoF? Isn’t it time to replace the attachment myths with evidence-based material about attachment---  and help rather than hinder parents?

  

Friday, January 11, 2013

Preschoolers and "Shooter Drills"


An e-mail last night from a friend who is on the staff of a day-care center brought up a question that I have not seen addressed until now: should we try to train preschool children to follow instructions to escape from a shooter in the building? Elementary and high school kids are drilled on what to do, and the cooperation of some of the children at Sandy Hook seems to have saved their lives. Why not do the same for preschoolers? My friend’s center is proposing to do this, but as she said, the idea does not seem to “sit right”. And I had to agree with her about that.

Like all teachers and parents nowadays, day care providers and preschool teachers have been forced to think about the impact of events like the Newtown killings on the children they work with. The National Association for the Education of Young Children—the primary standard- setting and accrediting body for early childhood programs—has provided a list of suggestions for helping young children feel more comfortable as they hear about kids being hurt or killed (see www.naeyc.org/content/coping-school-shooting). As far as I know, however, neither NAEYC nor any other organization has proposed that young children participate in “shooter drills” that involve running away and hiding, on cue.

Why is my friend’s center considering such drills? It’s not a freestanding center, but operates under the administration of a larger institution. The larger institution is responding to Newtown and other events by developing plans for dealing with a “shooter”, and in the course of this a member of the security staff--  father of a child at the day care center—has been assigned to develop a plan and educate the staff and children. But I am afraid that like many people who know little about early development, he has with the best of intentions simply seized a method used with older children and “pulled it down” to be applied to preschoolers. By doing so, he may be proposing a step that will not only be ineffective in an emergency, but that may in itself be harmful and disturbing to young children.

Let’s consider first how likely it is that a school shooting will occur at all. Just over 80 school or mass shootings between 1996 and 2012 are listed at www.infoplease.com/ipa/A0777958.html and this is the worldwide list. It  includes shootings in malls, religious buildings, and theaters as well as in schools. In other words, although constant repetition on the news gives us the impression that school shootings occur over and over, they are in fact quite unusual events, and a child is a good deal more likely to die in a car accident --  or by being shot at home-- than in a school shooting.

This doesn’t mean that we should not plan what to do in all emergencies, but we need to balance the good we can achieve by any move against the ill we may unintentionally cause by the same move. Just as it’s wrong to think that “any psychotherapy is better than no psychotherapy”, it’s a mistake to forget that our attempts to protect children can  have unwanted side effects, especially if they are not developmentally appropriate.

It seems hard for many people (including some parents) to remember this, but preschool children are as different from school-age kids as they are from infants. Preschoolers can seem very grown-up and often “talk a good game”, using big vocabularies and doing a good imitation of adult attitudes. But that’s when everything is going well. Let a 3-to-5-year-old feel sick, get hurt, or feel threatened, and it all comes apart. Young children’s natural response to distress is to hurry to a familiar adult and cling there. If there’s no adult, other children are the goal. Overcoming that tendency with drills is not very likely to be achieved. The more serious and intense the adults are, the more the children want to stay with them, and the more the children are likely to cry and become confused if pressed.  Loud noises and screaming would increase their tendency to stay close to their teacher rather than run away.

This suggests that “shooters drills” with preschoolers are not likely to be effective in the very unlikely event of a shooter appearing. And what would their probable side effects be? The essential characteristic of a good day-care center or preschool is that the children feel it to be a safe place. Feeling safe helps them overcome the well-known anxiety that accompanies separation from parents even at this “advanced” age. Unless young children feel secure in the presence of a familiar adult, their ability to explore and learn is diminished. What happens then when we face them—either with or without explanation--  with the idea that they must run away and hide rather than staying where they feel safe? If we explain the problem and introduce them to the idea that someone might come and shoot them right here in their own classroom, we can certainly expect repercussions, not only at school but in the form of fearfulness and sleep disturbances at home. If we don’t explain, but just run them repeatedly through a drill that will create concern and anxiety in the adults, the outcome can be similar--  especially if the children are not developmentally ready to do what the adults are urging them to do.

Expecting preschoolers to act to save themselves in a shooting attack is somewhat like expecting them to recognize what a child molester is doing and tell him “no”. Trying to teach young children these things may make adults feel better, but that’s all the good it’s likely to achieve--  and it may do harm.

I have an idea, though. If we want to protect young children from being shot—at school, in their homes, or on the street—why don’t we enact some serious gun control laws? It’s just a thought, but ya know, it’s so crazy it just might work.
  

Wednesday, January 9, 2013

Guest Post by Jane Bongato: Helping Your Adolescent Cope with Pressures


Adolescence is a difficult time in any child’s life, no matter how well adjusted they may be. With their bodies changing and an increased self-awareness, most young people struggle with a number of age-related issues such as peer pressure, sibling rivalry, body image, self-esteem, depression, relationships and anxiety over their future career and education.
As parents, it is our job to guide them through this challenging period in their lives and make their transition from childhood to adulthood as easy as possible.
Following are some tips and advice on ways to mentor your teen and help them cope with all the pressures that come with growing up.
Be there for them
The best thing you could do as a parent is to be there for your child when they need someone to talk to or even just a listening ear. Make sure that your teen knows that you will always make time for them and encourage them to share their hopes, dreams, worries and problems with you.
Be quick to praise but slow to judge, and always remind them that they are valued and loved. Even teens who don’t seem too interested in bonding with you once they reach a certain age will appreciate the fact that you are making an effort to communicate and spend time with them.
Communication shouldn’t only happen when you are disciplining them or when you think there may be a problem. It should be a daily occurrence, even if it’s just a friendly chat about how their day went.
Try to connect on a regular basis by doing simple things together, whether it’s preparing a meal, watching a TV show you don’t particularly care for or agreeing to listen to their music in the car during a long trip.
Don’t smother them with your own expectations
It’s fine to encourage different hobbies, educational achievements or career paths, but take care that you don’t weigh them with your own expectations. Remember that the most important thing is for your child to be happy and have the ability to express their individuality, even if it means that they choose a style, boyfriend/girlfriend or career that you would not have.
Most teens naturally rebel against their parents’ way of doing things, and trying to force them down a certain path will likely only cause them to run in the opposite direction.
Instead of smothering, allow them the freedom to choose their own hairstyles, clothing, friends, education and career (unless, of course, these are in some way unhealthy for them). 

Don’t downplay their problems
It’s easy to forget what it was like to be a teen once we grow up and start dealing with other problems that we perceive to be more “real.” However, as parents, we must be able to put ourselves in their shoes and think back to what it was like to be a teenager; when a bout of acne before a school dance seemed like the end of the world or the end of a two-day relationship meant you would never love again.
It is important to acknowledge their problems and struggles, no matter how small they may seem to us. Laughing it off or telling them that “it’s not so bad” or that “it could be worse” is not helpful and will only heighten their sense of being misunderstood.
Respect their privacy
It can be extremely tempting as a parent to meddle in every aspect of your teenager’s life and justify such behavior by telling yourself that you are doing it to keep them safe. However, not respecting your teen’s privacy will prevent them from trusting you and could breed anger or resentment later on in life.
There is a fine line between looking out for your child’s wellbeing and snooping through their private life. Things like reading diaries, logging into their social media accounts or listening in on private conversations should be avoided at all costs.
If you are concerned about them or believe they are getting involved in something dangerous, the best way to deal with it is to approach them directly and ask them about it. Don’t be afraid to step in if need be, but don’t go to unnecessary lengths to spy on them either.
Teach them what they need to know
As awkward as some things may be to bring up with your teen, it is important to make sure that they have all the information they need on important topics like relationships, safe sex, STDs, eating disorders and drugs and alcohol.
Yes, they may cringe or tell you they don’t want to talk about it or that they know all there is to know, but ignoring these issues or assuming they will learn about it in school or from a friend could leave them open to serious problems down the line.
If you don’t feel comfortable talking about these things with them yourself, you may want to consider enlisting help from someone else, like an aunt, uncle or close family friend, as teens often feel more comfortable discussing such issues with someone who isn’t their mother or father.
Providing them with educational material is also a good way to ensure that they are well-informed, without having to sit them down for “the talk”.
About the author:
Jane Bongato is part of the team behind Open Colleges ( http://www.opencolleges.edu.au/)
 Australia’s provider of child care courses (http://www.opencolleges.edu.au/childcare-certificate-and-diploma-courses.aspx).  She is an early childhood educator  with a background in psychology and for the past six years has worked closely with special needs children. She enjoys reading, painting or meeting friends during her spare time. (Find her on Google+ )

Tuesday, January 8, 2013

More on the International Problem of Holding Therapy: Nancy Thomas in Russia


Yulia Massino, a Russian blogger, has called my attention to the visit of Nancy Thomas, an advocate of Holding Therapy, to Russia in 2012. Yulia is especially concerned about the possible influence of Thomas because little of the  U.S. criticism of Thomas’ methods has been translated into Russian. Unless Russian parents are fluent in English and have access to professional and other publications, they are unlikely to be aware of the existence of serious concerns about Thomas’ claims.

Thanks to Google translate, it’s possible for non-Russian-speakers to have a good look  at http://attach2me.ru, a web site offering material by Nancy Thomas and other proponents of Holding Therapy to a Russian audience. Like other advertisements for the Holding Therapy belief system, this one begins with an unusual definition of attachment as a desire and ability to prolong emotional intimacy with another person, rather than one of the more common definitions, like a preference for being near a person when uncomfortable or threatened. It proceeds to describe a mental health diagnosis called Reactive Attachment Disorder as including failure to make eye contact except when lying and an interest in blood and gore---  none of which are part of Reactive Attachment Disorder as defined by DSM-IV-TR or by ICD-10.

In a move typical of Holding Therapy proponents, http://attach2me.ru lists a peculiar mixture of books that are all said to be “about attachment”. These include an important volume by John Bowlby, the major theorist of attachment, and one by Bowlby and Mary Ainsworth, his collaborator  and creator of the idea of differing  qualities of attachment. (Articles listed in another section are also primarily by Bowlby.)  In addition, however, the book section includes translations of works by the Holding Therapy advocate Nancy Thomas and by Gregory Keck and Regina Kupecky, authors well-known to support a belief system that shares with Bowlby’s conventional system no more than a handful of vocabulary words. Also listed is a translation of a book whose senior author is Foster Cline, the erstwhile leader of the “rage-reduction therapy” movement of the 1980s and 1990s, and like his colleague Thomas a promoter of an attachment theory quite unrelated to Bowlby’s.

Two questions present themselves: What are the differences between the Thomas/Keck/Cline view of the attachment and the conventional attachment theory formulated by Bowlby? And, given that the two approaches are mutually contradictory, why would proponents of one want to mention the other approvingly?

The first question requires more details but is in fact simpler to answer than the second. Here are some basic differences:

  1. The basic nature of attachment. For the Holding Therapy (HT) group, attachment is an emotional transformation something like religious conversion. Once done, it is difficult to undo or change, but shapes relationships through life by determining not only trust and intimacy, but obedience and gratitude to others. Disturbed attachment results in psychopathic behavior, serial killing, and sexual inappropriateness.
From Bowlby’s viewpoint, attachment is the formation of an early preference for familiar caregivers and sense of security in their presence. As cognitive and emotional development proceeds, existing attachments change toward  more mature relationships, and new attachments are formed. Early attachment experiences are one of several factors that determine later social relations.  Bowlby argued that poor early attachment can result in delinquency, but did not relate early experiences to later severe behavior problems.

  1. The timing of attachment processes. The HT group considers attachment to exist prenatally as a result of some form of communication between birth mother and unborn infant, but also to continue to develop later. Newborns are thought to have a strong attachment to their birth mothers and to suffer grief and rage if separated (e.g.by adoption).
Bowlby’s theory of attachment focuses on social interactions with a small number of caregivers in the second half of the first year as critical to attachment, but assumes that new attachments can develop in the second year and later. Newborns (that is, infants in the first month after birth) are not thought to have attachment or to experience suffering if separated from their birth mothers.

  1. How attachment occurs. The HT theory of attachment holds that this emotional commitment of the child increases through the first year insofar as caregivers can satisfy the child’s needs. (Infants with serious health problems are thought to fail in attachment if caregivers cannot comfort them.) The experience of need followed by gratifications presented by caregivers is referred to as the “first-year attachment cycle”, a concept absent from conventional views of attachment. Attachment is thought to be advanced and perfected during the second year of life when caregivers set limits on children’s behavior.
Bowlby’s theory of attachment focuses entirely on pleasant social interactions with familiar caregivers as the cause of attachment and the related sense of security with familiar people. Attachment is more difficult if caregivers are indifferent or unpleasant, or if the child has too many changes of caregiver.

  1. How attachment problems are thought to be treated. The HT approach is based on the assumption stated in the last paragraph, that attachment occurs because of satisfaction of physical needs and because of limit-setting. HT methods, especially those sometimes referred to as “Nancy Thomas parenting”, aim at re-enacting the events HT advocates believe are responsible for early growth of attachment to caregivers. In order to satisfy a child’s physical needs, it is essential to be sure that these needs exist and can only be gratified through the intervention of the caregiver or proposed attachment figure. Children are forbidden or prevented from efforts to help themselves in age-appropriate ways like preparing food or using the toilet at will. The child’s diet is limited in amount and variety (one Russian adoptee in the U.S., Viktor Matthey, was apparently fed on uncooked grains), leading to malnutrition and weight loss; he or she may be made to sleep in a cold room; and toilet use is available only with the stated permission of the caregiver. Along with actual “holding” treatment, these methods are thought to prepare the child for a new attachment, which is cemented by means such as extended mutual gaze, rocking and cuddling of older children as well as younger, and hand-feeding of milky sweets in apparent imitation of the provision of  milk from the breast. As all behavior problems are thought to be based on poor attachment, these methods are expected to help with all difficulties.   
Conventional child psychotherapies based on Bowlby’s theory, such as Robert Marvin’s “Circle of Security”, focus on increasing parents’ and children’s communications with each other, so parents become more aware of children’s cues showing that they need comfort and security, and children in turn have improved social experiences. Specific problem behaviors  like speech delays are treated in conventional ways and are not linked particularly with attachment history.  

  1. Safety and effectiveness. A number of cases of harm to children have been associated with HT and “Nancy Thomas parenting”, but no such association has occurred with conventional treatment. HT methods have no foundation in systematic evidence, but several conventional methods are evidence-based.


It is abundantly clear that the HT approach is vastly different in its assumptions about attachment than the conventional attachment theory developed by John Bowlby. Why, then, would http://attach2me.ru list together a series of books that contradict each other? The best explanation appears to be that the HT group wish to gain acceptance by “riding the coattails” of a major conventional psychological theory and associating themselves with a name that has been heard by every introductory psychology student for the last 40 years or so. Not guilt, but respect, by association is the goal of the promulgators of http://attach2me.ru. They’ve tried the same thing in the United States, but here they have met again and again with critical rejection by major professional groups. What a new frontier Russia must be for them--  a Promised Land where few have yet heard about the reality of HT, and most can’t read the endless criticisms of the method! Let’s hope that Pavel Astakhov takes note of what may be happening to Russian children in their own country.

N.B.  I believe I’ve heard that Jirina Prekopova is also making some approaches to Russia. What a Battle of the Titans that might be---  NT versus JP--- which can restrain the other longer?  
  

Sunday, January 6, 2013

Listen to Mama: What Newborns Learned Before Birth, and Some Implications


The “mother tongue” or the “cradle language”--  that’s what we call our earliest, and usually most fluent, language. We learn about its words and grammar from our earliest caregivers, of course, but for quite a while people have been suspecting that some features of language are learned before birth as well as after.

Like other sensitivities to touch stimulation, hearing--  the result of bending of hair-like cells in the inner ear—is well-developed before birth. Although human beings are specialized for hearing sound waves traveling through air, we can pick up sounds moving through water, or even through the earth (how they hear the stampede coming in cowboy movies, right?). This means it’s not so surprising that some sound waves resulting from speech can travel through a pregnant woman’s body and through the amniotic fluid to cause responses in the ears of an unborn baby even several months before birth.

But, so what if this does happen? Do those speech sound waves have any effect on the baby’s development, any more than do other sounds like a car starting, a dog barking, or mother’s teeth being brushed? The fact that something can happen doesn’t mean it does happen, so back in the 1980s researchers started looking to see whether newborns showed any effects of systematic speech sound experiences in the weeks before birth.

Well-known studies by DeCasper and others in the ‘80s had mothers-to-be record their voices reading either The Cat in the Hat or a similar-sounding story, The Dog in the Fog. The women did not know at the time they recorded which story they would later be asked to “read to their bellies” so the developing fetus could hear. Stories were randomly assigned and read repeatedly over the last weeks of the pregnancies. After they were born, the babies were allowed to listen to both stories and could control which one they heard by sucking on an artificial nipple. They spent more time listening to the story they had heard prenatally than to the other, very similar story, suggesting that they had been learning as they listened.

But there is an oddity in these results. The evidence is clear that the babies could tell the difference between the familiar and the unfamiliar sounds, and they showed us this by choosing to listen for a longer time to one story than they did to the other. But… newborn babies don’t usually pay more attention to familiar than to unfamiliar things, the way older babies and adults often do. Newborn babies show a tendency to habituate to things they’ve seen or heard before. After paying attention to familiar things briefly, they stop paying attention to them, and spend much more time attending to unfamiliar sights or sounds. The extent to which newborns do this is correlated with their later cognitive development. Yet DeCasper and his colleagues reported that the newborns in their study paid more attention to the sounds they had heard before. What was this about? Was it that because those sounds were not heard through the mothers’ tissues and amniotic fluid, they seemed a lot different from what they had been, and were thus “changed” and unfamiliar even though they were the same words? Or, perhaps, did the mothers who were reading “to their babies” speak differently than those who were reading for a recording?

In a recent study by Christine Moon, Hugo Lagercrantz, and Patricia Kuhl  (Moon, C., Lagercrantz, H., Kuhl, P.K. (2013). Language experienced in utero affects vowel perception after birth: A two-country study. Acta Paediatrica. doi: 10.1111/apa.12098), babies born in the United States and babies born in Sweden were compared to see whether they preferred (i.e., sucked more in order to hear) vowels characteristic of speech in the U.S. or Swedish vowels. In each country, the newborns were more attentive to the vowels that they had not heard prenatally. Newborns in the U.S. preferred to listen to Swedish vowel sounds, and Swedish babies preferred to listen to U.S. vowels sounds. As we would predict from their tendency to habituate, the babies paid more attention to the unfamiliar than the familiar vowel sounds. These results seem to be at odds with the DeCasper work, unless there’s some explanation like the ones I suggested in the previous paragraph.

To understand how infants’ mental abilities develop, it’s really important to know what can happen before birth, but at the same time to be aware of what probably does not happen until later. It’s also critical to remember that although great minds may think alike, newborns and older individuals don’t necessarily do so. The Internet abounds with comments from people who want to interpret young infants’ responses to speech in terms of what adults do or like…  for example, suggesting that learning from speech prenatally means that newborns have already established communication with their birth mothers in a sophisticated way.

Interpreting newborn behavior as if it involved the same motivations and abilities as adult actions is sometimes called adultomorphism, a made-up word derived from  “anthropomorphism” (acting as if animals have the same intentions and motives as humans). One highly adultomorphic thought pattern assumes that newborns long for the familiar and feel uncomfortable with the new and unfamiliar, as older children and adults often do. This type of adultomorphism gave rise to the idea that birth is an emotionally traumatic separation from the familiar and comfortable “communion” of fetus with mother--  an idea that is purely speculative, and no more logical than the guess that the child at the time of birth is bored silly and wants to get out and have a look around.

 But what infant behavior actually shows us is that for several months after birth babies are fascinated by the unfamiliar. For several months after that, they remain cordially responsive to friendly new people and interesting new situations. By the seventh or eighth month, they start to be wary of new people and things, and take a while to warm up to them. After eight or nine months – when attachment becomes evident in most babies--  they may be frankly frightened of new people and things, avoid them, and come to terms with them best when encouraged and supported by familiar caregivers in a familiar place. Strange though this behavior may seem to the inexperienced observer, in fact the baby is now much more like an adult than he or she was at birth. Like us, older babies are most likely to pay most attention to familiar sights and sounds and to learn from them.  Just try changing The Cat in the Hat to The Dog in the Fog and you’ll see what I mean.

Wednesday, January 2, 2013

Russian-American Adoption Issues: Some Background and Suggestions


The Russian ban on adoption of children to the United States has been the subject of a number of articles and an editorial in the New York Times over Christmas week of 2012. The Duma, the Russian parliament, passed legislation prohibiting adoption of Russian children to the U.S., and President Vladimir Putin signed the bill. The Times and other U.S. sources attributed the ban to Russian reprisal against the Magnitsky Act, a U.S. attempt to censure Russians for human rights violations. The Duma attributed it to the fact that 19 Russian-born children have died in adoptive homes in the U.S.  Curiously, however, the bill was named for Dima Yakovlev, whose tragic death in a hot car was one of the few that were clearly accidental rather than the result of systematic maltreatment. Like the Times, members of the Duma seem uninformed about the situations that probably gave rise to most of these deaths---  situations that may have been encouraged by adoption caseworkers in this country. (See
 http://www.vesti.ru  which for some reason won’t let me type the whole thing---- add to this  /doc.html?id=990      and then      898 [mysteriously, it seems to lock on me after the 990]). I believe, however, that Pavel Astakhov, the Russian Children’s Ombudsman, has some awareness of what has been happening.

Readers who have been following the Russian-American adoption situation for some time will realize that concerns about intercountry adoption have existed for years. An article by Jaci Wilkening in an Ohio law journal (http://moritzlaw.osu.edu/students/groups/oslj/files/2012/01/Wilkening.pdf) summarizes a good deal of the history and addresses some--  but not all—of the problems that need to be dealt with in order to protect both parents and children. (For example, Wilkening stresses the return of seven-year-old Artyom to Russia, rather than serious cases of maltreatment and starvation.)

In 1994, the U.S. signed onto the Hague Convention on Protection of Children and Co-operation in Respect of Intercountry Adoption. In 2000, this agreement was ratified through the Intercountry Adoption Act, but was not enacted through the promulgation of regulations until 2008. Both the Hague Convention and the IAA emphasize pre-adoption services, the appointment of a Central Authority in the receiving country  (in the U.S., the Department of State), assessment of the prospective adoptive parents, and appropriate counseling of the adoptive parents on the child’s history and cultural background, medical issues, developmental history, and so on.    

The IAA Regulations did not address post-adoption services, or significantly, post-adoption reporting, although a number of sending countries require such reports. According to Wilkening’s paper, Russia has required post-adoption reports 6 months, 12 months, 24 months, and 36 months after the adoption. China requires adoptive parents to state their willingness to provide reports as asked. Ethiopian law requires reports after 3 months, 6 months,  one year, and annually until the child is 18. Reports until age 18 have also been requested by Vietnam, Ukraine, and Kazakhstan.

In 2011, an agreement (Agreement Between the United States of America and the Russian Federation Regarding Cooperation in Adoption of Children; http://tsgsandbox.his.com/adoptions/content/pdf/us-russia_adoption_agmt-713%2011-signed_english.pdf) was signed and to come into force in October 2012. This agreement again stressed pre-adoption counseling and education, but also required that adopted children remain citizens of Russia while also receiving U.S. citizenship, addressed issues of dissolution of adoptions and re-adoption, and required that this all be performed by a competent authority as defined in the agreement. The child is also to be registered with a consular office and regular reports are to be sent, especially if requested..

As Wilkening points out, however, the U.S. State Department has no power to enforce compliance by adoptive parents, and is considered as showing good will if it encourages compliance. She stresses the need for post-adoptive services but appears to focus primarily on the rights of adoptive parents to receive a child with the characteristics they expected rather than to have medical or other surprises. The solution Wilkening proposes is to strengthen the authority of the State Department in these matters--  although she acknowledges the dislike of American adoptive families for reporting or being monitored in ways that are outside historical guidelines in U.S. family law.

Wilkening also comments on both mental health concerns and developmental or neurological disabilities as points that demand much more post-adoption attention. Interestingly, she stresses the potential mental health problems of institutionalized children rather than the possibility that adoptive parents may have mental health difficulties triggered by adoption, just as perinatal mood disorders like post-partum depression may be triggered by the birth of a child. In fact, post-adoption mental health services may be as necessary for adoptive parents or for other children in a family as they are for the adopted child. Wilkening’s paper also cites the testimony of  “a doctor” (in fact, the psychologist Ronald Federici) before Congess, in which he reported that 80% of foreign-adopted children he had evaluated were neuropsychiatrically impaired. This appears to be a PFA number---  Pulled From the Air--  but in any case is irrelevant unless we also know how many children he evaluated, and how that number compares with all foreign-born adoptees including those whose parents did not see a need for evaluation. As was the case for mental illness, Wilkening’s statement here seems incomplete, and it appears to me that improved pre-adoption services would be more to the point than more post-adoption services---  especially if the assumption is that adoptive parents are accepting seriously at-risk children out of inadequate counseling and education.

Like the Times statements, Wilkening’s article put little stress on the number of Russian and other foreign-adopted children who have died as a result of systematic maltreatment, and on the very real possibility that such maltreatment is advised as “attachment therapy” by caseworkers. A common feature of these child deaths is severe undernutrition, advised by “attachment therapists” and parent coaches like Nancy Thomas as a way to establish the dominance of the adoptive parent and thus (according to this belief system) to cause emotional attachment and the obedience and gratitude these people consider to follow as natural consequences of attachment. Examination of curricula for adoption workers and statements of parent organizations show that this approach, with its real potential for child injury or death, is rife in the United States.

What would the United States have to do to keep safe adopted children, from Russia or elsewhere? An essential step would be an independent examination of curricula used for the education and counseling of prospective adoptive parents. Currently, organizations that are said to be “competent authorities” are allowed to create their own curricula, certainly a task the State Department does not want to take on. Independent assessment of the curricula by knowledgeable scholars outside the “authorities” would reveal whether adoptive parents are actually being given unconventional and dangerous misinformation that will make them more likely to harm the children.  A similar examination of the training of adoption caseworkers would also be in order, as only a few years ago a major social work textbook stated approval of “holding therapy”. An additional step that could be very helpful is to ban homeschooling for foreign-adopted children, because contacts with schools and other community organizations can act as buffers against mistreatment, especially underfeeding.

Unfortunately, there remains a puzzling issue, one that is difficult to explain to the more centralized Russian Federation. This is the multiplicity of levels of services and law enforcement in the United States--  and the more than occasional conflicts between state and federal levels. For instance, in the case of Maxim Babaev (http://voicerussia.com/2012_12_23/Russian-Children-Sexually-Abused-Suffocated-by-US-Adoptive-Parents-Russian-Diplomat/), a Florida judge refused to allow the Russian consul contact with a 6-year-old adoptee who had been removed from abusive parents and placed in a foster home, saying he knew nothing about the bilateral agreement and did not have to cooperate with it.