Does Reactive Attachment Disorder Have Anything to Do With Cause and Effect Thinking?

A reader’s recent comment referred to the tendency shown by believers in the “Attachment Therapy” system to attribute children’s behavioral difficulties to a lack of  cause-and-effect thinking. At www.fromsurvivaltoserenity.com/2014/08/educating-about-rad.html, a graphic is presented showing dozens of “symptoms” of Reactive Attachment Disorder, few or none of them to be seen in the DSM-5 list of criteria for the disorder. Among them, problems with cause and effect thinking are noted. A document for teachers at www.attachmentnewengland.com/documents/educators/pdf also refers to such problems, and claims that children with Reactive Attachment Disorder cannot learn from behavior modification methods that use reinforcement for desirable behavior. (The latter document warns parents against using sarcasm, while providing a list of obviously sarcastic responses to children--  a point that raises questions about the sincerity of the writer—and states that attachment begins prenatally, raising further questions about the writer’s knowledge of the field.)

Strangely, however, these documents also stress the belief that children with behavioral difficulties can manipulate, exploit, and fool intelligent, well-trained, and experienced adults. How do they manage this, one must ask, if they cannot associate cause (their own behavior or speech) with effect (the beliefs and behavior produced in the apparently hapless adult)? For that matter, without some mastery of cause and effect associations, how can they do anything at all in the way of self-care, schoolwork, household chores, or play?

It does seem that just as these documents are not really talking about Reactive Attachment Disorder when they use that term, neither are they really talking about understanding cause and effect. Let’s have a look at the development of cause and effect thinking first, then maybe I can hazard some guesses about the real issues referred to by that name.

Learning about cause and effect is a gradual process, but one which begins quite early and is slowed only by cognitive impairment. Jean Piaget, the famous theorist of cognitive development, first described some steps in understanding cause and effect almost a hundred years ago. He suggested that between about 4 and 8 months of age babies begin to notice the effect of things they do, like kicking their feet or making sounds. They discover that sometimes their activities seem to make interesting events (like an adult smiling at them) continue--  but this little insight into cause and effect is only a beginning, because if the interesting event stops, the baby gives up and does not try to make it start again. From about 8 to 12 months, babies begin to put together single activities so that they can look, reach, and grab, and use that combination to keep interesting things going on. But, in Piaget’s theory (and many observations), a much more important step waits until about 12 to 18 months, when babies catch on to the fact that they can actually start interesting events by themselves--  and they do this over and over, by dropping and throwing objects and watching carefully to see what happens (cereal splashes, cheese doesn’t, and they all get eaten by the dog). This understanding of cause and effect is needed for a wide range of learned skills, from pulling a stool to the table in order to reach something, to drinking through a straw, to all forms of communication with other people and all planning of actions.

It’s common for people to assume that Piaget was taking a behaviorist position--  that infants develop cognitively only because they are repeatedly gratified by what happens when they exercise a new skill. That assumption is reflected in the idea of the “bonding cycle” of alternate needs and gratifications, as claimed by Attachment Therapy advocates. However, that is not at all what Piaget said.  His theory (and recent work on cognitive growth)  is based on the idea that cognitive development is driven from within and requires only ordinary experiences that the baby himself produces. When the attachmentnewengland document says “this [bonding] cycle promotes the development of cause and effect thinking which is the basis of all problem solving”,  it reveals a misunderstanding of how cognitive development proceeds. Naturally, reasonable physical care is needed for survival and healthy brain development, and social interaction is needed for attachment and language learning, but experiences of care are not privileged factors in the development of cause and effect thinking. To assume that they are is simply a rationale for the use of non-evidence-based methods.    

Of course, the understanding of cause and effect is not complete at age 18 months. The more steps intervene Rube-Goldberg-like between cause and effect, the harder the connection is to make. When someone doesn’t understand how something works, their comprehension of specific causes and effects will be limited. In the natural world, it is common for more than one cause to produce an effect, for one cause to produce more than one effect, and so on, and these situations make real understanding more difficult. In addition, even adults are prone to fallacious reasoning about causes. They may accept superstitious beliefs about spilling salt or having a black cat walk in front of them--  a matter of confusing cause and effect relationships. They may be swayed by fallacies about the order of events and how that reveals cause and effect, so that they assume that when B followed A, it must have been caused by A. They readily jump to the conclusion that if two things are correlated, one must have caused the other. In the Attachment Therapy- Nancy Thomas-Foster Cline belief system, they assume that when adopted children have mood and behavior problems, the events surrounding adoption must have caused the later problems.

Unless children have severe cognitive impairments, we can expect them at school age to be somewhere between toddlers and adults in their understanding of cause and effect. They know that they can make things happen, but they are still likely to display fallacious reasoning about complicated causes or those that are separated in time from their effects. Certainly they are able to know when their actions bring about immediate approval or disapproval from adults. As for responsiveness to behavior modification techniques, there is no reason why they should not respond as well to a properly-designed and implemented program as do all other living creatures right down to flatworms.

What’s the problem, then, if there’s no actual difficulty with understanding cause and effect? Might it not be that advocates of Attachment Therapy beliefs are convinced that when they use poor behavior management methods, those methods fail to be effective only because the children are so bad?  Using behavior modification or similar management methods requires careful planning and depends strongly on timely intervention. Research in this area showed many years ago that rewards work best when they come very quickly after an desired behavior, and reprimands or “consequences” for undesired behaviors work best if they occur in the middle of the act, or even better, just as the child prepares to do it. There is no reason to think that these rules would apply differently to children said to have Reactive Attachment Disorder than to other beings.

It’s my guess that much of the issue of unwanted behavior in “these children” (those considered to have attachment disorders by Attachment Therapists) actually has to do with the idea that the children must never “win” or “be in control”. The attachmentnewengland document recommends, per Nancy Thomas, that an adult “establish eye contact with the child and ensure that the child always looks up at the adult. The child with Reactive Attachment Disorder dislikes eye contact and will try to avoid it except when he/she is lying or trying to manipulate others. Avoid bending down to establish eye gaze with the student…”. In other words, mutual gaze is required because the child does not like it, and he or she must be made to submit, ideally through an uncomfortable posture that reminds the child of the adult’s size and power.

The document also insists that no explanations may be given to a child who is “consequenced”. “When giving a consequence, educators must stop themselves from telling the child why a consequence is given. When a child doesn’t have cause and effect thinking, he/she will never connect their inappropriate action with the consequence no matter how many times the connection is explained. … The child really doesn’t want to know why and just wants to argue… After the consequence has been given, it is important for educators to let go of caring about whether or not the consequence changes the child’s behavior, or has any impact upon the child, or his/her actions…”. 

It appears, then, that teachers are to abandon any hope of establishing cause and effect thinking in their pupils; if a child cannot make the connection with an explanation, surely he or she will not make it without one.  In addition, teachers are apparently being advised to abandon their own capacity for cause and effect thinking, and to ignore the outcome of their methods rather than to pay attention to what works for them with a given child. Rather than modeling the thinking behavior they should want, they are to adhere rigidly to what they are told, and to fall into their places in this authoritarian system just as the children are to do.

This is not about cause and effect thinking, any more than it’s about attachment or even Reactive Attachment Disorder as the evidence shows it to be. It’s all about obedience and punishment. Cotton Mather would recognize it easily.