Concerned About Unconventional Mental Health Interventions?

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

Sunday, April 12, 2015

Stealing Words' Meanings for Fun and Profit: Floortime(TM) and Tummy Time


In the Alice books, Humpty Dumpty and Alice have an argument. H.D. says that as far as he is concerned “glory” means “a nice knock-down argument”. Alice counters that you can’t make words mean just what you want, but Humpty says he can, and refers to “Saturday night when they comes around to get their wages”.

For Humpty Dumpty, it was the words that profited by getting paid for expressing a meaning other than their own. But people whose mental health interventions are not characterized by a strong sense of professional ethics can and do profit from using familiar words and giving them new meanings. This is especially likely when the familiar words reference treatments or concepts that are generally respected—the “new meanings” benefit from the respect that actually belongs to the old meanings.

As I mentioned some time ago in this blog (http://childmyths.blogspot.com/2011/05/what-is-floortime-well-folks-it-isnt.html), Ronald Federici and Heather Forbes borrowed the term “floortime” and applied it to their practice of physically restraining a child on the floor for supposed therapeutic reasons. As some parents and mental health professionals already know, Floortime™ has a specific meaning and indeed has been trademarked by its originators. Floortime™ is a method used by practitioners trained in DIR™ (Developmental, Individual-difference, Relationship-based treatment). Practitioners who use Floortime™ do play and interact with children on the floor, but their methods involve following the child’s lead and encouraging verbal and nonverbal communication through play. Really, no two things could be much farther apart in meaning than the respectful, empathic, interactive methods used by DIR™ professionals and the intrusive, authoritarian, coercive techniques used by Federici and his few followers. What was the point of calling the coercive methods “floortime” when this word had already been used for many years by DIR™ practitioners? Was it simply ignorance, or was it an attempt to get under the more popular umbrella of DIR™ by adopting what was essentially a stolen word? Profit, or just fun? I can’t explain it myself, but it worries me greatly to see meanings muddled in a way that advantages the muddlers.

More recently, I came across the theft of the term “tummy time”. Now, this is an expression that has been well-known to millions of parents over the last ten years, the period when infants in the U.S. have been supposed to be put to sleep in the supine position, and when developmentalists had figured out that supine-sleeping babies were not achieving motor milestones as the old standards said they should. Tummy time, a period of prone positioning for play or at least non-sleep activities, was advised as a daily experience that would foster motor development. A large number of young parents during this period have not done tummy time, because the babies don’t like it right away, but this is not the point; they have heard about tummy time and how you are supposed to do it to encourage your baby’s development.

But--  along come some other people and steal “tummy time” for their own meaning and purposes. I encountered this first in reading about the case of Kali Miller (http://obpe.alcsoftware.com/files/miller.debra%20(kali)%20a.f._559.pdf), the Oregon psychologist whose professional license was revoked because her recommendation of Nancy Thomas parenting methods was followed by the suicide attempt of a 12-year-old boy who was the target of the intervention. Miller apparently used the term “tummy time” to mean having the child crawl on hands and knees—an activity inappropriate for a 12-year-old, and without the slightest known developmental benefit for anyone whose motor development had been typical until that age.

Searching for other uses of the stolen phrase, I came across this: www.bestpractices4teaching.blogspot.com/2013/03/tummy-time-for-10-year-olds.html. This blogger states,”[I] sometimes wonder if ‘tummy time’ would work for a 10 year old”. She then refers to an article given to her by her (or, her children’s?) occupational therapist-- https://mysweetchaos.wordpress.com/2010/01/24/neurodevelopmental-reorganization/. Here we find a mother of children she speaks of as “RADishes” (I haven’t come across that one for a while). And mysweetchaos provides a post jam-packed with misinformation--  not only misinformation, but misinformation with a strong tang of Attachment Therapy beliefs about it.

I hardly know where to begin here. Mysweetchaos has provided what Barbara Pym would have called “such richness”. Starting at the top: “When a baby is on their tummy and they turn their heads from left to right to left to right and so on, this is developing their brain for reading. READING! [caps sic] When a baby moves their head up and down, they are developing their brain for math. MATH! Makes sense when we read left to right and solve equations top to bottom.” What to say about this farrago of nonsense? (I always think a farrago should be a kind of porridge, but that would work here too.) Let’s start with the simple fact that a large part of the world’s population does not read left to right. As Lerner and Loewe wrote, “the Hebrews speak it backward, which is positively frightening”, though perhaps not as frightening as mysweetchaos’s assumption that she knows what she’s talking about. Then, let’s look at the idea that “equations” go from top to bottom. Yes, children are taught to do arithmetic in columns, because that enables them to line up ones, tens, hundreds, etc. in ways that would be more difficult if the numbers were placed horizontally. But the equation, the actual arrangement that takes into account the principle of equality, can be horizontal, vertical, or diagonal. What’s more, if anyone understands equality, they know that it does not make the slightest difference whether you start on the left or on the right.

Skipping a bit, let’s go down to where mysweetchaos’s source tells her that many familiar problems (cf. “attachment disorder” checklists), like lack of empathy, overeating, poor appetite, and picking at scabs and other people, being superficially charming, etc., are due to “pons dysfunction”. The pons is a part of the brainstem that has multiple functions, including carrying messages from higher to lower areas and contributing to sleep, breathing, and bladder control. According to mysweetchaos, the developing functions of the pons have to be guided by  appropriate movement experiences, and if they were not guided, they will not develop. However, re-enacting those experiences, including crawling, patterning (honest, she says this), and vestibular movements (there are some movements caused by vestibular stimulation, but I don’t know exactly what she means) can recapitulate development and rebuild the pons. Ergo, children will develop empathy and stop being superficially charming if made to crawl around, and this is a part of “tummy time” (presumably, as recommended by pediatricians all over the U.S.). Of course, this whole discussion omits to mention children who never crawled because of paralysis or atrophied limbs, but are well-developed intellectually and emotionally, and children of previous generations who slept prone and did plenty of crawling, but who still had some cases of lack of empathy and superficial charm.

Where did mysweetchaos get all this stuff? Yes, I’m sorry to say, it appears that we have to look to her occupational therapist as her source. I don’t want to attack the whole OT profession, because I appreciate very much the ways they do things like check out people to see whether they’re competent to drive, and teach premature babies to nipple-feed. But I am tired of waiting for some OT to get up on her (usually) hind legs and state that Sensory Integration theory has never been supported by systematic evidence, or that recapitulation of development by re-enactment of early experiences is simply primitive magical thinking. I think it’s probably true that the person who connected the pons with superficial charm was probably a rogue practitioner—although not the only one around. Nevertheless, ideas apparently supported by the whole OT profession are behind these extravagant claims and the continuing commitment to patterning three decades after it was summarily rejected by physicians and psychologists.

And to call these methods “tummy time”, using the familiar words as if pediatricians recommended making older kids crawl! Is this for fun or profit?  Is it ignorance, or just the  old human urge to benefit from others’ ignorance? I don’t know, but I for one find it “positively frightening.”
  



2 comments:

  1. This reminds me as well of the crawling brou-ha-ha from a few years back, like if your kid went directly from sitting to walking (as mine did), this missed milestone would have significant repercussions on his or her physical streigth and school performance. Somebody even claimed that the antidote for this was to get your walking kid to crawl backwards. This is after they'd taken to walking like a fish to water and had zero interest in scooting around on the floor. I believe this was also recommended by an OT. Really, there are no words.

    ReplyDelete
    Replies
    1. I remember a kid in my old neighborhood who read extremely early, like age 4-- when he went to kindergarten, he couldn't skip, so he was prescribed remedial skipping lessons after school every day-- so he would be able to read!
      This misconception just won't go away, it seems, but part of the problem is that it is repeated over and over in woozle fashion, so everybody knows it must be so.

      I still hope to find some words to alert people to this, but I can't say I get a whole lot of support from my own profession.

      Delete