Concerned About Unconventional Mental Health Interventions?

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

Wednesday, May 6, 2015

What's Up With That, Doc? A Disturbing Doctoral Dissertation About RAD

While looking for some recent comments about Reactive Attachment Disorder recently, I chanced upon a 2014 doctoral dissertation that gave me considerable pause. This was a dissertation written in fulfillment of requirements for a doctorate in social work at the University of Iowa. The doctoral candidate, Matthew Lorenzo Vasquez, titled his dissertation “The impact of Reactive Attachment Disorder on adoptive family functioning”.  This in itself was a bit attention-getting, because I would expect a dissertation done today to look at the effects of RAD and adoptive family functioning on each other, not to assume that the disorder was there to begin with, and it caused changes in family functioning. But I wanted to read the thing to see whether I was right to question the nature of the document.

You can read this dissertation for yourself if you have the stomach for it--  it’s at ir.uiowa.edu/cgi/viewcontent.cgi?article=5299&context=etd. I’ll just give you some high points that will no doubt resonate with aficionados of the attachment therapy/holding therapy belief system.

We get right underway in the abstract and the first page of the introduction. Here we are told that “[c]hildren with RAD are known to engage in self-destructive behavior, talk of killing others or themselves, [and] direct verbal and physical aggression toward peers and adults”. This is of course true, just as it is true that children with other diagnoses, or with no diagnosis, may sometimes do some of these things. What is not true is that children who engage in self-destructive behavior, talk of killing, etc., etc., therefore have RAD. Although Vasquez references the DSM-IV-Tr description of RAD, he appears to have some other, unnamed source of information about diagnosis of RAD--  perhaps the work of Wimmer et al which appears in Vasquez’s reference list and which certainly posits RAD symptoms that are not to be found in any conventional discussion of RAD diagnostic characteristics. Although he mistakenly cites Parker, Forrest, and Reber, a non-existent source, it is plain to those of us who have studied the AT/HT belief system that Vasquez really means Reber (1996), a problematic paper, hard to find on the Internet nowadays, that made a variety of unsupported claims about RAD and used to be quoted frequently by practitioners of alternative psychotherapies.

Vasquez collected information by interviewing members of five volunteer families, and some interesting information it was, I can tell you.  For example, in discussing the methods a family used to respond to a child’s “meltdowns”, he comments, “In an effort to find some relief from Adam’s rages, Nancy [adoptive mother] started to bring Adam into the bathtub [with or without water is not stated]  and would hold him there in the dark  while he continued to scream” [as who wouldn’t scream? J.M.]. Nancy states that she learned this technique when working in a nursing home with people who had transient ischemic attacks…and seizures and hoped it would help Adam. Nancy then explained:

‘That’s when the meltdowns got shorter, and shorter, and shorter. Because he lost all his power. He had no power. Because sometimes he would get me frazzled you know and I was overwhelmed, you know? You don’t want to go there but you would. So he lost all his power when it went to the tub. And they just got, I bet, six to eight months before his meltdowns were 10 to 15 minutes in length.’

Vasquez then speculates that the approach was “so effective” (a speculation in itself of course) because the child could consciously decide whether he preferred to tantrum or to be held in the bathtub; Vasquez is uncertain whether he always had this ability or was given it as a result of the bathtub treatment.    
Rather than considering the meaning from the child’s viewpoint of being immobilized in the dark (and possibly in water), Vasquez is concerned with what it all meant for the parents. “Personally, I found the image of a young child being held in a bathtub, in the dark, while he screamed uncontrollably for hours at a time both profound and moving. … It … shows… what lengths some of these parents went to provide these children comfort and solace. Undoubtedly, to sit in a bathtub for multiple hours a day, restraining a screaming child for 6 to 8 months shows an incredible level of devotion and commitment to the care and well-being of these children”. Although many of us would query whether this behavior actually shows an incredible level of ignorance or of sadism, Vasquez does not mention that alternative explanation. Instead, he stays with the AT/HT tenet that adoptive parents are loving and good, as well as able and determined to make the best choices for children.

This is very depressing, but let me mention one other topic Vasquez mentions. It’s the old Darkness Behind the Eyes (see www.attachmentandtraumaspecialists.com/attachment_disorder/symptoms and other AT/HT sources). Vasquez says “hearing numerous reports about how these rages can be seen in the eyes of their child, I began to see this attribute as a significant feature in discussing these rages. “ He inquired of one mother about the idea that her child’s eyes changed color. She said “Mmm-hmm. Her eyes change color. They all do. They go DARK.” Another parent made the following statement: “When he would rage… it would almost look like there’s a fire in the whites of his eyes. He wore the footed pajamas, and at bedtime sometimes I would have to hold him down, and he would kick, and with all the lights off there would be sparks everywhere, I mean he was raging that fast.” Vasquez did not question these reports of physical impossibilities, but did note that the parents did not seem to attribute the events they reported to demonic possession. He did not examine the possibility that alternative practitioners and support groups had told the parents these things would happen.

So, do I blame Vasquez for this piece of work that repeats without question or comment various tenets of the AT/HT belief and treatment systems? Yes, to some extent I do. The man is not a scholar, although he seems to think he is, and he has done a sloppy job at best, mismanaging citations and references. He fails to note the discrepancies between the DSM criteria for RAD and the symptom list he emphasizes. He notes his attempts to manage his own biases by journaling, but does not attempt to discuss alternative interpretations for some of his conclusions. He did not do this work with due diligence, and if I contemplated employing him, I would be most concerned that the same degree of bias and carelessness would contaminate his professional contributions.

On the other hand, though, I cannot say that all the fault lies with Vasquez. As a doctoral student, he had a supervisor and a dissertation committee, all of them apparently with doctoral degrees. Why did they sign off on this level of work? Did they not realize that a dissertation may be cited, quoted, and used as the basis for further claims? As far as I can see, none of the committee specialize in adoption issues or in childhood mental health problems. Why did they agree to support this work if they knew little about it? Given that a doctoral candidate temporarily knows more about what he or she did than anyone else in the world, why did they not at least insist that this student explore alternative explanations of his interview findings? Do they not think that the discipline of social work depends on adequate research, not just on sympathy with suffering people?

It’s my hope that this committee and others supervising social work graduate students will read the forthcoming book by Bruce Thyer and Monica Pignotti, Science and pseudoscience in social work practice (Springer, 2015). Meanwhile, the rest of us have to deal with the release of yet another AT/HT proponent armed with an apparently respectable doctoral degree.  



  

13 comments:

  1. Of course .... if the adopter close a child in a dark bath ... sooner or later he would kill himself or injure yourself. For that to happen for sure ..... need to fill the bathtub with water or boiling water. If this does not work .... then the adopter have to give the child a cigar-lighter and a stack of newspapers. If that does not work .... well then you have to give him long stem hiking matches, a lump of cotton, durable cord and a bottle of vodka or solvent (petrol can) ... But enough of matches and hairspray or from deodorant sprays (well they explode). Then this child make a Molotov cocktail and explode themselves with the house. It will confirm that the child was dangerous, and always wanted to kill himself, foster family, and set fire to the house.

    Ok. Let there be only dark bath shut. Then the child gets enuresis, stuttering and faecal incontinence. This will be yet another "proof" that the child has a RAD.

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    1. Yes, this is definitely a cure without a disease-- or indeed a cure that can create its own disease, as you point out.

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  2. There's a captive audience for folks like that scarily incompetent PHD who buys the lies from self-proclaimed trauma mamas like this idiot:

    https://talkinrealhere.wordpress.com/2015/05/08/rock-that-boat-baby

    While I get that CPS has been known to screw up / be incompetent / flat-out lie about a foster kid's history of violence, I can't bring myself to believe it's their modus operandi.

    as a kid, my parents got the occasional call / visit from CPS because my baby sister was diagnosed with a severe mental illness in grade school and was sometimes a danger to herself/others -- but CPS went away quickly as my parents had REAMS of evidence that sis was very sick and a friendly local psych unit (aka her home away from home) full of health professionals willing to tell CPS that it is indeed possible for 6 or 8 yr old who "looks" normal to be suicidal and vouch for the fact that my parents were doing everything possible to get sis help.

    CPS on power-tripping witch hunts against a family? Or against the same damn family in multiple states? I guess it's possible... but must be unlikely.

    And in my personal experience, it takes a LOT to trigger a CPS investigation by turning up in the ER with an injured kid. My two kids broke 3 bones within an 18 mos period and had soooo many bruises ... nada! (This was the run up to my and my husband's realization that our fearless-but-klutzy-kids + level 6 /7gymnastics = disaster, and decision to sign 'em up for synchro swimming instead)

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    1. It's hard to know which is worse, the intentional harassment some of these people say they experienced, or just plain feckless and random investigating, or investigation done when cps workers don't like people and not done when they do.

      But isn't it strange that anyone expects a suicidal child, or one with any other problem, to "look" like they have a problem? And one who doesn't to "look" different from one who does?

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    2. Suicidal 6 yos are thankfully pretty rare, so I get that folks have doubts.

      I don't think anyone who called CPS on my parents did so out of spite -- it was concern for her wellbeing and/or a legal requirement for mandated reporters. My sister's behavior (when symptomatic) was objectively scary/dangerous. My parents were quickly cleared by CPS. As far as I'm concerned, the system worked.

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    3. I have no doubt that the system works pretty well most of the time. And my concern is not about the occasional human error, but about situations where CPS staff buy into "alternative" belief systems and make their decisions based on those.

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  3. How does an accredited institution even pass such drek? Is this guy a scientist or an apologist for RAD and holding therapy? This is shocking. You mentioned his supervisor--yes, I wondered about him/her too, and the committee. It's all very disturbing.

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    1. Well, I was shocked-- but of course people with these clinical or administrative degrees may or may not have any scientific training-- and that may also be true of the committee members. However, I would have expected them at least to demand an up-to-date literature search, and accurate citation of the authors he wanted to mention-- also, some discussion of observed issues-- if people tell you sparks fly from their child in the dark, what the heck do they mean? I see no point in this qualitative work unless there is some textual analysis.

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    2. This comment has been removed by the author.

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  4. Out of curiosity, do you know where I could get a copy of that Reber paper?

    I assumed the sparks thing came from static electricity, although what that has to do with anything else is another thing.

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    1. If you'll e-mail me at jean.mercer@stockton.edu, I'll send you a copy. I would post it here except for the copyright issues.

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  5. why is it always about the parents and THEIR connection to the child?

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  6. This is depressing as a social worker.

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