Friday, January 29, 2016
Brand Loyalty: IACD Redefines Reactive Attachment Disorder for You
What if your child had an ingrown toenail and you took him to the pediatrician? What would you think if the doctor said, “All right, we’re going to call this chickenpox. And we’re going to treat it with a method that that’s not known to be effective and is possibly harmful for both ingrown toenails and chickenpox.” Would you, perhaps, seek a second opinion?
Sounds goofy, but in fact this is exactly parallel to what the Institute for Attachment and Child Development, and many related organizations, are doing with respect to Reactive Attachment Disorder. The IACD website redefines Reactive Attachment Disorder as equivalent to, or another name for, the following list (www.instituteforattachment.ong/learn-about-attachment-disorder/common-questions/#1 ,and yes, it does say ong. I make plenty of typos but this isn’t one.) : Reactive attachment disorder or RAD, attachment disorder, oppositional defiant disorder, post-traumatic stress disorder, childhood trauma, PDD, and pervasive developmental disorder (sic-- does someone not know that PDD is the abbreviation for this term, which has been used to describe a form of autism?). Thus, it appears that in the IACD viewpoint, all of these childhood behavioral, mood, and cognitive problems are the same thing. Why DSM, ICD-10, and the Zero to Three early childhood classification system struggle so to distinguish among these categories-- well, one hardly knows; it would appear that they simply neglected to bring the IACD experts on board.
All right, so just as an ingrown toenail is chickenpox, it appears that PDD is Reactive Attachment Disorder. What are we told that the problem is, behaviorally speaking? It looks like the Randolph Attachment Disorder Questionnaire, so long debunked, is the focus of description, although I will concede that no one mentions Randolph’s claim that she could diagnose RAD when a child could not crawl backward on command (I not only did not make that up, I would not have had the imagination to do it). Here are the problems that identify Reactive Attachment Disorder, defined as including PDD etc. etc.: does not trust adults in authority (perhaps quite rationally?), has extreme need for control , is manipulative and hostile, has no empathy, remorse, or conscience, resists adult guidance and nurturing, lacks cause and effect thinking (but apparently this really means the child doesn’t anticipate being punished), provokes anger in others (the little beast!), lies, steals, and cheats, is destructive and cruel, argues excessively, is impulsive, and is superficially charming. Interestingly, at www.instituteforattachment.org/explore-our-services/family-treatment-program/#philosophy , the IACD site notes that the children “often treat dads better than the mom”, and apparently being nice to your mother is the essential point of good mental health in this belief system (perhaps a throwback to Bowlby’s original assumption that only one attachment relationship could exist in early life). As I’ve pointed out before, none of these characteristics jibe with the symptoms of Reactive Attachment Disorder as described in any edition of DSM, although it’s possible that some of them could be associated with ODD or PTSD-- not superficial charm, though, which comes straight out of a decades-old effort to create a checklist for psychopathy.
So why classify this long list of symptoms and diagnoses all under the rubric of Reactive Attachment Disorder? Why not do some differential diagnosis and recognize that children with different problems may need different handling? Why declare that it’s all RAD and one size of treatment fits all? Well, folks, I would suggest that this is a matter of branding.
IACD and similar groups have spent many years developing their brand and attempting to spread their definition of Reactive Attachment Disorder through on line advertising and the work of unwary journalists (see http://childmyths.blogspot.com/2015/11/letter-to-abc-about-their-inaccurate.html). They are the RAD brand for the great majority of people who never heard of DSM or ICD-10 and accept that an expert is someone who says he is an expert. Operating outside the mainstream of mental health work, they are little constrained by the professional ethics that require statements to be based on evidence; certainly, none of the research that is so vaguely alluded to has ever been published. And who is going to complain about them, after all? The children can’t do it, at least not until they reach adulthood, and the parents are not likely to do it, because this was all their idea to begin with, and they are happy recipients of sympathy, support, and unlimited references to their “awesomeness”. Also, they don’t have to mind their children while they’re in the “respite home”.
As we can see, although the IACD group may lack remorse or empathy and do not trust adults in authority (e.g. the various DSM committees), they do seem to be very good at associating cause and effect. Beat the drum loud and long for your brand, and people will buy it without examining your statements too closely. It’s worked so far, it seems, so I don’t expect them to stop unless someone takes legal action about fraudulent claims (of which I’ve listed a bunch here and have more to talk about in my next post). Where county social services have bought into the brand, by the way, the False Claims Act would allow an award to a whistleblower. Are there any takers?