True or False? "Ordinary Therapists Can't Treat RAD"

Once again I must thank Yulia Massino for pointing out a claim that needs refutation. In a tweet, Dawn Teo says “Traumatized kids don’t respond to traditional treatment. They need assistance from specialized clinicians.” This claim has been put forward by attachment therapists since the ‘90s, although initially they said not only that the children did not respond—they added that conventional treatment actually made the children’s conditions worse.

It’s hard to know where to begin to parse these statements. They provide not only an embarrassment of riches, but a good deal of embarrassment that people claiming to be mental health professionals would say such things. But we can begin with the simple fact that although attachment therapists have made these claims repeatedly, and have even provided lengthy rationales for why the claimed event might occur, they have never provided the slightest empirical evidence to support their statements. They have stated a hypothesis that is quite testable through systematic outcome research: that is, that when children with similar problems are assigned randomly to conventional treatment or to “specialized” attachment treatment, the latter group will have significantly better outcomes. They have not tested this hypothesis, but have simply asserted that the results of such a test are already known. This form of argument is common among alternative practitioners, who “already know” that their methods are effective and don’t feel the need to examine or allow for their own biases. For the rest of us, however, that approach is not adequate. The burden of proof for the statement is on the attachment therapists. (I would point out, by the way, that when parents pull their children out of conventional treatments because the therapist asks them to consider how they are contributing to a problem, this is not the same thing as the treatment “not working".)

What is “traditional treatment”, anyway? Does this mean a Freudian psychoanalytic approach, or Reichian character analysis? If so, no doubt it is true that these will not be very helpful for children (not that this means that attachment therapy is effective, of course).  There are excellent evidence-based treatments for children who are struggling with trauma, however. One of these, Child-Parent Psychotherapy, focuses on the needs and problems of preschool children who have endured traumatic experiences like seeing violent attacks on their mothers. Perhaps Dawn Teo and her colleagues do not regard evidence-based treatments as “traditional”? There would be a good deal of truth to that, historically speaking, of course, but her statement seems a bit different when we make it “traumatized kids don’t respond to evidence-based treatment”, so my guess is that this isn’t what she meant—but what she did mean, I am not sure.

Now, how about “traumatized kids”? There is a lot being said about trauma these days; in fact, trauma is the new fad word taking the place of attachment. This is not to deny the real importance of a trauma-informed view for those working with children’s disturbed moods and behaviors. But not everything is about trauma, any more than everything was ever about attachment. When children have actually experienced traumatic events, they need trauma-informed care—but undesirable behavior or moods do not necessarily show in and of themselves that they are caused by trauma. There are plenty of other factors that are possible causes of childhood disturbances, including genetic and prenatal problems, poor nutrition or exposure to toxic substances, delayed cognitive and language development, visual or hearing impairments, and physical illness. “Traumatized” is not a word to be used as shorthand for “adopted” or “Reactive Attachment Disorder” or “not behaving to parents’ standards”, nor does it mean the same thing as conduct disorder. If Dawn Teo was using the term in this shorthand fashion, her statement is not meaningful; if she really meant that there are no evidence-based treatments for traumatized children, she is simply wrong.

What about the “specialized clinicians” Teo references? Since she also alludes to an article from Forrest Lien’s Institute for Attachment and Child Development website, I can only assume that she means people like Lien and his staff, who were for many years involved with the alternative psychotherapy called attachment therapy by its practitioners (not the same thing as attachment-based therapies, by the way).  They have been committed for a long time to non-evidence-based treatments and have never published any reports on the outcome of their methods—in addition, as Rachel Stryker pointed out in her book The road to Evergreen, this group has defined long-term residential care as being a successful way for a family to “love at a distance”, so outcome measurements might have some unusual definitions.

Lien and similar practitioners have made much of their “specialization”, and this goes over well with the public. After all, if you have a Sears refrigerator, you call a Sears repairman; if you have gum disease, you go to a periodontist, so wouldn’t you seek a specialist for your child’s problems? The big difference is that although you can tell if your refrigerator isn’t working, and your regular dentist can tell you if your gums are in trouble, you, as the parent, are not likely to know which among many possible factors (some including your own behavior) are causing your child to be in difficulty. Indeed, you may not be able to ascertain on your own whether there actually is a problem or whether you are defining a normal child behavior as pathological simply because it is a nuisance. All this means that if you seek a “specialist”, you may be doing so on the basis of a misunderstanding of the child or family issues, and that “specialist” may define all problems as resulting from and treatable by aspects of his or her own “specialty”, like the little boy with the new hammer. In fact, contrary to Teo’s advice, parents who are concerned about child mental health need a person with broad general training in child development and clinical work with children, who will explore and consider all of the child and family factors that may contribute to a problem. That person may have been trained in an evidence-based treatment method, but he or she will never say that ALL other methods are ineffective, because there can be more than one effective method for a problem. (The person may, of course say that SOME methods are ineffective or even potentially harmful.)

What does this all add up to? Dawn Teo’s statement and those of all the others who have said the same thing over the years, are false.

Up next: a look at the IACD claims mentioned by Teo.