Concerned About Unconventional Mental Health Interventions?

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

Saturday, March 19, 2016

Adopted Children, Lying, Aggression, and Antisocial Behavior

This blog has intermittently been the scene of disagreements between me and certain adoptive parents. Our discussion usually goes something like this:

Parents: Our adopted children are terrible! They lie and steal and are even dangerous to other people. They have Reactive Attachment Disorder, that’s the problem.

Me: That’s not Reactive Attachment Disorder. Reactive Attachment Disorder is [defines RAD as in DSM-5, even in ICD-10 if feeling energetic].

Parents: Yes, they do have RAD!  How dare you say it’s not RAD! You’ve never lived with these kids, how would you know?

Me: I just said, those things you described are not the symptoms of Reactive Attachment Disorder. I didn’t say the kids didn’t do the things.

Parents: You ignorant no-good know-it-all, can’t you see that they need their attachment fixed, etc., etc.

Outside of the Attachment Therapy model, I have not seen anyone writing about RAD including antisocial behavior, or even about antisocial behavior as a problem of adopted children. However, while doing a search of the trauma literature for another purpose, I came across an article that focused on antisocial behavior as a particular problem of later-adopted children. The article proposed certain reasons for such behavior and also outlined a possible treatment, which I will describe. I must point out, though, that the article seems to have been published twice in the same journal in slightly different forms, is poorly proofread, and occasionally cites authors who have approved of holding therapy, so I don’t know exactly how seriously to take it. Nevertheless, some interesting points are made.

The article I’m referring to is: Prather, W., & Golden, J.A. (2009). A behavioral perspective of childhood trauma and attachment issues: Toward alternative treatment approaches for children with a history of abuse. International Journal of Behavioral Consultation & Therapy, 5(1), 56-74.

As you can see from the title of the journal, this paper takes a behaviorist position relative to both the causes and the treatments of undesirable behaviors of adopted children. They do not mention Reactive Attachment Disorder. Instead, they list various disturbing and undesirable antisocial behaviors like lying, sneakiness, and manipulation. Rather than proposing that these were caused by a poor attachment history, Prather and Golden discuss how these behaviors could have been rewarded, first by the child’s experiences with abusive or neglectful caregivers, and second by unintentional behaviors of foster or adoptive parents and of other children. Please note that these authors are not blaming the foster or adoptive parents, but pointing out that their natural actions toward the child may reinforce the very behaviors that they want to eliminate.

Prather and Golden point out that adopted children who behave antisocially may appear to lack “conscience”  or “attachment”, but in fact they have learned very well from their early experiences with abusive or neglectful caregivers. They have never been punished for lying or using unacceptable language—such actions may have been met with indifference or even amused approval. They may have been taught antisocial rules about hitting as a generally acceptable response, and may have been regularly teased into aggressive reactions by adults. They are likely to have learned to avoid adults in some or even most circumstances, as avoidance has led to the negative reinforcement of evading adult mistreatment. Whether or not they were attached emotionally to their caregivers may be seen as a minor problem compared to their history of learning to behave in “unattached” ways.

It is not surprising that abused or neglected children bring their learned behavior patterns with them to adoptive or foster homes. Once there, it may be a while before the new caregivers realize what undesirable behaviors are going on (and I wonder whether the time this takes is what is perceived as the “honeymoon” period of adoption). During that period, adults in the household may inadvertently reinforce the unwanted behaviors, for example, by failing to notice a lie or a theft. People outside the household are even more likely to provide accidental reinforcement, and this is related to an important issue.

The study of learned behavior has yielded some important principles about how reinforcement affects learning and behavior. The frequency of behavior is raised when the behavior is followed by reinforcement, but there is more to it than that. When the reinforcement stops, the length of time it takes for the behavior to stop depends on how and when the reinforcement used to occur. Paradoxically, when the behavior has been reinforced every time, stopping the reinforcement altogether causes the behavior to drop quickly to a low frequency—but if the behavior was reinforced only intermittently, it will persist for a long time after the reinforcement stops.

Most socially-reinforced behavior is reinforced only intermittently. The abusive and neglectful parents of the now-adopted or fostered children are very unlikely to have reinforced a behavior every time; in fact, they may have been just as likely to punish or to appear indifferent as to be amused or admiring of any action. This means that whatever behaviors were learned by the children, it will take a long time for them to be “unlearned”, especially if they are very occasionally reinforced by well-meaning adoptive or foster parents, by strangers, or by other children who are fascinated by the “bad kid”. Also, of course, some of the unwanted behaviors are self-reinforcing—the child is rewarded by getting the thing he stole or by avoiding punishment by lying.

So, what do Prather and Golden suggest as treatment for the concerning antisocial behaviors? I must emphasize that I have not found any published empirical work that they have done, but they made some suggestions that may be fruitful. Much of the focus is on “catching them being good”: encouraging the family to put less stress on “unattached” behavior and more on times when the problems are not apparent, and especially on ways that problems have been solved and parents have managed not to reinforce unwanted actions . Identifying antecedents, or triggering situations followed by unwanted behavior, can help anticipate and control how the child acts. (For example, does the child act up when the mother goes out without telling him she is going?) Acknowledging and paying attention to negative feelings is another important item, especially as the children may have become numb to their own feelings and therefore fail to experience or to anticipate a sense of guilt or fear of punishment. As Prather and Golden point out,” Unlike traditional attachment based family therapies, which often interpret verbal information in terms of underlying emotional dynamics, the rational cognitive emotive view of human behavior focuses solely on the causal sequences of a child’s experiences and perceptions, and the impact that the child’s negative thoughts concerning trauma have on the role of emotion in behavioral causation.”

Again, there does not seem to be any new evidence about how well this approach can be made to work. And those who are committed to an all-attachment, all-the-time perspective may say, “that’s just treating the symptoms!” But, to quote Nicole Hollander’s “Sylvia”, I might respond: Words to live by!

  

19 comments:

  1. I'll offer one anecdata that may (or not) support these authors' thesis: when I was a small child, around 5 years old, and beginning kindergarten, I was for a time labeled "asocial", because I behaved in a disturbing way. I disliked being with other kids, and often kicked, bit or hit them if they came near me or said nasty things to me. Other kids would often tease me for being fat, or because I preferred to sit by myself rather than playing with the group. Things got pretty bad (I don't recall all this clearly, btw, most of it was told to me later by my mother). In the end, the schoolmistress took it upon herself to intervene. She have me new assignments to do, different from the others (that was easy, I could already read, when the other children were still only learning letters). This opened a path to redirect the energy I used to employ in getting in trouble, and each assignment completed was an occasion of praise and reinforcement of "good behaviour". So far, this looks like what the authors are describing.

    Of course, I don't know how the background can compare with that of an abused or neglected child recently adopted: I always lived with my biological parents, and they weren't cruel or neglectful. Though that period of "bad behaviour" did follow a time when things were getting troubled at home: my parents had had another child, which triggered a severe jealousy; then my mother fell ill and couldn't devote as much time to us; she was also getting short-tempered and increasingly resorted to beat me and my sister for being "annoying", so there's a potential for 'learning' to use brutality, right there. The schoolmistress told my mother she thought my acting up was mostly from anger and that I vented frustrations by hitting other children. I don't know if my parents changed anything later, but before long, thanks to that person, I had learned some very useful social & intellectual skill.

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    1. Even though you were a "different kind of kid", I think your story is highly relevant. It's reasonable to assume that the mechanisms by which maltreated children develop behaviors are basically the same as the ones by which other children learn to behave in one way or another. Thank goodness your schoolmistress didn't decide you were just a "bad seed"!

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    2. Irene: in your memories - was it only or mainly from anger? Seems very similar to Helen Keller and so many gifted students who do not receive attuned and early stimulation - which is a form of covert neglect.

      Jean: certainly resonated with me. "The ones by which other children learn to behave in one way or another".

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  2. Thanks for this, it really resonates with what I have seen in my grandchildren adopted from foster care, and the issues my son and daughter in law are dealing with. They are doing very much what is recommended here and they do not believe in attachment therapy at all, researched it before adopting and were horrified. I of course added my knowledge to what they already knew.

    They reinforce what the kids, half-siblings 7 and 4, do well, and provide them with opportunities to get involved in activities they enjoy and do well at. They also gently correct behaviors that were ignored or condoned in foster care and probably with the neglectful biological family. The kids are basically good kids, but there are many things they were just never taught were not appropriate. Now they are learning and coming along, although of course it will be a long hard struggle in some ways. But seeing the kids as needing guidance, not some cruel and radical "therapy" will go a long way.

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  3. Thanks Mary Anne-- it's good to hear that your grandchildren are making progress!

    When I was reading the Prather article, I also kept thinking of the claim made by AT proponents that the children cannot understand cause and effect relationships, by which I think they mean that however much they punish, the child keeps doing the same thing. They seem to miss the importance of these intermittently reinforced behaviors, and how long they may hang on, especially if there is some accidental periodic reinforcement. It's really bizarre to claim that when someone keeps doing something wrong, this means they don't understand cause and effect. I am always typing ; when I mean to type ', even though I'm consistently punished by having to stop and correct it-- I suppose they would say that means I do not understand cause and effect-- I must have RAD-- next I will kill somebody, right?!

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    1. :-) about your typos, Mercer.

      Intermittent reinforcement for behaviour indeed! Accidental periodic reinforcement would be the powerful one.

      It does show that there is a gap in the initial and retrieval phase and the applying phase/cycle.

      Laicite!

      Maryanne: yes, opportunities beget more and different opportunities. This is exposure at work.

      "There are many things they just never were taught were not appropriate" - grammar and dependent clauses and L1.

      Wasn't guidance a sociological tool, especially in settlement work? Then when parenting became industrialised and professionalised...

      And these easily correctible errors do kill. When we have the measurements and the application not in the same place.

      Remember that the ' is closer to the carriage return and ; is for the letter and looks like an L. "you wi;; need to take a ;itt;e break".

      Maybe a punnet square for rights and wrongs and unintentional and intentional.

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  4. Unfortunately, in Russia the majority of people (even children) using obscene words. Obscene speech is almost an alternative language in which we can express any thought but that idea will be painted vulgarity or aggression. This language is easier than Russian literary language in which a lot of rules, a lot of different colors and a lot of exceptions that need to know and remember. Almost always in the Russian emergency situations people are moving to obscene speech. Children hear it and adopt this behavior. Struggle with this difficult and almost impossible. You could even say that there is no one to fight because in all segments of the population swearing occurs. There is even an opinion ...... not scary if you're talking on the obscene language but terrible if you do not know how to express my thoughts and feelings svoit literary language spoken by Pushkin, Tolstoy, Dostoevsky, and so on . T Akim manner of speech training comes not from the prohibition and condemnation of foul language, but by improving the skills of Russian literary language in children. As a result, a completely intelegentny and raised the child may break out a rough foul tirade of foul speech as soon as his emotional state is experiencing shock or negative. In addition, if a person is experiencing strong feelings .... to express these feelings is not enough to say "it hurts me. Or I hurt," At least it is necessary to say more than a dozen words to express all the feelings and sensations Spector. But suffice it to say 3 swear words that would be all around understand what happened to you and what you chuvtvuesh. I'm not making excuses. I want to explain that if a child Russian foul language ... so it no longer has the strength and desire to pick up normal speech. He simply expresses his anger and despair. More it means that he already do not care what you think about it because it is in the power of the emotions which can not cope on their own. It is necessary to give the child to cool down and return to the conversation when he will be ready to adequately react and perceive speech teacher or parent. Probably so ....

    The popular Russian comedy "Gentlemen of Fortune" is an episode where the gang leader of the gang members forbidden to use foul language to be more like normal people. At a time when heavy radiator falls on foot to one of the criminals ..... this man begins to speak at a literary Russian. This causes laughter in the audience.
    https://www.youtube.com/watch?v=82aEb9ArU4И
    A similar case. Boy learns poems of the Russian poet but does not understand the meaning of some of the obsolete Russian word. At the end of the video the child launched into a tirade of swear words.
    https://www.youtube.com/watch?v=W2BcED2vnHU

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    1. This happens in Ireland and Australia as well - as far as the swearing goes.

      I've noticed that a lot of the Slavonic languages with which I am familiar [Russian; Czech; Polish; Bulgarian; Slovak] have a great swearing vocabulary. Can't comment or only limitedly on the semantics and pragmatics you refer to in your response.

      Disinhibited Social Engagement Disorder seems to involve peer conflicts and superficial connections/behaviours in adolescence.

      Chuvtvuesh - experience?

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  5. Another non-standard situation is funny .... and at the end of the women, too, are moving to obscene language.
    https://www.youtube.com/watch?v=e7cseWsqiAk

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  6. And the boy in the video is a lot of literature Russian words to protect the mouse that caught his dad in the closet and want to kill. Malysh withstand a two-way pressure (father and older sister). He even remembers capybara capybara and says that is a relative of mice. If you can not kill capybaras ... so you can not kill the mice, too. He recalls puppies, kittens and other animals. His speech competent and logically built. However, I am not sure that this boy does not know the swear words. Surely he knows the words. But in this situation it appeals to reason and compassion adults and therefore do not have to advertise their emotions but to prove his truth. Another motivation speech ...https://www.youtube.com/watch?v=-Vs44mtUrO0

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    1. Dear Mikhail-- Thanks you very much for these examples and explanations. These are cultural differences that are very difficult to understand unless they are described and explained.

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    2. Mihail:

      Proving the truth is indeed very important.

      Have just read "Cultural Concepts of Distress" in an online copy of the DSM-5. It may be relevant for your readers, especially in the outer reaches of Europe and south and east Asia. [Japan and various manifestations of social anxiety, for instance].

      Ah - the boy was very familiar with wild animals. Double-bound, was he?

      We will have to find a way to embed the videos so we can see them the way they were intended!

      Re-release of Russian Ark is in several theatres - director's cut for 2016.

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    3. Adelaide Dupont
      Yes))) This boy struck me to the heart.
      He still won his father and older sister. They were forced to make excuses for him. But he defeated them again. His sister began to say, "What do you wound up? The mouse is in heaven ... it will be good." The father told the boy, "If such a hard life in mice and they have to survive each day .... might be better to die?" But the boy almost choked with anger and indignation. "No... Ale (elder sister) No! Mouse will not get into heaven. Only люди go to heaven. This mouse will die for ever. EVER!" Слова его отца вызвали жёсткий сарказм этого ребёнка "Mouse is happy when she is dead ??? BRAVO! Dad! BRAVISSIMO!"
      I guess this guy is a future lawyer)))

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    4. Mihail:

      ah! legalists!

      Yes - only humans go to heaven, hell, purgatory and limbo. And perhaps animal-persons.

      I think mice do have an appreciation of their lives that is short-term. I wonder if they squeak about heaven and hell.

      By lives probably "reproduction" functions I would mean.

      Excuses are not voluntary? That contradicts so many Anglophone ways of knowing, especially the strictly behaviouralist/intentionalist ones. They do fit better into a humanistic sense of our shared social world. And it is clear the boy has that to me!

      Hard lives - better to die [than live]?

      If mice have no afterlife the way humans and human-like persons do.

      The mouse in heaven will be good - it will behave itself? Or behaviour won't matter in the world where the mouse is? Or it's "only" a human consideration with human rules...

      And it is we who think and feel and act beyond survival...

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  7. Yes Jean, every nation has a national and cultural characteristics. These features are transmitted to different degrees each representative of nationality. It can not be ignored in adoption. All people are different. I can do quietly criticize Russian child for bad work done, and I know that he will understand me correctly and will not be offended if I am expressing the hope that his next job will be much better. But the child Caucasian (Chechen. Georgians and Ossetians etc.) will not accept criticism,
    if there were witnesses ..tem more if there are girls. This child will perceive my words as a degradation of his dignity and lose interest to work. Even orphans that are outside the national culture area .... showing signs typical of their nationality. In Russian children generally difficult to identify certain pattern of behavior. They can be incredibly shy and confusion .... or these same children become suddenly cheeky and unruly ..... then suddenly begin to show incredible generosity and kindness .... or a sudden severe aggression and greed.
    What are they? I think specifically of each child should be checked out some qualities in him more and look at the situation. Otherwise it is impossible to predict their behavior. But in one case, I was always confident and almost never wrong ..... if their behavior and actions depends the fate of the children's group ... then each of them will be the best quality that they have. It manifests itself in team games, contests, competitions and so on ....

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  8. Scary article, filled to the brim with faux RAD SYMPTOMS:

    http://m.huffpost.com/us/entry/understanding-reactive-at_b_9541622.html

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    1. Yes, isn't it! This stuff has so much traction, and one of the reasons is that psychologists have generally been unwilling to state opinions on popular material-- as witness Nancy Thomas being in line to give a presentation that would have earned APA continuing education credits and only being stopped at the last minute. I am hoping that we will do somewhat better soon. The clinical child psychologist Steve Hupp is putting together an edited book about science and pseudoscience in child and adolescent clinical work-- but this all should have been done years ago and very few of us wanted to do it.

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    2. Missy Manny:

      Helzier's article, especially the second and third paragraphs, would be taken with a great big glass of salt and chilli around here.

      Winter coats; spring coats.

      Can't these people get a Socratic dialogue going with some pretence to logic?

      This whole "Never ever question the parent".

      Looking out for Hupp's book and related material.

      The Little Red Hen, Mercer! "This all should have been done years ago and very few of us wanted to do it".

      I've noticed that the push has come from other, closely related fields, that are less "contested".

      When their credits were at stake!

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    3. Cluck, cluck! But part of the sky really was falling...

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