Concerned About Unconventional Mental Health Interventions?

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

Wednesday, December 21, 2016

One-Stop Thinking Makes People Misunderstand Child Development

We tend to be attracted by the idea of “one-stop shopping”, but we can pay the price of convenience by not getting exactly what we want. In fact, we may find ourselves regretting purchases we made just in order to save time. “One-stop thinking” presents the same problem: when we pay attention only to one factor that affects children’s development, we cut down on the time spent in consideration, but we risk making some big mistakes.

In reality, children’s physical and mental development are invariably affected by more than one factor, genetic or environmental. And usually, the influential factors are not just two or three, but many. Often, influences act bidirectionally, so that children affect their parents as much as parents affect their children. Influences can even be transactional in nature, so that bidirectional effects (for example, parents’ and children’s mutual influences, or families’ and schools’) change in their  nature over time and experience. Developmental outcomes may depend on some combination of environmental circumstances (helpful or harmful) and the characteristics of the child (vulnerable or resilient), with the best outcomes resulting for a resilient child in a helpful environment and the worst for a vulnerable child in a harmful environment.

In other words, it’s not rocket science--  it’s a lot more complicated than that (even though this statement is annoying to rocket scientists).

Recent years have seen a number of examples of one-stop thinking about child development, not by developmental scientists themselves, but by people popularizing and translating developmental research and theory. Unfortunately, oversimplified translations are often applied to pragmatic topics like how to intervene in children’s mental, behavioral, or educational problems. These may be welcomed by consumers of services, because their simplicity “makes sense”, especially if it echoes claims made familiar by repetition. Those familiar and simple claims amount to what the developmental scientist Jerome Kagan famously called “seductive ideas”—ideas that are so appealing to us that we buy into them without much investigation of their “one-stop” convenience.

Here are some familiar ideas that can lead to one-stop thinking if we do not pay careful attention.

Infant determinism is the idea that everything of developmental importance is accomplished during the first years of life. Early intervention follows on this idea by assuming that there is a desperate need to change completely the circumstances of every child who is abused or neglected in early life, most often by offering services to parents, but sometimes by foster or adoptive placement. One-stop thinking on this topic ignores two facts: that small changes in a family’s situation can help improve a child’s developmental trajectory, and that events such as school availability and neighborhood safety may later help restore derailed development. A 2014 article in the British Journal of Social Work (Featherstone, B., Morris, K., & White, S., “A marriage made in hell: Early intervention meets child protection.” BJSW, Vol. 44 (7), 1735-1749; oro.open.ac.uk/37437/3/329984C2.pdf) pointed to the mistakes made when child welfare workers do not try offering needed support to families rather than hurrying to intervene; this article is of particular interest in that it places this issue in a political context.

Attachment is an important concept in the study of child development as well as in practical decisions about child care and custody. But one-stop thinking about attachment and attachment disorders focuses entirely on these topics as the unique core of personality and behavioral development. As a result, educators and counselors may attend only to a child’s attachment issues and ignore all other child and family characteristics that may be affecting development. In addition, therapies directed at changing attachment may be proposed for an enormous range of mental health problems, from autism to oppositional defiant disorder. Interestingly, the fad of the last 30 or 40 years for an exclusive focus on attachment appears to be waning, and another fad is emerging.

Trauma, in the mental health context, describes experiences of seriously frightening or painful events that interfere with important relationships and thus with development. Trauma-informed approaches are essential for work with children and parents, as reactions to trauma may involve behaviors like fearfulness and aggressiveness, sleep disorders and bedwetting, for which children are brought into treatment.  Attempting to treat these without considering the influence of trauma is likely to be ineffective, if trauma is indeed involved. But one-stop thinking about trauma leads to the assumption that where there is a mood or behavior problem, there must be trauma in the background, even though there is no independent evidence that this has occurred. There is only a step from this assumption to the whole “recovered memory” charlatanry that was thriving 20 years ago and is still in existence. Seeing trauma everywhere is the new fad that has replaced the attachment fad; even the organization ATTACh, at one time the Association for Treatment and Training of Attachment in Children and a great proponent of attachment therapies, has now caught the trauma wave and become the Association for Training on Trauma & Attachment in Children.

Neuroscience is both a critical aspect of research on child development and an insidious temptation to one-stop thinking. I recently attended a presentation on the effects of poverty on children that used multiple PowerPoint slides of children’s brains to buttress the strong existing evidence that children growing up in poverty have worse physical and mental health, and worse academic achievement, than those growing up in better circumstances. No one (including me—I didn’t want to offend the speaker who kindly gave his time) demanded to know what on earth the brain images had to do with the argument that poverty is not good for children’s development. Using the slides was only a way to strengthen, not the argument itself, but the reception of the basic argument by an impressed audience. One of the problems with one-stop thinking about neuroscience is that the field itself, and what we know about it today, is too complex and too incomplete to allow us to use this information well. For example, a recent study described by Pam Belluck in the New York Times (Dec. 21, 2016, p. A15) noted that in the course of pregnancy women lose (yes, lose) brain volume in areas that are used in understanding how other people perceive things. Those who lost most volume, in the reported study, were most emotionally attached to their babies. Thus, loss of brain volume can improve certain capabilities, which we already knew from information about hormone-determined brain changes in boy and girl babies. But—according to the famous study of London taxi drivers, increased capabilities can also go with increases in brain volume! One-stop thinking is especially dangerous when the “stop” does not offer much clarity.

A real problem with one-stop thinking about children is that we don’t just create our own mistakes. We also have other people who would like us to make the mistakes they suggest, for the benefit of their own financial or personal aggrandizement. And often they are very attractive and persuasive people who appear to offer simple, achievable solutions to our complicated, intractable problems, or those of our children. They tell us they are world experts, or have cared for thousands of foster children, or even have a direct connection to supernatural powers. When we meet these people, we need to resist their one-factor solutions and remember the adage about rocket science.

And by the way, if it seems too good to be true, it probably is.




4 comments:

  1. It seems that all one has to do to become an "international expert" in child behavior is to make a slick website, knock off a couple of books, have a few years in clinical practice, and get a company to arrange speaking engagements, with continuing education credits sweetening the deal. All it takes is some marketing savvy and an easy, appealing take-home message.

    Take Nancy Thomas: She has no real credentials to be a "parenting expert," but she has a message that apparently appeals to many. She tells adoptive mothers that they should never be questioned about their parenting methods, and that they should be pampered by friends and relatives. Treated "like a queen." She tells her audience: "You're awesome to live with this puke." After an APSAC task force found serious problems with Nancy Thomas parenting, I asked one Colorado county DHS social worker why they continued to invite Nancy Thomas to talk to parents. She answered because she got high marks from past event attendees.

    I am troubled that these fads in one-stop thinking about child development can be found in DHS-sponsored materials and classes for foster and adoptive parents.

    I have attended some such classes provided by Colorado county DHSs and their partner organizations, such as Adoption Exchange. My experience is that these entities still rely on fringe beliefs about attachment and trauma, with some brain sciency stuff thrown in.

    This is a bit of a tangent, but I have to say I found the attitude of speakers especially troubling. I have found they tend to dehumanize adoptive/foster children -- portraying them as comically stupid or cunning adversaries, or both, because of early trauma. The speakers made an "us vs. them" alliance with the audience. Most of the empathy for the caregivers. All jokes at the children's expense.

    ReplyDelete
    Replies
    1. Yep, it seems to be all about charm and making your audience think they are admirable. The market for snake oil has never been better, especially since now all evidence and counterargument can be dismissed as "fake news".

      Delete
    2. Yes, I recall one particularly nasty Holding Therapist, who does a dangerous form of prone restraint, tried to dismiss critics by saying:

      "You know, there’s a group out there. I don’t know where they come off. They’re really against what they call 'touch therapy.' … [S]ome people get way to the extreme. … Advocates for Children in Therapy … said no child should ever be touched, never be held, never be cradled, and all this touch therapy, touch point therapy, or whatever, is wrong. And you know I’m thinking, if you’ve got a kid who’s never had any human contact, you’d better do something to get them on the pathways soon. So those kind of approaches are appropriate … "

      Delete
    3. Interesting to see how this comment tries to link AT with Brazelton's Touchpoints concept. It's so easy, and so deceptive to the naive, to associate with each other things that sound alike.

      As for never having any human contact-- perhaps someone can tell me how the child survived? Human beings are not precocial, after all.

      Sorry for the delay on posting this; it went agley somehow.

      Delete