Concerned About Unconventional Mental Health Interventions?

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

Saturday, January 30, 2016

One More on IACD: You Knew They Had to Talk About "Neuroscience"


   
  

 I hate to do one of these “research shows” numbers, but in fact there is a good deal of evidence that throwing irrelevant neuroscience references into an argument makes it harder for most people to detect logical errors (see, e.g., Weisberg et al., [2008]. The seductive allure of neuroscience explanations. Journal of Cognitive Neuroscience, 20, 470-477). This persuasive device has even been referred to as “neuroseduction”, and it is used freely by those who want to sell a practice or idea that is not really all it is claimed to be. Not surprising, then, that we see many such references at www.instituteforattachment.org.
Let me begin by talking about some of the logical problems that arise when people refer to mental illness as a brain disorder, as IACD does with reference to RAD. In this discussion, I am indebted to a recent article in American Psychologist (Schwartz, Lilienfeld, Meca, & Sauvigne’, [2016]. The role of neuroscience within psychology: A call for inclusiveness over exclusiveness. Vol. 71, 52-70).  These authors have produced a very clear and complete statement of the issues about neuroscience and mental health issues, and while I will summarize some of the high points, I would really recommend the article to anyone who has a serious interest in this area.

To begin with, of course mental or behavioral disorders are all associated with unusual brain functioning. To say this is simply to confirm that we don’t think a  disturbed noncorporeal mind or spirit is at work in mental illness. Thinking, feeling, and acting emerge from events in the brain and other parts of the nervous system and would not exist without an active brain. However, there is presently no information supporting the idea that a specific event in a specific area of the brain causes a predictable behavior, thought, or emotion. Given that most of our brain-behavior information comes from work on non-humans, a great deal of generalization is required even to think we have knowledge of general connections between brain areas’ activity and other observable events. Indeed, we may never have specific information about such connections, because behavior, thinking, and emotion are all events that occur in a historical and place context that may influence them as much as activities in the nervous system do.

In addition to the issue of context, we also have the fact that the rules that govern the functioning of parts of the brain may not apply in the same way when parts are working together with other parts. We may have an excellent understanding of the internal combustion engine, braking systems, and so on, but these do not help us prevent or disentangle traffic jams where many brakes and engines come close to each other, or contribute to the creation of codes of traffic laws. No matter how well we know about how brains function, we may never be able to jump from that knowledge to mastery of rules of human psychological functioning--- like traffic events, those rules may well have to be studied separately from the nervous system. They operate at a different level of analysis, just as engines and traffic do.

Why then do we have so many people, including governmental agencies, talking about “brain disease” and “brain disorder” rather than mental illness? My guess is that this began with advocacy groups like the National Alliance for the Mentally Ill (NAMI), who recognized the stigma attached to mental illness and the lingering belief that the mentally ill could be all right if they just exerted themselves a bit. “Diseases” and “disorders” can’t on the whole be blamed on their victims, whose brains have been “struck” by events beyond their control, so it’s very legitimate to fund programs to study and treat these problems, while such funding for mental illness might be seen as questionable. But when NAMI and other advocacy groups got this new locution in place, of course, they provided  powerful help for other organizations who were happy to throw “brain” into their mix and benefit from the resulting confusion.

Let’s look at some of the “brain” claims made by IACD. Here’s one: “Here at IACD we’ve learned that past experiences actually change  our brain patterns.” This is not a discovery that was made at IACD, nor is it actually a discovery at all--  instead, it is a viewpoint based on the current paradigm that rejects the idea of noncorporeal mental elements. Experiences are remembered and alter behavior, and the only way this can happen (without the existence of a nonmaterial mind) is by changes in the brain. In other words, this is not a discovery, but an assumption that most psychologists make nowadays. So what is the point of announcing that IACD agrees with the mainstream that memory results from changes in the brain? To use Benjamin Spock’s statement about alcohol rubs as an analogy, this statement “smells important”. In addition, it enables the author of these IACD remarks to continue and state without evidence that early adverse experiences cause the brain to be organized in a maladaptive way, and then to make a second logical leap and claim that the result of this organization is denial of painful feelings and avoidance of affection and nurturing interactions. This, of course, makes poor parent-child relationships all about poor brain organization, and not at all about parenting skills or parental empathy.

The view just described can also be used by IACD to state without evidence that attachment disorder “delays brain growth. … the kids in our program are ‘stuck’ developmentally and neurologically” (www.instituteforattachment.ong/explore-our-services/family-treatment-program/). Confusion and circularity reign here. If brain events cause attachment disorder, how can attachment disorder alter brain events? (Of course, this does not matter if the neuroscience references are simply for persuasive purposes.) However, the statement about being “stuck” is the important one, common as it is in attachment therapy circles. It suggests that both physical and mental development cease and remain in a holding pattern as a result of early adverse experiences. This is not the case. Where a problem exists, developmental change can be distorted, whether because there is no solution to a problem or because a “work-around” draws from usually-unrelated structures or functions, but development does not stop.

 Imagine, for example, physical damage to the brain that might result from an injury or from surgical treatment for cancer. If this occurs in the first months of life, other brain areas may be recruited to perform the function that would otherwise be lost. If it occurs during the preschool years, the child can be helped to find ways to compensate for the loss and come close to normal functioning. In neither case does the traumatized individual remain at the level of functioning present at the time of the injury, but development continues and turns toward the typical trajectory.

Is someone saying that emotional traumas are different? Sorry, you can’t do that if you’re going to define emotional problems as “brain disorders”. What then is the point of talking about this at all? Very simple--  it lays the IACD groundwork for the idea that treatment involves re-enacting the “attachment cycles” posited by attachment therapy, through a ritual dramatization of baby experiences, and thus, of course, rebuilding that brain. It also justifies another service offered by IACD, neurofeedback, which is claimed to alter frequencies of brain waves and “therefore” to improve daily life. Interestingly, the claims about neurofeedback, which actually does involve some aspects of brain functioning, are much less elaborate and vivid than other assertions about brain events on the IACD site--  but they do include an article by the egregious Sebern Fisher, well-known neuropseudoscientist.

Is all this fraudulent advertising as well as  a blow against critical thinking? It’s hard to say, because there are so few specifics given, except for the neurofeedback bit. It is not, however, the transparent reporting so much advised by all mental health and public health groups. And the “neuroseductive” aspects are more than plain.

 
   
  

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?


Thursday, January 28, 2016

Caveat Emptor: Looking Further at Claims by the Institute for Attachment and Child Development (IACD)

In my last post, I examined some assertions put forward by supporters and members of the Institute for Attachment and Child Development, a Colorado organization with a long history of various versions of attachment therapy. Today I want to spend some time examining the claims made by IACD at www.instituteforattachment.org/join-our-mission/end-the-stigma/.  (N.B., the page actually says www.institutefor attachment.ong, but I don’t see how that will work.)

The IACD page expresses concern about the “stigma” associated with attachment therapy. This term, of course, has an emotional appeal, as we all know from Erving Goffman and others that stigmas are bad, unfair, and especially in the case of mental illness should be fought and contradicted by all right-thinking individuals. In the case of attachment therapy, however, it is hardly the case that there is a “stigma” attached to it. To reject something is not to stigmatize it. Most mental health professionals have never heard of attachment therapy, and those who have have made clear public statements rejecting it on logical and evidentiary grounds as well as in terms of its potential to harm children. The 2006 Chaffin et al task force report which advised strongly against the use of attachment therapy is a case in point. A negative task force report is not a stigma, any more than the current deep concerns of psychologists “stigmatize” torture during interrogations.

The IACD page references as a source of the claimed “stigma” the unintentional killing of a child by a Colorado therapist in the course of a “rebirthing” session in 2000. This, it is argued, somehow caused “respected therapists” to be blamed. The two therapists involved, of course, were Connell Watkins (AKA C.J. Cooill) and Julie Ponder, who were assisted by a number of helpers. The child was Candace Newmaker, who had been brought by her mother for a course of attachment therapy sessions, with the “rebirthing” just a frill that was added because an itinerant rebirther, Doug Gosney, had recently passed through the area offering training sessions.

As Michael Shermer cogently argued a few years later, Candace’s death was a “death by theory”. It would have been harmless, though silly, to play out the rebirthing drama with this child, as had been done with other children in episodes lasting only a few minutes. But Watkins and Ponder were deeply committed to the attachment therapy belief system promulgated by Foster Cline, and they believed that the child’s reported difficulties were simply resistance. For therapeutic success, they had, they thought, to force her to acknowledge the authority of adults by obeying their instructions to emerge from the flannel sheet that wrapped her.  It was this set of beliefs, long associated with the alternative developmental theories of attachment therapy, that caused them to ignore her 40 minutes of pleas for help, her vomiting, and finally 30 minutes of unresponsiveness during which Watkins and Ponder leaned on her wrapped body and discussed real estate (as clearly shown in the session videotapes). Watkins and Ponder killed Candace because of what they believed, not because of the specific techniques they chose. It is perfectly disingenuous to attribute this death to rebirthing, but of course this was the position taken by many who wished to weaken legislation that tried to prohibit potentially harmful treatments.

Let’s go on to look at a later part of this IACD page, the purported history of attachment therapy. First, let’s examine the statement that attachment disorders were discovered in 1972 by persons in Evergreen, Colorado. I am afraid this does not hold up under a strong light. John Bowlby in the 1930s was already looking at connections between disturbed early relationships and later delinquent behavior, and following World War II wrote extensively about the effects on young children of separation from parents associated with evacuation from British cities during bombing. Anna Freud did the same, and Rene’ Spitz focused on the depression and physical illness of babies grieving over separation. At a far less respectable level, Robert Zaslow, a California psychologist, began in the 1960s to use a form of holding therapy to create attachment, whose absence he considered the cause of autism and schizophrenia. After losing his license following a serious injury to an adult patient, Zaslow traveled the country giving demonstrations (one person who was present has reported to me that these included a 12-hour holding session with a young schizophrenic man). He encountered Foster Cline, a physician, in Colorado and recruited him to the attachment therapy doctrine. Cline later surrendered his Colorado medical license as part of a disciplinary proceeding after a child was injured. Cline preached that “all bonding is trauma bonding” and that physical restraint and authoritarian methods were the essence of child mental health treatment. (Zaslow went to Germany, where he published his new theory of the “Medusa complex” and the power of eye contact.)

Meanwhile, beginning in 1980, DSM had listed a syndrome called Reactive Attachment Disorder of Infancy and Early Childhood. This was a problem of babies and toddlers, and involved apathy and disengagement; it was seen as a feeding disorder, of concern because the children were not thriving physically. Later versions of DSM suggested that the real issue had to do with  inappropriate social engagement on the part of toddlers and preschool children. Cline and his group quickly picked up this term--  indeed, Zaslow had years before based his views on a mélange of Bowlby’s early, ethological attachment theory, and on the claims of Wilhelm Reich. By 2000, the checklist by which Cline’s followers diagnosed Reactive Attachment Disorder had been formalized by Elizabeth Randolph (N.B. license also revoked)  into the Randolph Attachment Disorder Questionnaire, whose manual plainly stated that the problem was not RAD, but something else that they were calling just “attachment disorder”. (This issue about what is RAD and what isn’t also comes up on the IACD website, but I will save that discussion for later.)

The IACD “history” proceeds to say that in the early 1990s, the organization ATTACh (Association for Treatment and Training of Attachment in Children) had already begun to be concerned about Cline’s “rage reduction” therapy. I do not believe this is true, although obviously I am not privy to all of the discussions that went on in ATTACh at this time, and I would be most interested in any substantiated correction. ATTACh materials up until about 2004 continued to list the names of therapists who certainly were using Cline-like treatments (in fact, it would appear that some of these are still listed). Only after Candace Newmaker’s 2000 death, and more importantly her therapists’ 2001 conviction and imprisonment, did ATTACh make public statements that rejected coercive treatment of children. This was in spite of the fact that the social worker Beverly James had already, in a 1994 book, expressed outrage and concern about the methods being used by this group.

One more rather interesting point about the IACD “history” (which seems to have been shaped to position Forrest Lien as the great leader of treatment for unhappy parents, and perhaps incidentally, their children): the page states that holding therapy “should consist of: essential components that include eye contact, appropriate touch, empathy, genuine expression of emotion, nuturance [sic], reciprocity, safety, and acceptance, While a variety of holding positions can be used, the physical safety of the client is the primary consideration” (italics removed). (Does it not boggle the mind, by the way, that any psychotherapist, far more one treating children, would have to state explicitly that he or she will avoid physically harming the patient? ) This statement appears to omit any consideration of either demonstrated effectiveness of the method (an outcome checklist seems to be in use, but no outcome research has been published), or, just as importantly, of emotional harm. Children who have experienced abuse or been engaged sexually by adults, or who are in treatment at the behest of adoptive parents, may experience being held as threatening and overwhelming, especially if they are past the preschool period when physical holding by parents is culturally acceptable.  The burden of proof is on IACD and its supporters to show that these techniques do not result in later emotional disturbance such as depression and suicidal thinking or actions. A discussion of the nature of informed consent for children, and the extent to which children who are under the control of adults are able to exercise this, would be most relevant here.

Curiously, the lengthy IACD statement about the nature of holding therapy is followed by the assertion that no form of holding is now used there, but no details of the actual treatment are provided, other than a reference to “revisiting the attachment cycles” by therapeutic foster parents. I’ve followed a number of links that purport to tell me more about the IACD treatment model, but they all end up with the same vague discussion.  

And there’s more: we’ll look on another day at IACD claims about what RAD is, and, most interestingly, about the idea that therapists are dealing with a :brain disorder”.    


Tuesday, January 26, 2016

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.      

Monday, January 25, 2016

Ordinary Child Abuse versus "Nancy Thomas Methods": What Investigators Should Know

However similar their results may be, two forms of child abuse are different in their motives, and to some extent in their methods. “Ordinary” child abuse can result from parental mental disturbances, from stress and frustration, from misunderstandings about discipline, or from a range of other factors like impulsiveness. Ideologically-motivated child abuse results from belief systems that claim that ill-treatment is beneficial for children and for their families, especially for adopted and foster children who have been neglected or abused in the past. In spite of some discussion in professional circles of coercive parenting based on an authoritarian belief system—often called “Nancy Thomas methods” after the former foster parent who has established an instructional empire claiming that coercive adoptive parenting creates child attachment—child welfare and criminal investigators may not realize that such ideological methods exist.

When questions are raised about a child’s care, investigators look for evidence of abusive or neglectful treatment, and because ideology-based coercive methods like limiting diet and threatening abandonment are correctly construed as abusive, they are likely to stop the investigation when they find those. But what happens next? Adoptive parents may present an appearance quite different from what investigators sometimes expect in abuse cases, and this may lead to questions about the need for, or the accuracy of, the investigation. Adoptive and foster parents have passed screenings for their health, education, solvency, and living conditions—otherwise they would not be permitted to adopt or foster (except in the shady circumstances of “rehoming”). They are likely to have extensive support systems in church and community groups as well as in adoption or foster care organizations, giving them plenty of character witnesses. If they are using coercive methods, they may have learned them from others in these organizations, and at least will feel supported by knowing that other people they like are doing the same things.

When the apparent respectability of the parents, their list of character witnesses, and their support systems are in place, and if no little or no direct harm  has been done to a child so far, an investigation may come to a halt prematurely. A strong potential for harm will still be in place, because the experiences of the child in “Nancy Thomas parenting” are equivalent to the adverse childhood experiences shown to cause both physical and emotional damage over the long term (see “Adverse Childhood Experiences Study”, www.acestudy.org). To protect children in these situations, investigators need to know what information is required to decide whether abusive coercive methods are being used by a family. That information will include not only what the parents do, but what instruction or encouragement makes them do it.

In cases of ordinary, non-ideological child abuse, investigation and evidence of abuse can lead to a range of outcomes, all presumably improvements of the child’s situation. At one extreme, children may be placed outside the family; at the other, stresses that have caused abuse may be ameliorated by improved housing or medical care and treatment by methods such as Child-Parent Psychotherapy. When abusive treatment occurs because of a shared belief system, and when abuse is assumed to have a beneficial effect on the child, it is much more difficult to think of ways the family can be helped--  and for that reason it is especially important for an investigation to reveal these factors in abuse. Abusive parents who believe they are doing the right thing are likely to continue their actions, but to become very careful about being detected by anyone outside their belief system. 

Several years ago, an adopted 10-year-old girl in Georgia ran away twice from her adoptive home. On the second occasion, the deputy sheriff who brought her back made an excuse to get inside the house, where he noticed that there was an alarm on the girl’s bedroom door. He knew enough to be aware of what this might mean, and an investigation of the situation was launched. Here was the complicated story: when a local couple (not the adoptive parents at the time of the runaway) had gone to Russia to adopt a boy from an orphanage, they had yielded to requests to take the boy’s sister as well.  But, it seems, they did not like her very much. They enlisted a couple of local practitioners of holding therapy to put her straight and periodically sent her to a “respite” foster home in the area. During one of the respite home visits, the first adoptive parents decided they did not want the girl any more, and they left it to the therapists and the foster parents to tell her this. The foster parents then said they would adopt her, and this was managed legally and bureaucratically--  not too hard, probably, because the people were already licensed as foster parents.

When the deputy reported what he saw in the house, a child abuse investigation followed. The adoptive parents’ fundamentalist church weighed in with many character references and statements that the couple could not possibly be abusive. In a lengthy hearing, both the character references and the facts of the girl’s treatment were considered--  but, it then transpired, the second adoptive parents had already sent her out of the state to the Seventh Day Adventist Miracle Meadows School in West Virginia, an organization frequently accused of abusive treatment of children (and recently closed down). This, of course, placed the case outside the Georgia jurisdiction.

What did the Georgia deputy know he should look for? What alerted him to the fact that this was not a simple runaway situation?

Here are some items that may give away the use of coercive parenting methods that reach abusive levels:
1 . Alarms and locks on bedroom doors
2. Minimal furniture in child’s bedroom
3. No lights in bedroom
4. Alarms and locks on refrigerators and food cupboards (unless there is medical evidence of an eating problem)
5. Evidence that a child’s diet has been limited; low weight for age; neighbors or teachers have seen child look in garbage for food
6. Evidence that a child has been put to tedious, unnecessary physical work, like moving stones from one side of the yard to the other and back again
7. Literature and videos by Nancy Thomas or similar authors in the home
8. Computer searches for organizations like radzebra.org, attach-china.org, attachment.org
9. Claims that the child suffers from Reactive Attachment Disorder, or simply “Attachment Disorder”
10. Claims that the child is dangerous but the parents want to keep him or her with them
11. Evidence of treatment by holding therapy
12. Evidence that a child past the toddler stage has still been fed with a baby bottle
13. Evidence that a child has not been enrolled in school or that homeschooling has been irregular
14. Family membership in a fundamentalist church that encourages adoption as part of the “Great Commission”
15. Multiple adoptions; evidence of use of “rehoming” for informal changes in child placement

Few of these facts or parent statements will be associated with non-ideological child abuse (although the two forms of abuse may overlap in their use of cages or similar restraint devices and of “hot-saucing” as a punishment). Even when there is evidence of abuse, the existence of a single one of these items does not demonstrate that investigators should pursue the case as one of ideologically-motivated mistreatment. When there are a number of these items noticed, however, it would be wise to understand that the parents in question may not be innocent simply because their character witnesses say so, nor may they be inclined to stop the abusive treatment of the current target child. Neither will they be unlikely to treat other children in the same way, because they believe it is the right thing to do.     


Sunday, January 24, 2016

Block That Diagram! The "Attachment Cycle" and Persuasive Arguments

Over the years, I’ve commented a number of times on the claims of attachment therapists about what they call the “attachment cycle”. (I’ve also written about this on my other blog, http://thestudyofnonsense.blogspot.com.)  The “attachment cycles” – they actually claim two of these events—are the AT alternative theory about how a child’s attachment to adults develops. I call this an alternative theory because in fact it is in no way related to conventional attachment theory based on the work of John Bowlby. It's not actually an alternative for anyone who is well-educated about child development.

To state it very briefly, conventional attachment theory sees secure emotional attachment as based on social interactions between parent and child. During the first months of life, most of those social interactions occur in the context of caregiving, so sensitive and responsive parenting is a proxy measure for social interaction. Later in the first year, social interactions also include communication by voice, gesture, facial expression, and so on, and these events are often but not always associated with daily care routines. Unresponsive or depressed caregivers, or those who are concerned that their baby not be “in control” of them, are less likely at all times to interact socially with babies. Nevertheless, although the babies may develop insecure or ambivalent attachments that are within the normal range, they do develop attachment, because attachment is such a robust developmental phenomenon. In the second year, social interaction continues to strengthen attachment relationships (as shown by the children’s tendency to seek familiar people when distressed), but another factor comes into play: children who are beginning to walk and talk and generally be autonomous need to have boundaries set for them by their caregivers. This boundary-setting can be done kindly or unkindly, effectively or ineffectively, but caregivers who have been good at social interaction are probably better at being both kind and effective, so we would expect to see secure attachment emerging side by side with awareness of boundaries during the second year, even though the setting of boundaries is not directly related to attachment. As the child gets older, and the parent develops further as a parent, the two ideally create what Bowlby called a “goal-corrected partnership” in which each modulates wishes and behavior to help maintain the emotional connection between them. This partnership provides a developing pattern for partnerships outside the family, which after all is the eventual point of attachment.

The alternative theory of “attachment cycles” has different goals and posits different events. The goal assumed by this vernacular theory is that the child should obey, appreciate, love, and be grateful to the parent, not only in childhood, but in adolescence and even in adulthood. These outcomes are the measure of attachment, and a disobedient or noncompliant child is considered to have some form of disorder of attachment. Attachment, and therefore obedience, are considered to develop as a result of two sets of repeated experiences. The first one, in the first year after birth, involves the child needing something and the parent responding by satisfying that need, repeated many hundreds of times. Hunger and feeding are often given as examples of this “first-year cycle”, but there are many other discomforts with which a parent may help an infant. Parents who do not regularly satisfy the child’s needs are thought not to be fostering attachment, even when they are highly socially responsive but it is impossible for them effectively to help a sick or injured child. Such children are said to be at high risk of failure of attachment, with resulting noncompliant or even criminal behavior, as a result of their early experiences when the “cycle” could not occur.

The second set of experiences, the “second-year attachment cycle”, involves strict boundary- and limit-setting by parents. When a toddler does not seem to have learned boundaries, he or she is said to be lacking in attachment, because obedience is conflated with attachment in this alternative system. Noncompliant older children are also said to have disorders of attachment, although there is no evidence that attachment is necessarily a cause of disobedience, whether or not the two behaviors tend to develop in the same context.
How do attachment therapists persuade parents that these “attachment cycles” exist and function as claimed? One way is to present circular graphics of the “cycles” and trace them around and around to show how events get repeated. As it happens, of course, the series of events is in reality not a “cycle”, in which the same pattern would be represented repeatedly, with the same outcome each time. Instead, as both parent and child are changing through experience and maturation, their interaction does not stay the same, and it would be better represented by a waveform indicating each person’s constantly altered needs, communications, and responses. It’s hardly imaginable that the same process could persist through all the rapid changes in parent and baby during the first year.

But, be that all as it may, the AT proponents continue to present these circular patterns that are supposed to show how trust and attachment build with repeated need and gratification. Yulia Massino recently sent me material showing how this has been used in Russia by American evangelical groups who want to influence Russian adoption and fostering practices. It’s my thought that these people are aware of the persuasive power of mysterious diagrams. Just as juries have been shown in the past to be more easily persuaded when they are shown brain images as part of an argument, parent audiences may regard the presenter of the “cycle” diagram to be somehow more knowledgeable than his or her qualifications show. People really do not like to do the work of figuring out a diagram, especially one that is as abstract as the “cycles” are. Do they figure that anyone who understands that diagram must be pretty smart, so they, the audience members, should just accept what they have to say? Maybe that’s the way it works. If so, the best education about attachment may involve learning to interpret graphs and to move from the graph’s abstraction to the concrete reality it claims to represent. On the case of attachment, a circle does not do a good job of representing the actual interactions that culminate in attachment behavior.