Concerned About Unconventional Mental Health Interventions?

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

Saturday, February 27, 2016

Apparent "Parental Alienation" and the "Chameleon Child"

 It would be silly to claim that no parent ever caused a child to be alienated from and to reject contact with the other parent. This can be done inadvertently, as when one parent is afraid of the other and an infant sees this through social referencing, or it can be done intentionally with the goal of hurting the other adult. However, it is not silly to consider that the apparent alienation of a child, with refusal to be with one parent, can have a wide variety of causes. That range of causes is not so easy to explore, and a parent who feels rejected may readily assume that any problem is of the other parent’s making.

Benjamin Garber has discussed one possible situation, in which each parent believes that the child fears and wants to avoid the other parent. He calls this pattern the “chameleon child” (Garber, B.D. [2014]. The chameleon child: Children as actors in the high conflict divorce drama. Journal of Child Custody, 11,25-40). The point of Garber’s discussion is not to blame children, but to consider that they are not simply passive recipients of parental pressure. Rather, they actively involve themselves in an uncomfortable situation and attempt to adapt themselves to the situation, and the situation to themselves. In pointing this out, Garber follows (without mentioning it) some important principles of modern developmental psychology. One of these principles is that the effects of family experiences are not just bidirectional but transactional: parents and children affect each other, and the ways in which they do this change over time. The second is that children’s own characteristics can influence the ways in which experiences affect them. This is most often discussed in terms of the ways a child’s genetic make-up and her experiences interact to change developmental outcomes, but it can also be considered with respect to the ways a child’s needs may evoke responses from caregivers, or the ways a child may actively seek to get from caregivers what he or she wants; in either of these cases, the child can also be influenced by the caregivers’ responses.  

The “chameleon child”, according to Garber, is one who tells the father how much the child likes to visit him, and what bad things the mother does. The same child does the reverse with the mother, praising her and criticizing the father. For both parents, the child cries and resists going to the one she is not presently with. Each parent is convinced that the other parent is mistreating the child and that the child hates and rejects the other one.

What is going on here? Is the child simply a wicked little creature who lies and likes to cause trouble? No--  a much simpler and more accurate statement would be that the child wants both parents and wants to have them together. The child wants both parents to love him, so he tells each one what that parent seems to be fascinated by hearing: 1. How much the child likes to be with the present parent, and 2. What bad things the other parent does. This line of conversation gets the deep interest and attention of whichever parent is hearing it at a given time. The child does not imagine that parental conflict is heightened by the stories told to each parent. On the contrary, he may imagine that the conflict is just about him, that one or both parents don’t like him so much and that’s why each is with him for only part of the time, and that if he can get them to like him more, they will reunite and both be with him all the time.

What about the parents? Are they trying to cook up some attack against each other? They may be, but chances are that they, and their attorneys, and their therapists, are all just suffering from the same confirmation bias that all of us have to fight. This means that they (and we) are ready to hear and remember information that supports a way of thinking that we already have, and ready to ignore or forget anything that confuses us by contradicting or only partially supporting our existing assumptions. For each one, the co-parent is a person who is unreliable, or unsympathetic, or sneaky, or cruel in some way--  if it were not so, they would not have separated, and that is the opinion of both the “one who left” and the “one who was left”. That such a person might mistreat a child in some way seems fairly credible, and anything that supports the idea that mistreatment has actually happened fits beautifully into confirmation of this  assumption. In addition, of course, each of the parents sees himself or herself as a protector of children, and to find that someone else treats the child badly and should be stopped is an event that confirms the bias about the self as well as about the other adult. These biases are so powerful that most parents do not investigate further or seek other information to help them decide whether a conclusion is correct—and this may be true of the attorneys and the therapists as well.

Garber recounts an anecdote that shows how confirmation bias can not only lead to the wrong conclusion, but can interfere with seeking stronger evidence about an issue. A four-year-old girl returned from a visit to her father and announced cheerfully to her mother, “Daddy showed me all about sex!”. The mother was flabbergasted, but not altogether surprised--  after all, we all know about pedophiles, don’t we? After a restraining order and much consulting and investigation, it turned out that the father had taken the girl to a museum with an entomology exhibit. He showed her all about, not sex, but insects. The child was obviously safe and happy, but the mother’s confirmation bias prevented her from asking a few questions about this “sex” business, which might have revealed that butterflies and moths were the real topic.


That child’s “chameleon” position came to be when the mother misunderstood or misinterpreted a statement that everyone would agree to be ambiguous at the very least. But a number of children provide fodder for their separated parents’ confirmation biases by adapting their behavior to what a parent seems to want to hear, praising the present parent and criticizing the absent one. Like real chameleons, the children make themselves safe and comfortable by doing what the social environment signals them to do, in ways that are no more antisocial than telling Aunt Lily you like your birthday present when you actually don’t. We want children to have these skills of social adaptation. We also want to know if anything bad does happen to them. For the best outcome, then, we need for co-parents, attorneys, and therapists to examine their own confirmation biases and seek all the factors that may determine a child’s attitudes and statements, rather than leaping to either the parental alienation or  the child abuse conclusions. 

Friday, February 26, 2016

Why Some People Who Should Know Better Still Assume That Reactive Attachment Disorder Involves Violent Behavior

Both professional journals and little independent blogs like this one have been stating for years that Reactive Attachment Disorder may be accompanied by aggressive behavior, but it is not the cause of that behavior, nor is aggressive behavior a symptom of the disorder. The last word about this was thought to have been said by the joint task force on Reactive Attachment Disorder of the American Psychological Association, Division 37, and the American Professional Society on Abuse of Children, headed by the late, much-respected, Mark Chaffin (Chaffin et al, 2006).  

Nevertheless, both parents and mental health professionals continue to assume that “the list” promulgated by attachment therapists, including not only aggression, but “fascination with blood and gore”, cruelty, and unwillingness to make eye contact on the parents’ terms, is an accurate description of Reactive Attachment Disorder. This is even evident in master’s and doctoral theses, which are presumably approved by a committee whose members are regarded (by someone) as knowledgeable.

Why? Why doesn’t this trailing edge pass over us? There are lots of reasons why people believe foolish things, and no doubt they all apply, but there is more to it than that. The problem I want to point to today has to do with the failure of editors and reviewers to properly monitor publications in professional journals, and the resulting publication of inaccurate and misleading claims.

Let’s look at three such publications that I stumbled across while looking for something else.

  1. Taft, R.J., Ramsay, C.M., & Schlein, C. (2015). Home and school experiences of caring for children with Reactive Attachment Disorder. Journal of Ethnographic & Qualitative Research, 9, 237-246. [these authors appear to work in special education and curriculum]
Taft et al state that “Children with RAD demonstrate significant and often dangerous behaviors..” (p.238). They follow this statement with a reference to the DSM-IV diagnosis, but without noting that none of the DSM editions refers to dangerous behavior. In a later paragraph, they reference an attachment therapy practitioner as saying (incorrectly) that children with RAD defy traditional treatment , and then go on to say that the Chaffin et al (2006) APSAC-DIV 37 task force reported that “some RAD children exhibit extreme disturbances”—whereas in fact Chaffin et al acknowledged that extremely disturbed childhood behavior is possible, but did not connect it with RAD. Later, Taft et al describe the children as “very intentional” about threatening or inappropriate behaviors, and state that concerning behaviors are purposeful and directed toward targets rather than the results of temper tantrums or responses to specific triggering circumstances. These statements were based on interviews with parents, most of whom attended a RAD support group (where presumably they told each other these stories and perhaps competed to be the bravest or most martyred parent). The paper’s reference section includes Nancy Thomas, a major promulgator of inaccuracies about Reactive Attachment Disorder, and Michael Trout, a member of APPPAH and believer in prenatal attachment.

  1. Shi, L. (2015). Treatment of Reactive Attachment Disorder in young children: Importance of understanding emotional dynamics. American Journal of Family Therapy, 42, 1-13. [this author is a marriage and family therapist]
Shi describes the case of a four-year-old boy, prenatally drug-exposed, and fostered by a sequence of five families, one of which was said to have chained him to a table. The current foster parents at the time of writing had three bio children and two other foster children in the house as well as this child; the foster mother ran a day care in her house while attending community college part-time. The father wanted to give the child up, but the mother resisted this. In spite of some obvious environmental problems past and present, Shi diagnosed the child as having Reactive Attachment Disorder. Shi stated that the child fit the “classic” RAD picture as described in DSM-IV-Tr, and then immediately proceeded to describe the child’s relevant behaviors, none of which are described in the DSM discussion.

The behaviors in question were, first, “a persistent fear state. He would eat non-stop when food was on the table and would not stop eating until he was forced to. He would steal food and hide it in his bedroom. He would eat garbage… shampoo and charcoal.” [N.B. these statement were exactly as I have given them here, with no evidence of a persistent fear state actually being given—JM].

A second category of behaviors was “dysregulation of affect. He urinated on the carpet when he was upset. …He broke toys on purpose, left holes in walls…ruined furniture, abused family pets, bounced on his two-year-old sister… He would not show emotions when hurt or injured but would cry dramatically over small, insignificant things.” The connection between urinating on the carpet and dysregulation of affect was not made, but as was the case for the fear state, neither the categories nor the specific behaviors are discussed in DSM.

A third category was “avoidance of intimacy…any attempt at physical contact would result in his screaming at the top of his lungs. He had no tolerance for anything soft or comforting. He… slept on a bare mattress. He would fake emotions from time to time yet any genuine feelings and emotions were scarcely observed.” Shi did not comment on how it could be detected that the child was faking an emotion, or how reluctance to lie on bedding was equated with avoidance of intimacy.

Treatment involved play therapy sessions, plus the prescription of ten minutes one-on-one with the foster mother every day. (The foster father also left the home, a factor that was not further discussed.) In an outcome described as “magical” and a “miracle”, after 16 sessions the child got a lot better and maintained his gains over several years, during which the foster mother worked to adopt him. Certainly the therapist and foster mother deserve full credit for their commitment and their work with this child, but the assumption that they were “treating RAD” was never justified.

  1. Stinehart, M.A., Scott, B.A., & Barfield,H.G. (2012).  Reactive Attachment Disorder in adopted and foster care children: Implications for mental health professionals. The Family Journal, 20(4), 355-360. [the corresponding author is in a department of counselor education]
From the abstract onward, this paper shows serious confusion about the nature of Reactive Attachment Disorder  and about the development of attachment. The title refers to RAD, but the abstract speaks of disordered or disorganized attachment. In reality, disorganized attachment behavior is a category used when assessing toddler attachment by means of the Strange Situation. Young children with disorganized attachment behave in unusual ways when reunited with the mother after a brief separation, freezing in place, falling to the ground, or backing toward the mother. The mothers may look frightened of the children and are often suffering from traumatic experiences. This kind of behavior is by no means a positive sign or a predictor of excellent development, but neither is it a symptom of a clear-cut pathology or of Reactive Attachment Disorder. Disorganized attachment reveals a situation in which both mother and child are in need of help to recover from trauma, but it need not be associated with separations or with abusive or neglectful treatment of the child; Reactive Attachment Disorder is by definition found after situations of neglect (sometimes including abuse) or multiple separations associated with neglect.

Having gotten off to a bad start on this paper, Stinehart et al then compound the problem by stating their inaccurate position on the development of attachment. Here’s what they say: “even before birth, a fetus begins to form an attachment to the woman carrying it. After birth, an infant will display an almost biological need [?—JM] to attach to a primary caregiver, typically a mother… [this relationship] is consistently strengthened as a child is comforted when scared, fed when hungry, and in general is made to feel safe and secure. An infant will seem to seek an unbroken gaze into the caregiver’s eyes and may attempt to mirror the caregiver’s facial expressions…”. The authors next repeat their problem from the abstract, by referring in one paragraph to disorganized attachment and proceeding in the next to discuss RAD, implying without either argument or evidence that the first is to be identified with the second. Finally (for the present purposes), Stinehart et al list a series of symptoms that they declare to be part of Reactive Attachment Disorder: early feeding problems, colic, failure to thrive, food hoarding, gorging, and pica, lack of impulse control and of empathy, tantrums, depression, inattentiveness, antisocial actions, cruelty, etc., all as seen in various on-line lists but not in DSM.

To comment briefly on these claims: 1. Attachment does not begin before birth; 2. Attachment is thought to develop as a result of the enjoyable social interactions that usually accompany the caregiving routines mentioned by Stinehart et al. 3. Infants do not make a great deal of eye contact until at least 4 or 5 months of age. 4. When they do make eye contact, the unbroken gaze is only a few seconds in length, as the child looks away to other parts of the face or to other objects, then returns to mutual gaze briefly. 5. Mirroring caregiver facial expressions occurs within a day after birth in the right conditions, and is probably far more important in attracting the caregiver to the baby than in establishing the baby’s attachment. 6. Need I say again that although disorganized attachment indicates a relationship that needs support, it is not the same thing as Reactive Attachment Disorder? No one has demonstrated a connection between these two behavior patterns. 7. Once again, although children may display all the problems on the list, and need help if they do, these problems are not symptoms of Reactive Attachment Disorder.

How did these three papers get published? One reason is that professionals trained in fields that do not involve child mental health have convinced themselves that it is easy to pick up a developmental psychology background that has been missing from their studies. But, more directly and importantly,  journal editors in those fields, who cannot be expected to  know all the material relevant to every submitted paper, err by choosing reviewers who are also untrained in child development. Thus, there is approval of publication of claims that contradict established information and favor pseudoscientific views of children’s mental health. Once publication has taken place, there is no recalling the material, even when an editor revokes a published paper; it stays somewhere on the Internet as a “peer-reviewed” publication. (Unfortunately, this is all too often right, as the reviewer is apparently an equal of the author with respect to understanding the issues.)


Editors and reviewers for guilty journals  need to do a better job. Allowing misinformation to be published is harmful to children and families in ways that are difficult to undo once they have occurred.
 

Thursday, February 25, 2016

What Happened to the Caged Vasquez Children? A Little Bit of News

It may be that most readers do not remember the 2007 trial of Sylvia Jovanna Vasquez, an adoptive mother in Santa Barbara, California, on charges of mistreating her children. According to testimony, Vasquez had kept three of the children (then 13, 9, and 6) in cages with buckets for sanitation and had limited the quantity and variety of their food. A fourth girl was treated very well--  except that arrangements were made for her to receive injections of Lupron, a drug used to treat precocious puberty and delay development. (Because she was already 12 years old, whatever signs of puberty she showed were certainly not precocious. In addition, nude photographs of her were found.) In spite of evidence of mental disturbance (see www.independent.com/news/2007/jun/07/fighting-hand-bleeds-you/ ), Vasquez had been permitted to adopt these children--  and she ran a day care center as well. It was an altercation with a worker at the day care center, and Vasquez’ threat to have her deported, that led the worker to report the mistreatment of the children to authorities.

Santa Barbara judge Frank Ochoa heard Vasquez’ claims that she had simply been following the directions of a book by Nancy Thomas that was recommended to her by a caseworker and a psychologist, and he told her that if she would explain exactly what had happened, he would give her the minimum sentence. But by the time the trial was done--  and especially after the cages were brought into the parking garage under the courthouse and Judge Ochoa actually crawled inside one—he expressed regret that he had made that commitment. Incidentally, although Vasquez was forbidden to communicate with the children, who were in foster care, during the trial, she did so through notes in books.

Vasquez was finally sentenced to one year in prison plus years of probation, over the objections of the prosecutor, but in line with the promise Judge Ochoa had made. Because she had already been incarcerated for 6 months during the investigation and trial, she actually served only 6 more months after the conviction. The children remained in foster care and information about them was very properly not available to the public.  

Nine years later, the children are about 22, 21, 19, and 15 years old, respectively. Nothing appears to be known about the older two, but there has recently been news about one of the caged girls. Nineteen-year-old Cynthia Vasquez is working at the shelter where she was taken by authorities when the children’s situation was first revealed (http://www.keyt.com/news/caged-child-abuse-survivor-speaks-out/38138980 ). Cynthia commented that as a child she just assumed that what was done to her was supposed to happen, that it was part of the experience of an adopted child and would eventually be over. However bizarre it seems to us to have a child live in a cage and eat raw eggs, it was probably no more bizarre or improbable than anything else that had occurred in Cynthia’s life until that time--  a point we should keep in mind when we think how abused children try to make sense of their mistreatment and why they may be emotionally attached to their abusers.

Vasquez claimed that she needed to cage and starve the children because they had “attachment disorders”. It is hard to know what she was thinking, but she seems to have accepted uncritically the claims of Nancy Thomas and others that any child who has been abused and/or separated from the birth mother must perforce have “attachment disorders”, that these children may appear to behave perfectly normally by means of their cunning and skill at exploiting other people, that they must be treated in order to prevent them from becoming dangerous, and that the treatment involves the total assertion of adult authority.  Like Thomas, Vasquez placed this “treatment” as the top priority for the children’s care, so she did not send them to school--  education being, as Thomas has put it, “a privilege and not a right”, and of course this action prevents the treatment from becoming known to nosy teachers and unsympathetic social workers or neighbors.

I am not bringing up this case in order to intrude further into Cynthia’s life or the lives of her brother and sisters. I simply want to point out that, contrary to the beliefs of Thomas & Co., Cynthia obviously understands cause and effect relationships and has a strong empathic response to children in the shelter. These capacities she developed in spite of her exposure to the Vasquez version of Nancy Thomas methods, not because of them.

In all candor, of course, I would like very much to know what has become of all of the children (if I recall correctly, the boy had been sent to a Utah boarding school), how they are doing now, and not least, what has Vasquez been doing during her period of probation? If she has managed to get involved with children, that is something that should be made public.
  


Saturday, February 20, 2016

Divorced Parents: Does Your Child Not Want to Visit You?

Some divorced couples find that children easily go back and forth from one household to the other, take it for granted that this will happen, and maintain good relationships with both parents. But many discover that this ideal situation is present at some times but not at others, perhaps changing with the child’s age or other events in their lives. In some cases, a child vehemently refuses to visit one of the parents at some point, feelings are badly hurt, and blame is cast in various directions.

When a child “rejects” a parent, it’s all too easy for the “rejected” or “non-preferred” person to accept advice about parental alienation (PA) and to seek treatment that will make the child enthusiastic and affectionate. Psychologists and others who think in terms of PA often claim that there are only two reasons why a child would reject a parent and refuse to visit. One is that the parent has been in some way abusive, so that the child’s response is a rational one. The alternative is that the child is behaving irrationally because of the influence of the preferred parent, who is deliberately and intentionally alienating the child’s affections by stating that that the other parent is someone to be feared and avoided.

I have no doubt that intentional parental alienation does happen sometimes, and that this can occur even when a marriage is still intact. It’s also possible that a parent of a young child may unintentionally convey fearfulness of the other parent, and the child may pick up on and share  that feeling, becoming reluctant to approach one of the parents. Nevertheless, it is simplistic to assume that there are only two categories of situations where a child rejects or avoids a parent—the rational avoidance of a person who has been abusive, and the irrational avoidance of a good parent at the instruction of the other parent. I would submit that in many cases, refusal of contact may be perfectly rational in the context of the child’s own experience and age-related needs and abilities, although it appears irrational to the adult who considers the child’s actions only in terms of the adult’s own needs, knowledge, and cognitive abilities—that is, the adult approaches the issue with an adultomorphic bias that attributes adult characteristics to the child.

Let’s look at some examples of situations where a child has never been abused by a parent, but has excellent reasons to avoid visiting that parent--  reasons that he or she either will not or cannot confide to adults.

  1. A 6-year-old boy who spends most of his time with his father begins to refuse visits to the mother after he overhears the mother’s boyfriend telling her she must “make a man of him” by taking away his nightlight and spanking him if he cries. The mother does not comply, but the boy is still disturbed and unable to explain the problem to anyone.   
  2. A 12-year-old girl who recently had her first menstrual period no longer wants to visit her father. She can’t explain this, but she does not know how she can handle menstrual hygiene without speaking to her father about it, which seems to her the most embarrassing thing that could possibly happen. What, for instance, if she got her period unexpectedly and got blood on the bedsheets?  She feels that would be the end of the world.
  3. A 13-year-old boy has spent occasional weekends with his mother for years, but now does not want to go. He feels frequent intense urges to masturbate but has no privacy in her apartment, as he has always slept in one of the twin beds in her room. If he spends much time in the bathroom she knocks and asks if he is feeling all right.
  4. A 14-year-old girl has been visiting her father happily over a period of several years, but began to refuse after the father’s girlfriend moved in with him. A therapist consulted by the father has stated that she has Separation Anxiety Disorder, although she has no problem going to school or elsewhere and will visit the father’s house but does not want to sleep over.   
  5. A boy in his middle teens has been visiting his father overnight for ten years, through a remarriage, a new divorce, and another marriage. He comes home looking distressed one day and tells his mother he does not want to sleep there again. There is no separate bed for him at his father’s house and he is expected to share a big bed with the younger stepbrother. He does not want to discuss this with his father and asks his mother simply to tell the father that he would prefer to have a visit with the father somewhere away from the house.


All these situations, except possibly the bed-sharing, may appear “irrational” to adults who cannot or at least do not take the child’s perspective. The child’s reluctance or inability to explain the trouble adds to this appearance of irrationality. Although the “rejected” parents may hasten to blame the refusal on an alienating co-parent, it’s clear that there are several other causes for the children’s feelings. One is the tendency, sometimes called “funneling”, for non-custodial parents to fail to notice developmental changes and to continue to treat children as if they are still at the age where they were when the marriage came apart. One is the presence of new romantic partners in the parents’ lives and the difficulty of providing the children with their accustomed time alone with a parent, complicated by the real uncertainty about what the relationship between child and new partner should be. Another, and an important one, is the role of verbal or nonverbal communication about sexuality with an opposite-sex parent, whether this has to do with the child’s own sexuality (including menstruation) or with the child’s awareness of the parent’s love life—so especially disturbing for adolescents, who do not want to know about this even when their parents are happily married. All of these issues need to be considered before there are PA accusations, and certainly before children are separated from the preferred parent’s home by court order.   

Attachment Insecurity: Not Nearly As Scary As It Sounds

To speak of someone as “insecure” is one of the great vague negative comments of the 21st century. Insecurity is thought to be the cause of all kinds of problem moods and behaviors like jealousy, backbiting, and oversensitivity to criticism. When children seem insecure, Americans are often disturbed by the idea that they won’t grow to be independent and self-sufficient, as our national values have long stressed. Such children are supposed to be forced to become “not insecure”--  the classic example is this dialogue: “He’s always carrying that blanket around. He must be insecure.” “Yeah, we’d better take the blanket away from him.”

All this concern about insecurity is amplified when the reference is to insecure attachment. Attachment is important, and (as above) insecurity is important, so insecure attachment must be extra important. Judges making child custody decisions may ask questions about it even if expert witness psychologists have not mentioned the issue.

But, when you come down to it, insecure attachment is well within the normal range of development. It may be not be ideal, but it’s okay. Insecurely attached kids grow up, go to school, have friends, get jobs, get married, etc. Any problems they have may be related to temperament, learning difficulties, socioeconomic status, or the continuing effect of whatever it was about their families that made them insecurely attached to begin with,  just as much as it is related to the insecure attachment specifically.

When Mary Ainsworth, John Bowlby’s colleague, did her original work with toddlers tested on the Strange Situation, she assigned 65% of them to Group B (later called securely attached), 20% to Group A (insecure-avoidant), and about 15% to Group C (insecure-ambivalent). The Group A children responded to brief separation and then reunion with their mothers by avoiding or snubbing the returning mothers; Group B actively sought contact with the returning mothers and were easily comforted; Group C were anxious while the mother was gone, and when she came back they went to her but pushed her away or resisted her. (Ainsworth did not use the disorganized/disoriented attachment category, which was created later).
What if Ainsworth had never used the terms insecure-avoidant, insecure-ambivalent, or secure? Would we be so worried about a child placed in Group A or C by a trained observer if we didn’t use the word security to describe what’s going on? I would speculate that we might not have so much concern if we didn’t already associate insecurity with undesirable mood and characteristics, especially the American bug-a-boo, lack of independence.

Ainsworth did not create her classification plan by following the children, seeing what characteristics they later developed, and retrospectively labeling the toddler behaviors in terms that depended on demonstrated childhood or adult characteristics. No—she  started her work with Bowlby with an existing assumption about security as a foundation for personality.  While a graduate student in Toronto in the 1940s, Ainsworth worked with William Blatz, who did not publish much but who had formulated a theory of personality that stressed early development and the basic need for exploration and learning. (For interested readers, I should point out that I am using only a small amount of the information about Blatz provided by van Rosenmal, van der  Horst, and van der Veer in their 2016 paper “From secure dependency to attachment”, History of Psychology, Vol. 19, pp.22-39). Blatz defined security as “the state of consciousness that accompanies a willingness to accept the consequences of one’s own decisions and actions”, or occurred if someone else could be depended on to help with the consequences. Young children experience an immature, dependent security,  but when they are sure an adult will help them, they can explore and use the adult as a secure base. Confidence and movement toward independence come with exploration and learning about the world. Initially, Blatz felt, a stable mother/caregiver was essential, but as the child explores further, a whole social network comes into the picture. People who do not have a stable caregiver or who do not learn successfully from exploration have to depend on defense mechanisms like rationalization to deal with the discomfort of insecurity.

In the first work that Ainsworth and Bowlby did together, they referred to the positive relationship between mother and child as one of “secure dependency”. Not much later, however, they substituted the term “attachment” for  “secure dependency”—“attachment” having been used for a long time to mean something like “devotion” in adult relationships. Thus, “attachment” and “security” developed the connection that is now so well known, leading many people to assume that an insecure attachment is no attachment at all.   

Am I suggesting that early attachment has no significance at all? No, of course not. Early attachment behavior is a reasonably good proxy measure for how caregivers act toward the child, and how caregivers act toward the child will help shape development throughout childhood and adolescence. Certainly, the small proportion of children who show disorganized attachment by freezing or falling to the floor when reunited with the primary caregiver are showing us that there are problems in the relationship (often associated with traumatic experiences the caregiver has had). These parents and children need help to improve their situations.

However, most ways of caring for children are “good enough”, whether or not they are associated with insecure attachment behavior. Their outcomes are adequate for development of adults who can take normal places in society. Insecure attachment is not the cause of horrible outcomes, for the individual or for the rest of us. In any case, children who appear insecurely attached may well move toward secure attachment over time. Decisions about child custody or placement should not depend on whether attachment is assessed as secure or insecure in the toddler period. That may appear to be a scientific use of data about child development, but instead it is just one more effort to detour around the complexities of family issues and to define that difficult concept, the best interest of the child.



Thursday, February 18, 2016

Eye Contact with Babies Part 2: What , When, Why, and How




Hello readers-- I am starting a new post for responses to http://childmyths.blogspot.com/2011/07/eye-contact-with-babies-what-when-why.html.

There is a long list of queries and responses on that post, and I cannot seem either to publish or to answer any more. I hope people will see my notice and come over to this one instead.

I am going to start with a query I received but could not publish on the old post.

AND--  I'm so sorry but I cannot make this query and response line up properly with the margins! It looks okay to me, but when I publish it's out of line. I hope people can figure out what this reader and I were talking about. When I have time I will retype the whole thing, which may be the only solution...  no, wait! Problem solved-- I managed to post this as a comment.





Wednesday, February 17, 2016

Five Ways of Looking at "Attachment Disorders"

What is a syndrome of behavior and/or causes that leads to a mental health diagnosis? When we talk about mental health diagnoses, we are trying to use an analogy to diagnoses of physical illnesses and injuries. Like mental health diagnoses, classifications of physical health problems have to place people into categories for which they meet some, but not necessarily all, of the criteria. These diagnoses may in both cases also involve symptoms that can be found among the criteria for more than one category of problems. But--  there is one big difference between mental health and physical health diagnoses. For problems of physical health, there is a physical cause that may be hard to ascertain but is certainly there; without a specific physical cause, a specific diagnosis will not be made.

In the case of mental health diagnoses, physical causes are rarely present in detectable forms. Genetic factors may play important roles in causing mental illness, but although there is much ongoing research in this area, the complexity of the human genome makes it difficult to isolate genes and genetic events that may be at work. Occasionally criteria for mental health diagnoses  include  causes in the form of experiences (for example, post-traumatic stress disorders), but such causes have not been demonstrated for most mental health disorders, and it may be very difficult to trace histories of experience in early life. 

Our lack of understanding of causes of mental illness means that criteria for a diagnosis generally depend on systematic observation of many cases and the establishment of evidence that certain symptoms tend to be found together in ways that may overlap somewhat with other diagnostic categories but that can be regarded as having their own unique pattern. Our understanding of these patterns changes with new information, and that is why lists of diagnostic categories and their criteria change over time, and categories may be added or deleted.

In the 2013 edition of the American Psychiatric Association’s Diagnostic and statistical manual of mental disorders (DSM-5), changes were made in the description and criteria for Reactive Attachment Disorder, a diagnostic category that had been changing over the years since 1980, when it was classed as a disorder of feeding. This category had involved two potentially problematic patterns of social interaction by young children, one in which the child was anxious about separation and clung to caregivers, and one in which the child appeared interested in adults but indifferent to particular people, with no preference for familiar caregivers. In DSM-5, two separate categories were used. In one, Reactive Attachment Disorder, the child does not seek comfort from caregivers or respond to it when distressed; the child is not responsive to others and shows little positive emotion; the child may be irritable, sad, or fearful when interacting with an adult, even when there seems to be no evident threat to the child. For this diagnosis, there must also be a history of extremes of inadequate care, the child must be at least 9 months old because attachment does develop sufficiently before that age, and the child must be less than five years old when the problematic behavior begins.

The second DSM-5 category, Disinhibited Social Engagement Disorder, involves behavior rather different from the typical responses of young children to separation from familiar people or to the approach of strangers. Children with DSED readily approach strangers and are overly familiar with them in physical and verbal ways (as compared to what is typical of young children). They are less likely than typical children to “check back” by looking at or speaking to a familiar caregiver when exploring unfamiliar settings. They show little hesitation about going with an unfamiliar adult. To receive the DSED diagnosis, the child must also have experienced extremes of inadequate care and be at least 9 months old. There is no upper limit for when the  behavior begins, no doubt for the reason that such friendly, non-anxious behavior is much more typical of older children and should not be seen as problematic; what is “overly familiar” also changes with age.

DSM-5 is often treated as the “last word’ about mental health diagnoses, but in fact there are other sets of diagnostic categories. One of these is the one your insurance carrier is likely to use: the World Health Organization’s International classification of diseases and related health problems (ICD-10). ICD-10 includes the diagnostic category Reactive Attachment Disorder of Childhood and describes this as involving persistent abnormalities in the child’s pattern of social relationships, including fearfulness and hypervigilance, poor social interaction with peers, aggression toward self and others, misery, and possible growth reduction or growth failure. This syndrome is said probably to occur as a result of serious neglect, abuse, or mishandling, but unlike DSM-5, such a history is not required for the diagnosis. It’s notable that although the term “attachment” is found in the name of the diagnosis, the criteria do not particularly mention social interactions with adult caregivers.

ICD-10 also includes Disinhibited Attachment Disorder of Childhood, which is essential described in the same way as DSM-5 described DSED. The interesting difference is that ICD-10 says that depending on circumstances there may be associated emotional or behavioral disturbance.

ICD-10 dates back to an initial publication in 1992, and there is an ICD-11 in the works. Drafts of proposed material for ICD-11 are available. For Reactive Attachment Disorder, the draft proposes that the disorder occurs in cases of grossly negligent child care and involves grossly abnormal attachment behaviors. The child does not seek comfort from familiar caregivers or other adults and does not respond to offered comfort. The disorder cannot be diagnosed before one year of age or 9 months developmental age. The draft notes that there are normal variations in selective attachment behavior and these should not be confused with Disinhibited Attachment Disorder.

The ICD-11 draft uses the term Disinhibited  Social Engagement Disorder instead of Disinhibited Attachment Disorder, and again proposes that this problem must occur in the context of a history of inadequate care. The criteria are similar to the DSED criteria. The disorder is not to be diagnosed before age one year and must begin before age 5 years.

But ICD-10 and ICD-11 are not the “last words” either. Because diagnosis of early childhood mental health problems may be quite a different task than diagnosis of adults, the Diagnostic Classification of Mental Health and Development Disorders of Infancy and Early Childhood (Revised edition; DC:0-3R) has been developed. DC:0-3R has dropped the term Reactive Attachment Disorder and instead refers to Deprivation or Maltreatment Disorder of Infancy. This may appear in three patterns. The first, an emotionally withdrawn or inhibited pattern, may be characterized by failing to seek comfort when stressed, showing few attachment behaviors (cooperating, seeking help from others), appearing emotionally blunted, showing frozen watchfulness, avoiding and failing to initiate social interactions, or actively resisting comforting. The second pattern, an  indiscriminate or disinhibited pattern, involves a lack of the usual shyness about interacting with strangers, seeking comfort and proximity even with strangers, and even resisting comforting by familiar people. In a third pattern, there may be a combination of features from the first two. As its title suggest, DC:0-3R is a classification system for infants, toddlers, and preschoolers, and would not be used for older children.

What’s the fifth way of looking at ‘attachment disorders”? I’m only mentioning this one because I want readers to compare it to the legitimate attempts to define the diagnosis. Here’s part of a list of symptoms given by Nancy Thomas, the well-known proponent of  an alternative theory of child development,  at www.attachment.org/reactive-attachment-disorder/ : superficially engaging and charming, lack of eye contact on parents’ terms, indiscriminately affectionate with strangers, cruel to animals, etc. etc. If anyone reading this has been exposed to this view of “attachment disorders”, let me suggest that you compare it carefully to the DSM-5, ICD-10/11, and DC:0-3R efforts. Keep in mind that that the first four were based on careful observation and ongoing discussion by people trained in research methodology. The last one was borrowed from the old Hare Psychopathy Checklist, slightly revised to bring in some alternative beliefs about eye contact and some behaviors related to conduct disorders—also, to give parents a good scare.

It’s evident that professionals are still refining their formulations of “attachment disorders”. However, none of these efforts so far have included the list at www.attachment.org, and I am quite certain that they never will.


Sunday, February 7, 2016

Trouble Publishing and Replying on Eye Contact

Terri and Svetlana--  I am having difficulty publishing your comments and my replies. I'll work on this, but maybe there are just too many comments on that post? You might want to try sending comments to this post.

Best,
Jean

Tuesday, February 2, 2016

Jean Mercer's CV (Feb. 2, 2016)

Here is an updated CV for anyone who's interested:

                                                CURRICULUM VITAE

                                                   JEAN MERCER*
                

134 E. Main St., Moorestown, NJ 08057
E-mail: Jean.Mercer@stockton.edu

EDUCATION:
            Mt. Holyoke College, 1959-1961
            Occidental College. 1961-63; A.B. in Psychology, 1963
            Brandeis University, 1963-67; Ph.D. in Psychology, Feb. 1968

EMPLOYMENT:
            Assistant Professor, Wheaton College, Norton,MA. 9/67-6/69
            Assistant Professor, State University College, Buffalo, NY 9/69-6/71
            Assistant Professor, Richard Stockton College, Pomona, NJ 9/74-9/77
            Associate Professor, Professor, Richard Stockton College, Pomona NJ 9/77-2/81
            Professor of Psychology, Richard Stockton College, Pomona, NJ 2/81-2006
            Professor Emerita of Psychology, Richard Stockton College, 2006--

PROFESSIONAL ACTIVITIES:
            Consulting reader, Infants and Young Children,1992- 2000
            Editor, The Phoenix (NJAIMH Quarterly Newsletter), 1994-1999; Editor,
            Nurture Notes (NJAIMH Newsletter), 2000-2001.
            Vice President, New Jersey Association for Infant Mental Health, 1996-2000
            President, New Jersey Association for Infant Mental Health, 2000-2005
            Past president, ex officio Board of Directors member, NJAIMH, 2005- 2009
            Member, Prevention and Early Intervention Committee, New Jersey Community
                 Mental Health Board, 2000-2002
            Consulting editor, Scientific Review of Mental Health Practice, 2002-2010 
            Member, New Jersey Better Baby Care Campaign Advisory Committee, 2002-3
           
           
Fellow, Council for Scientific Medicine and Mental Health, 2003-
  Faculty member, Youth Consultation Services Institute for Infant and Preschool Mental             Health, 2003-    
  Chair, Board of Professional Advisors, Advocates for Children in Therapy, 2003--
  Expert witness, Utah Division of Occupational and Professional Licensing, 2005
                (license revocation matter)




[*Name was legally changed from Gene Alice Lester, May, 1977]
                                                                                           
         
    
  Expert witness, Middlesex NJ Family Court, 2005 (best interest hearing)                  
  Member, "Critical Pathways" teleconference on training and credentials (formed after ZTT/Mailman Foundation Infant Mental Health Systems Development Summit Conference, September 2005)
Expert witness, Thibault vs. Thibault, Pasco County, Florida, 2006 (child custody and discipline matter)
Expert witness, California vs. Sylvia Jovanna Vasquez, Santa Barbara County, CA,         2007 (child abuse matter)
  Reviewer, American Journal of Orthopsychiatry, 2008.
  Testimony, Robertson vs. Mannion, Montgomery County, PA, 2008 (child custody  matter)
  Founding member, Institute for Science in Medicine, 2009; Board of Directors, 2014-
Reviewer, Choice: Current Reviews for Academic Libraries, 2009-
Board of Directors, Delaware Valley Group of WAIMH, 2010—2014.
Co-director, PA-IMH infant mental health breakfast series, 2014-
 Editorial board, Child & Adolescent Social Work Journal, 2014—
Reviewer, Professional Psychology, 2015—
Reviewer, Child and Family Social Work, 2015—
Reviewer, Evidence-based Practice in Child and Adolescent Mental Health, 2016
           


OTHER MEMBERSHIPS:

American Psychological Association
Pennsylvania Association for Infant Mental Health
Society for Research in Child Development

PUBLICATIONS:

Lester, G., & Morant, R. (1967). Sound localization during labyrinthian stimulation.
            Proceedings of the 75th Annual Convention of the American Psychological
            Association, 1, 19-20.
Lester, G. (1968). The case for efferent change during prism adaptation. Journal of
            Psychology, 68, 9-13.
Lester, G. (1968). The rod-and-frame test: Some comments on methodology. Perceptual
            and Motor Skills, 26, 1307-1314.
Lester, G. (1969). Comparison of five methods of presenting the rod-and-frame test.
            Perceptual and Motor Skills, 29, 147-151.
Lester, G. (1969). The role of the felt position of the head in the audiogyral illusion. Acta
            Psychologica, 31, 375-384.
Lester, G. (1969). Disconfirmation of an hypothesis about the Mueller-Lyer illusion.
            Perceptual and Motor Skills, 29, 369-370.
Lester, D., & Lester, G. (1970). The problem of the less intelligent student in the   introductory    psychology course. The Clinical Psychologist, 23(4), 11-12.
Lester, G., & Lester, D. (1970). The fear of death, the fear of dying, and threshold            differences for death words and neutral words. Omega,1, 175-180.
Lester, G. (1970). Haidinger’s brushes and the perception of polarization. Acta
            Psychologica, 34, 107-114.
Lester, G., & Morant, R. (1970). Apparent sound displacement during vestibular   stimulation.     American Journal of Psychology, 83, 554-566.
Lester, G. (1971). Vestibular stimulation and auditory thresholds. Journal of General
            Psychology, 85, 103-105.
Lester, G. (1971). Subjects’ assumptions and scores on the rod-and-frame test.
            Perceptual and Motor Skills, 32, 205-206.
Lester, G., & Lester, D. (1971). Suicide: The gamble with death. Englewood Cliffs, NJ:
            Prentice-Hall.
Lester, D., & Lester, G. (1975).  Crime of passion: Murder and the murderer. Chicago:
            Nelson-Hall.
Lester, G., & Rando, H. (1975). No correlation between rod-and-frame and visual
            normalization scores. Perceptual and Motor Skills, 40, 846.                                                                                                                               

Lester, G., Bierbrauer, B., Selfridge, B., & Gomeringer, D. (1976). Distractibility,
            intensity of reaction, and nonnutritive sucking. Psychological Reports, 39, 1212-1214.
Lester, G. (1977). Size constancy scaling and the apparent thickness of the shaft in the
            Mueller-Lyer illusion. Journal of General Psychology, 97, 307-398.
Mercer, J. (1979). Small people: How children develop and what you can do about it.
            Chicago: Nelson-Hall.
Mercer, J. (1979). Personality development and the principle of reciprocal interweaving.
            Perceptual and Motor Skills, 48, 186.
Mercer, J. (1979). Guided observations in child development. Washington, D.C.:    University       Press of America.
Mercer, J., & Russ, R. (1980). Variables affecting time between childbirth and the             establishment of lactation. Journal of General Psychology, 102, 155-156.
Mercer, J., & McMurphy, C. (1985). A stereotyped following behavior in young children.
            Journal of General Psychology, 112, 261-265.
Mercer, J. (1991). To everything there is a season: Development in the context of the
            lifespan. Lanham, MD: University Press of America.
Mercer, J.,& Gonsalves, S. (1992). Parental experience during treatment of very small
            preterm infants: Implications for mourning and for parent-infant relationships.
            Illness, Crisis, and Loss, 2, 70-73.
Gonsalves, S., & Mercer, J. (1993). Physiological correlates of painful stimulation in          preterm infants. Clinical Journal of Pain, 9, 88-93.
Mercer, J. (1998). Infant development: A multidisciplinary introduction. Belmont, CA:
            Brooks/Cole.
Mercer, J. (1999). ‘Psychological parenting” explained (letter). New Jersey Lawyer, July    12, 7.
Mercer, J. (2000/2001). Letter. Zero to Three, 21(3), 39.
Mercer, J. (2001). Warning: Are you aware of “holding therapy?” (letter). Pediatrics, 107,             1498.
Mercer, J. (2001). “Attachment therapy” using deliberate restraint: An object lesson on      the       identification of unvalidated treatments. Journal of Child and Adolescent
            Psychiatric Nursing, 14(3), 105-114. This paper is posted at
            http://www.bpkids.org/learning/reference/articles/index.htm#journals_#
            with permission of the publisher to the Child and Adolescent Bipolar
            Foundation.

Mercer, J. (2002). Surrogate motherhood. In N. Salkind (Ed.), Child Development
            (pp. 399). New York: Macmillan Reference USA.
Mercer, J. (2002). Child psychotherapy involving physical restraint: Techniques used in four         approaches. Child and Adolescent Social Work Journal, 19(4), 303-314.
Kennedy, S.S., Mercer, J., Mohr, W., & Huffine, C.W. (2002). Snake oil, ethics, and the   First     Amendment: What’s a profession to do? American Journal of
            Orthopsychiatry, 72(1), 5-15.

Mercer, J. (2002). Attachment therapy: A treatment without empirical support. Scientific
Review of Mental Health Practice, 1(2), 9-16. Reprinted in S.O. Lilienfeld, J. Ruscio, & S.J. Lynn (Eds.), Navigating the mindfield: A user’s guide to distinguishing science from pseudoscience (pp. 435-453). Amherst, NY: Prometheus Books.

Mercer, J. (2002). The difficulties of double blinding (letter). Science, 297, 2208.
Mercer, J. (2002) Attachment therapy. In M.Shermer (Ed.), The Skeptic Encyclopedia of
            Pseudoscience (pp. 43-47) .Santa Barbara, CA: ABC-CLIO.
Mercer, J., & Rosa, L. (2002). Letter on Attachment Therapy. New Jersey School
            Psychologist, 24 (8), 16-18.
Mercer, J., Sarner, L., & Rosa, L. (2003). Attachment therapy on trial: The torture
            and death of Candace Newmaker. Westport, CT: Praeger. (see also reviews in Scientific     American, PsycCritique, Scientific Review of Mental Health Practice).

Mercer, J. (2003). Letter to the editor. APSAC Advisor,15(3), 19.
Mercer, J. (2003) Attachment therapy and adopted children: A caution. Readers’
            Forum. Contemporary Pediatrics, 20(10), 41.
Mercer, J. (2003). Violent  therapies: The rationale behind a potentially  harmful child        psychotherapy and its acceptance  by parents. Scientific Review of Mental Health
            Practice,  2(1), 27-37.  
Mercer, J. (2003). Media Watch: Radio and television programs approve of Coercive         Restraint Therapies. Scientific Review of Mental Health Practice, 2(2).
Mercer, J. (2004). The dangers of Attachment Therapy: Parent education needed.
             Brown University Child and Adolescent Behavior Letter, 20(10), 1, 6-7.
Mercer, J. (2005). Bubbles, bottles, baby talk, and basketty. Early Childhood Health Link
            (Newsletter of Healthy Child Care New Jersey), 4(1), 1-2.
Mercer, J. (2005). Coercive Restraint Therapies: A dangerous alternative mental health      intervention. Medscape General Medicine, 7(3). (see also letters in subsequent issue).           http://www.medscape.com/viewarticle/508956.

Mercer, J. (2006). Understanding attachment: Parenthood, child care, and emotional         development. Westport, CT: Praeger.
Mercer, J. (2006). IEPs and Reactive Attachment Disorder: Recognizing and addressing   misinformation. Scope (Newsletter of the Washington State Association of School             Psychologists), 28(3), 2-6.
Mercer, J., Misbach, A., Pennington, R., & Rosa, L. (2006). Letter to the editor (age          regression definition). Child Maltreatment, 11, 378.
Mercer, J. (2007). Behaving yourself: Moral development in the secular family. In D..McGowan (Ed.), Parenting beyond belief (pp. 104-112). New York: Amacom Books.

Mercer, J., & Pignotti, M. (2007). Letter to the editor (neurofeedback research critique).    International Journal of Behavioral and Consultation Therapy, 3 (2), 324-325
Pignotti, M., & Mercer, J. (2007). Holding Therapy and Dyadic Developmental     Psychotherapy are not supported, acceptable social work interventions: A         systematic research synthesis revisited. Research on Social Work Practice,17 (4), 513-519.
Mercer, J. (2007). Systematic child maltreatment: Connections with unconventional parent and professional education. Society for Child and Family Policy and Practice Advocate (Division 37 of APA), 30 (2),  pp.5-6.
Mercer, J. ( 2007).Media Watch: Wikipedia and "open source" mental health information.  Scientific Review of Mental Health Practice. 5(1), 88-92.
 Mercer, J. (2007) Destructive trends in alternative infant mental health approaches.           Scientific Review of Mental Health Practice, 5(2), 44-58.
 Mercer, J., & Pignotti, M.  (2007). Shortcuts cause errors in Systematic      Research          Syntheses: Rethinking evaluation of mental health interventions. Scientific   Review of         Mental Health Practice, 5  (2), 59-77.

Mercer, J. (2008). Minding controls in curriculum study (letter). Science, 319, 1184.
Mercer, J. (2009).Child Development: Myths and Misunderstandings.Los Angeles,CA: Sage.
Mercer, J., Pennington, R.S., Pignotti, M., & Rosa, L. (2010). Dyadic Developmental Psychotherapy is not "evidence-based": Comments in response to Becker-Weidman and Hughes (2009). Child and Family Social Work, 15,  1-5. http://www.wiley.com/bw/journal.asp?ref=1356-7500 . DOI:10.1111/j.1365-2206.2009.00609.x.
Mercer, J. (2009). Child custody evaluations, attachment theory, and an attachment measure: The science remains limited. Scientific Review of Mental Health Practice, 7(1), 37-54.

Mercer, J. (2010). Themes and variations in development: Can nanny-bots act like human caregivers? Interaction Studies, 11(2), 233-237.
 Mercer, J. (2011). Attachment theory and its vicissitudes: Toward an updated theory. Theory and Psychology, 21, 25-45.
Mercer, J. (2011). The concept of psychological regression: Metaphors, mapping, Queen Square, and Tavistock Square. History of Psychology,14, 174-196.
Mercer, J. (2011). Some aspects of CAM mental health interventions: Regression, recapitulation, and “secret sympathies”. Scientific Review of Mental Health Practice, 8, 36-55.
Mercer, J. (2011). Book review: Rachel Stryker’s (2010) The road to Evergreen. Scientific Review of Mental Health Practice, 8, 69-74.
Mercer.J. (2011). Martial arts research: Weak evidence. (Letter). Science, 334, 310-311.

Mercer, J. (2012). Reply to Sudbery, Shardlow, and Huntington: Holding therapy. British Journal of  Social Work, 42, 556-559 . DOI: 10.1093/bjsw.bcr078.
Mercer, J. (2013). Child development: Myths and misunderstandings, 2nd ed. Los Angeles, CA: Sage.
Mercer, J., (2013). Deliverance, demonic possession, and mental illness: Some considerations for mental health professionals. Mental Health, Religion, and Culture 16(6), 596-611. DOI:10.1080.13674676.2012.707272.
Mercer, J. (2013). Attachment in children and adolescents. (Childhood Studies section). H. Montgomery (Ed.), Oxford Bibliographies Online. www.oxfordbibliographies.com.



Mercer, J. (2013). Holding Therapy in Britain: Historical background, recent events, and ethical concerns. Adoption & Fostering, 37(2), 144-156.
Mercer, J. (2013). Holding therapy: A harmful alternative mental health intervention. Focus on Alternative and Complementary Therapies, 18(2), 70-76.
Mercer, J. (2013). Giving parents information about Reactive Attachment Disorder: Some problems. Brown University Child and Adolescent Behavior Letter, 29 (8), 1, 6-7.

Mercer, J. (2014). International concerns about Holding Therapy. Research on Social Work Practice, 24(2), 188-191.
Mercer, J. (2014). Children in institutions. (Letter). Zero to Three, 34(4), 4.

Mercer, J. (2014). Examining Dyadic Developmental Psychotherapy as a treatment for adopted and foster children. Research on Social Work Practice, 24, 715-724. Doi:10.11771049731513513516803.

Mercer, J., ( 2014). Alternative psychotherapies: Evaluating unconventional mental health treatments. Lanham, MD: Rowman & Littlefield.
[Review: Thyer, B. (2015). Playing whack-a-mole with pseudoscientific psychotherapies. PsycCritiques, 60(28), Article 5.]


Mercer, J. (2014). Parenting: Section deserves a scolding (LTE). Science, 345(6204), 1571.

Mercer, J. (2015). Attachment therapy. In S.O. Lilienfeld, S.J. Lynn, & J.M. Lohr (Eds.), Science and pseudoscience in clinical psychology (2nd edition). New York: Guilford.

Mercer, J. (2015, in press). Attachment therapies. In R. Cautin &  S.O. Lilienfeld (Eds.), Encyclopedia of clinical psychology. New York: Wiley-Blackwell.

Mercer, J. (2015, in press). Controversial therapies. In R. Cautin & S.O.Lilienfeld (Eds.), Encyclopedia of clinical psychology. New York:Wiley-Blackwell.

Mercer, J. (2015). Thinking critically about child development: Examining myths and misunderstandings ( 3rd ed. of Child development: Myths and misunderstandings).
            Los Angeles, CA: Sage.

Mercer, J. (2015). Revisiting an article about Dyadic Developmental Psychotherapy: The life cycle of a “woozle”. Child and Adolescent Social Work, 32(5), 397-404.

Mercer, J. (2015). Examining DIR/Floortime as a treatment for children with autism spectrum disorders. Research on Social Work Practice, 25(1-11).

Mercer, J. (2015), Examining Circle of Security: A review of research and theory. Research on Social Work Practice, 25(3), 382-392.





             
UNPUBLISHED/ IN PREPARATION:
Lester, G. (1968). Some investigations of the audiogyral illusion. Unpublished Ph.D. thesis, Brandeis University.
Mercer, J. (1993) The successful single parent. Unpublished book-length ms.
Mercer, J.  The developing child in
            changing times: Infancy through adolescence  Unpublished book-length ms.
Invited comments on the New Jersey Children’s Initiative proposal (March 10, 2000);
             with Gerard Costa and Elaine Herzog.
Invited comments on the U.S. Bright Futures children’s mental health proposal (July 5,     2000); with Gerard Costa.
Mercer, J. (2000). Notes on Attachment Therapy: Relevant Research and Theory. Prepared for    use by the prosecution in the trial of Connell Watkins, Colorado, April 2001.
Sarner, L., & Mercer, J. (2003). Statement to Human Resources Subcommittee of House   Ways   and Means Committee. http://       waysandmeans.house.gov/hearings.asp?formmode+view&id+1342.
Mercer, J. (January, 2005). Expert witness report. State of Utah Division of Occupational             and             Professional Licensing. Case number 2002-223.
Mercer, J. (April, 2005). Expert witness report.  Child custody case, Middlesex Family Court,       New Brunswick, NJ.
Mercer, J. (October, 2006). Expert witness report. Child custody case, Pasco County,      Florida.

Mercer, J. (ed.) (in preparation). Encyclopedia of child development. Vol. 6 (Family). Wiley-Blackwell.

BLOGS AND OTHER INTERNET MATERIALS:


“Attachment therapies and associated parenting techniques.” www.scienceinmedicine.org/policy/papers/AttachmentTherapy.pdf.

“Critical thinking and the mastery of child development concepts.” www.thelizlibrary.org/liz/critical-thinking.html.



 PRESENTATIONS:
Various presentations on child development and parenting issues to parent groups and
            training workshops, including CASA.

“Law, policy, and attachment issues”; presentation at the Second Annual Conference on   Attachment of the New Jersey Psychological Association. June 9, 2000, Newark, NJ (Social work CE units).

“Custody changes and their effect on children’s development”; presentation at New Jersey State Child Placement Advisory Council conference, April, 2001 (Social work CE units). 

“Bad language: How the professions confuse each other with words,” welcoming address             at conference on Attachment, New Jersey Association for Infant Mental Health,
            Piscataway, NJ, April, 2002 (Social work CE units).

“That cranky, crying baby”; presentation at National Association for Education of Young             Children  Conference on Health in Child Care, Princeton, NJ, May, 2002;      repeated May,             2003,  May, 2004.

“Warning Signals: When parents consider unusual mental health treatments for their          children”; presentation at Third Annual Multicultural Health Conference, Richard       Stockton College, Pomona, NJ, Sept. 2002.

“Misuse and abuse of attachment theory”; keynote speech at 2002 Annual Meeting, New Jersey Association for Infant Mental Health, Piscataway, NJ, Nov. 2002.

“Attachment Therapy: Science adversaries appeal to scientific evidence.” Institute of        Contemporary British History conference, “Science, Its Advocates and Adversaries”,       London, July 7-9, 2003.

“Analyzing Attachment Therapy”, at “Right From the Start: Supporting the Earliest          Relationships and their Impact on Later Years,” professional conference presented by Youth Consultation Services  Institute for Infant and Preschool Mental Health,        Newark, Sept. 24-25, 2003 (continuing professional education credit-bearing).

“Principles of Infant Mental Health”, at “What Does Infant Mental Health Mean to Me?”,            professional conference sponsored by New Jersey Association for Infant Mental            Health,            Gateway Maternal-Child Health Consortium, Northwest Maternal-Child Health         Consortium, Piscataway, NJ, Nov. 13, 2003 (continuing professional education credit- bearing).

“Attachment and Attachment Therapy: The Good, the Bad, and the Ugly”, at  annual       meeting, Gateway  Maternal-Child Health  Consortium. East  Orange, NJ, March          25,       2004 (Continuing professional education credit).
“Attachment.” Annual conference of New Jersey Association for Education of Young      Children, East Brunswick, NJ, Oct. 16, 2004 (continuing professional education
            credit)
Discussion of Attachment Therapy. “All in the Mind”, Australian Broadcasting Company,            Dec. 18, 2004. Transcript available at http://abc.net.au/rn/science/mind.

“Attachment: Social and Emotional Development from Birth to Preschool.” Conference    of         Coalition of Infant and Toddler Educators, East Brunswick, NJ, March 18, 2005.
“Attachment Therapy: Concerns on Unvalidated Treatments.” Institute for Infant and       Preschool Mental Health Didactic Series, Youth Consultation Service, East    Orange, NJ, May 12, 2005.

"Violent therapies with children: History and theory.” 9th  International Family Violence Research Conference, Portsmouth, NH, July 11, 2005.
Invited state delegate and New Jersey presenter, Infant Mental Health Systems Development Summit conference, sponsored by Mailman Foundation/Zero to Three. Washington DC, Sept. 22-24, 2005.
New Jersey Perinatal Mood Disorders training program presentations, 2005-2006.
“Dangerous therapies”, with Alan Misbach. LCSW.  Independent Educational Consultants Association conference, Philadelphia, Nov. 14, 2005.
"Attachment Therapy". Institute for Infant and Preschool Mental Health Didactic Series, Youth Consultation Service, East Orange, NJ, April 27, 2006.
"Attachment Therapy" comments, Paula Zahn show, CNN, Nov. 14, 2006.
"Attachment Therapy" comments, Court TV, Nov. 27, 2006.
"Understanding attachment." Delaware Valley Group, WAIMH. Dec. 1, 2006.

"Strategies for picky eaters." Jan 31, 2007, NJ WIC training, Ewing, NJ.
"Just the facts, ma'am: Asking and answering the right questions about evidence-based treatment." May 17, 2007. Florida Association for Infant Mental Health, Ft. Lauderdale.
Panel on secular parenting, moderated by Dale McGowan. Atheist Alliance International,
             annual conference, Arlington, VA, Sept. 29, 2007.
"Circumstantial Evidence: Evaluating Design and Details of Outcome Research" (poster presentation). Dec. 1, 2007. Zero to Three National Training Institute, Orlando, Florida.

"Theory of Mind: A New Approach to Attachment." Conference of Coalition of Infant and Toddler Educators, New Brunswick, NJ, March 14, 2008.
"Novel Unsupported Therapies: Pseudoscientific and Cult-like". With Monica Pignotti and James Herbert. International Cultic Studies Association conference, Philadelphia, June 27, 2008. 
"Attachment Theory, Evidence-based Practice, and Rogue Therapies: Using and Misusing the Concept of Attachment." With R.S. Pennington, L. Rosa, and L. Sarner. Wisconsin School Psychologists Association conference, LaCrosse, WI, Oct. 29, 2008.

"Are There Research-based Child Custody Evaluations? An Ongoing Case and an Ongoing Discussion." Annual  Conference, New Jersey Association for Infant Mental Health, Dec. 12, 2008, North Brunswick, NJ.
“A Problematic Parenting Pattern Associated With Child Deaths.” Eastern Psychological Association, March7, 2009, Pittsburgh, PA. 
“Personalities and Power Struggles: Discipline, Temperament, and Attachment.” Coalition of Infant and Toddler Educators Annual Conference, March 14, 2009, Somerset, NJ.
“Don’t Be So [Un]critical! Using Critical Thinking to Foster Mastery of Child development Concepts.”  Developmental Science Teaching Institute, Society for Research in Child Development, April 1, 2009, Denver, CO.
“Psychological Concepts and Measures in the Family Court”. Judicial Orientation, Essex Vicinage (NJ). Princeton, NJ, Oct. 2, 2009. (With Michelle DeKlyen, Ph.D.)
“Are There Research-Based Child Custody Evaluations?”. Conference on Infants and Children in the Courts, sponsored by Youth Consultation Service and NJAIMH; Clara Maass Medical Center, Belleville, NJ, March 19, 2010.

“Unconventional Psychotherapies: Some Questions About Their History.” Eastern Psychological Association, March 11, 2011, Cambridge, MA.
“Myths and Misunderstandings.” Conference of the Delaware Valley Group of the World Association for Infant Mental Health, Feb. 3, 2012, Philadelphia, PA.
Comments on Attachment Therapy and treatment of Russian adoptees. “Life with Mikhail Zelensky”, Rossiya-1 TV, Feb. 21, 2013.
“Fetal Psychology in Psychohistory.” Eastern Psychological Association, March 2, 2013, New York.

“Jirina Prekopova’s holding therapy: Scientifically founded or otherwise?” Conference of the International Working Group on Abuse in Child Psychotherapy, April 20, 2013, London.
“  ‘Nancy Thomas parenting’ in the U.S. and Russia: Another part of the holding therapy problem.”  With Yulia Massino. Conference of the International Working Group on Abuse in Child Psychotherapy, April 20, 2013, London.
Testimony on “conversion therapy” bill, New Jersey State Assembly committee, June, 2013, Trenton.
“Evidence-based treatment versus alternative psychotherapies.” APLA  (Associace pomahajic lidem s autismem; Czech division of Autism Europe), October 17, 2013, Prague, CR.
“What are holding therapies?” APLA, October 19, 2013, Samechov, CR.

“About attachment”. PA-IMH breakfast group, Oct. 3, 2014, Philadelphia, PA. APA CEUs given.

“Systematic misunderstandings about attachment. Nov. 20, 2014, ABCT, Philadelphia, PA. Preconference, “Social Learning”.

“Legislation to prohibit potentially harmful psychotherapies for children: Three cases.” Poster presentation, APA, Toronto, 2015.

“Challenges of disseminating evidence-based material through the Web.” . Symposium: The Role of Technology in Disseminating Psychology. APA, Toronto, 2015.
“Born that way! The role of temperament”. PA-IMH breakfast group, Oct. 2, 2015.

“Temperament.” Philadelphioa School for the Deaf, Jan. 27, 2016.