Concerned About Unconventional Mental Health Interventions?

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

Thursday, October 19, 2017

Questions About Eye Contact and Autism

Several people have recently tried to post comments about infant eye contact and autism on the What, Where, When page. You can't do it, it's filled up! And I can't put your queries or my answers there, either.

Please use this page for posting eye contact questions.

One recent question was about prematurely-born twins-- I just want to remind everyone that developmental age for premature babies should be counted from when they should have been born, not from when they were born. You can't expect babies born 6 weeks early to do at one month the same things done by babies born at full term.

Sunday, October 8, 2017

Talking Attachment Trauma: Sense and Nonsense

I recently received some court documents that included the statement of a psychiatrist who was arguing as an expert witness against a proposed custody change, from a mother who was accused of “parental alienation”, to the father who was alleging that the mother had caused their children to dislike and avoid him. The psychiatrist discussed the family history and the children’s attitudes and behavior in detail, emphasizing that adolescents are often temporarily “alienated” from their parents without having been encouraged to take this position by anyone. The psychiatrist concluded that “parental alienation” was not at work in the family in question, and I think he was quite correct in that conclusion.

However, this expert witness then proceeded to take a very risky step to cement his argument. Not satisfied with having shown evidence that there was no “parental alienation” going on, he marched forward onto thin ice by claiming that individuals in late childhood or early adolescence would suffer from “attachment trauma” if separated from their primary attachment figure (in this case, the mother). This was nonsense, and the expert and the children were very lucky that no one on the opposing side apparently knew that it was nonsense.

It is certainly true that most children between the ages of 6-8 months and 18-24 months will show extreme distress if abruptly separated from familiar caregivers. If the separation goes on for more than a few days, toddlers become lethargic and depressed and do not eat or sleep well. To understand what is happening here, we need to keep in mind that the attachment relationship the children originally experienced was one that penetrated their entire lives. Caregivers who are familiar attachment figures understand a child’s signals and cues and respond to them promptly and in ways a child can anticipate. Good caregivers are able to predict what will scare a given child and what words or actions are comforting to a particular child when he or she is distressed, so they can often “buffer” unpleasant experiences and help keep the child calm and engaged. A caregiver’s understanding of a given child needs to be and usually is quite individualized, because what works with one child will not necessarily work with another, even with respect to such basic caregiving functions as feeding and putting to sleep.

A young child who is separated from familiar caregivers and given to the care of a stranger loses all of the details of familiar experiences and finds that the whole world has altered, not just the presence of one person. Communication that used to work smoothly may no longer work at all until the child and the new caregiver come to know each other. All of these factors contribute to the distress of the toddler separated from a familiar caregiver, and if the environment has also changed because the child is taken to the new caregiver’s home or to a hospital, there is still more distress for the uncomprehending toddler.

These problems become gradually diminished if separation takes place after the child has mastered some communication through speech, assuming that the new caregiver and the child share a language. They are also diminished if the new caregiver can give plenty of time to the child and can make serious efforts to offer comfort and help—as one of John Bowlby’s colleagues showed, these circumstances can greatly lessen the traumatic impact of separation (although after a week or more of separation, toddlers may show their distress by “snubbing” a parent who returns for them).

When older children and adolescents are abruptly separated from a familiar caregiver, their responses are vastly different from what we see in toddlers. It is certainly true that under some circumstances they will show distress and concern, sadness and even depression. But these responses are not drastically different from what we would see in an adult who is suddenly abandoned by a spouse, whose parent dies, or whose close friend moves far away. Not all disruptions of life are traumas, and certainly not all losses of intimates are attachment traumas in the sense that we might use that term for a toddler’s experiences. An older child or adolescent prefers not to be separated from a loved parent unless he or she wants a temporary separation and can control how it happens. Toddlers do not ever seem to want a separation, but older children and adolescents do want choices about separation and use those choices as part of their developmental task of achieving autonomy. To be forced into a separation is distressing to the older child in part because this situation contradicts the child’s developing autonomy. In addition, a separation like custody change almost invariably means that the child or adolescent also loses many familiar parts of life—his or her own room, friends, neighborhood experiences, and possibly even a school situation if the child is attending a public school and moves out of the school district. These changes are distressing and will probably produce intense complaints and resistance on the child’s part, but they are not attachment traumas, or even traumas at all.

I am not intending to argue that custody changes after allegations of “parental alienation” are a good idea—I am fairly sure that in most cases they are not. I simply want to point out that we need to use terms like attachment and trauma in ways that are developmentally appropriate. The fact that an abrupt separation from a caregiver can be devastating for a toddler does not mean that the result is the same for an older child or an adolescent. If it were, we would not see sleepaway camp as a step toward maturity, nor would there ever have been boarding schools for privileged children.  Whatever they had to do with the battle of Waterloo, the playing fields of Eton were not the site of attachment traumas.