Monday, July 16, 2018
When Children Are Disruptive, Aggressive, Uncooperative: Thinking Outside the “Attachment Disorder” Box
It’s disturbing and even scary when children constantly disobey, disrupt, and behave aggressively toward other people. Small wonder that parents worry that they will not be able to control those child behaviors and the children will get worse and worse until they become dangerous criminals. Adoptive parents are often especially concerned because they wonder what unknown genetic element may be influencing the children’s development and personalities.
The answer given to these worried parents by some alternative psychotherapists is that the children are suffering from “attachment disorders”—that these disorders came from separation from the birth parents and adoption, or from painful medical experiences in infancy, or from institutional care. Alternative therapists may even claim that disruptive behaviors are part of the conventional diagnosis of Reactive Attachment Disorder, although they are not. When these claims about attachment effects are made, it is often suggested that the children need some form of “attachment therapy” that will correct the effects of their early experiences. If the children don’t get those treatments, the parents are told, they will become murderers, thieves, etc.—and their first victims will be their parents. This frightening argument can be very persuasive to anxious and uncertain parents, and they may well sign on for the treatment suggested.
Unfortunately, although the parents’ concerns are certainly legitimate, these disturbing behaviors have nothing to do with attachment, and even if they did, “attachment therapies” done by alternative therapists are not known to affect attachment. But what should they do? A recent article by Jonathan Perle, in Early Child Development and Care (2018), “Rethinking ‘wait and see’ philosophies for childhood disruptive behavior: A guide for paediatric medical providers” provides some suggestions about how families can work with their pediatricians to evaluate and work to correct disruptive behaviors like defiance, tantrums, aggression, and bad language in children from 2 to 7 years of age.
First, Perle points out that some disruptive behaviors like tantrums are very predictable in young children. Issues arise when the behaviors are more frequent than would normally be expected, persist to a later-than-usual age, cause disruption for the whole day rather than being resolved, or get more frequent with time. Difficult as disruptive behaviors may be for families, they cause even more problems for the children in the long run, as exasperated parents punish to the point of physical abuse, schools isolate and fail to educate the “problem child”, and other children reject and avoid the disrupter.
Perle notes that the longer these problem behaviors go on, the more difficult they are to treat. Children learn to use disruption as an effective way to avoid things they don’t want to do (and every child is asked daily to do things he or she doesn’t want). Parents, teachers, and other children drop their demands in order to escape the unpleasantness created when they press a disruptive child to cooperate. Thus both the disruptive child and other people daily experience the reward of letting the child do as he or she likes. Repetition and reward lead to stronger learning, and adult attempts to withhold that reward by insisting on cooperation lead to such an outburst of unwanted behavior that they usually give in.
In Perle’s paper, he comments on previous research on children’s disruptive behavior that gives us an idea of what is common, “normal” behavior and what is not. Tantrums in children aged 3 to 5 are usually brief, no more than 5 to 10 minutes, and they are not very aggressive. The children scream, fall to the ground, cry, make mild aggressive remarks (“Don’t like you!”), and may impulsively strike or kick out, but do not usually bite, kick or hit with intensity. Children this age do not usually attack animals or people or destroy property in any severe way. The usual behaviors may include some sulking and pouting after the tantrum, but as children get older and develop better language and self-regulation skills there is less of that. By age 5 or 6, severely aggressive behaviors and daily tantrums with refusal of compliance even when adult raise their voices would be considered unusual and treatment would be a good idea for the child and the family. Adults particularly need to learn and practice ways to guide the child toward compliance without causing the disruptive behavior to escalate or to be maintained.
Importantly, Perle notes that disruptive and apparently aggressive behavior may emerge from a child’s anxiety. For instance ,“ a child who is afraid of insects such as bees or ants may begin to protest, then cry, then ultimately hit or kick an adult to get away from insects when brought to a park. Similar reactive avoidance-based disruptive behaviours could be seen related to a variety of emotional fears including dark situations, inclement weather, separation from a caregiver, social settings, or in response to sensory-based sensitivities (e.g. a child exhibits a tantrum in response [to], or to avoid over stimulating items or situations such as clothing, noises, smells, foods, or light”. In these cases, the child may have learned that disruptive behavior is rewarded by helping the child escape from a frightening situation, and unless the child’s anxiety is understood it will be difficult to understand what the reward is.
These problems of disruptive behavior, although very real and potentially becoming worse, have nothing to do with attachment, nor will they be improved by “attachment therapies”. Effective treatments involve various evidence-based types of parent management training. Happily, when these are used, families benefit not only from improved daily life, but they are also likely to feel that everyone is now better “attached” than they were.
Sunday, July 15, 2018
Like many other poorly substantiated events and entities, some alternative psychotherapies get woozled. The ones that don’t get woozled do not have much success.
Alterative psychotherapies (APs) are the psychological equivalents of complementary and alternative medicine (CAM), but as they are hardly ever used in a “complementary” fashion, along with conventional evidence-based treatment, it makes sense to call them “alternative” alone. APs are lacking in research support, but they are also implausible—illogical, incongruent with what we know about development and personality, and dependent on unlikely mechanisms of change. They are potentially harmful, sometimes seriously so, but always causing harm in the sense of wasting time and money that could be invested in effective treatment. APs are not the same thing as experimental treatments; those are interventions that have not yet been supported by empirical work but that are logical, congruent with established information, and dependent on well-understood mechanism of change. Genuinely experimental treatments are used in ways that allow information about their effectiveness to be collected, but APs are not.
Woozling is a process by which people come to think that something exists or is effective just because they have heard of it before. This useful term comes from the Winnie the Pooh story in which Pooh and Piglet interpret their own tracks in the snow as an indication of ferocious beasts they call woozles—there’s no sign of the woozles except that Pooh and Piglet have seen those tracks before.
How can psychotherapies become woozles? Like the celery stick the toddler refuses the first time he sees it, but accepts after several presentations, woozled therapies begin to look acceptable to many when they become familiar—even if they might seem ridiculous at first sight. Therapies that are somehow connected with emotional attachment tend to be easily turned into woozles, because the concept of attachment is now so familiar. This process has occurred with a range of APs that claim a basis in attachment: Attachment Therapy, Holding Time, Festhaltentherapie, Dyadic Developmental Psychotherapy. When a woozle has developed, its proponents benefit because they no longer have to argue in favor of their assertions when “everybody knows” that something is correct.
Like the Bellman in “The Hunting of the Snark”, who said “what I tell you three times is true”, proponents of APs often depend on simple repetition to make their audience familiar with their claims and to facilitate the woozling process. But the world of the Internet offers many other routes to woozle status for AP advocates: Facebook pages, organizations of concerned supporters, and easy publicity in general. We are presently seeing the woozling process at work, as proponents of “parental alienation” (PA), its diagnostic methods, and its proposed treatments move forward to take PA out of the confidentiality of the family courts and into the public domain, so that public attitudes and pressure can in their turn exert pressure on the courts.
To recapitulate briefly, the theory of “parental alienation” is that in many cases where children of divorced couples are reluctant to visit one of their parents, the reason is that the other parent has created a state of alienation by persuading the child that the rejected parent is bad, abusive, or whatever. PA proponents have argued (without presenting supportive evidence) that alienated children suffer from deficits in critical thinking and/or may develop narcissistic traits, and therefore are developing both intellectual and emotional problems that will become quite serious. Because the preferred parent has caused these changes, the PA advocates argue, that parent has been abusing the child and should therefore lose custody. Several programs are offered with claims to restore the child to emotional health as indicated by a new acceptance of the formerly-rejected parent; all of these involve court orders for removal from any contact with the preferred parent.
The assertions of PA proponents are without acceptable empirical support and have other parallels with the alternative psychotherapies (APs) described earlier. They are working toward woozle status, though. How, then, is the woozling process going on?
There are many people who want to create a PA woozle, but I am going to choose one who gives a good example of how this can happen. This person, who has done absolutely nothing illegal or even obviously unethical, is Jennifer Harman of Colorado State University. She is a psychologist by training, apparently not a licensed clinical psychologist, but a “coach” who provides services . Harman has had a very active professional life (psy.psych.colostate.edu/psylist/Harman.pdf) with a long-term interest in health issues, particularly HIV. In 2016, it appears, she made her first presentation about PA.
So why do I point to Harman as an example of PA woozling? First of all, she has initiated the Colorado Parental Alienation Project, in which, as far as I can tell, she will have undergraduate research students analyze interviews with persons who believe they have been affected by parental alienation; this project is discussed at This seems to have become rather a tradition among PA researchers—find some people (rejected parents or rejecting children) who believe that PA has occurred, then ask them about it, but don’t compare them to people who do not believe this has happened to them. Do, however, make this research project widely known so that PA becomes familiar to a wide audience. . In other words, like the PA proponent Amy Baker, it appears, she is collecting information from people who believe they have lost their children’s affection because their ex-spouses campaigned to denigrate them, rather than for any of the other reasons (not even including experiences of abuse) why a child or teenager might resist contact with someone.
In a conspicuously woozling move, Harman had at the time of the CV linked above made a grant application for a project on strategies to address PA in schools. This is indeed a classic woozling approach, successful for organizations like Love & Logic and of course for a myriad of APs dating back to “patterning”. Put your assertions in front of teachers and parents, as well as kids who will learn from them, and the familiar woozle will begin to emerge, helped along by TV and print journalists who will announce the services the schools are providing.
But, you say, don’t people using conventional psychotherapies do these things too? Don’t they have websites, have research projects and advertise for participants, and offer training to schools? Yes, indeed they do. So why are those treatments not woozles? It’s because they have bothered to find the empirical support for their programs first , before making these public presentations. They have demonstrated effectiveness, not just assertions. Woozles, in contrast, use public presentation and the ensuing familiarity of their ideas to create an impression of empirical support when there is none—and this seems to be the direction some PA proponents are presently going.
Once again, I do not say that Harman is doing anything illegal, or even anything unethical by any ordinary professional guidelines. She has a perfect right to use information she believes is correct for any purpose she can. The problem is that while she and others move PA closer to woozle status by making it familiar to the public, it becomes essential for psychologists, lawyers, and other professionals to spend more of their time on anti-woozle duty and on communicating the realities to each other as well as to the wider audience. When presenting about PA at ABCT a couple of years ago, by the way, I got the distinct impression that few of the psychologists there had ever even heard of PA—that’s why I point out the need to communicate to each other as well as to the public.
Thursday, July 12, 2018
Many more eloquent writers than I am have recently protested against the separation of migrant children from their parents who have entered the United States illegally or in the hope of asylum. In the last day or so, journalists have published descriptions of the reunions of a small number of the youngest children with their parents. Those descriptions are not surprising, although they are not what we would expect when we look at the separations and reunions “adultomorphically”—that is, as if the children should have the same thoughts and emotions that we adults would have if we were in their shoes (which they don’t).
What seems to have surprised some people is that 2- and 3-year-olds who have been very distressed by separation from their parents do not seem happy when reunited. They often stare as if they don’t recognize the parent, then begin to cry. Although they have been separated for only a few weeks, there seems to have been a dramatic impact on their responses to their parents. If they are followed up for further weeks or even months, it’s predictable that they will still behave differently than they did before, but that their behavior now will involve clinging to the parent “insatiably” as well as showing irritability and easy anger.
Parents who have gone away for a cruise or other child-free vacation for a couple of weeks, leaving a young child with a familiar grandparent or babysitter in their own home may recognize some of this mood and behavior that occurs on their return. Even pick-up after a day in child care may be fraught in the same way, with the child snubbing the parent and resisting going-home tasks like putting a jacket on.
Years ago, the attachment theorist John Bowlby made a short film called “Nine Days in a Residential Nursery” which you can read about at http://www.robertsonfilms.info/young_children_in_brief_separation.htm. In this documentary film, we see 17-month-old John who is left in a nursery while his mother is having another baby. His father visits occasionally. As was considered normal in the 1940s, the mother is in the hospital for over a week and the father is not expected to care for John during this time. John’s distress and difficulties with eating and sleeping are clear, and in short order he develops a cold as well. There are many other toddlers in the nursery, some of whom live there full-time and are much more noisy and aggressive than John is used to. The nurses are kind in an impersonal sort of way, but change frequently according to their work schedules, and there is no single reliable person that John can seek for comfort. When John’s mother comes home and comes to pick him up, he snubs and resists her and she is surprised and distressed. Whether her own distress increases John’s is not discussed.
John’s experience has some but not all the elements experienced by young migrant children separated from their parents. The separation is abrupt and inexplicable from his point of view and he does not have enough language development to ask or understand what is happening. He is placed in a completely strange physical environment, with strange and ever-changing caregivers, and with large numbers of other children. No one knows (or apparently cares much) about his own familiar habits, his expectations, or his ways of communicating that work well with his parents but not with strangers. When his mother returns, she too is distressed, and her face tells him that something scary is happening—he can’t know that it is his own behavior that is scaring her.
In addition to all these elements they share with John, today’s separated migrant children have already been brought far from their familiar homes and have missed their usual schedules of eating and sleeping for weeks or months in the past. They may be suffering from untreated illnesses at a time of life when fatigue, fear, sickness, or injury would normally make them seek comfort from familiar caregivers who are now absent. Whatever language development they have attained is of little use if caregivers do not speak their languages. The children’s forced removal from their parents is carried out by intimidating people, frightening both parent and child, and the parent’s expression of fear, added to the probably grim expression of the official, add to distress. The separation then lasts for much longer than what John experienced and in some cases will undoubtedly become permanent. Even when reunion occurs, the parents’ fear, depression, and distress during their own detention make it difficult for them to respond sensitively to the children’s needs.
Without wanting to get into the morass of discussion about separation of migrant parents and children, I do want to point out that the young children’s experiences do not have to be so distressing. It would cost money to make them less so, so I am sure this won’t happen. However, John and Joyce Robertson, colleagues of John Bowlby, showed that the distress of separated toddlers and preschoolers was much less if they had a consistent, predictable, sensitive, responsive caregiver who would work to understand their communications and to offer comfort and help as needed. Insights from child care can also be helpful in supporting young children in these stressful conditions; for example, not only is it important to have a low ratio of children to caregivers, but young children do best in small groups rather than in a large room with many children and adults. Caregivers trained in sensitive practices like Floortime can also buffer the effects of the adverse experiences of separated children.
But, as I said, that would all cost money…