The "Parental Rights Amendment"--Or, the Parental Interests Amendment

As www.parentalrights.org shows, a small group of senators and representatives are supporting what they call a “Parental Rights Amendment” to the U.S. Constitution. Here are the provisions of the proposed amendment:

1. Parents have a fundamental right to direct their children’s upbringing, care, and education.
2. Parents have the right to choose from public, private, and religious schools or to choose to school their children at home.
3. Infringement on these rights is allowable only when the highest levels of government interest are involved.
4. This does not extend to the right to make a decision or action that would end a child’s life.
5. No treaty or international law may be construed to modify these provisions.

The basic concerns here seem to be in favor of parental choices of health and medical care (but not parental decisions to terminate pregnancy or to withhold treatment from a severely compromised newborn). Another concern--  apparently secondary, but possibly not so—is to continue to prevent the U.S. from ratifying the United Nations Convention on Children’s Rights and the United Nations Convention on the Rights of Persons with Disabilities. (Efforts to avoid ratification of the UNCCR have been successful for almost 30 years now, so chances are that www.parentalrights.org will continue to be happy about this.)

Arguments in favor of institutionalizing parental rights often focus on errors of child protective services staff who have “taken away” children inappropriately. There is no question that these problems occur with alarming frequency (see for example http://childmyths.blogspot.com/2013/08/when-attachment-therapists-dont.html).

However, it would be a great mistake to imagine that these errors are more frequent than erroneously failing to take custody of a child when the child is in real danger. The Barahona case in Florida was an egregious example of this, involving the common problem that caseworkers liked and thought well of parents and therefore did not even bother to contact the endangered children (http://childmyths.blogspot.com/2011/07/adoption-trust-compacency-and-barahona.html). A recent case was that of Timothy Jones of South Carolina, who is accused of killing his five children and driving with their bodies to Alabama (Blinder, New York Times, Sept 12, 2014; A18. According to the Times, Jones had been investigated in May and August 2014, following reports that one son had “extensive bruising”. The August investigation report spoke of Jones as “overwhelmed” by caring for the five children, ages 1 to 8 years, on his own following a divorce. Interviews with the children suggested that he depended on physical punishment as discipline, having the children do push-ups and beating them with a belt, and that he used rough horseplay. The May investigation concluded that there was not enough evidence for an arrest. (There had been earlier investigations of the conditions of the family home while Jones’ wife was still living there.)  

Advocates of a Parental Rights Amendment seem to be concerned only with errors of child protective services staff that lead to mistakenly taking the child into custody. The errors that leave children in the custody of parents who later injure or kill them are not mentioned. (To be fair, the website does state that prevention of abuse or neglect by governmental agencies would be continued under the amendment, because such prevention is a governmental interest of the highest order. However, it is unclear what parental actions would be included as neglectful or abusive under the amendment.)

For some decades now, U.S. courts have made decisions about child custody on the basis of the ill-defined term “the best interest of the child”. I refer to this term here for one reason only: its very existence indicates our awareness that the best interest of a child may not be the same as the best interest of a parent, and neither may be the same as the best interest of the state. All these interests may overlap to a greater or lesser extent, but they are not necessarily identical. This point is made even more  clear by the fact that the advocates of a Parental Rights Amendment have as a major concern the rejection of the Convention on the Rights of Children. They want priority given to the interests of parents which do not necessarily overlap with the interests of their children. (Because the concept of a “right”, fundamental or absolute, is difficult to define, I would suggest that we speak of parents’ and children’s interests, not their rights. This terminology may help us avoid the influence of the “natural law” system and focus on the outcome we desire.)

Modern democratic government is based on acceptance of the fact that different groups (and government itself) have different interests, and the principle that balancing the interests of different groups is the best way to assure survival of the entire community. Because interests of parents and children may not be identical, and because children are not competent to make use of civil rights and therefore possess them in a limited way only, the best interest of the government and community is in the protection of children from a range of dangers, including those that may unfortunately arise from their caregivers. To prioritize parental rights through a constitutional amendment would be to interfere with both children’s interests and those of the larger community as a whole.  Think about the amendment as a Parental Interests Amendment and I think you’ll see what I mean.

I don’t believe proponents of the Parental Rights (or Interests) Amendment are concerned about the outcome of balancing interests that I mentioned in the last paragraph. On the contrary, their motives are ideological rather than pragmatic. Exploration of the www.parentalrights.org site shows the influence of charismatic Christian leaders, for whom the establishment of correct lines of authority is an overriding goal. Legal arguments provided by parentalrights.org come from the law school of Regent University, a Christian school founded by the charismatic Pat Robertson. To put parents firmly in charge, and to avoid the “ungodly” influences of the United Nations (a concern of fundamentalists for many years now)--  these are goals that exist because of religious and political beliefs about authority, not because their outcomes are held to have value for the community.   

More about Nasty Tastes and "Consequences" for "Choices"

Some time ago, I posted comments about the suggestion of a “nanny blog” that children should be disciplined by having unpleasant substances placed in their mouths (http://childmyths.blogspot.com/2012/03/putting-nasty-tastes-in-childs-mouth.html). I gave a number of reasons why this approach is inappropriate and potentially harmful to children.

A few days ago, a comment on that post was submitted by “Adam”. He said, “Since when is giving someone vinegar in any way hurting them. If you do your research you will see that vinegar has many healthy benefits to them. Giving it as a consequence is a deterrent. While I agree with spanking too, does this not hurt? The idea is not to hurt but to teach that for a bad choice comes a consequence. You may think that taking away a little tv time will do the trick but you have to consider the situation. Any kind of punishment is wrong if not done with love. If any of these are done out of anger they are wrong.”

It’s difficult to tell exactly what Adam’s argument is, of course. The original post had to do primarily with the recommendation of Tabasco sauce and pepper for disciplinary techniques, although vinegar and lemon juice were mentioned--  so it’s really irrelevant whether some people believe that vinegar is good for you (as are some of the other substances mentioned, including soap, when used for appropriate purposes).

The central point of Adam’s argument, I think, has to do with “consequences” and with punishment, and with the similarities and differences between the two. Like many other people, Adam seems to confuse these terms, and to follow a line of thinking in which a parent might say “I consequenced my daughter.”

I think the confusion shown by Adam and others can be traced to belief systems like that characterized by Foster Cline’s commercially-successful “Love & Logic” program. Perhaps finding that parents felt anxiety and guilt when they saw themselves as punitive, L & L introduced “consequence” as a transitive verb. The L & L group also created a false analogy between the impersonal painful effects of the physical environment on those who ignore its rules, and the personal administration of discomfort by adults who believe that painful experiences should alter a child’s unwanted behavior.

Ignoring the realities of the natural world does have its consequences, often uncomfortable and sometimes even fatal. Don’t wear your jacket when the temperature is dropping, and you might be miserably cold. Jump out a second-story window, and you could die or at least be seriously injured. It doesn’t matter who you are or whether some other person decides you’ve been bad or not--  these consequences are always the same, when conditions are the same.

Things parents do to children with the intention of discouraging unwanted behavior are punishments, not consequences. They do not just happen naturally, but occur when the adults make decisions about the behavior and how to respond to it. Unlike consequences, punishments don’t happen in exactly the same way every time. Sometimes parents decide that an unwanted act was accidental and don’t punish it. Sometimes they are too tired to follow through. Sometimes punishment is given so long after the unwanted behavior that it is completely ineffective. And sometimes there is no punishment because the parent does not find out about the act at all (and in that case, the child experiences all the reward value of whatever it was he wanted to do, without any associated punishment).

A strange but true point about the use of punishment is that both rewards and punishments are most effective when they are small. Intense, frightening punishments arouse so much emotion that children may not be able to understand their connection to the unwanted behavior. That would be likely to be the case when young children are “hot-sauced” as a punishment. Mild punishments like a raised parental voice or simply being physically stopped from an action, if they follow immediately or even better coincide with an unwanted act, are much more effective than intense punishment.

A recent webinar about working with FASD children, provided by the Canadian group CHNET-WORKS (www.chnet.works.ca) gave some useful hints about helping children comply with adult wishes. These were directed primarily at FASD problems, but also considered relevant to autistic children and others with problems of brain functioning. These children may be seen as noncompliant or oppositional rather than as unable to obey adult rules, although the latter point may be the real case.. Dan Dubovsky of SAMHSA gave some especially useful suggestions that are applicable to many children and adolescents.

One important point is that multiple rules or multiple directions may be confusing to some older children, just as they are to toddlers. When the adult says “take those clothes upstairs and put them away,” and the child does not follow through, the problem may well not be deliberate disobedience, but a state of confusion or even the inability to remember the second instruction after the first has been accomplished. Breaking a task into small, definite pieces may be necessary before poorly-functioning children can complete the entire task.

Dubovsky also suggested that only a reward system be used, rather than  including punishment or “consequences”. Children with cognitive difficulties respond well to small rewards (including praise), but can be upset or confused by punishment--  and this would be especially true of punishments that are delayed, as I mentioned earlier.

Another way of smoothing life with a poorly-functioning child is to give help in handling transitions--  getting up, going to bed, leaving for school, having company come. The child may need repeated warnings of what is going to happen in order to tolerate the change, even though these transitions occur every single day and adults imagine that the child will be comfortable with them.

As a final point, I want to refer back to one of Adam’s statements and point out how this way of thinking can cause poor handling of some children. Adam said that  “for a bad choice comes a consequence.” This “good choice, bad choice” talk is very common nowadays, and I think is harmless with well-functioning children, although it’s really just the modern way to say “good girl” or “bad girl”.

However, the idea of a “bad choice” contains within it the assumption that a child is making a choice, and that the ensuing action is voluntary. In other words, the reasons for all behaviors are thought to be within the child. This assumption is called the “fundamental attribution error”, and it is a matter of ignoring or minimizing the impact of external factors on behavior. To avoid the fundamental attribution error, it is important to realize that the child’s actions may be shaped by external factors, as much or more than they are by his or her decision about what to do. A crowded, over-stimulating room may cause disorganized, “hyperactive”, distractible behavior. An angry adult who appears threatening may cause stonewalling or lying. A set of overly-complicated instructions may be followed by failure to comply. These external factors can be altered by adults in ways that can change child behavior--  but this will not happen until the adults drop the idea that children’s behavior is necessarily a matter of “choice”.

Following some of the suggestions in this post will work much better than putting unpleasant substances in children’s mouths.

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Help for Sick Mother of Autistic Boy in Czech Republic

About a year ago, I posted an account of my visit to a conference held by APLA, the Czech autism group (http://childmyths.blogspot.com/2013/10/holding-therapy-from-westminster-to.html). While I was in Prague I met many friendly and concerned researchers, therapists, and parents of autistic children. One was Marcela, the mother of an autistic boy, who may be seen in healthier days at www.youtube.com/watch?v=8Z9x-wwh-UGs.

Very sadly, Marcela had an illness that has now become much worse and that will probably have no good outcome. Her greatest wish is to be able to have her autistic son cared for in their home during the rest of her life, and afterward, rather than having to have him placed in an unfamiliar care setting that would be difficult for him to cope with. Social services in the Czech Republic cannot help with this.

The APLA group (www.apla.cz) has set up a fund for people who would like to respond to Marcela’s very understandable wish. I made a contribution by wire transfer this morning. If you would like to do so also, here is the information you will need:

IBAN CZ864000000000511144082   (that’s 9 zeroes in a row)  SWIFT/BIC SOLACZPP

Recipient name: APLA

Recipient address: Brunnerova 1011/3, Prague 17, Czech Republic   

Bank name: LBBW Bank CZ A.S.

My correspondent, Alena Bilkova of APLA, also included the information: text “Erik”, but my bank did not use this.

If you would like more information, you can contact Alena at a.bilkova@volny.cz. Alena does not speak much English, but her daughter can translate for her.

Sept. 19, 2014: Sadly, Marcela died a few days ago. Her son's father has stepped forward to say that he will learn how to care for the boy, but he cannot quit his job, so continuing contributions to the fund will be much appreciated.

More Mistakes About RAD: Time to Mow the Hay at Miracle Meadows

The Miracle Meadows School in Salem, West Virginia, has made the local news a good deal recently. The commitment of the school to an unconventional view of Reactive Attachment Disorder and its treatment--  a view that has been associated with child injury and even death—means that this situation should receive much broader attention from parents and child maltreatment experts.

On Aug. 19, 2014, Miracle Meadows had its school exemption status revoked (www.wboy.com/story/26349774/miracle-meadows-school-employees-to-face-additional-charges). The exemption in question is one that frees religious schools from many of the requirements for public and independent schools (Miracle Meadows is a Seventh Day Adventist School).  One of the reasons for revocation was that a staff member apparently used a chokehold until a child lost consciousness. This event was followed by the arrest of a major figure in the school for child neglect and abuse (www.wvmetronews.com/2014/08/22/founder-of-miracle-meadows-school-arrested-on-charges-involving-child-neglect-and-abuse/). The school responded with denial and a press release stating plans for a lawsuit against the state agency (www.wdtv.com/content/files/Press%20Release%2082514.pdf).

What is the real story here?

I first came across Miracle Meadows in 2010 when I was asked to testify in a case involving an adopted Russian girl living in a southern state. “Marjorie”, as I’ll call her, had been adopted along with a sibling from a Russian orphanage. The adoptive parents had wanted only the sibling, but under pressure agreed to take “Marjorie” as well. However, on getting home, it appeared that they did not like “Marjorie” very much, whereas they were very pleased with the sibling. They put “Marjorie” into holding therapy with a pair of local licensed professional counselors who had been trained by the state some years previously to do this alternative therapy. Feeling no more pleased with “Marjorie” than they had before the treatment, the adoptive parents sent her several times for “respite care” with licensed foster parents. This did not do the trick either, so the adoptive parents decided they did not want her any more. The foster parents agreed that they would take her, and the counselors broke the news to “Marjorie”, who apparently did not even have a farewell meeting with the people who had brought her from Russia. How the legal steps that should have been part of this “re-homing” occurred seems to be unclear.

The foster parents were also committed to the alternative view of Reactive Attachment Disorder, as advocated by Nancy Thomas and Foster Cline, but not by any conventionally-trained practitioner using evidence-based methods. After some time with the foster parents, “Marjorie” ran away, but was found and brought back by a sheriff’s deputy. When she ran away a second time, the deputy made an excuse to come into the house, where he saw evidence of unusual treatment like an alarm on the bedroom door and little furniture in the room (I don’t know whether the deputy actually knew this, but these items would be congruent with Nancy Thomas’s advice.) An investigation followed, and in the midst of it, the foster parents sent “Marjorie” out of state to Miracle Meadows School.

Let’s have a look at this school and its history. In 2000, the West Virginia Department of Health and Human Resources brought a suit against William and Gayle Clarke and Miracle Meadows School, asking that the Clarkes turn over medical an school records of students enrolled at Miracle Meadows, in connection with an ongoing investigation of allegations of abuse and neglect, and that students and staff be made available for interviews in connection with the investigation. The investigation had begun with two girls running away, complaining of sexual abuse, and later recanting after having been returned to the school, then stating that they were afraid to remain at the school. Further investigation led to statements by DHHR that one boy had been forced to spend the night in a 5 X 5 secured room with a space heater, and that another had been beaten with a board.

The circuit court denied the DHHR suit on the grounds that requiring the Clarkes to hand over records would violate their constitutional rights against self-incrimination. The appeals court affirmed this (www.courtswv.gov/supreme-court/docs/fall2000/27915.htm).

It appears, however, that the school administration in its own statements has incriminated itself, not necessarily of beating children with boards, but of its commitment to non-evidence-based, alternative beliefs about Reactive Attachment Disorder and methods of treating behavior problems in children and adolescents.

For example, the school web site lists the same notional symptoms of Reactive Attachment Disorder , like fascination with blood and gore and lack of eye contact “on parents’ terms”, as are stated by Nancy Thomas and other proponents of holding therapy (www.miraclemeadows.org/#!untitled/c1hax). This list of symptoms is in no way congruent with the criteria for diagnosis of Reactive Attachment Disorder given in DSM-5 or any earlier DSM edition. The school application form provides a similar checklist (www.media.wix.com/ugd/b07d53_d482b005fd8ca609991e8c059aed0fad.pdf ).

The school has also presented a statement (www.media.wix.com/ugd/b07d53_599f36a47eb64f74ac6b09fbd4d6424a.pdf ) giving inaccurate material about RAD, claiming the usefulness of the alternative psychotherapy qEEG, and referencing training on RAD done in the state where “Marjorie” lived. The statement is signed by two licensed professional counselors who were certainly working outside their appropriate scope of practice if they claimed to be able to diagnose and treat this disorder . One of the signers had been involved in the case of “Marjorie”.

The school had posted a statement about Reactive Attachment Disorder by its division CARE, the Center for Attachment Resources and Enrichment (www.miraclemeadows.org/#!CARE-Releases-Statement-About-RAD/c4sd/F1882D98_74AA-4AE6-BEB9-E39ED2F32CB3 ), but although the link to this statement worked several days ago, it does not work for me today.

In addition, several Internet sites address the involvement of Miracle Meadows with alternative views of Reactive Attachment Disorder. www.gofundme.com/8xs8fg says Miracle Meadows specializes in RAD, but this parent apparently found the financial and other demands of the school excessive. www.3abn.com/Series/CLR/CLR000099A.html  provides a transcript of radio program referring to the made-for-TV Nancy Thomas movie “Child of Rage”, which has done so much to spread misinformation about attachment disorders. Finally, of particular interest is www.archives.adventistreview.org/article/6088/archives/issue-2013-1506/alternative-adventist-education , which states that Miracle Meadows staff were undergoing “training in RAD” in 2013 but fails to give the identity or the qualifications of the trainers.

The application form for Miracle Meadows (www.media.wix.com/ugd/b07d53_d482b005fd8ca609991e8c059aed0fad.pdf ) asks parents to agree that they understand the “activities” associated with the school and to authorize these activities, stating that “I am aware of the risks involved in such activities”. Parents must also agree with other rules, for example that “… parents are never to discuss leaving MMS with their students without prior permission from MMS administration. Doing so is grounds for immediate dismissal of the student.”  “…students are dismissed if parents do not pay tuition and/or are involved in unresolvable loss of trust with the school which impacts the students.”  This highly authoritarian position is congruent with the authoritarian ideology of Cline and Thomas, as exemplified with Cline’s statement years ago that “all bonding is trauma bonding.”

Practitioners of dangerous alternative therapies are rarely or never accused of criminal activity until children are injured or killed. The law prohibits child neglect and abuse, but only in a few cases has it named specific treatments as forbidden. Some states have now passed laws against “conversion therapy” as a way to change sexual orientation, and it would be a real step forward if that legislation could be expanded to include other potentially harmful treatments that are abusive of children. New laws should focus particularly on residential treatment centers and boarding schools where children may essentially be prisoners, without protection of any kind against ill-advised or overtly sadistic staff members.  

The Miracle Meadows lawsuit against West Virginia DHHR should be met with vigorous investigation of practices in the school, and would be an ideal foundation for legislation that would prohibit holding therapy and related methods. It’s very disturbing to me that as a society we fret about spanking with the open hand, while we have not yet come to terms with the existence of barbaric practices like those that seem to have prevailed at Miracle Meadows.

DSM-5 and Autism

I had the good fortune yesterday to attend a lecture about the DSM-5 approach to diagnosing autism, given by Judith Miller of the Center for Autism Research at Children’s Hospital of Philadelphia. Dr. Miller provided a good deal of interesting information, and I want to summarize some of this.

Insurance companies adopted DSM-5 on January 1, 2014, and that fact caused much concern among parents of autistic children (previously diagnosed with Pervasive Developmental Disorders),  who were afraid of losing services that their children needed and had been receiving. This worry was triggered by the awareness that DSM-5 had dropped Asperger’s disorder as a diagnostic category and had removed Rett’s syndrome from the new Autism Spectrum Disorder diagnosis. However, children who had received the autism/PDD diagnosis in the past are “grandfathered”  into the new category and do not lose services. (This applies primarily to children diagnosed previously with Asperger’s syndrome. Rett’s syndrome is no longer a psychiatric diagnosis, but a medical one, as a genetic cause for it has been discovered.)

DSM-5 requires a narrative description of a child’s atypical behavior. This narrative includes reference to eight categories of problems, and assessment of the severity of each. It’s notable that delayed language, long considered a criterion for autism, is no longer included; assessing language problems is important, but these difficulties are not unique to autism, and children for whom language is the major issue should be evaluated for social (pragmatic) communication disorder.

Here are the eight categories to be considered in diagnosing Autism Spectrum Disorder. All need to be considered with respect to typical behavior for the child’s age, rather than in absolute terms.

1.      Nonverbal communication. This includes age-appropriate use of eye contact, gesture, and body language as means of communication.

2.      Difficulty with relationships. This applies to relationships in general, not just to peer relationships, and it includes delays in pretend play.

3.      Social-emotional reciprocity. Depending on the child’s age, this can include delays in playing peek-a-boo or other social games, difficulty in picking up social cues like facial expression, lack of social sharing through telling interesting things or attending to others’ interests, and impaired conversations in which the child is unable to start a conversation, to end one, or to take turns in speaking. People may be “used as tools” (for example, child places mother’s hand on a doorknob to get it opened) rather than approached with communication.

4.      Circumscribed interests. The child’s interests are intense and very specific, are often not interesting to others, but sometimes, as in the case of sports or music, may be the foundation of social interactions.

5.      Routines and resistance to change. The child may not be able to process what is happening outside the routine, and disturbance of the routine may be followed by a tantrum. The behavior may resemble anxious behavior or obsessive and compulsive patterns. (Typically-developing toddlers also show this tendency to some degree.)

6.      Stereotyped movements, speech, object use. Flapping, pacing, and bouncing movements, and repetitive or echolalic speech are included, as is the intense need to hold onto specific toys. (Again, toddlers’ typical development may have these features.) These behaviors are rhythmic and volitional rather than random fidgeting or involuntary tics, and the child seems “zoned out” while doing them.

7.      Unusual sensory reactivity or interest.  Some, but by no means all, children with ASD are overwhelmed by lights or sounds or textures, and some are “obsessed” by spinning objects, flashing lights, or smells. (Although these behaviors are sometimes attributed to sensory integration disorder, there is little evidence that such a disorder exists.)

8.      Onset in early developmental period. The previous criteria for diagnosis of autism had specifically stated that the disorder began before 30 months, but this criterion is now less stringent.

Several of these criteria must be met in order for a child to receive the new ASD diagnosis, but few children will show all of them. As Dr. Miller’s presentation pointed out, autism is a heterogeneous disorder, and in addition to that fact, there may well be co-occurring problems to be diagnosed. It’s important to avoid the “diagnostic overshadowing” that was shown decades ago in assumptions about Down syndrome--  that is, that if a child had Down syndrome, all difficulties were explained by that diagnosis. Any child may have ASD and also have medical problems and/or additional psychiatric or developmental diagnoses.

Readers of this blog regularly send in queries about very young infants and the possibility of identifying autism on the basis of their current behavior. Looking at the list of criteria above shows that infants under 6 months do not have the abilities to do any of these things other than using eye contact as a social signal, and typically-developing infants under 3 months do very little even of that. Until a child reaches an age where typically-developing children are able to behave in ways relevant to the rest of these criteria, the child’s atypical behavior cannot be used to assess for ASD. Because we are all concerned nowadays about the need for early identification and intervention with problems, young parents are afraid of missing some very early cues and passing some “window” during which their child could be helped. Nevertheless, although there is some work going on to try to identify ASD problems earlier, this cannot yet be done. And, in all candor, it would not be clear how to intervene with young infants even if early diagnosis were possible. The only advice that can be given is that good development is supported by sensitive and responsive parenting, and this presumably applies to children with ASD as well; such parenting may not prevent or cure ASD, but it will help to provide the best developmental outcome for a child’s particular issues.

An audience member at Dr. Miller’s presentation spoke of her experiences with parents who are willing to accept the ASD diagnosis before there has been a complete diagnostic work-up--  even, at times, when they see that their child shares some characteristics with another child who has been diagnosed. This may again have to do with the belief in the importance of early identification and intervention, or with the understanding that services are available for a child with the ASD diagnosis when they may not be there for a child with somewhat similar problems but no diagnosis. However, everyone should understand that ASD is not necessarily easily diagnosed, and that excellent training and experience are needed to put this diagnostic skill within a professional’s appropriate scope of practice. Remember, too, that there are specific genetic and other medical problems that may resemble aspects of ASD, but their treatment needs to be rather different than what ASD would require.

Does Reactive Attachment Disorder Have Anything to Do With Cause and Effect Thinking?

A reader’s recent comment referred to the tendency shown by believers in the “Attachment Therapy” system to attribute children’s behavioral difficulties to a lack of  cause-and-effect thinking. At www.fromsurvivaltoserenity.com/2014/08/educating-about-rad.html, a graphic is presented showing dozens of “symptoms” of Reactive Attachment Disorder, few or none of them to be seen in the DSM-5 list of criteria for the disorder. Among them, problems with cause and effect thinking are noted. A document for teachers at www.attachmentnewengland.com/documents/educators/pdf also refers to such problems, and claims that children with Reactive Attachment Disorder cannot learn from behavior modification methods that use reinforcement for desirable behavior. (The latter document warns parents against using sarcasm, while providing a list of obviously sarcastic responses to children--  a point that raises questions about the sincerity of the writer—and states that attachment begins prenatally, raising further questions about the writer’s knowledge of the field.)

Strangely, however, these documents also stress the belief that children with behavioral difficulties can manipulate, exploit, and fool intelligent, well-trained, and experienced adults. How do they manage this, one must ask, if they cannot associate cause (their own behavior or speech) with effect (the beliefs and behavior produced in the apparently hapless adult)? For that matter, without some mastery of cause and effect associations, how can they do anything at all in the way of self-care, schoolwork, household chores, or play?

It does seem that just as these documents are not really talking about Reactive Attachment Disorder when they use that term, neither are they really talking about understanding cause and effect. Let’s have a look at the development of cause and effect thinking first, then maybe I can hazard some guesses about the real issues referred to by that name.

Learning about cause and effect is a gradual process, but one which begins quite early and is slowed only by cognitive impairment. Jean Piaget, the famous theorist of cognitive development, first described some steps in understanding cause and effect almost a hundred years ago. He suggested that between about 4 and 8 months of age babies begin to notice the effect of things they do, like kicking their feet or making sounds. They discover that sometimes their activities seem to make interesting events (like an adult smiling at them) continue--  but this little insight into cause and effect is only a beginning, because if the interesting event stops, the baby gives up and does not try to make it start again. From about 8 to 12 months, babies begin to put together single activities so that they can look, reach, and grab, and use that combination to keep interesting things going on. But, in Piaget’s theory (and many observations), a much more important step waits until about 12 to 18 months, when babies catch on to the fact that they can actually start interesting events by themselves--  and they do this over and over, by dropping and throwing objects and watching carefully to see what happens (cereal splashes, cheese doesn’t, and they all get eaten by the dog). This understanding of cause and effect is needed for a wide range of learned skills, from pulling a stool to the table in order to reach something, to drinking through a straw, to all forms of communication with other people and all planning of actions.

It’s common for people to assume that Piaget was taking a behaviorist position--  that infants develop cognitively only because they are repeatedly gratified by what happens when they exercise a new skill. That assumption is reflected in the idea of the “bonding cycle” of alternate needs and gratifications, as claimed by Attachment Therapy advocates. However, that is not at all what Piaget said.  His theory (and recent work on cognitive growth)  is based on the idea that cognitive development is driven from within and requires only ordinary experiences that the baby himself produces. When the attachmentnewengland document says “this [bonding] cycle promotes the development of cause and effect thinking which is the basis of all problem solving”,  it reveals a misunderstanding of how cognitive development proceeds. Naturally, reasonable physical care is needed for survival and healthy brain development, and social interaction is needed for attachment and language learning, but experiences of care are not privileged factors in the development of cause and effect thinking. To assume that they are is simply a rationale for the use of non-evidence-based methods.    

Of course, the understanding of cause and effect is not complete at age 18 months. The more steps intervene Rube-Goldberg-like between cause and effect, the harder the connection is to make. When someone doesn’t understand how something works, their comprehension of specific causes and effects will be limited. In the natural world, it is common for more than one cause to produce an effect, for one cause to produce more than one effect, and so on, and these situations make real understanding more difficult. In addition, even adults are prone to fallacious reasoning about causes. They may accept superstitious beliefs about spilling salt or having a black cat walk in front of them--  a matter of confusing cause and effect relationships. They may be swayed by fallacies about the order of events and how that reveals cause and effect, so that they assume that when B followed A, it must have been caused by A. They readily jump to the conclusion that if two things are correlated, one must have caused the other. In the Attachment Therapy- Nancy Thomas-Foster Cline belief system, they assume that when adopted children have mood and behavior problems, the events surrounding adoption must have caused the later problems.

Unless children have severe cognitive impairments, we can expect them at school age to be somewhere between toddlers and adults in their understanding of cause and effect. They know that they can make things happen, but they are still likely to display fallacious reasoning about complicated causes or those that are separated in time from their effects. Certainly they are able to know when their actions bring about immediate approval or disapproval from adults. As for responsiveness to behavior modification techniques, there is no reason why they should not respond as well to a properly-designed and implemented program as do all other living creatures right down to flatworms.

What’s the problem, then, if there’s no actual difficulty with understanding cause and effect? Might it not be that advocates of Attachment Therapy beliefs are convinced that when they use poor behavior management methods, those methods fail to be effective only because the children are so bad?  Using behavior modification or similar management methods requires careful planning and depends strongly on timely intervention. Research in this area showed many years ago that rewards work best when they come very quickly after an desired behavior, and reprimands or “consequences” for undesired behaviors work best if they occur in the middle of the act, or even better, just as the child prepares to do it. There is no reason to think that these rules would apply differently to children said to have Reactive Attachment Disorder than to other beings.

It’s my guess that much of the issue of unwanted behavior in “these children” (those considered to have attachment disorders by Attachment Therapists) actually has to do with the idea that the children must never “win” or “be in control”. The attachmentnewengland document recommends, per Nancy Thomas, that an adult “establish eye contact with the child and ensure that the child always looks up at the adult. The child with Reactive Attachment Disorder dislikes eye contact and will try to avoid it except when he/she is lying or trying to manipulate others. Avoid bending down to establish eye gaze with the student…”. In other words, mutual gaze is required because the child does not like it, and he or she must be made to submit, ideally through an uncomfortable posture that reminds the child of the adult’s size and power.

The document also insists that no explanations may be given to a child who is “consequenced”. “When giving a consequence, educators must stop themselves from telling the child why a consequence is given. When a child doesn’t have cause and effect thinking, he/she will never connect their inappropriate action with the consequence no matter how many times the connection is explained. … The child really doesn’t want to know why and just wants to argue… After the consequence has been given, it is important for educators to let go of caring about whether or not the consequence changes the child’s behavior, or has any impact upon the child, or his/her actions…”. 

It appears, then, that teachers are to abandon any hope of establishing cause and effect thinking in their pupils; if a child cannot make the connection with an explanation, surely he or she will not make it without one.  In addition, teachers are apparently being advised to abandon their own capacity for cause and effect thinking, and to ignore the outcome of their methods rather than to pay attention to what works for them with a given child. Rather than modeling the thinking behavior they should want, they are to adhere rigidly to what they are told, and to fall into their places in this authoritarian system just as the children are to do.

This is not about cause and effect thinking, any more than it’s about attachment or even Reactive Attachment Disorder as the evidence shows it to be. It’s all about obedience and punishment. Cotton Mather would recognize it easily.

   

Why Mental Illness Isn't Exactly a Brain Disorder

It’s a common thing nowadays to hear mental illnesses referred to as “brain diseases” or “brain disorders”. The National Alliance on Mental Illness (NAMI) has made a particular point of this.

In a policy statement in 2014 (www.nami.org/TextTemplate.cfm?Section=NAMI_Policy_Platform&Template=/ContentManagement/ContentDisplay.cfm&ContentID=124562 ), NAMI made the following statements:

 “NAMI advocates for research and services in response to major illnesses that affect the brain, including schizophrenia, schizoaffective disorder, bipolar disorder, major depressive disorder, obsessive-compulsive disorder, panic and other severe anxiety disorders, borderline personality disorder, post traumatic stress disorder (PTSD), autism and pervasive developmental disorders, and attention deficit/hyperactivity disorder.”

“NAMI … believes that mental illness is essentially biological in nature. Mental illness affects behavior and behavior can affect mental illness—but mental illnesses are not behavioral.  The term ‘behavioral health’ obscures and hinders effective treatment of co-occurring disorders. Also, because behavior is perceived as a matter of choice (‘good’ or ‘bad’ behavior), the very term ‘behavioral health’ can add to the stigma and discrimination endured by people living with a mental illness.”

“Therefore, throughout this document, we are discussing the term ‘brain disorder(s)’ interchangeably with mental illness and serious mental illness.”

The NAMI statement is not easy to unpack, but its goal is clearly to emphasize a medical-biological view of all mental illnesses whether they have strong genetic components (autism, for example) or derive from factors in the environment (PTSD). It is true that the term “behavioral health” is confusing, because surely a behavior cannot be healthy or unhealthy independent of some other aspect of the individual, but this does not seem to be the reason for NAMI’s rejection; instead, there is an assumption that behavior is generally seen as voluntary, and that calling it “good” or “bad” indicates this and leads to stigmatization of mentally ill persons. These various choices of terminology are confusing, as they conflate mental illness both with sin and with problems like seizure disorders, Parkinsonism, and dementia, which are clearly brain disorders but have little in common with the mental illnesses listed earlier.

Is mental illness properly seen as a type of brain disorder, or has this view been determined by public relations concerns like those of NAMI and by a history dating back 30 years or more? Before discussing possible answers to this question, let me point out that whether or not moods and behavior that distress mentally ill persons and others are brain disorders, it is probably not appropriate to think of them as intentional, or to blame adult patients or the parents of mentally ill children for disturbing characteristics. Considering non-brain factors as contributing causes of mental illness does not condemn us to hating the mentally ill, or using confinement, starvation, and cold as “treatments” for their challenges.

Gregory Fritz, writing his editorial column in the Brown University Child and Adolescent Behavior Letter, recently addressed some of these issues with respect to brain disorders as a cause of depression (“The chemical imbalance explanations for depression: Setting the record straight”, CABL, 30(9), 8). Fritz noted that he still hears “the idea of a chemical imbalance discussed in relation to depression, though fortunately not among psychiatrists. Given that there is no empirical evidence for this explanation of the cause or treatment of depression [my italics—JM], why is it so tenaciously a part of the lay understanding of the disorder?” (as indeed brain disorders are a part of popular assumptions about all mental illnesses).

Fritz went on to say that the chemical imbalance theory of depression was not invented by the public, but “was presented to them by psychiatrists, the popular press, and pharmaceutical advertisements starting with vigor in the 1980s… The hypothesis was that altered levels of neurotransmitters lead to disturbances of mood. It was an attractive hypothesis, one that was behind the development of the SSRI family of antidepressants—for which there is solid evidence of benefit in treating depression.” But, Fritz commented, “There were two major problems with the popularization of the chemical imbalance idea: (1) an appealing hypothesis was treated as fact [my ital—JM], and (2) evidence that SSRIs had a significant clinical impact… was treated as proof of the mechanism of depression.”

Why have ideas about brain problems as causes of mental illness become so entrenched? The NAMI material suggests that one real reason is the belief that blame and stigmatization are diminished when brain disorders are pointed to as the basis of mental problems. Fritz’s editorial also emphasized the human “distaste for ambiguity” as responsible for the assumption that depression is caused by chemical imbalances in the brain. He pointed out the difficulties we have with dealing with the “complex truth about depression—that many genetic, environmental, biological, social, physiological, and psychological factors interact with development and other, still unknown factors in complicated ways to produce depression, and that we’re still not sure how antidepressants work”; this statement could be applied equally to other forms of mental illness.  

Evidence about differential effects of early maltreatment on different parts of the brain suggests that attributing mental illness to “brain disorder” in general is painting with too broad a brush. Simultaneously, though, the concept appears to be too narrow when we consider the list of known and unknown factors that appear to help determine mental illness. In either case, overemphasizing the role of brain structures and functions as causes of mental illness is treating a hypothesis as a fact, which is not likely to lead us to any real understanding.  We can surely treat mentally ill children and adults benevolently without oversimplifying the causes of their problems.   

No,Your Baby Can't Read-- She's Working on Baby Jobs

{My thanks to Barbara Reynolds for bringing this to my attention!}

The video series Your baby can read, by Robert Titzer, appeared some years ago and is still being sold on Amazon (where, to my incredulous amusement, it’s sold in the form of CDs, “as seen on TV”, presumably by non-reading adults). Titzer has claimed remarkable effects on early learning achieved by putting infants as young as three months in front of a screen. By nine months, these children were supposed to be able to read words--  a promise that led to many purchases by parents who thought they were doing the right thing, but a claim that had no evidence basis and indeed was contradicted by reliable information.

Fortunately, the Campaign for a Commercial-Free Childhood (www.commercialfreechildhood.org)  (the same group  that fought “Baby Einstein”) went to work against the sale of Your baby can read, and now can celebrate success in getting rid of this material (and we’ll see how soon Amazon drops it--  I notice that they’re having a sale right now, a bit like the paint manufacturers selling off the lead-based paint years ago).

It’s difficult to fight fraudulent commercial claims in the United States, where commercial speech receives more legal protection than it does in many parts of the world. However, in 2011, the Campaign for a Commercial-Free Childhood (CCFC) and its attorneys filed a complaint with the Federal Trade Commission on the ground that Your baby can read was falsely marketed as educational for infants. In particular, CCFC stated that there was no evidence that the program teaches babies to read, or that there is a “window of opportunity” for learning to read that closes at age 5 years or earlier, or that babies exposed to the Titzer program do better than other children later in life. In 2012, a FTC decision and settlement prohibited advertising that claimed any educational benefits for the program, with a judgment of $185 million against the company. A final order for the settlement was entered in the U.S District Court for the Southern District of California last week.

What evidence would Titzer and his company have needed to present in order to argue that their claims were not fraudulent? Testimonials, of course, would not be sufficient, however enthusiastic they were. Organizations like the American Psychological Association define evidence-based treatments as those shown to be successful by specific types of research; an adequate number of infants would have to be assigned randomly to a group receiving the Your baby can read package, or to a comparison group that did not receive it, and the Your baby group would have to show statistically significant superiority over the other group on some measure. What’s more, an independent researcher would need to replicate the study and find similar results. Weaker types of research could be used to argue that the claims were not fraudulent, under some circumstances, but Titzer appears to have established neither strong nor weak evidence to support the claims he made.

One of Titzer’s most questionable claims was about a “window of opportunity” to learn to read quickly, which was said to close by about age 5--  at about the same time that most children begin the process of learning to read. It’s true that there are “windows of opportunity” in the form of critical or sensitive periods, during which certain aspects of development (e.g., binocular vision, learning of the sounds characteristic of a language, or attachment to a familiar caregiver) occur more readily than they would earlier or later in the individual’s life. But reading obviously does not have a window of opportunity in early life, or young children would learn to read very quickly simply as a result of being read to or hearing adults read signs or other material out loud. For some children, learning to read is not a genuine developmental possibility until about age 8, and adults who have not been schooled learn to read when given instruction, as we see from accounts of slavery in the U.S. and the motivation of adult slaves to learn this forbidden skill.  

 Why can’t babies read? There are a number of developmental steps that must be in place before reading can be learned. In languages like English where speech sounds (phonemes) are represented by letter shapes (graphemes), a new reader must understand that connection and then learn the associations between specific phonemes and graphemes. (And pity the poor reader of English, where several different phonemes may be represented by a grapheme, or various graphemes may work together or separately to represent a phoneme!) This connection cannot possibly happen before the baby has learned, in the second half of the first year, to realize that only the phonemes of its family’s language are part of speech, and that all other “mouth noises” that humans can make should be ignored while trying to understand speech--  that when people say “uh, mmm” or cough, those sounds don’t carry the meanings that speech has. A baby who has not yet learned about phonemes can’t connect speech sounds with graphemes.

Although babies can learn to recognize shapes, there are some shape features of graphemes like those in our Roman alphabet that will elude them for years to come. Even at kindergarten age, many children cannot yet recognize that the orientation of a shape makes the difference between “b” and “d”, or “p” and “b”, or between “g” and “q” in some type faces. They do not “see letters backward” but have not reached the developmental milestone of paying attention to right-left or up-down differences.

So, babies can’t learn to read, no matter what methods we might try. And they already are busy with their own baby tasks which must come before speaking and certainly before reading. Those tasks are ones that babies do not learn from a screen, but do master as a result of looking at and listening to smiling, playful, talking, singing caregivers, adults who delight in the babies’ joyful responses to social fun. You can’t package the experiences that help babies develop skills that will help them learn to read with pleasure, when the time for reading comes.  

Child Trafficking By Any Other Name Smells Equally Bad

Over a year ago, I posted several pieces (e.g. http://childmyths.blogspot.com/2013/01/kafka-again-more-on-capture-of-child.html ) describing the situation of a woman I called Eve Innocenti. (She has told me it’s all right to use her real name, but I am not going to because I’m concerned about unforeseen consequences of disclosing.) Eve has two sons who are in the custody of a Colorado county following more or less accidental proceedings years ago, coupled with the involvement of the biological father of one (yes, one ) of the boys and the father’s wife. It does not really matter how this all came about, except for the fact that there was never any abuse or neglect of the children on Eve’s part, and retrospective attempts to claim that there was some have been completely unsuccessful. (For example, there was a claim that one child showed signs of fetal alcohol effects, therefore Eve must have drunk alcohol while pregnant, therefore she was by definition abusive; however, when after examination the child was clearly stated NOT to show any such signs,  that whole structure fell to the ground.)

Well, it’s all still going on. One child (B.) is with his father and stepmother and is not allowed contact with Eve. The other boy (K., as in Kafka)  is in a placement managed by the Institute for Attachment and Child Development ( the quondam Attachment Center at Evergreen, Colorado), whose director, Forrest Lien, is well-known as a proponent of the alternative psychological theories and treatments associated with Attachment Therapy. K. has unsurprisingly been diagnosed with Reactive Attachment Disorder among other things and is on heavy medications as well as receiving unspecified psychotherapy, and being denied contact with his mother. Eve’s efforts to work through her lawyer and the children’s law guardian have been fruitless. She wrote recently, “I’m at a serious loss here. I have done everything I can and nothing has worked. Laws don’t mean anything, rules and regulations don’t matter, the county can get away with everything and no one will stop any of it. I am now convinced that I will never see [K.] again. [B., the older boy] will make his way home, something I am sure of, but poor [K.] has never stood a chance.”

Why is Eve so particularly discouraged at this juncture? There is in fact something new happening. Although her parental rights with respect to K. have not been terminated, and although she is still required to pay the county for his support, she is told that a search is on for adoptive homes for him. This is happening in spite of the fact that adoption cannot occur unless parental rights are first terminated, but of all the possible reasons for termination, as described at https://www.childwelfare.gov/systemwide/laws_policies/statutes/groundtermin.cfm, Eve’s case presents only one, and that one has occurred against her wishes--  her involuntary failure to see the children for many months.  

As the statutes about termination of parental rights show, it’s assumed that it is in the interests of as state and its citizens not to terminate rights unless it is clearly necessary for the protection of a child. Maintaining family relationships, and reuniting separated parents and children, are goals secondary only to keeping a child safe.  The stress on family reunification is so strong that there has been more than one incident in which children who have been placed in foster care because of abuse or neglect (remember, this was not what occurred in Eve’s case) were mistakenly reunited with parents who are not safe, and there were tragic consequences. Why, then, do we see a case where a mother who has never been neglectful or abusive, who is not indigent, and who wants the children--- is nevertheless apparently en route to termination of her parental rights with respect to at least one child?

I don’t know why, of course. But I do have some suspicious thoughts about this situation, and they have to do with the hurry to make adoption arrangements. Children are a commodity in the eyes of some people nowadays, and we pay for our commodities when we must. Commodities brokers are also paid by those who want the items they supply. Who is going to benefit financially from the adoption of K.? Is money or other benefits going to change hands--  indeed, have they already done so?

If this is the case, and caseworkers or other county employees are already arranging a transfer of “ownership” for which they will be paid, I would say that there is a name for what they are doing. It is child trafficking. Most commonly, this term is used to describe purchase of children for sexual use, but it does not necessarily mean this (although that definition cannot be ruled out, I am very distressed to say). People can traffic children as slave workers, or as adoptees for those desperate for parenthood for any of a number of reasons. Once a judge follows the recommendation of a caseworker to give legal custody to a purchaser (and someone who gives a kickback to a caseworker is a purchaser), a child may have no way to call society’s attention to his plight until he reaches adulthood.

I don’t say that this is what is happening to K. I don’t know. But I think readers will agree that the scenario I have presented is not an impossible explanation of events without any other obvious rationale.

Are Hugs Necessary?

Reader Sandee—who had asked me to comment on Tina Traster in the previous post--  was also questioning the idea that all children must be physically affectionate with their parents, or something is not right. She referred to an adoptive family in which the mother wanted the child to huge the dad, and had another child tell her that it was a good thing to do.

A hug from the right person at the right time can be a very pleasant and gratifying thing, of course. Because we know this and are concerned for others, as adults we may hug people we don’t really want to hug, or at least hug them under circumstances that don’t appeal to us. But does hugging mean we really care about someone, and does failure to hug mean we don’t?

Seems pretty unlikely--  yet some purveyors of parenting advice have made almost exactly that statement with respect to adopted children. According to them, a symptom of Reactive Attachment Disorder, the notional scourge of adopted children, is a failure to show affection on the parent’s terms. That means how, when, and where the parent elects to have an affectionate exchange. Nancy Thomas, the “foster parent educator”, has stressed that the parent need not and even should not hug a child who asks for a hug, but should insist that the child hug the parent at some future time when the parent chooses it. The child who does not comply to the parent’s satisfaction must be a little RADish (as they used to say—I haven’t seen this for a while) and is certainly not attached (i.e., obedient and grateful) to the parent; serious unconventional treatment is needed.   

Why do people like or not like to hug other people? Part of this certainly has to do with ever-changing cultural standards. Older readers will remember when hugging was pretty limited to occasional bouts with family members who had been absent for a while, or to actual or potential romantic partners. Young children got a goodnight kiss, or a kiss-to-make-it-well when needed , and had their hands held when crossing the street, but that was about it. Everybody else got handshakes, or in the case of older ladies and theatrical people, an air kiss. Graduations were formal events where principals or presidents presented diplomas and shook hands; they did not kiss all and sundry. A hug for the wrong person at the wrong time or place could give considerable offense.

Fast-forward to approximately the 1970s, where peace, love, and freewheeling pre-HIV sexuality created an atmosphere where only uptight old fuddy-duddies would fail to hug at all opportunities. It was refraining from hugging that was offensive, not doing it.

So, at which time did parents and children actually love each other? Was their affection indicated accurately by the amount of hugging? I would presume not, and I would strongly question the idea that children who do not hug when ordered don’t love their parents, or that those who do hug as ordered, do love them. I would also note the likelihood that children who come from “hugging cultures” are no different in their filial affection than those who come from “non-hugging cultures”. No, what has happened with all of them is that they have learned to comply with social rituals just as all human beings do.

It’s common for people to assume that a hug is motivated by a need to give and receive affection. Therefore, they figure, if there is no hug, there must have been no need for an affectionate exchange… and, stretching logic considerably, if you make a hug happen, you will also cause the antecedent need for affection to appear! Unfortunately, this line of thought is not only illogical but omits the possibility that a person who wants to give and receive affection may have learned ways to show love that are not hugs and perhaps not even physical acts. An enthusiastic handshake or a bow and namaste may express what a hug says for other people.

If it’s hard to think whether this is correct, just consider--  has your experience been that parents and children kiss on the lips, or not? If you are used to one in a nonsexual relationship, you probably find the other quite unnerving, yes?    

There are also some normal individual differences between people that can affect their hugging tendencies, quite independent of whether they care for someone or not. It can be perfectly normal to prefer less or more touch, just as a preference for bland or spicy food is a normal individual difference. The preference for mutual touch is to some extent different from or independent from the kind of tactile sensitivity that demands that all clothing tags be cut out upon purchase. Individual experiences based on other characteristics can also help determine touch practices; one of my sons, who as a skinny child was a great lap-sitter, got at the age of 10 one of those awful orthodontic appliances they called “headgear” and could only be kissed by his ear when he had it on--  to this day, that’s the way I kiss him and the way that feels comfortable to us. His brother, who was a lot heavier so I could not cope with him on my lap after about age 6, never had that appliance, and I kiss him much more in the middle of the cheek, as he does to me.   

Bottom line: hugging someone is not necessarily an indication of real affection for that person, nor is failing to hug a symptom of “non-attachment”. Also, making a child hug or be hugged doesn’t make the child love the huggee. If people care about each other and enjoy some of their time  together, who can ask for more? After all, the ritual is not the relationship.

Traster and That Primal Wound: Quick, Call a Celebrity!

A reader, Sandee, suggested the other day that I write about a disinformative blog, http://www.adoption.net/adoptive-parents/blog/rescuing-julia-twice-conversation-with-the-author-adoption-groups-can-t-stop-talking-about?vnc=wuavX09V9a14E.  The blog post in question poses Tina Traster as an expert on the development of adoptive children and pursues her beliefs with admiration. She seems to have become the Jenny McCarthy of the adoption world and is having her 15 minutes of fame in a similarly dangerous way (dangerous to other people, that is). This is evident in one of the interviewer’s first questions: “What is RAD, in your own words and as a parent?” (my italics).

Who cares how Tina Traster defines Reactive Attachment Disorder “in her own words”? Are diagnostic criteria now a matter of personal opinion? Do worried hospital ethics committees now tell each other, “this is serious. We’d better consult a celebrity”? There is no question that over the years the DSM criteria for Reactive Attachment Disorder have changed somewhat (it was originally defined as an early feeding disorder), but the term has never been up for grabs in Humpty Dumpty fashion.

Someone I knew a long time ago insisted on calling apple jelly marmalade, and was always annoyed when he was handed marmalade after asking for it, rather than getting the apple jelly he meant. If we are going to communicate about anything--  and especially about important issues rather than condiments—we need to be in agreement about the meanings of terms, and for maximum communication we do well to accept the definitions of people who have studied a topic systematically and empirically. Traster and many others of her type want to define Reactive Attachment Disorder as “apple jelly” when knowledgeable people have already defined it as “marmalade”. This does nothing but darken counsel, and it leads unsophisticated readers to think that Traster is talking about the same disorder that is described in DSM ; but, she isn’t.  

That Traster is not really talking about Reactive Attachment Disorder is evident in the list of symptoms she describes as characteristic--  none of which are diagnostic criteria given in any of the editions of DSM. Traster states that the children who should receive the Reactive Attachment Disorder diagnosis are superficially charming and manipulatively engaging with strangers, but aloof and disengaged with familiar caregivers. She says they don’t make eye contact, chatter incessantly, and want to control everything. They also fail to connect cause and effect, according to her.

Anyone who has studied the alternative or vernacular psychological theory that is the basis of Attachment Therapy will recognize these characteristics as part of the diagnostic checklist used by people like Walter Buenning and Elizabeth Randolph,  and more recently by “Kali” Miller, who has had her psychology license suspended in Oregon. Children who show some of these symptoms in a severe and persistent way may indeed have mental illnesses or other conditions which if unresolved will produce a concerning developmental trajectory; it’s also possible that their parents or caregivers are the ones with the emotional or behavioral problems, or that the adults may have fallen for a much mistaken belief system.  Superficial charm and exploitation of others (if intense) can be aspects of psychopathy. Failure to make eye contact can be a part of autistic spectrum disorders, or, of course, it can be culturally determined, as many groups regard a child’s direct gaze at an adult as highly disrespectful. Constant talking can be part of some genetic disorders, and as for wanting to control everyone and everything, who doesn’t?! The cause and effect thing is something that Attachment Therapists seem to have picked up from Piaget’s work on cognitive development, but they don’t appear to have thought through what a person would be like if he or she actually did not understand cause and effect (could they catch a thrown ball, for example?). I think what they actually mean by this is that the children keep performing unwanted acts even though they are severely punished for them; however, the parents’ failure to understand behavior management is not the same thing as the child’s inability to comprehend cause and effect relationships.

But let’s go on with this interview. Where does Traster think Reactive Attachment Disorder comes from? She names a number of potentially harmful experiences such that no one in their right mind would predict good outcomes as their results. But then she goes on to the crunch: that the real causal problem is “the traumatic break of the maternal bond, or the primal wound,as some call it…”. Now, talk about failure to understand cause and effect relationships! Traster is assuming that early separation from the birth mother is traumatic, because she believes that there is a “maternal bond” or emotional connection of child to mother, that has occurred before birth. She ignores the well-known development of child attachment to caregivers (father too) over the later months of the first year after birth, and therefore misses the developmental period during which abrupt, long-term separation does cause obvious emotional trouble. Why does she do this, other than simple ignorance about child development? She is following the claims of various “alternative” thinkers, such as Nancy Verrier, David Chamberlain, Lloyd DeMause, the Association for Pre-and Perinatal Psychology and Health, Nandor Fodor, Frank Lake, old uncle Georg Groddeck, and all. These people have all claimed that on the basis of their own mystic knowledge, sometimes assisted by LSD or partial asphyxiation, that empirical evidence about early development should be rejected and their own assumptions accepted instead.

Now Traster states that she is no longer worried about her adopted daughter because the child is both “bonded and attached”. She seems to miss the point that the real meaning for “bonding” has to do with the adult’s emotional commitment to the child, not vice-versa. And this interview shows enough of her ongoing concerns about how people have treated her (no baby shower!) that one does wonder to what extent her own needs have gotten in the way of the relationship with the child. Her warning that parents should avoid therapists who seem to be “charmed by the child” also suggests an ongoing uncertainty about which person is the child, and which person a therapist has to find charming. Again, this is good old Attachment Therapy stuff--  that the adult caregivers deserve special attention and care and are having a really hard time, while the unfortunate child is simply causing trouble and should be ignored by other people (e.g., Nancy Thomas’s advice that the children should wear dark glasses when in public so they can’t give people sad looks).

Really, it’s all very depressing. Traster knows how to work the celebrity thing, and her followers love that. The fact that she’s wrong again and again, and that there are many other people who know better than she does, just doesn’t seem to make much difference. Unfortunately, celebrities aren’t held accountable for bad outcomes, as professionals sometimes are.