That Reber Paper, Attachment Therapy, and Darkening Counsel

Everybody is busy nowadays, and even mental health professionals who should know better sometimes skimp on careful reading of articles that they later quote or reference. Occasionally they make other hurried mistakes like drawing a bibliography from an article without carefully examining the papers that are included. There are worse things to do, you say? Yes, that is surely true – but unfortunately these careless practices can bring misinformation into the mainstream and encourage beliefs and actions that are indeed worse.

A case in point: an article from the 1990s that conveys dozens of erroneous statements about attachment, attachment disorders, and Attachment Therapy has been cited repeatedly, by authors and editors whose positions give them great influence. The article in question is by Keith Reber (1996), “Children at risk for reactive attachment disorder: Assessment, diagnosis,and treatment.” Progress: Family Systems Research and Therapy, 5, 83-98. (Progress was and perhaps still is a publication of the Phillips Graduate Institute in Encino, CA, one of the freestanding mental health training organizations, unaccredited outside the state,  that appeared in California in the 1970s.) Reber’s paper has been cited many times, and has even formed part of the training of lawyers who will serve as guardians as litem for children; a paper on mental health needs of dependent children references Reber (http://guardianadlitem.org/Practice_Manual_files/PDFs/Ch17_MENTAL_HEALTH_NEEDS_OF_DEPENDENT_CHILDREN.pdf).

Yet, almost everything Keith Reber said in that 1996 paper is wrong, and not just wrong, but wrong in ways that are potentially harmful to children and families. So what did he say? I’m going to quote and comment on a number of points, but I have to say that this paper, once easily found on the Internet, is now not to be found there. I have a copy and will forward it to readers who give me an e-mail address.

To begin at the beginning, Reber believed that the emotional attachment of a child to a parent begins before birth as a “connectedness in utero…Attachment begins before birth on a neurological and emotional level. “ In addition to the effects of neurochemicals and hormones on the child, Reber stated that the mother’s attitudes before birth affect the child’s attachment.( It is difficult to quote only a small part of these remarks without losing the effect of the logical jumps of the original, but Reber in a single sentence linked the claims of Verney that unborn children are conscious and aware with the statement of Fahlberg that attachment influences the sense of self. ) However, these statements by Reber are without empirical support in spite of the numerous unrelated citations he provides, and in fact all the evidence tells us that attachment—as discussed and defined by Bowlby and many others--  does not occur  until some months after birth, and develops as a result of social interactions. To assume that Reber’s statements were correct is to open the door to a host of unjustified fears on the part of adoptive families, and to suggest to them that harmful treatments like Attachment Therapy are necessary for them.

Naming some frequent forms of social interaction between parents and babies, Reber stated that when these are absent, infants “can lose interest in the world, become ‘insecure’ or ‘anxiously attached’, or even die”.  No doubt there is a little truth to this last claim, because social interactions so often occur in the context of daily care routines, and where there are few social interactions, the chances are that daily care activities are missing too. It’s also likely that in the absence of normal social interactions, infants may fail to engage with either people or objects. But how do these serious consequences parallel insecure or anxious attachment? Although these qualities of attachment are not ideal, they are nevertheless well within the normal range and are not related either to a disengaged, autistic style, or to unexplained death. Reber appears to have been determined to attribute all unwanted outcomes to attachment problems.

Now, I need to quote an entire paragraph from Reber’s paper (but I will omit citations to save space): “After birth there are several specific child behaviors and maternal responses that need to take place in order for the child to develop normal attachment… The child behaviors include crying, smiling, clinging, rooting, postural adjustment, and vocalization, and are exhibited by children a few days after birth… They are goal-oriented… and are the child’s way of making contact and encouraging the caregiver to respond to him. When a caregiver meets the expressed needs of a child, the child begins to experience trust. This process is often called the Trust Cycle. There is some disagreement, however, about whether or not these behaviors need to take place immediately after birth…”

Let’s examine the statements in this paragraph. First, Reber seems to have had some uncertainty about whether some necessary child behaviors occur a few days after birth, or whether they need to take place immediately after birth in order for attachment to occur. The basic problem here seems to be that Reber was not sure whether he was talking about bonding, the adult’s intense positive response to the baby (at one time erroneously thought to occur only within a brief sensitive period following birth), or about attachment, the baby’s gradually developing desire to maintain proximity to the familiar caregiver. The child behaviors described are certainly attractive to caregivers, and the caregiver’s responses both demonstrate adult bonding to the child and help to facilitate the gradual development of the child’s attachment to the adult. However, Reber was so concerned with early behavior that he barely mentioned the adult social responses that do indeed support the child’s attachment to a familiar person and which need to continue over many months before attachment is apparent. Instead, he seems to have attributed attachment (or trust--  which he seems to have thought to be the same thing) to gratification of needs, as in the old Freudian “cupboard love” principle. As for the proposed process “often” being called the Trust Cycle, I suggest that readers Google this term and let me know if they can find a single use of either Trust Cycle or Attachment Cycle outside the writings of Attachment Therapy proponents. (In fact, you will see that the great majority of references to this involve the National Trust and cycle paths.)

Reber continued his discussion with the statement that “Attachments run along a continuum between securely attached and unattached, with the normal child falling somewhere in the middle” ( as statement he references to the AT proponents Magid and McKelvey). Now, interestingly enough, there is an ongoing discussion among students  of attachment as to whether attachment behaviors can in fact be ranked on a continuum, and whether we might fruitfully regard secure attachment as “more of something” than insecure attachment of various kinds. However, most writers who discuss attachment assume that there is no continuum, but rather several attachment patterns that are qualitatively different from each other. This was the view taken by Mary Ainsworth in her studies during the 1970s, but she and more recent researchers have not usually considered either an “unattached” pattern or the “disorganized” pattern described by Mary Main and others. The three basic attachment patterns were all considered to be  aspects of typical development. In any case, Reber’s reference to a continuum from secure to unattached  with the normal child in the middle would seem to assign the “normal child” to an anxious or insecure position, which Reber earlier classed as a risk with disengagement and even death.

Are any readers still with me? This is a very trying task, isn’t it? But I’m afraid it’s all too much worth doing because of the role Reber’s paper has played in providing misinformation and obfuscation to people who want a quick read on attachment and Reactive Attachment Disorder. Still, I will just mention two other points about the paper.

Let me take one sentence from a paragraph on the third page of Reber’s paper. He says, “The tie in between abuse and attachment disorder is supported by the work of Cicchetti and Barnett (1991) who classify eighty percent of maltreated infants as having insecure/ambivalent attachment.” But---  one moment, please. How did we get from attachment disorder to insecure/ambivalent attachment? Insecure attachment is not ideal, but is one of the normal patterns of attachment originally described by Mary Ainsworth in her studies of normal populations. It is not an attachment disorder, and certainly not Reactive Attachment Disorder as defined by any version of DSM. Reber has conflated a normal attachment pattern with a psychiatric disorder and has thus provided a source for confused thinking about attachment issues, a source that will continue to function until mental health professionals have learned to dismiss his paper as worse than useless.

Now, a final point about the paper, before I go on to report some facts about its author. In spite of just having provided the then-current DSM description of Reactive Attachment Disorder, Reber gave a table that is supposed to guide diagnosis of RAD on completely different grounds than those referenced in DSM. Anyone who has read the writings of Attachment Therapy advocates will recognize the symptoms that Reber wants to have diagnosed as RAD. These include all the usual: superficially engaging, no eye contact, fights for control over everything, affectionate with strangers but not parents, cruel, hoards food,  fascinated with blood and gore, lacks cause and effect thinking, has abnormal speech patterns, etc.,etc. The actual sources of these items are probably to be found in a psychopathy scale created decades ago by Hare, but Reber attributes them to the files of the Family Attachment Center in Salt Lake City. But this is as far as his attribution goes. He does not deal with the obvious unanswered questions: how many children were seen at this center in total? How were the claimed symptoms assessed? What proportion of children had each symptom? And, rather importantly, what information was used to connect any of the symptoms to any attachment behavior or attachment history? In the absence of answers to these questions, it seems most likely that these claims were created more or less out of the whole cloth--  yet poorly trained mental health professionals and many journalists have happily accepted them, and like Reber have seen them as justification for the use of Holding Therapy..

Does Keith Reber still make the same claims? Who was or is he, anyway? As far as I know, he has never published another paper, but he seems to have kept the same belief system. Trained as a marriage and family therapist, he probably received little instruction on the actual development of attachment, but instead was easily convinced by the AT proponents he quotes in his paper. His continued use of Holding Therapy caused his professional license to be revoked in Oregon  (www.oregon.gov/oblpct/BoardAction/Reber.pdf). In 2003, the Utah Division of Professional Licensing asked a state judge to order Reber to cease practicing at a clinic that had been associated with the death of a child (www.deseretnews.com/article/1001664/Orem-therapist-lost-license-over-controversial-methods.html?pg=all). He would now seem to be a hearing aid salesman in Provo, UT.

Whether because of carelessness or genuine misunderstanding, Reber’s 1996 paper—which might have been expected never to be read--  has had an extraordinary  and highly negative impact on public understanding of Reactive Attachment Disorder. When I see this paper in any list of references, I immediately question whether the author of the citing material has any real knowledge of the subject. Sometimes people have apologized to me about citing Reber and have confessed that they simply copied someone else’s reference list. Others presumably actually believe Reber’s claims.

Parents, journalists, and mental health professionals, I ask you to recognize the Reber paper for what it is and to stop using it as a source. For the sake of children and families, let that publication die a well-deserved death and proceed to the obscurity that should have been its original fate!

Debunking Da Bunk: A Discussion of James Van Praagh and His Claims

I was greatly surprised a few weeks ago when I saw that my pre-retirement college, Richard Stockton College, was having an appearance in its Performing Arts Center of the “medium” James Van Praagh. Though I recognized the privileges of freedom of speech that belong to Van Praagh, Stockton, and everybody else in this country, I was disturbed and offended by the college’s allowing this performance without any analytical or contradictory discussion. Like many other colleges today, Stockton is emphasizing critical thinking skills, and it seemed to me that to have Van P’s show, and nothing else, was really a failure to model such skills for students.

I put out a message to college faculty and staff, stating my position and asking whether anyone wanted to have a panel, discussion, “teach-in”, whatever you might want to call it. Feelings about this appeared to run high, but with a wide range of opinions, from those who shared my concerns to those who thought it was silly or even puritanical to criticize what was advertised as a “fun afternoon”. Nevertheless, some people stepped forward as willing to speak in public about their opinions of Van P, mediumship, and spiritualism in general.

The programs for Van P’s performance made very strong claims for his ability to talk to the dead and to bring messages from the dead to the living. (The dead presumably do not need a return service.) According to the program, Van P “is known as a ‘survival evidence medium’, meaning that he provides evidential proof of life after death via detailed messages from the spiritual realms.” I don’t think you can make the claim more plainly than that, nor can you make claims more plainly than Van P’s announcement during the performance that he can see people’s auras and know if they are lying, and that each of us has a colored ribbon from the top of our heads all the way up to a star that has our name on it.

Van P’s performance is presented as evidence that all his statements are correct. He states that a spirit is near him and identifies the age and sex of that person or states a name or an initial letter that may have meaning for someone in the audience. When there is a response from an audience member, Van P then spins out and develops the message by using information the person provides. “He was a man who liked facts”—“Yes, he was a lawyer”--  “You still have some of his law books”—“Yes”—“One is tan with a red top to the pages”--  “Yes!”, et cetera. In one case, however, there was what appeared to be a remarkable “hit” on a fact, which led me to wonder to myself whether there were confederates in the audience. If you’d like to know more about what Van P does, there is a youtube piece about  this showman-shaman: https://www.youtube.com/watch?v=b_1TtZ1tNww.

What I actually want to talk about here is the discussion that followed the performance. I don’t suppose anything was said that has never been said before, but there were one or two points that I did not expect. A number of people from the audience followed us into the discussion room and demanded to know whether we would be “for” or “against”; when I said that was what we were going to talk about, they reversed course and were gone at once. Three people who were apparently believers in mediumship stayed for a short time and one spoke of a previous meeting she had had with Van P, as well as of her contacts with her recently-deceased mother. I appreciated her willingness to give this information. Most of the other participants were current or retired faculty of the college, or students, but Michael Cluff of the South Jersey Humanists was kind enough to come and address humanist concerns about exploitation of the bereaved by self-proclaimed mediums. Others talked about issues like the confirmation bias and poor judgment of probability that plague human thinking about spiritualistic practices.

A question that I did not expect came from a historian of religion, who asked us all why we need to debunk spiritualist beliefs, given, she said, that these must play some role in the culture’s functioning or they would not be there (a side argument almost started on that last bit). This excellent question forced many of us to think hard about the assumption that I and others made: that if it’s bunk, it should be debunked.

It took a while to focus on this issue, as we had all been too busy debunking to think about why we wanted to do it. The first reason was one that had already been mentioned several times--  that those who claim to talk to spirits and bring information to the living may be exploitative and drain the vulnerable of their resources. It was also suggested that for the bereaved to spend their time consulting mediums caused delays in the grief process; however, we did not really know if this was true or even if it had been studied systematically, and there was also some uncertainty as to whether grieving really has to follow the guidelines standardized for it in the Unites States in the last century.

After a while, people began to consider the “slippery slope” concern: that acceptance of an unfounded spiritualistic belief system might make it easier for individuals to accept without evidence other beliefs, leading to practical decisions that might be harmful. One participant pointed out the multimillion-dollar industry making homeopathic medicines--  drugs that are thought by their advocates to impart their “vibrations” to water, so that a highly diluted version is expected to have a more powerful effect than one that is undiluted (the opposite of the usual dose-response relationship). Drugstores stock these, and convinced parents treat their children and themselves with totally ineffectual homeopathic remedies rather than seeking real medical care, creating a potential for harm. Along the same line, I spoke about the issues familiar to some readers of this blog--  the conviction that mothers and unborn babies communicate by telepathy and that the mother’s thoughts of ambivalence about the pregnancy “mark” the baby psychologically, causing adopted children above all to be scarred in ways that cannot be treated with standard psychological or psychiatric care and must be “healed” by unconventional, potentially harmful, treatment.

We were thus able to find practical advantages to effective debunking (although we remained pessimistic about the possibility of actually achieving this with true believers). Still, I continue my commitment to my a priori position:

If it’s bunk, it should be debunked.

And it seems pretty clear to me that Van Praagh’s claims are bunk.   

  

"Her Brain Needs All the Stimulation It Can Get": The Death of Kianna Rudesill

In Illinois, a trial for murder is presently underway. Heather Lamie is accused of having caused the death in 2011 of her 4-year-old foster daughter, Kianna Rudesill (see www.pantagraph.com/news/local/crime-and-courts/live-tweets-from-the-heather-lamie-murder-trial/article_18c5d535-adc8-55a8-8890-fe3d5f3ea.html

and www.pantagraph.com/news/local/crime-and-courts/live-tweets-from-the-heather-lamie-murder-trial/articl_62bf4158-4fbb-5ff1-9900-7c7785c-16b76.html). Kianna died of head injuries that according to medical experts could not have been self-inflicted.

It appears that the defense will call as an expert witness the pediatric forensic pathologist Janice Ophoven. Ophoven has become known for her contributions to the defense of parents accused of killing children. Her testimony shown at www.yorknewstimes.com/news/contracted-doctor-takes-stand-for-defense/article_7a631db0-66b411e2-8a43-001a4bcf887a.html shows her arguments against a conclusion that a parent had nonaccidentally killed a child. She gave similar arguments in the Yhip case in California and the Trevor Smith case in Ontario, both to be found through Google. (The Yhip case is of particular interest if you want to look at this background.)

Until recently, prosecutors and forensic examiners investigating the causes of a child’s death had to work by reverse inference based on bruises and other evidence, to consider how injuries might have come about and what causes were most likely. The actual events leading up to the death, in the previous days and hours, were known only to the accused--  if indeed to them. But today there is a new source of information: the text messages sent and received by the accused during the run-up to the time of death. These may be of much importance in establishing what happened, and in the case of Kianna Rudesill’s death, they appear to say much.

Heather Lamie and her husband Joshua texted to each other about Kianna’s condition, expressing no sympathy about an injury the child appeared to have. The texts included the admonition to respond to Kianna’s being “out of control” by a simple expedient: “Beat her ___”.

Sad and telling as these texts may be, they open a number of important questions. Did these people not understand that their texts could be read later? Or, did they think that it was not important to hide what they said, because they believed they were doing the right thing? If they believed they were doing the right thing, why did they think so? Did they, like the adoptive parents implicated in the death of Nathaniel Craver in York, PA in 2009, have contacts with people who would advise them that they must unbendingly assert their authority over a foster child? Were they instructed that the child was intentionally defying them by failing to comply, and that all methods were acceptable in the fight to save her from herself?

I ask these—clearly speculative--  questions because of a specific text sent to her husband by Heather Lamie. Referring to putting Kianna into the shower, she texted: “Yes it is kind of cold but her brain needs as much stimulation as it can get.” This statement has many implications beyond the obvious message of cruelty.

I think it is quite possible that Heather’s treatment of Kianna was based on recommendations made by proponents of Attachment Therapy, either directly or as passed along by would-be helpful friends and neighbors. These recommendations often confuse social stimulation--  much needed by developing babies--  with sensory stimulation, and assume that intense sensory stimulation of all kinds serves to force brain development. Those making the recommendations also propose that all failures of children to satisfy parents’ wishes are results of poor brain development. The “logical” conclusion of these two assumptions is that sensory stimulation causes improved brain development, improved brain development causes compliance with parents’ wishes, and therefore sensory stimulation ranging from doing jumping jacks to cold showers is beneficial. There is certainly no evidence to this effect, although many occupational therapists and special educators persist in practices like skin brushing because of their commitment to the connection between sensory stimulation, brain changes, and improved behavior. (Interestingly, Jessica Beagley, of hot sauce fame, also put her adopted Russian son in a cold shower and videotaped this to send to “Dr. Phil”; she appears to have been surprised that she was charged with child abuse. She claimed that the boy had Reactive Attachment Disorder, suggesting that she might have been influenced by Attachment Therapy beliefs.)

Heather’s and Joshua’s attitudes toward Kianna, as shown in their texts, were also reminiscent of the views of Nancy Thomas, who has become a spokesperson for Foster Cline and others of the authoritarian Attachment Therapy school of thought. Thomas has recommended assuming that children are lying about injuries, or that they have deliberately hurt themselves in order to cause trouble for adult caregivers. When Kianna’s leg was injured at home, her preschool teachers carried her from place to place during the day. Joshua texted about this, ”If it hurts that bad she can go to bed.” Thomas and other Attachment Therapy authors like Keith Reber have attributed illnesses including vomiting to the intentional actions of children, and have argued that showing sympathy to sick or hurt children is simply allowing oneself to be manipulated and thereby making the children’s mental illness worse. The Lamies may or may not have taken this belief straight from Attachment Therapy, but instead may have shared it as part of the “old-fashioned” way of dealing with children  recounted in many memoirs, especially of those who grew up in the Middle West or West of the United States. Nevertheless, the possible association of their actions with Attachment Therapy needs to be explored, and I hope the prosecutors will realize this.

And what if the Lamies’ actions toward  Kianna did indeed come from a caseworker or therapist adherent of Attachment Therapy? The Lamies will have to take their own responsibility for their actions, but their advisor (if there was one) will not, unless a malpractice complaint is brought, and that is highly unlikely until NASW and other professional organizations face up to their obligations in matters of this kind.

Oct. 7, 2014: Heather Lamie has been convicted on two counts. No caseworker or therapist was charged.

  

A Survivor of Attachment Therapy Speaks

I don't know how to bring some very important comments to this page, so let me ask everyone interested in AT to go to http://childmyths.blogspot.com/2012/03/attachment-therapy-where-are.html, and look at the comments by McKenzie Schmitt.

The post originally asked for accounts of AT by people who had experienced it as children and who felt it had been helpful. There have been none.

Instead, here is an account that speaks volumes about the real nature of the treatment.
 .

Sensory Rooms and Gift Horses

Most people have heard the admonition “not to look a gift horse in the mouth” – in other words, not to query or criticize anything we are given for free. Well, it seems that an organization has provided to some Russian orphanages a small stable of gift horses in the form of “sensory rooms” (http://psypress.ru/psynews/d8484.shtml). Most Russians are not examining the value of these gifts carefully, so I will do it for them.

What are sensory rooms? They are rooms full of equipment that provides sensory stimulation through flashing lights, changing colors, and so on. Google the term and you will find that you can buy one on line for more than $20,000, and it will include the following: an infinity tube, a bubble tube, a LED fiber optic cascade, a projector wireless, color changer, and other bits including a bean bag chair. I don’t know what all those things do exactly, but they are said to change your room into a Multi-Sensory Environment (their caps).

What are sensory rooms for, and why would anyone want to have them? Basically, they are the same kind of thing as “snoezelen” (see http://childmyths.blogspot.com/2011/03/ja-das-ist-ein-snoezelen-bank-or-theres.html). These activity rooms were originally created in the ‘70s for fun, by graduate students in the Netherlands, and I would speculate were planned to make recreational drugs even more recreational. More recently, they have been used with dementia patients and with autistic children--  but without any evidentiary support for the helpfulness of this practice.

Now, the Russian orphanage managers and their donors are assuming that young children in institutional care will benefit in some way from periodic sessions in the sensory room. Once again, there is no empirical evidence to support this idea, so perhaps it would be a good idea to ask where anyone got this notion.

The basic belief behind sensory rooms (and similar treatment) is that human personality and intelligence are shaped by the impact of sensory experience—that infants are “blank slates” whose development and eventual characteristics derive from the sensory experiences they have had. This idea dates back to the French philosophe Condillac, who at the time of the French Revolution put this suggestion forward as relevant to creating good citizens in the post-revolutionary world. J.M.G. Itard, an admirer of Condillac, used this approach as he attempted (unsuccessfully) to work with the “wild boy of Aveyron”, an apparently feral, language-less boy who was about 12 when “caught”. Itard used a variety of sensory stimuli such as massage and the production of different sounds in his efforts to produce in the “wild boy” more normal levels of ability, which of course Itard assumed to develop in most people as a result of the sensory experiences of which the “wild boy” had been deprived. Similar approaches were taken later in the 19^th century as American educators tried to work with blind and deaf children. (This was the reason for the famous scene in the life of Helen Keller, when Annie Sullivan pumped water over her hand.) Some children responded well to social interaction and stimulation, but more generally it appeared that whatever the source of their cognitive and sensory limitations, they could not be cured just by additional sensory experience.

But--  here we are today, with sensory rooms for sale, and in use in institutions like the Russian orphanages, from which children often emerge with poor cognitive abilities and possibly with emotional disorders as well. If there is no evidence that sensory rooms provide effective treatment, why are people spending resources for them,  that might be used more helpfully in other ways? No doubt some of this is the “trailing edge” of Condillac’s thinking, but I believe there are some other misunderstandings at work here.

A primary problem with regard to the sensory room practice has to do with the confusion between social stimulation and sensory stimulation. Genuine deprivation of sensory stimulation in early life has been shown to result in later cognitive weaknesses in animals, and Jerome Bruner in the 1950s generalized this finding to human beings. Because some (but not all) aspects of sensory development are guided by sensory experience, it’s true that problems like poor depth perception can result from a lack of sensory experience. However, in the 1970s, Jerome Kagan, studying Mayan infants who were reared for the first year in darkened huts, found that although the children seemed cognitively slow at a year of age, they recovered over the next several years as they became involved with a stimulating outside environment.

In any case, children in institutions are not deprived of sensory stimulation, as has been done experimentally with animals and as has occurred for cultural reasons in some human situations. Institutional infants have plenty of illumination and things to look at, including other children, adult caregivers, windows, doors, and so on. (This may not seem like an interesting view to adults, but it is quite enough to support the growth of cortical sensory areas.) Institutions tend to be  noisy, with talk by caregivers and older children, crying of babies, and so on. There are also smells, tastes, and the experience of physical handling.  But just having these experiences--  or the experience of the sensory room--  is not enough to encourage good cognitive or emotional development in the very young.

What is missing, then? Institutional children are often deprived of social stimulation, for example of infant-directed speech with a pitch and tempo of interest to infants, or of the smiling, interested gaze of a caregiver. (Of course, these experiences may also be missing in foster homes or even in poorly-functioning families.) Social stimulation at its best encourages cognitive development by helping to guide infant attention to important sensory events and by regulating or buffering sensory experiences that may be overwhelming for an infant. But there is more to it than that.  A well-trained and engaged caregiver does not just speak in an infant-directed way—he or she changes the voice in an effort to get the infant’s attention, or softens speech if the infant seems over-stimulated by it. Such a caregiver smiles and gazes at a baby, but if the baby averts his or her gaze, the caregiver waits until the baby looks back before making other efforts to interact. Good caregivers recognize that in order for a baby to learn from sensory stimulation, the sensory experience must be neither too intense nor too weak, neither too rapid in tempo nor too slow.  They also realize that for infants and toddlers, much of their most important sensory experience occurs during care routines like feeding and diapering, and that these routines can provide an essential ”curriculum” for teaching young children.

In sum, sensory stimulation is not useful for early development unless adult caregivers actively engage in shaping the infant’s sensory world in ways that foster attention and learning. Unless caregivers are doing this job in sensory rooms, any stimulating properties the rooms have may simply overwhelm young children and minimize any learning effects that they might conceivably have.

Could the money contributed for the purchase of sensory rooms have been better spent? Yes, but to do so would involve ongoing commitment of dedicated amounts over a period of years. Real advantages for young children’s development do not come from “one shot” solutions like the gift of a sensory room, but they are a matter of hiring and training excellent and sufficient staff.  Help of especial importance is given by increasing staff salaries and living conditions so that turnover of employees is reduced and a stable social environment is provided. Without stability, caregivers cannot get to know the children, and unless they know the children well and read their communications of interest or aversion, the caregivers cannot buffer sensory experiences to provide the best levels of stimulation.  

Throughout human history, and all over the world, most babies have not had environments that looked or sounded interesting to adults, but they developed and learned well because they had plenty of social stimulation by engaged caregivers who modulated sensory experiences to suit the children’s needs. Living arrangements that fail to provide this help will not support good development whether they are orphanages with sensory rooms, foster homes, or the children’s biological families.

Before the Fringe: Do Today's Unconventional Beliefs Have Common Ancestors?

A member of a Facebook discussion group recently speculated on whether there was a connection between the concerns of Christian groups in the ‘80s and ‘90s about abortion, and the “Satanic panic” of the ‘90s, which featured stories about how devil-worshippers conducted unholy rituals that killed babies. I don’t know the answer to this problem, but the question itself points up the possibility of connections between unorthodox beliefs and other religious or political principles and practices. These connections could involve ideas whose popularity was high long ago—a sort of  ”trailing edge” phenomenon--  or current beliefs which either affect each other directly or which are brought about by a shared predecessor.

I understand that historians don’t like this kind of search for connections, and I can see how it might be thought of as cherry-picking. Nevertheless, I think it may be useful to see whether the predecessors of today’s unconventional beliefs were also the “fringe” of their own times, and how they connect with other “fringes”..

Some aspects of current unconventional thought may be the “trailing edge” of Transcendentalism, a philosophy of the mid- 19^th century that stressed the unity of physical and mental processes, the role of Nature in human life, and the importance of traditional Asian beliefs as guidance for Western thinkers.  Bronson Alcott (“Grandfather” of Little Women) was a Transcendentalist who tried to keep his family on a farm, “Fruitlands”, through a New England winter, living on oatmeal and apples and wearing only cotton and linen so as not to exploit animals; his wife finally persuaded him that the younger children needed milk as well, and after a while the family moved back to Concord.

This is simplifying a bit, but by the 1880s Transcendentalism had given rise to the New Thought, a system that emphasized the power of thought over physical events. The New Thought included approaches like Christian Science, a belief system that stressed physical health as it might be influenced by thought, and one which hangs on as a somewhat conventional, minimally evangelical religious group in the United States. The influence of the New Thought is still apparent in some current Internet and print  publications about Attachment Therapy, in which it is claimed that children can voluntarily vomit, defecate, or even die, out of their desire to disturb and humiliate their adult caregivers.

But although Transcendentalism and then the New Thought seem to be precursors of some alternative psychological beliefs, it’s difficult to bring those older beliefs into alignment with other “fringe” ideas--  especially those that have to do with physical facts and the history of the universe. In a 2012 book, The pseudoscience wars: Immanuel Velikovsky and the birth of the modern fringe, Michael Gordin discussed a number of beliefs that emerged between the 1940s and the 1970s and that seem to provide a foundation for more recent alternative beliefs. I want to summarize those and see if there is any evident connection between them and other unorthodox beliefs, whether about alternative psychotherapies or about Satanic ritual abuse.

Gordin concentrated on issues of pseudoscience and the demarcation problem of discriminating between science and pseudoscience. (This is a more difficult task in the physical sciences than in psychology or medicine, where the occurrence of injury as the result of an assumption provides a brighter demarcation line.) He organized this discussion around the 1950 publication of Worlds in Collision by Immanuel Velikovsky, a former psychoanalyst. Velikovsky’s book collated accounts of events in the Bible and other texts that could support the idea of planetary catastrophes having occurred within recorded history--  for example, the story of the sun having “stood still” for hours during an Old Testament battle. Using such examples, Velikovsky put forward the claim that changes in the planet and solar system have not been gradual and uniform as is assumed by geologists and astronomers. Instead, Velikovsky argued, a comet that later became the planet Venus brushed Earth with its tail, causing disasters but also creating the manna that fed the Jews in the desert (the explanation for this last bit was provided, but I really can’t get into it). The present form of the solar system was thus less than 5000 years old.

Worlds in Collision was published by Macmillan, the leading scientific textbook publisher of the time, after having been reviewed by someone who was only peripherally involved in astronomy. Its publication was followed by severe criticism of the publisher, not so much for having accepted the book at all, but for allowing it to be presented as if it were a scientific undertaking. (The author himself was at times quite willing to have it regarded as history.) Concerns about how the public might be deceived by Worlds were exacerbated by summaries and serializations of the book in the popular magazines Harper’s and Collier’s. Scientists who spoke critically of Worlds were, however, also concerned about the reality or appearance of censorship of scientific work; these worries were based on the current political witch-hunting of Senator Joseph McCarthy, and the recent history in the Soviet Union of suppression of modern genetic work in favor of the anti-Darwinian view of inheritance, Lysenkoism.

Velikovsky did not go away. He continued to write and developed a small but devoted following who by the 1970s became part of what Gordin called “counter-establishment science”. The counterculture, with its commitment to the Free Speech Movement of a few years before, helped establish several journals that gave serious consideration to Velikovsky’s proposals. As time went on, college courses examined his work as a breakthrough that went beyond the existing system of thought. Even quite recently, as Gordin pointed out, the whole 2012-Doomsday scenario included references to Worlds in Collision. Referencing Randolph Weldon, author of Doomsday 2012, Gordin noted: “Weldon supplements Velikovsky’s account with a mechanism that disturbed the solar system in antiquity, issuing the comet that became Venus… This hidden force was what the Mayas had calculated would return at the end of the Long Count, and a new force will soon terrorize and destroy Earth.” 

Where does this lead us with respect to alternative beliefs about psychology? Did such beliefs share ancestors with Velikovsky’s theory of the solar system? Except for the fact that Velikovsky had trained as a psychoanalyst, and psychoanalytic concepts of the unconscious and of repressed memory have been important parts of alternative psychologies and psychotherapies, it is difficult to see any direct connections—but there are commonalities between the psychological “fringe” and the physical science “fringe”. There are also unshared characteristics.

1. Do the physical and the psychological “fringes” both appeal to nonmaterial forces as explanations?... Velikovsky’s arguments were supportive of a “young earth” approach and therefore of creationism with its strong spiritual emphasis, and he drew evidence from sacred writings of various kinds, treating them as historical evidence. Nevertheless, his explanations were as entirely material as one sees in conventional science. Lysenkoism used a material explanation too. In alternative psychologies and psychotherapies, however, it is common to see appeals to supernatural phenomena like telepathy or to the effects of unknown energies.
2. Have physical and psychological “fringe” material been presented to the public in the same ways?... Velikovsky’s publication of Worlds in Collision with a well-known scientific publisher was something of a fluke. Most such material has been published by specialty presses and has not been widely advertised. The same has been true of psychological “fringe” material until the late 1990s and later, when there were publications of such material by the Child Welfare League of America, Academic Press, and Wiley. 
3. Have physical scientists and psychologists responded in the same ways to ‘fringe” materials?... Gordin’s book discussed the confused response of physicists and astronomers to Worlds in Collision. Physical scientists wanted to argue against Velikovsky without falling into the censorship trap; some focused their criticisms on the publisher, whose approval of the book seemed to imply that it should be included in their respected natural science list. Others ignored Velikovsky’s arguments, or, like Albert Einstein, were friendly but would not give the support Velikovsky wanted. Psychologists have on the whole ignored issues about alternative psychologies and psychotherapies; the American Psychological Association has even in recent years given continuing education credits for study of alternative treatments. A possible explanation of this indifference comes from a comment by Martin Gardner on the work of Wilhelm Reich, a direct predecessor of today’s alternative psychotherapies: “The reader may wonder why a competent scientist does not publish a detailed refutation of Reich’s absurd biological speculations. The answer is that the informed scientist doesn’t care, and would, in fact, damage his reputation by taking the time to undertake such a thankless task” (quoted by Gordin).
4. Have countercultures supported both physical and psychological “fringe” ideas over time?... The role of the ‘70s secular counterculture in popularizing and maintaining interest in Worlds in Collision--  even bringing it into college courses—is clear. The religious counterculture that supports creationism has also played a role. These countercultural phenomena were not just anti-science in a general way, but fought the authority of science by declaring their own sources of authority to be paramount. Aspects of the secular counterculture are also apparent as supports of some alternative psychologies and psychotherapies--  for instance, the countercultural appeal to “Asian tradition” as a source of knowledge shows up in the energy therapies of different kinds.  The idea of repressed memory is also fostered by the secular counterculture’s stress on emotion as a more trustworthy guide than thought. Religious countercultures like the charismatic movement have supported alternative approaches that focus on adoption issues or posited prenatal experiences of interaction with the mother; these concerns relate clearly to positions on abortion and extramarital sex.

It’s hard to come to any clear conclusion here. Alternative beliefs about the physical world and about psychological phenomena share some but not all concepts and histories. The one factor that seems to me to be most important in encouraging the “fringe” is the existence of countercultures that can increase their own power and prestige by advocating for a “fringe” belief. But perhaps an equally important point is the fact that as Martin Gardner said, “the informed scientist doesn’t care.”

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.

.

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.