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Concerned About Unconventional Mental Health Interventions?

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

Wednesday, July 13, 2011

RAD on Youtube; or, Caveat Spectator

“Open source” mental health information on Wikipedia is problematic enough, as I’ve written elsewhere, but at least it tends to be watched and corrected (or perhaps just edited) by interested editors and Wiki admins, and citation of sources is supposed to be required. Youtube productions can present a more serious problem, because no one can make corrections by editing within a video; the best they can do is to make their own video and strive to correct any misconceptions that may have been caused by the original presentation. In addition, it’s up to the contributor to decide whether any source of information should be cited-- and often none is given

I’ve been looking at Youtube material that purports to discuss Reactive Attachment Disorder, and a depressing job it’s been. I can’t possibly talk about everything I’ve seen that’s wrong, especially that old TV melodrama “Child of Rage”! However, I do want to comment on two of these gems,, whose authorship is not clear, and, created by the Association for Treatment and Training of Attachment in Children (ATTACh). Each of these is full of inaccuracies, inconsistencies, and downright errors (it’s a trivial point, but the creator of the anonymous video apparently believes that Mary Salter Ainsworth was a man).

The anonymous video (uploaded by one vsulley) commits the very worrisome error of conflating Reactive Attachment Disorder (RAD) as described in the Diagnostic and Statistical Manual of the American Psychiatric Association with the notional problem sometimes called just “Attachment Disorder” (AD for short). Reactive Attachment Disorder is characterized by age-inappropriate social behavior, especially with respect to familiar caregivers. Children may be unusually aloof, independent, and willing to interact with strangers for their age, or unusually clingy and demanding of adult attention for their age. The RAD diagnosis can be given in either of these cases, but only if the behavior began before age 5 years and if there is a history of poor care. AD has nothing to do with symptoms of RAD, and the manual for the Randolph Attachment Disorder Questionnaire, a test intended to detect AD and cited in this video, actually states that it is not intended to diagnose RAD. Speculative discussion of AD, whose existence is not supported by systematic evidence, claims that symptoms of the disorder include a fascination with blood and gore, cruelty to animals and younger children, refusal to make eye contact on adult terms, “crazy lying”, and so on. These are obviously very different symptoms than those associated with RAD (not to mention the lack of evidence that such a disorder exists or is related to attachment in any way). But the anonymous video treats RAD and AD as equivalent and cites a very weak 2003 Journal of Psychology article by Hall and Geher as a major source. On the positive side, this video does not support the use of holding therapy and notes the lack of evidence that HT is effective, neglecting, however, to state its potential harmfulness.

The ATTACh video, posted by the parent-professional organization that has for many years promulgated the idea that adopted children are likely to suffer from mental health problems associated with attachment, takes a different approach. It rejects the DSM description of Reactive Attachment Disorder as an insufficient diagnosis for the posited problems of adopted children, but rather than referring to AD (once a major tenet of ATTACh’s belief system), the video emphasizes the Developmental Trauma Disorder proposed by Bessell van der Kolk but not included as a diagnostic category in the work on the upcoming DSM-V edition. The ATTACh video fails to state that a lack of systematic evidence for the disorder suggested by van der Kolk is the reason why DTD will not be included in the new revision.

The ATTACh video re-emphasizes a position long taken by the organization-- that Reactive Attachment Disorder in childhood develops into serious personality disorders, antisocial personality, depression, anxiety, and suicidal thinking. The video completely omits any discussion of longitudinal research by Michael Rutter and his colleagues, showing how few children adopted from Romania had later mental health problems. I’ve discussed this research at and included the comment of the developmental scientist Megan Gunnar that so-called attachment problems may not be associated with attachment at all.

There are two other interesting points about the ATTACh video, and both of them require some explanation for those who cannot “read between the lines”. One is a startling acknowledgement of the influence of Foster Cline on the organization and the continuing importance of his views of attachment and related disorders. Foster Cline is an M.D. who was strongly influenced by Robert Zaslow, a psychologist who developed an intense and intrusive form of holding therapy in the 1970s. Cline learned Zaslow’s methods and applied them during the ‘80s and ‘90s, during which time he compared holding therapy to chemotherapy as a painful and frightening but necessary treatment that should not be avoided in spite of its dangers (it was eventually associated with a number of child deaths). Cline stated that “all bonding is trauma bonding”. Both Zaslow and Cline surrendered their professional licenses after disciplinary actions following injuries to patients. It is quite remarkable to me that ATTACh continues to state its Cline connection in contradiction to its efforts to become a kinder, gentler organization following the 2000 death of Candace Newmaker during a therapy session.

A second point, and one surprising to me, is the appearance in this video of the psychologist Michael Trout. Trout, at one time a highly-respected clinician, has in the last 15 years become greatly involved with the Association for Pre- and Perinatal Psychology and Health (APPPAH), a group committed to the idea that babies remember their gestations (perhaps even conceptions) and births and will sometimes spontaneously report on these. APPPAH attributes much emotional disturbance to prenatal and birth trauma and supports massage of neonates by individuals like William Emerson, who claims to release birth trauma by pressure on infants’ heads and necks. In the video, Trout specifically refers to the mantra “baby can remember” on which much APPPAH thinking is based.

Rather than providing reliable facts about childhood mental health issues, the ATTACh video gives some revealing information about the direction ATTACh seems to be going. A connection with APPPAH is a remarkable step away from the “mainstream” status once aspired to by this group. The ATTACh video is thus remarkably informative about ATTACh-- but not so much about Reactive Attachment Disorder.

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