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Concerned About Unconventional Mental Health Interventions?

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

Thursday, March 14, 2013

The RAD Defense: Questionable Testimony in the Chritton Trial

What is the RAD defense? It’s an argument in a court of law, claiming that harm done to a child was not the fault of an abusive adult, but was in some way related to the child’s diagnosis of Reactive Attachment Disorder. The RAD defense may argue that the child injured himself or herself—as, for example, in the case over a decade ago of the Russian adoptee toddler David Polreis, who was said to have beaten himself to death with a wooden spoon, or the more recent case of Nathaniel Craver, who was said to have hurled himself against a stove until he inflicted fatal head injuries. The RAD defense does not appear to have been successful in the sense of leading to acquittal of those accused of child abuse, but it may have acted to mitigate their sentences.

Now the RAD defense is back with us in a complicated though fortunately non-fatal case. As many readers already know, in the Chritton case a teenage girl was found walking barefoot in the Wisconsin winter. She was taken to a hospital, where she was found to weigh only 68 pounds and to be of very small stature for her age. She told a story of having been kept in a basement by her father and stepmother, given little to eat, and provided with very limited toilet facilities. This story, shocking enough in itself, was further complicated by the presence in the house of a step-brother who was a sexual predator and by the apparent failure of social services to manage any part of the situation. While in the hospital, the girl developed refeeding syndrome, a potentially fatal physical response to the restoration of a normal diet after long starvation.

The father and stepmother, Chad Chritton and Melissa Drabek-Chritton, are being prosecuted on a number of charges. Their lawyer has invoked the RAD defense, claiming that the girl starved herself as a consequence of Reactive Attachment Disorder, as recounted here:

To support the RAD defense, the Chritton attorney has called an Iowa therapist, Rhonda Lettington, who testified about the “numerous symptoms” of RAD and stated that medical records show that the girl has the disorder.

In my opinion, calling Lettington was a desperate move on the part of the defense, and I am surprised that she was qualified as an expert witness by the judge (still, I suppose they have to qualify somebody). Let’s look at her credentials. According to her website,, Lettington has a bachelor’s degree in psychology (and I as a long-time professor thereof can tell you that this teaches very little indeed about mental illness), a master’s in community counseling and one in professional development (?), and certification in alcohol and drug counseling. She is a licensed mental health counselor and belongs to several counseling organizations. She has trained in EMDR, a poorly-evidence-based but probably harmless technique, and in Healing Touch, an “energy therapy” that uses touch or hand positions near the body for spiritual and other benefits and that remains unsupported by evidence as a treatment for physical or mental disorders. Lettington appears to have no training in assessing or treating childhood mental illness, but she has some adopted children, so I suppose she says this has trained her.

This is exactly the kind of person I try to direct people away from when they ask for advice about childhood mood or behavioral disorders. Assessing and treating such disorders requires training at the doctoral level and specialized work on child development and family issues. A degree in counseling is simply too general to be of use in these complicated situations where mental illness can interact with normal developmental change and where parental moods and practices require expert guidance. By the way, the use of “alternative” methods like EMDR and Healing Touch should be red flags warning knowledgeable persons away from a practitioner.

Let’s also look at the claims about Reactive Attachment Disorder that Lettington makes on her website. It’s no surprise to find the good old checklist trotted out (just like the one at that I mentioned the other day).  Some of the items here--  apparently meant to be applicable for children of any age—are a high pain tolerance, a lack of cause and effect thinking, and destructive or cruel behaviors. These, and the other “symptoms” cited, are in no way connected with the description of Reactive Attachment Disorder in DSM. Lettington would appear to have recounted this list to the judge, but we can’t tell yet whether anyone else’s testimony has corrected her. Interestingly, at the bottom of the list, Lettington also says that physical health is affected by RAD; although the original description of RAD in DSM-III did consider RAD to be the appropriate diagnosis for some cases of  infant failure to thrive, it has not otherwise, or since then, ever been spoken of in the mainstream literature as having physical effects. (Of course, such a claim does provide a foundation for the RAD defense, if no one contradicts it.)

We can also have a look at the links provided by Lettington’s site. Interestingly, there is a link to Families by Design, Nancy Thomas’s outfit. Did the Chrittons get some information about Nancy Thomas parenting, with its limitations on diet? I have no idea, of course, but the existence of this link certainly raises questions. Had the Chrittons consulted Lettington? Was their treatment of the girl advised by her, or simply accepted as a possible approach?   Or is it just that Lettington, like many another alternative therapist, believes in principles that are without empirical foundation but make the RAD defense possible?  

On the basis of other cases involving the RAD defense, I have one prediction: whether  Lettington or another practitioner advised the Chrittons, that person will not be prosecuted. If convicted, the Chrittons will be punished, but their advisers--  in person, on videos, or in books—will be free to give the same dangerous advice to other families. The First Amendment is supposed to be limited in the sense that one may not falsely shout “Fire!” in a crowded theater. Is it not time that we limited the protection of people shouting “RAD!” ?

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