What's Up With That, Doc? A Disturbing Doctoral Dissertation About RAD

While looking for some recent comments about Reactive Attachment Disorder recently, I chanced upon a 2014 doctoral dissertation that gave me considerable pause. This was a dissertation written in fulfillment of requirements for a doctorate in social work at the University of Iowa. The doctoral candidate, Matthew Lorenzo Vasquez, titled his dissertation “The impact of Reactive Attachment Disorder on adoptive family functioning”.  This in itself was a bit attention-getting, because I would expect a dissertation done today to look at the effects of RAD and adoptive family functioning on each other, not to assume that the disorder was there to begin with, and it caused changes in family functioning. But I wanted to read the thing to see whether I was right to question the nature of the document.

You can read this dissertation for yourself if you have the stomach for it--  it’s at ir.uiowa.edu/cgi/viewcontent.cgi?article=5299&context=etd. I’ll just give you some high points that will no doubt resonate with aficionados of the attachment therapy/holding therapy belief system.

We get right underway in the abstract and the first page of the introduction. Here we are told that “[c]hildren with RAD are known to engage in self-destructive behavior, talk of killing others or themselves, [and] direct verbal and physical aggression toward peers and adults”. This is of course true, just as it is true that children with other diagnoses, or with no diagnosis, may sometimes do some of these things. What is not true is that children who engage in self-destructive behavior, talk of killing, etc., etc., therefore have RAD. Although Vasquez references the DSM-IV-Tr description of RAD, he appears to have some other, unnamed source of information about diagnosis of RAD--  perhaps the work of Wimmer et al which appears in Vasquez’s reference list and which certainly posits RAD symptoms that are not to be found in any conventional discussion of RAD diagnostic characteristics. Although he mistakenly cites Parker, Forrest, and Reber, a non-existent source, it is plain to those of us who have studied the AT/HT belief system that Vasquez really means Reber (1996), a problematic paper, hard to find on the Internet nowadays, that made a variety of unsupported claims about RAD and used to be quoted frequently by practitioners of alternative psychotherapies.

Vasquez collected information by interviewing members of five volunteer families, and some interesting information it was, I can tell you.  For example, in discussing the methods a family used to respond to a child’s “meltdowns”, he comments, “In an effort to find some relief from Adam’s rages, Nancy [adoptive mother] started to bring Adam into the bathtub [with or without water is not stated]  and would hold him there in the dark  while he continued to scream” [as who wouldn’t scream? J.M.]. Nancy states that she learned this technique when working in a nursing home with people who had transient ischemic attacks…and seizures and hoped it would help Adam. Nancy then explained:

‘That’s when the meltdowns got shorter, and shorter, and shorter. Because he lost all his power. He had no power. Because sometimes he would get me frazzled you know and I was overwhelmed, you know? You don’t want to go there but you would. So he lost all his power when it went to the tub. And they just got, I bet, six to eight months before his meltdowns were 10 to 15 minutes in length.’

Vasquez then speculates that the approach was “so effective” (a speculation in itself of course) because the child could consciously decide whether he preferred to tantrum or to be held in the bathtub; Vasquez is uncertain whether he always had this ability or was given it as a result of the bathtub treatment.    

Rather than considering the meaning from the child’s viewpoint of being immobilized in the dark (and possibly in water), Vasquez is concerned with what it all meant for the parents. “Personally, I found the image of a young child being held in a bathtub, in the dark, while he screamed uncontrollably for hours at a time both profound and moving. … It … shows… what lengths some of these parents went to provide these children comfort and solace. Undoubtedly, to sit in a bathtub for multiple hours a day, restraining a screaming child for 6 to 8 months shows an incredible level of devotion and commitment to the care and well-being of these children”. Although many of us would query whether this behavior actually shows an incredible level of ignorance or of sadism, Vasquez does not mention that alternative explanation. Instead, he stays with the AT/HT tenet that adoptive parents are loving and good, as well as able and determined to make the best choices for children.

This is very depressing, but let me mention one other topic Vasquez mentions. It’s the old Darkness Behind the Eyes (see www.attachmentandtraumaspecialists.com/attachment_disorder/symptoms and other AT/HT sources). Vasquez says “hearing numerous reports about how these rages can be seen in the eyes of their child, I began to see this attribute as a significant feature in discussing these rages. “ He inquired of one mother about the idea that her child’s eyes changed color. She said “Mmm-hmm. Her eyes change color. They all do. They go DARK.” Another parent made the following statement: “When he would rage… it would almost look like there’s a fire in the whites of his eyes. He wore the footed pajamas, and at bedtime sometimes I would have to hold him down, and he would kick, and with all the lights off there would be sparks everywhere, I mean he was raging that fast.” Vasquez did not question these reports of physical impossibilities, but did note that the parents did not seem to attribute the events they reported to demonic possession. He did not examine the possibility that alternative practitioners and support groups had told the parents these things would happen.

So, do I blame Vasquez for this piece of work that repeats without question or comment various tenets of the AT/HT belief and treatment systems? Yes, to some extent I do. The man is not a scholar, although he seems to think he is, and he has done a sloppy job at best, mismanaging citations and references. He fails to note the discrepancies between the DSM criteria for RAD and the symptom list he emphasizes. He notes his attempts to manage his own biases by journaling, but does not attempt to discuss alternative interpretations for some of his conclusions. He did not do this work with due diligence, and if I contemplated employing him, I would be most concerned that the same degree of bias and carelessness would contaminate his professional contributions.

On the other hand, though, I cannot say that all the fault lies with Vasquez. As a doctoral student, he had a supervisor and a dissertation committee, all of them apparently with doctoral degrees. Why did they sign off on this level of work? Did they not realize that a dissertation may be cited, quoted, and used as the basis for further claims? As far as I can see, none of the committee specialize in adoption issues or in childhood mental health problems. Why did they agree to support this work if they knew little about it? Given that a doctoral candidate temporarily knows more about what he or she did than anyone else in the world, why did they not at least insist that this student explore alternative explanations of his interview findings? Do they not think that the discipline of social work depends on adequate research, not just on sympathy with suffering people?

It’s my hope that this committee and others supervising social work graduate students will read the forthcoming book by Bruce Thyer and Monica Pignotti, Science and pseudoscience in social work practice (Springer, 2015). Meanwhile, the rest of us have to deal with the release of yet another AT/HT proponent armed with an apparently respectable doctoral degree.