This blog has intermittently been the scene of
disagreements between me and certain adoptive parents. Our discussion usually
goes something like this:
Parents: Our adopted children are terrible! They lie
and steal and are even dangerous to other people. They have Reactive Attachment
Disorder, that’s the problem.
Me: That’s not Reactive Attachment Disorder.
Reactive Attachment Disorder is [defines RAD as in DSM-5, even in ICD-10 if
feeling energetic].
Parents: Yes, they do have RAD! How dare you say it’s not RAD! You’ve never
lived with these kids, how would you know?
Me: I just said, those things you described are not
the symptoms of Reactive Attachment Disorder. I didn’t say the kids didn’t do
the things.
Parents: You ignorant no-good know-it-all, can’t you
see that they need their attachment fixed, etc., etc.
Outside of the Attachment Therapy model, I have not
seen anyone writing about RAD including antisocial behavior, or even about
antisocial behavior as a problem of adopted children. However, while doing a
search of the trauma literature for another purpose, I came across an article that
focused on antisocial behavior as a particular problem of later-adopted
children. The article proposed certain reasons for such behavior and also
outlined a possible treatment, which I will describe. I must point out, though,
that the article seems to have been published twice in the same journal in
slightly different forms, is poorly proofread, and occasionally cites authors
who have approved of holding therapy, so I don’t know exactly how seriously to
take it. Nevertheless, some interesting points are made.
The article I’m referring to is: Prather, W., &
Golden, J.A. (2009). A behavioral perspective of childhood trauma and attachment
issues: Toward alternative treatment approaches for children with a history of
abuse. International Journal of
Behavioral Consultation & Therapy, 5(1), 56-74.
As you can see from the title of the journal, this
paper takes a behaviorist position relative to both the causes and the
treatments of undesirable behaviors of adopted children. They do not mention
Reactive Attachment Disorder. Instead, they list various disturbing and
undesirable antisocial behaviors like lying, sneakiness, and manipulation.
Rather than proposing that these were caused by a poor attachment history,
Prather and Golden discuss how these behaviors could have been rewarded, first
by the child’s experiences with abusive or neglectful caregivers, and second by
unintentional behaviors of foster or adoptive parents and of other children.
Please note that these authors are not blaming the foster or adoptive parents,
but pointing out that their natural actions toward the child may reinforce the
very behaviors that they want to eliminate.
Prather and Golden point out that adopted children
who behave antisocially may appear to lack “conscience” or “attachment”, but in fact they have learned
very well from their early experiences with abusive or neglectful caregivers.
They have never been punished for lying or using unacceptable language—such actions
may have been met with indifference or even amused approval. They may have been
taught antisocial rules about hitting as a generally acceptable response, and
may have been regularly teased into aggressive reactions by adults. They are
likely to have learned to avoid adults in some or even most circumstances, as
avoidance has led to the negative reinforcement of evading adult mistreatment.
Whether or not they were attached emotionally to their caregivers may be seen
as a minor problem compared to their history of learning to behave in “unattached”
ways.
It is not surprising that abused or neglected
children bring their learned behavior patterns with them to adoptive or foster
homes. Once there, it may be a while before the new caregivers realize what
undesirable behaviors are going on (and I wonder whether the time this takes is
what is perceived as the “honeymoon” period of adoption). During that period,
adults in the household may inadvertently reinforce the unwanted behaviors, for
example, by failing to notice a lie or a theft. People outside the household
are even more likely to provide accidental reinforcement, and this is related
to an important issue.
The study of learned behavior has yielded some
important principles about how reinforcement affects learning and behavior. The
frequency of behavior is raised when the behavior is followed by reinforcement,
but there is more to it than that. When the reinforcement stops, the length of
time it takes for the behavior to stop depends on how and when the
reinforcement used to occur. Paradoxically, when the behavior has been
reinforced every time, stopping the reinforcement altogether causes the
behavior to drop quickly to a low frequency—but if the behavior was reinforced
only intermittently, it will persist for a long time after the reinforcement
stops.
Most socially-reinforced behavior is reinforced only
intermittently. The abusive and neglectful parents of the now-adopted or
fostered children are very unlikely to have reinforced a behavior every time;
in fact, they may have been just as likely to punish or to appear indifferent
as to be amused or admiring of any action. This means that whatever behaviors
were learned by the children, it will take a long time for them to be “unlearned”,
especially if they are very occasionally reinforced by well-meaning adoptive or
foster parents, by strangers, or by other children who are fascinated by the “bad
kid”. Also, of course, some of the unwanted behaviors are self-reinforcing—the child
is rewarded by getting the thing he stole or by avoiding punishment by lying.
So, what do Prather and Golden suggest as treatment
for the concerning antisocial behaviors? I must emphasize that I have not found
any published empirical work that they have done, but they made some
suggestions that may be fruitful. Much of the focus is on “catching them being
good”: encouraging the family to put less stress on “unattached” behavior and
more on times when the problems are not apparent, and especially on ways that
problems have been solved and parents have managed not to reinforce unwanted
actions . Identifying antecedents, or triggering situations followed by
unwanted behavior, can help anticipate and control how the child acts. (For
example, does the child act up when the mother goes out without telling him she
is going?) Acknowledging and paying attention to negative feelings is another
important item, especially as the children may have become numb to their own
feelings and therefore fail to experience or to anticipate a sense of guilt or
fear of punishment. As Prather and Golden point out,” Unlike traditional
attachment based family therapies, which often interpret verbal information in terms
of underlying emotional dynamics, the rational cognitive emotive view of human
behavior focuses solely on the causal sequences of a child’s experiences and
perceptions, and the impact that the child’s negative thoughts concerning
trauma have on the role of emotion in behavioral causation.”
Again, there does not seem to be any new evidence
about how well this approach can be made to work. And those who are committed
to an all-attachment, all-the-time perspective may say, “that’s just treating
the symptoms!” But, to quote Nicole Hollander’s “Sylvia”, I might respond: Words
to live by!
