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Concerned About Unconventional Mental Health Interventions?

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

Monday, July 16, 2018

When Children Are Disruptive, Aggressive, Uncooperative: Thinking Outside the “Attachment Disorder” Box

It’s disturbing and even scary when children constantly disobey, disrupt, and behave aggressively toward other people. Small wonder that parents worry that they will not be able to control those child behaviors and the children will get worse and worse until they become dangerous criminals. Adoptive parents are often especially concerned because they wonder what unknown genetic element may be influencing the children’s development and personalities.

The answer given to these worried parents by some alternative psychotherapists is that the children are suffering from “attachment disorders”—that these disorders came from separation from the birth parents and adoption, or from painful medical experiences in infancy, or from institutional care. Alternative therapists may even claim that disruptive behaviors are part of the conventional diagnosis of Reactive Attachment Disorder, although they are not. When these claims about attachment effects are made, it is often suggested that the children need some form of “attachment therapy” that will correct the effects of their early experiences. If the children don’t get those treatments, the parents are told, they will become murderers, thieves, etc.—and their first victims will be their parents. This frightening argument can be very persuasive to anxious and uncertain parents, and they may well sign on for the treatment suggested.

Unfortunately, although the parents’ concerns are certainly legitimate, these disturbing behaviors have nothing to do with attachment, and even if they did, “attachment therapies” done by alternative therapists are not known to affect attachment. But what should they do? A recent article by Jonathan Perle, in Early Child Development and Care (2018), “Rethinking ‘wait and see’ philosophies for childhood disruptive behavior: A guide for paediatric medical providers” provides some suggestions about how families can work with their pediatricians to evaluate and work to correct disruptive behaviors like defiance, tantrums, aggression, and bad language in children from 2 to 7 years of age.

First, Perle points out that some disruptive behaviors like tantrums are very predictable in young children. Issues arise when the behaviors are more frequent than would normally be expected, persist to a later-than-usual age, cause disruption for the whole day rather than being resolved, or get more frequent with time. Difficult as disruptive behaviors may be for families, they cause even more problems for the children in the long run, as exasperated parents punish to the point of physical abuse,  schools isolate and fail to educate the “problem child”, and other children reject and avoid the disrupter.

Perle notes that the longer these problem behaviors go on, the more difficult they are to treat. Children learn to use disruption as an effective way to avoid things they don’t want to do (and every child is asked daily to do things he or she doesn’t want). Parents, teachers, and other children drop their demands in order to escape the unpleasantness created when they press a disruptive child to cooperate. Thus both the disruptive child and other people daily experience the reward of letting the child do as he or she likes. Repetition and reward lead to stronger learning, and adult attempts to withhold that reward by insisting on cooperation lead to such an outburst of unwanted behavior that they usually give in.

In Perle’s paper, he comments on previous research on children’s disruptive behavior that gives us an idea of what is common, “normal” behavior and what is not. Tantrums in children aged 3 to 5 are usually brief, no more than 5 to 10 minutes, and they are not very aggressive. The children scream, fall to the ground, cry, make mild aggressive remarks (“Don’t like you!”), and may impulsively strike or kick out, but do not usually bite, kick or hit with intensity. Children this age do not usually attack animals or people or destroy property in any severe way. The usual behaviors may include some sulking and pouting after the tantrum, but as children get older and develop better language and self-regulation skills there is less of that. By age 5 or 6, severely aggressive behaviors and daily tantrums with refusal of compliance even when adult raise their voices would be considered unusual and treatment would be a good idea for the child and the family. Adults particularly need to learn and practice ways to guide the child toward compliance without causing the disruptive behavior to escalate or to be maintained.

Importantly, Perle notes that disruptive and apparently aggressive behavior may emerge from a child’s anxiety. For instance ,“ a child who is afraid of insects such as bees or ants may begin to protest, then cry, then ultimately hit or kick an adult to get away from insects when brought to a park. Similar reactive avoidance-based disruptive behaviours could be seen related to a variety of emotional fears including dark situations, inclement weather, separation from a caregiver, social settings, or in response to sensory-based sensitivities (e.g. a child exhibits a tantrum in response [to], or to avoid over stimulating items or situations such as clothing, noises, smells, foods, or light”. In these cases, the child may have learned that disruptive behavior is rewarded by helping the child escape from a frightening situation, and unless the child’s anxiety is understood it will be difficult to understand what the reward is.

These problems of disruptive behavior, although very real and potentially becoming worse, have nothing to do with attachment, nor will they be improved by “attachment therapies”. Effective treatments involve various evidence-based types of parent management training. Happily, when these are used, families benefit not only from improved daily life, but they are also likely to feel that everyone is now better “attached” than they were.

1 comment:

  1. Hi Dr.Mercer

    This was a very helpful post. It was very valuable to read. I was also wondering if you have any posts on in utero trauma? I hear that term a lot now. Specifically, is prenatal substance exposure considered an in utero trauma? What exactly is in utero trauma? Is prenatal substance exposure the same level of trauma as if a child had experienced real trauma after they were born? I am just confused. As an adoptive mom, my son has never had a traumatic day in his life. We've had him since he was born. Yet he was drug and alcohol exposed prenatally. I'm being told this is considered trauma and I should be doing trauma based therapy with him. He does have significant behavioral and regulation issues at age seven. But I attribute that more to being meth, alcohol and heroin exposed prenatally from his birth mom and ADHD. But I'm hearing a lot about in utero trauma in adoption circles. If you could direct me to any blog posts I'd be grateful. Thank you!