How Not to Get Any Help for Children That You Think Have Reactive Attachment Disorder

Have you, or has someone else, decided that your child has Reactive Attachment Disorder? Has this diagnosis been made because the child is aloof, aggressive, sneaky, and avoids being affectionate on your terms? I know there are a lot of you out there, and many of you feel pretty desperate—you don’t even like the child any more, and that disturbs you as much as the child’s behavior does. You and the child need the help of knowledgeable professionals, or it seems that the least awful thing that could happen is disrupting the adoption or putting the child in residential treatment until age 18.

I’m going to tell you how NOT to get any help for your family. Part of my instructions will be drawn from a book by Keri Willimas, “Reactive Attachment Disorder (RAD): The essential guide for parents”, a self-published book available on Amazon.

1.     1.  Get into an argument with any available professional about whether your child’s behavior problems and your emotional distress are caused by Reactive Attachment Disorder. Insist that no matter what the mental health professional shows you in DSM-5, the problems that concern you are indicative of an attachment disorder and nothing else. Stay focused on the name that’s used, not on a discussion of the mood and behavior problems of the child and others in the family. If the professional tells you the name is not important, leave and do not make another appointment. This will ensure that your family does not get any help in thinking about the many sources of behavior problems and various effective ways of treating them.

2.      2. Go immediately back to your on line support groups and have them reinforce your beliefs that attachment and attachment disorders in the child are at the root of all family problems. Ask them to recommend practitioners who will accept your diagnosis and start doing attachment therapy of some kind. This will guarantee that you will not risk encountering any professional psychologists or clinical social workers who are trained in work with children’s behavior problems.

3.    3.   If you lose faith and call a mental health professional with advanced training, or a clinic that employs such people, be sure you demand immediately to know whether they treat Reactive Attachment Disorder (or simply, attachment disorders). If they hesitate or ask you to be more specific about the problem, hang up--  they obviously are not RAD specialists. This way you won’t accidentally connect with anyone who might have the training to help your family.

4.    4.   If you locate some mental health professionals that you might use, be sure to choose the one with the lowest level of training and licensure; with any luck you could find someone who is operating under another person’s license. The less trained the people are, the nicer they are, and the more likely they are to listen to you unquestioningly. If you do this, you can be almost sure that you will not run up against a practitioner who knows more than you and your support groups do and might actually be of help.

5.     5.  Always assume that only other people who have lived with a child with behavior problems can understand or be of any help to you. This will assist you in avoiding mental health professionals who are trained in working with many kinds of families and many overlapping problems.

6.      6. Be sure not to use any evidence-based programs like Parent-Child Interaction Therapy that ask you to learn new things or to work with your child in new ways. Insist that the child be fixed and that no other family changes take place. Generally, this will avoid any beneficial changes.

7.    7.   It’s wise to choose only treatments that assume one single factor, like RAD, as the cause of any of the problems you are experiencing. Most problems have multiple causes, so focusing on a single one can help you avoid any benefits of treatment that you might otherwise get.

8.      If you choose a treatment program, make sure it’s trademarked. That will mean that nobody can get at evidence to test whether it is both safe and effective. The proprietors will be able to make all sorts of claims and have their statements protected as commercial speech. You won’t have to worry about understanding empirical research or asking any of the right questions, which will be much more comfortable for you although not very likely to be of any help to your family.

9.      Always follow the recommendations made by Keri Williams in her book (mentioned above). She certainly knows how to prevent even the best-qualified mental health professional from helping your family. For instance, she advises parents, “Be very cautious about sharing sensitive information about yourself with your child’s therapist. It’s easy to think of them as objective. They’re not. If it comes to taking sides, they’re on your child’s side. Don’t blurt out that you don’t feel affectionate towards your children, that you are frustrated, or that you are angry. If you do, that’s almost certainly the only thing they’ll focus on going forward. They’ll conclude that your feelings and actions, not RAD, are the cause of your child’s behaviors. If the therapist focuses on ‘fixing’ you, your child will not get the help they so desperately need.” This approach, akin to treating repeated illness with antibiotics rather than considering what environmental factors are causing it, will certainly make sure that your family avoids help but is instead encouraged to find residential placement for a child and “love her at a distance”--- and all your friends will say how brave you are and how sad it is that your child was so damaged that no one could help. (How about suing the adoption agency too?)

You see, it’s pretty easy when you know how. You can be sure your aggressive or behaviorally disturbed child never gets any help, while at the same time claiming the moral high ground as the victim and sufferer who has only been trying to do the best thing for everyone. Just don’t forget to talk about RAD a lot.

What Bowlby Really Said, or, More Fun with Parental Alienation

I don’t usually watch to see what Craig Childress says on Facebook, but a lawyer colleague has called my attention to his recent comments about attachment and its implications for children who avoid one of their divorced parents. He attributes his own ideas to John Bowlby, Mary D.S. Ainsworth, and Otto Kernberg, not to mention Sal Minuchin, and describes these people with a novel collective noun as a “pantheon of kahunas”.

The problem is that Childress either doesn’t know or doesn’t understand what Bowlby actually said about attachment, or that attachment theory has changed a good deal in the course of decades of research and discussion. (I published an article in 2010 in Theory & Psychology, titled “Attachment theory and its vicissitudes”—and there have been many vicissitudes.)

Bowlby’s work was focused on trying to find explanations for some common and obvious toddler behaviors. These were of course not newly discovered but had been described for centuries, even mentioned in the Iliad. The two basic kinds of behavior Bowlby was looking were, first, the tendency of toddlers to stay close to familiar people under some circumstances, to avoid strangers and strange events, and to show severe and lasting distress when separated from familiar people, and, second, the tendency of toddlers to be curious and explore the environment under some circumstances. They stay near and they go away, with apparently contradictory motives. Why does this happen? Attachment theory began as an attempt to answer this question and built from there.

However, Bowlby’s original concern was with the way toddlers try to stay near familiar people, especially if they (the toddlers) are sick, injured, frightened, or in a strange place. He saw children hospitalized in England in the ‘30s and ‘40s, when parents were not allowed to visit and surgeries like tonsillectomies were common. Those children were terribly distressed and for months after would cling to a parent as they had not done before. Bowlby also saw European children brought to England by the Kindertransports when their families were threatened by the Nazis—suddenly packed up and sent off with strange caregivers and large groups of other children and suffering from separation, fear, and often physical distress as well. In addition, Bowlby observed English children evacuated to the countryside when London was being bombed nightly.

In all these cases the young children were badly distressed both short-term and long-term in ways that were not the same for children of school age or older. Bowlby prepared two reports for the World Health Organization, entitled “Maternal Care and Mental Health” and “Deprivation of Maternal Care”. In other words—Bowlby attributed the children’s problems to loss of the mother. He believed that human beings in early childhood were able to form an attachment to only one person, and that one was the mother. Bowlby called this tenet of his early theory monotropy. As we can see in his film “Nine Days in a Residential Nursery”, about a toddler left at a residential child care facility while his mother has another baby, fathers were not considered by Bowlby at this point to be attachment figures, and the lonely, frightened little boy in the film does not respond much to his father’s occasional visits.

Nowadays, we assume that fathers, mothers, grandparents, sisters, brothers, and babysitters can all be attachment figures for young children. Bowlby clearly did not think so—and would not have supported Childress’s view that children’s attachment to their fathers is a critical issue. It was all about mothers at that early stage in attachment theory. Why? Well, two reasons. One is that parenting behaviors have changed, with fathers given (and taking) more responsibility for child care, at least in educated middle-class groups. Bowlby would have been astonished at the idea of fathers in the delivery room (remember, even Dr. Spock said that the best thing a father could do for the child is to love the mother). But in addition to that matter, Bowlby focused on mother-baby relationships because he was searching for an explanation of toddler behavior in the lives of animals. He attributed the child’s desire to stay close to mother to evolutionary processes such that children of our remote ancestors were more likely to survive and reproduce if they fled to mother when something strange happened. Genetically-controlled behaviors of that kind are easily observed in some animals and were being studied by ethologists like Nikolaas Tinbergen. Whether human beings also showed such “fixed action patterns” was a major question, and Bowlby argued that toddler behavior toward familiar people was an example of what is sometimes described as “instinct”. Because most animals that show the tendency to stay near an adult do this with their mothers, Bowlby looked to behavior toward the mother as the foundation of social and emotional development, or attachment.

By 1995, Michael Rutter, one of the most important figures in the modernization of attachment theory, had marked a number of changes in the way the theory was developing. He ruled out monotropy (the exclusive attachment to the mother), as all the evidence was that toddlers usually have multiple attachments. Writing in the journal Child Development in 2002, Rutter referred to the overuse of the attachment concept as “evangelism”, and said “[It] is clear that parental loss or separation carries quite mild risks unless the loss leads to impaired parenting or other forms of family adaptation.” Presumably Childress would claim that lack of contact with one parent, as desired by the child, would be “family maladaptation”, but this claim cannot be derived from Bowlby (unless it’s the mother who is missing!) or from the more recent version of attachment theory as discussed by Rutter.

There’s a lot more to be said here, with respect to Bowlby and attachment theory. As the years passed, Bowlby dropped his ethological view and began to think of early attachment behavior as the foundation of an internal working model of social relationships, like the mental models  earlier suggested by Kenneth Craik. These models helped to determine social expectations and social behaviors and were “goal-corrected”, altering with time and social interaction, so that the original “attachment system” did not last for very long. (By the way, almost nobody ever talks about the exploratory system, which acts in cooperation with the attachment system and in Bowlby’s original formulation keeps a balance with attachment.) The attachment system of any individual turns into  an internal working model in the course of development, so it cannot become “deactivated” any longer, or contribute to pathological mourning if the child experiences separation in the school years or adolescence, as is the case for most of the families Childress attempts to describe.

One last thing here: Kernberg and narcissism as associated with broken attachment. Sorry, this is not what people think today. Narcissism in adolescents is connected with “overparenting”, “helicopter parenting”, but especially with excessive psychological control of children by their parents. Psychological control involves strenuous efforts to change children’s beliefs, attitudes, and emotions to those that are preferred by one or both parents. How better could we describe some of the interventions offered for “parental alienation”!

Separating Migrant Children from Their Parents

I don't seem to be able to overcome the format of the material I copied and 
pasted here, so you may not be able to read everything-- but the journal links should work anyway.

I'm sure that some readers are very interested in the outcomes for migrant children of the practice of  separating them from their families.  Here are some things you might want to read about this, especially if you work directly  with children or with their families.  The first piece, from the NYT, is a description of the changed behavior of some children who have  gone through separation and then  been reunited with their families. It shows clearly that the problems are not  over when reunion has occurred.  https://www.nytimes.com/2018/07/31/migrant-children-separation-anxiety.html Here are a number of free articles from a professional journal, addressing a variety of problems related to early childhood trauma  resulting from violence and separation. As the leading publication for pediatric mental health, the Journal of the American Academy of Child and Adolescent Psychiatry has  published many articles demonstrating the damaging effects of early childhood trauma on later development, the role of parental stress in the  intergenerational transmission of both psychiatric and other medical outcomes, and the positive role of parents in promoting child and  adolescent mental health. We oppose the practice of separating immigrant children from their families. In collaboration with our publisher, Elsevier, we have created a free collection of articles published in JAACAP on the effects of separation,  early life trauma, and related topics, and will maintain and update it until this practice is no longer the norm. Select articles from this collection include: Mental health in Syrian refugee children resettling in the United States: war trauma, migration, and the role of parental stress Childhood trauma and illicit drug use in adolescence Traumatic stress interacts with bipolar disorder genetic risk to increase risk for suicide attempts Trauma exposure and externalizing disorders in adolescents Default-mode network abnormalities in pediatric posttraumatic stress disorder Intergenerational transmission of maternal childhood maltreatment exposure: implications for fetal brain development The network structure of posttraumatic stress symptoms in children and adolescents exposed to disasters Trauma exposure and posttraumatic stress disorder in a national sample of adolescents Preventing children's posttraumatic stress after disaster with teacher-based intervention Developmental timing of trauma exposure relative to puberty and the nature of psychopathology among adolescent girls What are the transgenerational consequences of maternal childhood adversity and maternal stress during pregnancy? Transforming trajectories for traumatized children View the full collection of articles on the JAACAP.org website under the collections tab in the menu. View articles

The Demand for Obedience: How Two Alternative Psychotherapies for Children Resemble Each Other

Discussions of non-evidence-based medical treatments often use the term CAM—complementary and alternative medicine. The idea is that such treatments can be used in two ways. They may be complementary to evidence-based medicine, as when yoga or nutritional components are added to conventional cancer treatment. Or, they may be used as alternatives and substituted for evidence-based treatments, as when substances made from apricot pits are used to treat cancer rather than radiation or chemotherapy.

Non-evidence-based treatments also exist in psychotherapy, but they are usually used as alternatives rather than as complementary additions to evidence-based treatments. Because of that, I usually call them alternative psychotherapies (APs) rather than using CAM or CAP to describe them. APs are not just treatments that lack a good evidentiary foundation; there are psychotherapies that are still in the process of data collection that are not APs in spite of their relatively small evidentiary support. APs are different in that they are not plausible, because they employ faulty logic or because they are not congruent with things we know about human beings. APs for children and adolescents are noticeably out of step with established information about child development, for instance. APs also have potentials for causing harm to clients, sometimes serious harm, sometimes harm in the form of opportunity costs as families expend resources on ineffective treatments.

APs for children and adolescents may resemble each other even though the theories behind them and the practices they employ are quite different. This is especially the case when the focus of the treatment is on compliance and obedience to adults. 

My original interest in APs involved Attachment Therapy, a treatment for children that stresses obedience and considers compliance to be the indicator that children have formed emotional attachments to adults. This is implausible for many reasons, but especially because it assumes a single factor at work to determine complex behaviors that are based on both maturation and experience. Advocates of Attachment Therapy have published descriptions of their practices and discussions of their rationales for limiting children’s diets, requiring tedious and difficult manual labor, and threatening children that they will never go home if they do not cooperate. Members of groups like the Facebook closed group Attachment Therapy Is Wrong have disclosed their experiences in this form of AP.

More recently, I have identified some treatments for “parental alienation” as APs. These treatments purport to correct children of divorced parents who strongly prefer one parent and resist visiting the non-preferred parent. The children are thus disobedient to the non-preferred parent, and if they have been ordered by a court to visit they may also be failing in compliance to the court and its officers. Parental alienation treatments have been described by their advocates as involving multiday workshops in which children may not contact the preferred parent, must spend time with the non-preferred parent, and must watch educational videos and engage in “fun” activities followed by a required vacation with the non-preferred parent. Some of the programs maintain separation from the preferred parent for 90 days or more and make communication with that parent contingent on complying with rules for desired behavior toward the non-preferred parent. The children have no money or phone allowed to them and are often a great distance from home.

 Although as far as I know there is no social media site where adolescents or young adults have described their past experiences with parental alienation treatments, over the last year I have seen a number of accounts of the proceedings as experienced and recalled by those who have been through them. These accounts have some details in common. One is that the children (I am going to include adolescents in this category) were taken from school or home to the place of treatment by youth transport services workers. The transporters in some cases applied handcuffs to the children before transporting them by car or plane. Money and phones were taken away, so although some children were told that they could leave the treatment rooms if they liked, and that they were not being forced to do anything, in reality they had little choice except to find themselves alone on the streets of a strange city. Cooperation was also obtained  by means of threats—for example, if a child would not eat when given food, he or she might be told that this was very unhealthy and it would be necessary to place the child in residential treatment for his or her own good. Wilderness therapy programs were often mentioned, with emphasis on the impossibility of escaping or communicating with anyone on the outside. Other threats involved manipulation of concerns about the preferred parent, for example that he or she would go to jail or be fined a large amount if the child did not cooperate, watch the videos, play the games, and talk to and make eye contact with the non-preferred parent.

The common themes of Attachment Therapy practices and those of parental alienation interventions are evident. The children are essentially held captive by practitioners. They have in many cases experienced physical restraint—handcuffs for the parental alienation cases, “take-downs” for the Attachment Therapy situations. Although in theory they may be able to leave the premises, in practice this would mean going into a frightening milieu that they are not prepared to handle. In both cases, descriptions by victims include constant intrusive supervision and demands for compliance with unnecessary assignments, whether cutting the grass with nail scissors in one case or watching videos and discussing them in the other. Victims of both methods have reported practitioners’ laughter at the children’s discomfiture. Threats of abandonment or of more intense seclusion and isolation are in both case used to manipulate children’s behavior. In both therapies, children learn to comply to whatever extent they are able  in order to escape from the pressure and constant demands they experience. Only children who for physical or mental reasons cannot comply will not show the temporary behavior changes required of them, and as a result advocates of both methods claim that their treatments are effective.

I don’t discount the importance of some degree of obedience and compliance in children and adolescents. Their own safety may well depend on established habits of attending to adult advice. However, when a psychotherapy focuses entirely on compliance as an indication of mental health, and especially on compliance to an adult’s demands for affection and gratitude, a mistake is being made. This is particularly true when an intrusive treatment is directed toward older school-age children and young adolescents, whose normal developmental trajectory is moving them away from their relationships with parents and toward relationships with peers, romantic connections for the future, and cooperation with friends, teachers, and employers.

Finally, I want to point out that treatments involving parent-child relationships need to involve changes in both child and adult, without which the relationship itself cannot really change. In infant mental health circles, one important principle is that treatment must be treatment of the dyad, and this is true in a more complicated way of relationships between parents and older children too. Yet the APs discussed in this post focus on making the child change. Why? Presumably this is because a) the child can’t get away, and b) the adult is paying the bill. It’s certainly not because there is evidence that this approach is effective, or even that it is consistent with the ideas of family systems that are so often and so nonchalantly invoked.

A New Book About Crime and Children

Children and crime can be connected in a lot of different ways. Children can commit crimes, sometimes starting when very young as “runners” for older criminals. If caught, they may receive various penalties considered as interventions, from placement in foster care to imprisonment (sometimes with life sentences!) as juveniles. They can be victims of crime, too, and some would even argue that in having been brought into criminal activity they have already been victimized. Arguments about children’s rights and the reasons children become criminals—or victims of crimes like child abuse and neglect—are intense, and reflect the ongoing culture wars of the United States and their associated differences on child-rearing and treatment of adult criminals.

Clearly it is a complicated task to discuss the many topics we can categorize as “children and crime”. There are plenty of books out there that focus on some single topic like child maltreatment or juvenile justice. But a new book by Dr. Connie Tang brings all these topics together in a coherent way. Children and crime (Rowman & Littlefield, 2019) is an unusual and valuable contribution that can be used with benefit by the general public as well as by undergraduate and graduate students in psychology, sociology, social work, and criminology. (And if you belong to the general public you don’t have to  worry about the learning objectives and thought questions in each chapter, but just dip in to what catches your attention!)

Children and crime emphasizes the need for critical thinking about complex problems by discussing the real problems of research design that must be addressed when it is impossible to do experimental work that separates possible causes and effects in a meaningful way. This is the part of the book that most psychologists and psychology students will find most useful. But in addition Dr. Tang expresses a deep compassion and sympathy for children caught in the toils of crime, a practical concern reflecting her early training as asocial worker. A third factor that makes this book unique is Dr. Tang’s awareness of cultural differences, born of her own upbringing in China and adult life and parenthood in the United States (which, full disclosure, she and I have discussed many times).

Like any other serious work on the events of childhood, Children and crime has to deal with the fact that although laws are written as if every person from birth to age 18 has the same needs and abilities, this is actually far from true. Dr. Tang shows three graphs early in the book that demonstrate this fact clearly with respect to children and their involvement with crime. The first graph shows that almost 50% of child victims of  homicide are under 6 years of age; 10% are between 6 and 11; perhaps 7% are 12-14; and more than 35% are 15-17. In other words, young children are most often killed, school-age children and young adolescents quite rarely, and older adolescents with increasing frequency. In a second graph, the child homicide victim’s relationship with the killer is shown. Almost 60% of victims under 6 are killed by family member, another 20% by acquaintances, very few by strangers, and almost 20% by unknown persons.  Child victims between 6 and 11 are killed with about the same frequency by family and unknown persons (about 40% each), and less than 10% of the time by both acquaintances and strangers. By ages 12-14, family killers are reduced to 10% and stranger killings to about 15%, while acquaintances are the killers 25% of the time and killers are unknown in about 50% of cases. These developmental changes proceed with victims aged 15-17, who are rarely killed by family, somewhat more often by strangers, but nearly 40% of the time by acquaintances and 55% of the time by unknown persons. A third graph shows victim age differences in weapons used in the killing: for the youngest children, knives or objects are rarely used, firearms in only about 15% of cases, and the most common method of killing (50%) is “personal”--  that is, the child is killed by beating, strangulation, or similar methods. By ages 6-11, firearms have become the method of killing 50% of the time and “personal” methods have shrunk to 5%. By ages 12-14, 65% of the child victims are killed by firearms, and by ages 15-17 this has increased to 85%.

These developmental differences in child homicide victims reflect a range of factors like physical vulnerability, contact with family and with outsiders, and active involvement in dangerous activities, all of which change with age. Children and crime offers information about psychological theories of development and about social and community factors like those discussed by Urie Bronfenbrenner, as Dr. Tang uses these concepts to discuss how maltreatment, delinquency, and children’s eyewitness testimonies can be understood.

This is a really valuable book. It is not a general discussion of children and the law , or even an extensive discussion of the laws of various countries concerning  a single topic (like the enormously-detailed tome of Hoyano and Kennan, Child Abuse: Law and Policy Across Boundaries, that covers most English-speaking countries). Much more usefully for most readers Children and crime brings together overviews of relevant topics in ways that introduce important ideas to beginning students or general readers and that prepare readers to go more deeply into the complex research literature.

PS: I do have a tiny criticism. If I had written this book (which I would be proud to have done) I would not have been so nice about repressed memory! This is a contentious topic, but I think the results are in, and do not support the idea of repression or the related “recovered memory”.