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Child Psychology Blogs

Concerned About Unconventional Mental Health Interventions?

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

Monday, November 26, 2018

Preschool Child Defiant or Disruptive? Some Ideas You Might Want to Use

When preschool children are defiant, disobedient, and disruptive, there are a lot of difficulties created for everyone. Nothing goes smoothly at home, from getting dressed to bedtime. For today’s multitasking families, having a child who gets expelled from preschool or day care can be a disaster. Parents become concerned over the child’s future--  what happens when he (usually, but not always) gets bigger and it’s impossible to force compliance? And the child too suffers from a constant barrage of disapproval and punishment, gets kicked out of story hour at the library, and is not allowed to play at the houses of friends whose mothers have had enough of dealing with bad behavior.

What can be done to help these children and their families? It’s clear that more punishment, time-outs, even spankings are not the answer, but tend to make the situation even worse.

In response to the high number of expulsions and suspensions of preschool children, positive behavioral intervention and support (PBIS) has been developed. It seems to be an effective way for schools and teachers to deal with problem behavior in preschoolers, and it can be used by parents as well. This approach depends on figuring out why and under what circumstances young children misbehave—something they can’t explain to you no matter how much you ask them.

Very few children are actually defiant, disobedient, and disruptive all the time, even if it sometimes feels that way to adults. When they do misbehave, the problem may be as much or more about the circumstances, the time, and the place, as about the child’s own nature. Unfortunately, frequent child misbehavior makes adults mad, impatient, and in a hurry to punish even though nothing has happened yet. This makes matters worse, as both child and adult begin to anticipate trouble and to expect bad experiences with each other, and both may become less and less able to deal effectively even with small problems.

However, if we can pinpoint the situations where preschoolers have trouble  behaving well, we may be able to take special care with those situations and slow down or stop the development of serious social problems. Anticipating that a child may find some experience difficult to deal with can allow an adult to “buffer” the situation, reduce its impact on the child, and guide the child through the troubled time. How do you pinpoint and anticipate hard times? It’s difficult unless you have some systematic way to do it.

you can find a template for observing a child’s behavior and keeping a record of what you see. Doing this systematically for each behavior problem can let you see a pattern of behavior that will help explain why the child is having trouble and what you may be able to do to help improve things. Records like this should be made when children are physically aggressive to adults or other children, when they run off from where they should be and don’t answer adult calls, and when the child does things like head-banging or self-biting that could cause injury—really important problem behaviors that need to be stopped for the good of everyone concerned. (You may also want to keep records of tantrums, inappropriate language, hitting, destroying property, and disruptive behavior if children persist in these even as they get older or if your usual methods do not seem to handle them effectively.)

The form stresses the circumstances that accompanied the behavior problem, for example, large or small group activities, nap time, or meals. Young children often have difficulty in handling transitions of any kind, whether it’s getting dressed, leaving home in the morning, having Mom leave and Dad or a baby-sitter arrive, the beginning of mealtimes, and so on. If this is the case, the cure may be for adults to anticipate the transition and give a “distant early warning”—tell the child what will happen five or ten minutes early, or use a timer of some kind to help the child prepare (this gets easier when they can tell time). The child may have had exactly the same experiences the day before and we might think he will know what’s happening, but this may not be one of the skills of a 3- or 4-year-old, who needs to be reminded in order to accept changes that adults want without so much difficulty. Sometimes transitions are allowed to be too open-ended, as when an adults tells the child it’s time to leave but then gets caught up in a phone call or other adult event, which can create almost as much trouble as failing to give warning.

Positive behavior interventions and supports also involve giving praise when children are behaving as we would like them to, rather than just taking good social behavior for granted and getting angry at or punishing unwanted behavior.  Although people usually concentrate on what children do wrong, it may also be important to record the times and circumstances when a child does very well, and to be prepared to praise and thank the child for that desirable behavior.

The point of PBIS is to watch carefully to figure out preschoolers’ social strengths and weaknesses. When there are clear weaknesses under certain circumstances, we can often tweak the circumstances or use friendly guidance to make things a bit easier until a child masters a social or self-regulatory skill. We would do this for educational or athletic skills, for example by reminding an older child to “sound out” a word she can’t read, or by helping a child practice dribbling a ball. But we often forget that children have to learn how to behave as well as to read or play a game.  

Although PBIS methods were created for use in schools, they can work for parents too, and can help stop the vicious circle of child misbehavior and parent anger. And, if your child is expelled from preschool or day care, remind the school that PBIS is available--  and it works.

Wednesday, November 14, 2018

The Background of "Three Identical Strangers"

Probably most interested people saw the movie Three Identical Strangers before I did—I only got to it on an airplane recently. This semi-documentary story of triplets born in the early ‘60s and adopted by separate families through a well-known New York adoption agency is fascinating but does not really touch on all the historical details.

As you may already know, the Identical Strangers, reared separately and with no knowledge of each other, met by accident as young men, were fascinated by the immediate relationship they formed, started a restaurant together, and became media darlings to some extent. Looking into the circumstances of their separate adoptions, they were able to find out that their placements had been part of a study conducted by the child psychiatrist Peter Neubauer  in an effort to examine the effects of nature (heredity) and nurture (experiences of caregiving) on child development. Each of the triplets recalled childhood events in which psychologists or other observers came to their homes and tested their development in various ways. The adoptive parents did not know that they had only one triplet per family, and they accepted the testing as part of a study of normal child development. In fact, the boys had been placed in homes that were expected to present some contrast in childrearing methods—one affluent, one middle-class, and one working-class, with the idea that these different homes would provide different experiences for each of the three genetically identical children.

When the triplets and their adoptive parents found that they had not been informed about the circumstances or the study, they were deeply offended and angry, feeling they had been treated like lab rats or guinea pigs. They began to search for the still unpublished results of the study as well as attempting successfully to find the identity of their biological mother. Peter Neubauer has died, and the data collected in the study is sealed in the archives of the Yale Child Study Center, not to be opened until 2060, when all or most of those involved in the study will also be dead. The two surviving triplets are frustrated and distressed by this and feel that it was wrong to keep them from knowing their brothers. They have also found that a number of identical twin pairs were placed apart and included in the research; some of them have reunited, but there are probably some who still do not know they have a twin.

It’s very understandable that the triplets and some of the twins have strong negative feelings about these events in their lives. The fact that the adoptions took place through a Jewish agency, and many of the children were Jewish, calls up horrible reminiscences of Nazi experimentation on children. Today’s research ethics would not permit any such study to be done now.

But is it reasonable to blame Peter Neubauer, the cooperating adoption agency, or anyone else involved in the implementation of the study for the choices they made? Today, yes, they would be considered culpable, but if we look at historical background the conclusion is less clear.

First, let me point out that before reliable birth control and legalized abortion, there were large numbers of “illegitimate” or “unwanted” babies who needed care. Unmarried mothers were strongly discouraged from keeping their babies. Even healthy, married mothers who had multiple births might well be advised to give a baby for adoption because of practical and medical issues that could arise from trying to rear two or three infants together. (The famous Dionne quintuplets in Canada were actually taken to be raised in a government institution because of this kind of reasoning.) The idea of separating children at birth was very much a current one at that time, so it is very likely that triplets would have been separated for adoption under any circumstances; the Neubauer study was simply a matter of following up on the children’s development after placement was already made. The placement of the children in the three somewhat different homes was a little unusual, because ordinarily adoption agencies tried to place children with adoptive families whose socioeconomic status was about the same as the birth mother’s (birth fathers did not come into the equation at this point). However, the three families were all sufficiently well off to care for adopted children, and all had already adopted at least one child successfully, so although one of the boys may have had more luxuries than the others, no one suffered from poverty or deprivation, and in fact the families were more similar to each other than we would be likely to see in today’s increasing inequity.

How about the secrecy? Today, we encourage adoptive families to learn all they can about the adopted child’s biological background—even to enter into an open adoption where the birth mother stays in contact with the child. We stress the need to be clear with the child about his or her adoption from an early age. Adopted children today are much more likely to be of different ethnicities from their adoptive parents and siblings, so adoptive status is often easily visible to outsiders. These circumstances were not usually the case when the triplets were born. Secrecy in adoption was seen as essential for the birth mother, who could now go on with her life without having to fear that anyone--  including a future husband and children—would ever know about her distressing history. Adoptive parents themselves often preferred to keep the adoption a secret out of concern for the social stigma that known infertility might bring for them; men especially might not want the adoption to be known, out of feared confusion between infertility and impotence. If no one was to know about the adoption, certainly the children could not be told, because they would be bound to ask questions or tell people outside the family, and as a result many adopted individuals found out that they were adopted only after the deaths of their adoptive parents.

The Neubauer study also took place in the wake of revelations about an earlier study that purported to investigate effects of nature or of nurture in adopted children, especially in twins one of whom had been adopted. A British psychologist, Cyril Burt, had conducted what appeared to be extensive studies looking at the effects of heredity and environment on intelligence. He published conclusions showing a strong effect of heredity on intelligence, with twins reared in different families resembling each other closely on intelligence tests. But Burt’s work turned out to have many flaws. For example, one of a pair of twins might remain with the birth family while the other one was placed with a cousin or aunt in the same village, and the children might grow up going to school and playing together, so their environments were really not different. In addition, it became plain after a while that Burt had actually used fraudulent methods of analyzing and presenting his data, publishing statistics that simply were not possible calculations.

The Burt scandal meant that questions about heredity and environment were completely unanswered. Peter Neubauer thought to do work that would help to answer those questions with children who were already being separated at birth and whose adoptive status was already being kept secret. The one twist in placement of the triplets was the use of three families somewhat different in socioeconomic status, but all perfectly capable of adopting and rearing children. Neubauer’s work did not meet either the scientific or the ethical standards of the present day, and the sealing and archiving of the records does raise many questions, but the story of the triplets should not be interpreted as evidence of cruelty or indifference to the needs of children and of families. We can sympathize with the surprise and distress felt by the triplets as the story unwound (and thank for their willingness to tell us their experiences) without assuming that the study was conducted by “mad scientists”.

Saturday, November 3, 2018

Parental Alienation Treatments: The Experiences from the Children's Perspectives

When children and adolescents are placed in psychological treatment outside their homes—even treatments that last only a few days—they are sometimes held incommunicado by their therapists and staff members. Not only are they kept without phones or money, but they are told that if they do not cooperate they will be sent to wilderness camps or residential treatment centers where they will not be able to reach anyone they know. This can happen in many forms of treatment, but it seems to be especially characteristic of programs that purport to treat “parental alienation”, in which a child of divorced parents rejects contact with one of the parents.

Under the heading “When threats substitute for therapy”, I wrote the following description of a parental alienation treatment on this blog in September 2016. I’m repeating this right now because “Polly” and two other young people have now told their stories on a television program. I’ll give the link to that program later in this post.

“I recently received a long email from a young woman I’ll call Polly. She is 17 years old, has finished high school, and recently went to court to become legally emancipated. But her emancipation petition was not Polly’s first experience with the courts. Her parents, who are divorced, have become locked into an accusation of “parental alienation”—the idea that Polly and her sister, who preferred to live with their father and avoid their mother’s household and her boyfriend, must have this preference because their father had “brainwashed” them into believing bad things about the mother. (Proof of this claim was that the girls insisted that it was their own decision!)

Polly’s mother contacted a California therapist whose psychology license had been revoked but who said he could practice a “psychoeducational” method called Family Bridges. As is the case for many proprietary treatments, it is not easy to find a description of Family Bridges. However, Polly has described what happened to her and to her younger sister when a judge ordered the girls to travel from their home state to California and to participate in Family Bridges. 

According to Polly’s report, when the girls tried to refuse, they were taken away from the courthouse by employees of a “youth transport service”. (These “services” and the little regulation they undergo were discussed by Ira Robbins at The transporters responded to Polly’s crying and lying down on the ground by telling her that her father would go to jail if she didn’t go, and hinting that she herself would be confined in a residential treatment center. The two girls were taken to a town in California, where they were met by their mother, the mother’s boyfriend, and several psychologists, who met them in a hotel room and apparently do not have an office. The plan was to provide the girls with treatment that would convince them that their father had made them think that their mother was abusive.

The treatment, or “psychoeducation”, consisted of watching and discussing a number of video presentations. These included material about visual illusions, about how people may express opinions that are not really their own because of social pressures, and about the well-known study by Milgram in which participants who believed they were giving other people serious electric shocks often continued to do so when ordered by an authoritative experimenter. The implications of these presentations were apparently that the girls should understand that opinions they thought were their own had actually been created in their minds by their father—a plan with its own logic, perhaps, but not one based on any evidence that deeply emotional beliefs can easily be changed, nor indeed on any evidence that they had been influenced in their opinions by the father.

At almost 18, Polly was almost four years past the age when adolescents are normally given the chance for informed consent to medical or other therapeutic procedures. Instead, threats were used to force her cooperation, and her concerns and opinions were ignored. The threats came into the picture when Polly continued to be resistant and to speak rejectingly to her mother in spite of this “treatment”. According to Polly, one of the psychologists told her, “If you continue that behavior, you will be sent somewhere else. You seem like you need more help than we can give you”—superficially an offer of help for a vulnerable person, but in essence a threat of further disruption to her life. Arrest was threatened if she did not mind her mother, and for several days both girls were told that if they did not cooperate they would go to a treatment facility for juvenile offenders or to wilderness therapy--  these both being situations where teenagers are held incommunicado, have no opportunity to report abuse, and live in austere, even dangerous conditions. Back at the mother’s house, too, incarceration in a residential treatment center was the threat used to obtain obedience.

If Polly had not succeeded in her emancipation petition, or if she had been much younger, no doubt her behavior would have continued to be manipulated by threats--  and perhaps some of the threats would even have been acted upon. What if her behavior had changed in response to those threats? Would that have indicated that the “treatment” was effective—or simply that people respond at least temporarily to sufficiently serious threats?

One other question: when people are trained to do interventions that in practice include threats, are they trained in effective threatening?”

Now, in November, 2018, “Polly”--  real name Arianna—has joined with two other young people who have experienced Family Bridges to describe their feelings in the aftermath of the program, in the following Bay Area television interview:

Journal articles by Richard Warshak,  a major advocate for Family Bridges, fail to note the concerns raised by Arianna, Sam, and Leo, or to discuss how the use of youth transport service workers can alter the children’s experiences. Even a 2018 article by Warshak in the Journal of Divorce & Remarriage ignores these points, although many psychologists today are voicing serious concerns about adverse events associated with some psychological treatments and the need to report these as part of any research program.

Family courts need to be aware of the information provided by the reports of young adults about Family Bridges and other “parental alienation” treatments and to take these into account as seriously as they take the claims of program proponents. In addition, judges--  and the public in general—should be alert to the rhetorical device employed by Linda Gottlieb in her contribution to the television interview, when she abuses analogies to create the argument that parental alienation can be equated with child sexual abuse.