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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, February 24, 2020

PA, CC, and ABAB

I recently had an inquiry from a mother who is about to face a child custody trial in which a fan of Craig Childress is advising her opponent about “parental alienation”. This mother and others find it hard to figure out what Childress is talking about in his book “An Attachment-based Model of Parental Alienation”, published by a company that shares his office address. They are often especially concerned about Childress’s way of identifying “parental alienation” (PA) in children of divorce who want to avoid contact with one of their parents. 

People have frequently asked me about Childress's diagnostic methods. What I am about to discuss is in his book "An Attachment-based Model of Parental Alienation", pp. 308-310. 

Childress suggests that diagnosis should be done using an ABAB single-case protocol. This is a real thing. It is intended to help decide whether a particular treatment is helpful to a particular person. Here's what happens with the ABAB method:

Condition A is a set of circumstances that the client is experiencing. During these circumstances, observations are made of a concerning behavior. For example, a child is living with his mother and has no contact with father; behaviors showing hostility and rejection toward the father are recorded.

In Condition B, the client is placed in a different set of circumstances and the concerning behavior is again observed. For example, a treatment is started, and the child's rejection of the father is recorded.

Condition A is repeated and the concerning behavior is recorded. For example, the child is returned to the mother's custody and attitudes toward the father are again recorded.

Finally, Condition B is repeated.

If the concerning behavior (rejection of father) is less in condition B than in A, this is an indication that the treatment may be effective. Childress also concludes on p. 310 that if the treatment is effective, this is powerful evidence that the mother's pathogenic parenting is responsible for the child's behavior.

BUT! Here's where his claims fall apart.

1.      When the ABAB protocol is used, Conditions A and B must be different only in one characteristic. If they are different in more than one way, it is impossible to know which factor might cause the difference. So, typically, ABAB might be used to test a treatment (Condition B) for bedwetting. The child stays at home and follows his ordinary habits, but sometimes receives the treatment and sometimes does not. Differences in bedwetting between A and B suggest that B is an effective treatment (although it could also be that the child just matured)....In Childress's method, however, there are many differences between A and B. B includes separation from the preferred parent, much contact with the nonpreferred parent, possibly different behavior from the nonpreferred[parent than occurred in the past, and four days of “High Road” treatment, which may include transportation by youth transport service workers. The child is frightened and has no idea what is happening. As most of these kids are not very young children, we can expect them to catch on to what they are supposed to do and to do it in order to avoid further unpleasant events. Whether behavior is different in A and B because of separation, because of treatment, because of fear, or whatever-- that cannot be told from this approach.
2.      The ABAB approach could only be considered diagnostic if there were just one cause for the behavior, and just one treatment that was already well demonstrated to treat the problem effectively. This is not true of rejection of a parent, so whatever happens on ABAB, it does not show what caused the problem. With respect to the ABAB evidence showing what caused the rejection, Childress seems to envision only one way in which the behavior can be caused. Like other PA advocates, he has a single-factor theory that omits to consider any of a myriad causes of behavior and especially does not look into the rejected parent's own actions, whether abusive or simply awkward and lacking in parenting and communication skills. The ABAB protocol is a real set-up, as most children are likely to alter behavior as instructed when powerless in a strange situation; when they do so, Childress then points to this-- skipping a number of logical steps-- as empirical evidence of the diagnosis. (What he would conclude if the child did not change, I cannot guess, but it would probably be that the preferred parent has caused serious mental illness in the child!)

The ABAB protocol sounds most impressive to those who have never heard of it, but the way Childress uses it (if indeed he does—he does not seem to provide any examples of actually doing this) cannot demonstrate that a treatment works with a particular child. (It is not intended to, and cannot, show that a treatment is generally effective). The ABAB protocol, no matter how well implemented, cannot show the cause of a problem unless there is only one cause AND unless it has been demonstrated that the treatment is generally effective.

A long time ago, Dr. Spock wrote that if your child has a fever, you can sponge her with cool water and it helps as much as an alcohol rub, but “it doesn’t smell so important”. Childress’s ABAB protocol smells important to people who don’t understand it, but in fact the odor you detect is not alcohol.