More on Attachment Therapy in Russia

Yesterday I wrote about the exportation to Russia of practices related to the “attachment therapy belief system” (ATBS) by Kenneth Frohock of the Attachment Institute of New England and his colleagues. I thank my Russian colleague Dr. Yulia Massino for the information she has provided about this matter. What I write today will be drawn from what she has shown me.

Further material from Frohock’s Russian presentations is at

 https://youtu.be/vc27yB1e7EQ?list=PLqBJeoyXk6A90g5jSLnLTafN0jEhs_Vpb&t=2886.

Frohock asserts that problems of adopted children, as complained of by the adoptive parents, are in part due to their dependence on or addiction to the stress hormone cortisol. Prenatally exposed to high levels of cortisol, they have become dependent on it and seek stress in order to maintain the cortisol levels they are accustomed to. Thus, they need to be treated as if they were drug addicts—an analogy that enables AT proponents to assume that the children are manipulative, are liars, and are determined to have their own ways without consideration of others or even of their own long-term best interests. (It also brings in Frohock’s stated earlier work with addicts.)

Have many adopted children experienced high levels of cortisol in their prenatal lives? Yes, they probably have, as their biological mothers were often in high-stress situations and produced cortisol that circulated in the bloodstream and reached the fetus. Adoption stories always involve some sort of stress or even tragedy, without which no adoption would have occurred. It’s the rare case nowadays when a baby is adopted because the mother died in childbirth, or both parents were killed soon after the birth. Generally, the adoption occurs because the mother cannot care for her baby for various reasons, those reasons being present and causing stress throughout the pregnancy.

However, to blame concerns about adopted children on cortisol dependence is a bit like thinking that “anatomy is destiny”. Whatever brain chemistry is like at birth, it can and usually will change as a result of care experiences. The role of cortisol during birth is in fact paradoxical. Babies born vaginally have a peak of stress hormones during birth, and these hormones act to marshal the baby’s adaptations to life outside the womb—helping, for example, to change the prenatal arrangement of blood vessels around the heart and to make it possible to get oxygen effectively from the lungs to the rest of the body. Babies born by Caesarian section do not have the same experience, do not produce that peak of stress hormones, and are less alert and well-organized shortly after birth than they would otherwise be. This suggests that early experiences with stress and hormonal responses should not all be interpreted in the same way.

Newborn babies are usually not very good at self-calming. They lack the abilities to position themselves comfortably or to get the thumb to the mouth to suck. When stressed, they cry themselves to exhaustion unless a caregiver helps them calm. But after weeks or months of help in calming, well-cared-for babies develop their own self-calming methods and are no longer at the mercy of stress experiences. Whatever their prenatal experiences with cortisol may have been, they now have an opportunity to over-ride those effects and organize themselves to work with a lower level of stress. Of course, if they are sick or injured or poorly cared for, they may not succeed as well in learning how to regulate their emotions.  This suggests that even if stress has played an important role in a baby’s prenatal life, as is common in adoption cases, most adopted babies will be helped to overcome this problem, although it is reasonable to think that a baby who experienced prenatal stress and then did not receive sensitive, responsive care might have continuing difficulty.

Frohock suggests that adopted babies have special problems self-calming and basically do not want to be calm. This idea is rather difficult to test, as there are so many other factors such as temperament or drug or alcohol exposure that determine how fussy or difficult a baby may be. However, it is a huge mistake to assume that early experiences are “destiny”. Whatever actual harm to brain physiology or chemistry a baby may have experienced, its development does not stop at that point. Overemphasis on brain processes ignores the high plasticity of young children’s brain development—loss of a brain hemisphere in the early months is soon overcome by reorganization and development of the remaining hemisphere, compensating for most of the loss. 

Good experiences with caregivers can guide development in very positive ways, and experiences continue to shape development throughout childhood, adolescence, and even adulthood. Even when caregivers have not been managing well, both parent and child can get back on the best developmental track through evidence-based treatments like Parent-Child Interaction Therapy (PCIT).

Frohock’s view of stress-induced problems of infants is thus not in line with much of what is known about brain development. His further claims about stress effects are even farther off the mark. Having asserted that children are in essence “addicted” to stress hormones and behave in such a way that they experience high levels of these hormones, Frohock goes on to claim that adoptive parents develop a similar addiction as a result of being with their “addicted” children. Indeed, he says he becomes similarly dependent as a result of working with such families! It’s curious that he attributes such a high level of plasticity (the tendency to be affected by the environment) to human beings on the one hand, but on the other hand denies the possibility that normal family life can be a strong influence on the development of adopted children. These children, he seems to say, have low plasticity in this one area and must be treated with “intensive” methods including physical restraint. It's also curious that "addicted" parents (and "addicted" Frohock) are unhappy about the children's behavior-- surely, if they are dependent on cortisol, they would prefer for the children to create a high level of stress in order to keep themselves and the adults comfortable?

It’s all a bit contradictory and confusing, and suggests that Frohock’s experience treating drug addicts has provided him with a large hammer and the tendency to look for objects that need to be banged with it. Regrettably, he has found people who support his banging methods. For example,the organization of his seminars found funding not only from the Russian government fund, but from the charitable foundation "Arithmetic of Goodness",  created by  a vastly wealthy Russian businessman, Roman Avdeev, https://www.a-dobra.ru/wp-content/uploads/Aprel_2_compressed_min_min_1.pdf , which advertises Frohock’s seminars. ( My thanks to Dr. Yulia Massino for this source and translation.)

Is Avdeev a “true believer” in the Frohock claims? He may be, but my bet is that he has simply been persuaded by Frohock’s confident statements of success. Surprisingly few people understand the first thing about attachment, and surprisingly many are willing to accept almost any statement that references attachment. Unfortunately, they are deeply convinced that they know all about it. (If you say bonding, they’ll go for that too.) I was recently asked by a U.S. attorney, one very involved in child maltreatment issues, whether attachment theory was not based on a nursing mother’s care for her baby. Like many people, she mistook the adult side of the parent-child attachment relationship for the child’s side. I assured her that attachment theory was not based on parent behavior (however important it may be for guiding development), but on the infant-toddler pattern of staying close to a familiar person and protesting against separation. I am not really sure that she believed me! And I am not at all sure that Avdeev does not have similar—or equally inaccurate—beliefs about early development.

Some readers may be asking, "Why is this so important? Are people not allowed to believe what they want to believe and to make the choices they want?" Yes, of course, they are allowed to believe and choose for themselves. Whether they should be allowed to do this for their children is another matter-- and what about the choices people make that are not even about their own children? Spreading misinformation about child development and parenting has a number of possible bad consequences. One is that children may be mistreated, and it seems possible that Frohock's methods are mistreatment, as older forms of holding/attachment therapy certainly were. Less directly, misinformation may have two ill effects related to adoption. One is to make adoptive parents expect that children will show some unwanted behavior and signs of serious mental and behavioral problems, when this is not necessarily the case. These parents may see ordinary age-appropriate behavior and believe that it is simply the first symptom of real problems. A second issue is that people considering adoption may believe that any problem a child has can be treated successfully, and they may thus commit themselves to adopting more children than they can effectively care for and children with serious difficulties that will not be helped by treatments like Frohock's. These problems can result even for families that do not seek Frohock's treatment for their children.