tag:blogger.com,1999:blog-2743746633913926150.post3160921219464377815..comments2024-03-12T07:00:44.143-04:00Comments on CHILDMYTHS: Diagnosing Reactive Attachment Disorder with Scales and QuestionnairesJean Mercerhttp://www.blogger.com/profile/14619393019771381980noreply@blogger.comBlogger14125tag:blogger.com,1999:blog-2743746633913926150.post-56239659252433462332016-06-19T09:40:50.059-04:002016-06-19T09:40:50.059-04:00Just because you want to predict whether a specifi...Just because you want to predict whether a specific individual will be an axe murderer doesn't mean you can. It's only possible to predict that for groups - the researchers are being more honest, not less accurate.Ettinahttps://www.blogger.com/profile/12391427859178500937noreply@blogger.comtag:blogger.com,1999:blog-2743746633913926150.post-12473080181780318252015-05-30T08:54:02.068-04:002015-05-30T08:54:02.068-04:00The thing is, researchers are interested in studyi...The thing is, researchers are interested in studying differences between groups of people. On the whole, they are not attempting to make predictions about an individual (e.g., if this person gets a weekend pass from the mental hospital, will he murder his mother with an ax?). Predicting which group will do less ax-murdering, on the average, does not require the same accuracy as predicting which individual will do less. The fact that clinicians sometimes fudge diagnoses (especially of RAD) is neither here nor there. Jean Mercerhttps://www.blogger.com/profile/14619393019771381980noreply@blogger.comtag:blogger.com,1999:blog-2743746633913926150.post-20886440453290943542015-05-30T08:11:32.671-04:002015-05-30T08:11:32.671-04:00"identify RAD for research purposes (in othe..."identify RAD for research purposes (in other words, with less accuracy required than we would demand for individual evaluation)"<br /><br />Less accuracy? I always thought research diagnoses were more accurate. Clinicians sometimes put kids in a diagnosis that they feel meets their needs, even if it's not technically accurate. Meanwhile, researchers are just focused on the technical accuracy of the criteria, not on whether they think this kid needs therapy funding that is earmarked for X diagnosis.Ettinahttps://www.blogger.com/profile/08230821659466586897noreply@blogger.comtag:blogger.com,1999:blog-2743746633913926150.post-51877750347219139722013-09-30T17:32:41.945-04:002013-09-30T17:32:41.945-04:00Thanks for the agreement, Joe.
Your comments abo...Thanks for the agreement, Joe. <br /><br />Your comments about the different hats to be worn are certainly correct on paper, but it's very common in rural areas to find that any psychologists present are doing all the jobs to be done, as well as buying grass seed from their patients at the hardware store on weekends. A judge who tries to enforce differences between forensic and treating psychologists will get into trouble for demanding that the county pay for someone to come from a distance and testify, when there's a psychologist right there who always works with the court anyway. <br /><br />By the way, the case I mentioned in this post is still hanging fire, the bio mother has not been allowed any contact with the children, and there is talk of freeing one of the children for adoption-- even though his mother is able and willing to care for him! Jean Mercerhttps://www.blogger.com/profile/14619393019771381980noreply@blogger.comtag:blogger.com,1999:blog-2743746633913926150.post-66102646592686944352013-09-30T14:14:37.955-04:002013-09-30T14:14:37.955-04:00I am a limited licensed psychologist with a Psycho...I am a limited licensed psychologist with a Psychology Specialist degree in Michigan. A couple of points: A Forensic Psychologist (specializes in legal testimony) is kept separate from the treating psychologist. Code of Ethics 7.03 “In most circumstances, psychologists avoid performing multiple and potentially conflicting roles in forensic matters. When psychologists may be called on to serve in more than one role in a legal proceeding - for example, as consultant or expert for one party or for the court and as a fact witness - they clarify role expectations and the extent of confidentiality in advance to the extent feasible, and thereafter as changes occur, in order to avoid compromising their professional judgment and objectivity and in order to avoid misleading others regarding their role.”<br /><br />In the Peamble to the Code of Ethics, psychologists “…perform many roles, such as researcher, educator, diagnostician, therapist, supervisor, consultant, administrator, social interventionist, and expert witness.” The treating psychologist is mandated to ONLY treat what (s)he concurs with diagnostically. In order to provide psychological treatment, the psychologist must provide a diagnosis to provide treatment. <br /><br />Secondly, there is not a diagnostic test to determine the presence or absence of Reactive Attachment Disorder. The RADQ stands for Randolph Attachment Disorder Questionnaire, not Reactive Attachment Disorder Questionnaire. Her criteria are not the same as the DSM-IV-TR criteria. While it is one of the better known of Attachment Disorder checklists, its use by attachment therapists and others to diagnose RAD is simply and clearly unethical. The checklist includes 93 discrete behaviors, many of which either overlap with other disorders, like conduct disorder, oppositional defiant disorder, ADHD, bipolar disorder, and adjustment disorder, or are simply not related to attachment difficulties. While the checklist may be extremely helpful to identify specific symptoms, it cannot be used to diagnose or even support a diagnosis. It has no official recognition, has had no validity studies, has not shown the ability to produce results that a differential diagnosis wouldn’t better explain, to mention some difficulties off the top of my head. <br /><br />Hope this helps – though I realize it is about a year after the original posts.<br /><br />Joe Elwart, Psy.S., LLPMordecaihttps://www.blogger.com/profile/14433252490115520830noreply@blogger.comtag:blogger.com,1999:blog-2743746633913926150.post-89609784739484374332012-11-20T07:54:36.442-05:002012-11-20T07:54:36.442-05:00Go for it-- I have to say I dread to think what y...Go for it-- I have to say I dread to think what you're going to find out.Jean Mercerhttps://www.blogger.com/profile/14619393019771381980noreply@blogger.comtag:blogger.com,1999:blog-2743746633913926150.post-19516548375052611952012-11-19T23:58:56.763-05:002012-11-19T23:58:56.763-05:00Yep, I will. We see the psychiatrist every 2 month...Yep, I will. We see the psychiatrist every 2 months, so it will take a while to get an answer. I'll poke around too and see what social workers know about how the judges in our area tend to rule on Rogers Orders requests, and whether a RAD diagnosis usually helps to get an affirmative ruling. Risperdal is clearly indicated for aggressive behaviors; there's no need to bring RAD into it. But too many people can't seem to comprehend that aggression in children can arise from ADHD and PTSD---and lack of age-appropriate social skills or exposure to domestic/institutional violence (including the overuse of restraints in residential treatment centers), which are very common among older children who have spent years in foster care. But our culture doesn't like to treat or medicate for problems that its own system of "care" helps to create. Diagnosis: Foster Care System Disorder. Treatment: Years of therapy and anti-psychotics. Nope, it's not likely that we'll look at our damage-causing processes head on; let's look for the flaw in the child, instead---or in the birth family, who in most cases cannot respond with any facts that might be relevant or will not be believed.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-2743746633913926150.post-65727207159391649402012-11-19T09:31:29.298-05:002012-11-19T09:31:29.298-05:00I am certainly learning a lot here. What a disturb...I am certainly learning a lot here. What a disturbing thought, that the courts have bought into this idea! Please,if you don't mind,let me know if you manage to find out whether this was just a pragmatic move on the psychiatrist's part, or what. Jean Mercerhttps://www.blogger.com/profile/14619393019771381980noreply@blogger.comtag:blogger.com,1999:blog-2743746633913926150.post-76820006937676717982012-11-19T02:40:21.941-05:002012-11-19T02:40:21.941-05:00I discovered, in the middle of an IEP meeting for ...I discovered, in the middle of an IEP meeting for my (foster/adoptive) daughter this week, that she's been diagnosed with RAD by her psychiatrist; no one let me know. But when the school was asking about her medications and diagnoses, and I offered ADHD and PTSD, her social worker chimed in "And RAD." I must've glared at her, because she then whispered to me, "The psychiatrist provided that diagnosis for the Rogers Order." Long story, but in Massachusetts any foster child who needs to receive an atypical anti-psychotic medication needs to have court approval via something known as a Rogers Order. After many other medications were tried, the only medication that helped my daughter get a handle on her aggression (while we attend therapy 3 times weekly) turned out to be Risperdal, and the psychiatrist prescribed it on an emergency basis. She never spoke to me about adding (or rather, reinstating) a diagnosis of RAD. (My daughter had been previously diagnosed with RAD by a social worker, who was recommending that she be placed, permanently, in a group home, at age 10, because she'd never be able to live in a family. Subsequent therapists dismissed that diagnosis and prognosis, with good reason.) So, added to the "need" for a RAD diagnosis by insurance companies, you might want to add the need from the courts, although I'm not yet sure whether that's why this psychiatrist has diagnosed RAD or whether she actually believes it. Time for a discussion, for sure, though I don't believe the diagnosis is correct. <br /><br />[I'm posting anonymously to preserve some privacy for my daughter.]Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-2743746633913926150.post-5127008082056552612012-11-10T08:21:30.088-05:002012-11-10T08:21:30.088-05:00Another disturbing factor is that babies who are s...Another disturbing factor is that babies who are sleeping on their backs, per instructions to prevent SIDS, are likely to be delayed in the developmental milestones you quoted, relative to the existing norms which were taken from data on prone-sleeping babies. This means that parents who believe in Randolph's claims and are watchful for signs of AD may decide they see this notional disorder in infants in the first year of life.<br /><br />In addition, toddlers and preschoolers, whose torsos are inflexible because they have not yet developed some rib movements that occur slightly later, do not swing their arms when they walk. Arm-swinging results from counter-rotation of the shoulders to maintain balance as weight is shifted from one foot to the other. If your torso doesn't bend, you don't counter-rotate your shoulders, and your arms don't swing. Therefore Randolph's "signs" condemn most preschoolers to an AD diagnosis.<br /><br />Once again, we see the RAD/AD crowd displaying abysmal ignorance about normal developmental changes, just as they show it about natural changes in attachment behavior. Jean Mercerhttps://www.blogger.com/profile/14619393019771381980noreply@blogger.comtag:blogger.com,1999:blog-2743746633913926150.post-17388567553357396892012-11-09T23:23:07.061-05:002012-11-09T23:23:07.061-05:00Thank you.Thank you.Marianne Miltonnoreply@blogger.comtag:blogger.com,1999:blog-2743746633913926150.post-63685347937112646332012-11-09T21:31:14.288-05:002012-11-09T21:31:14.288-05:00It wasn't only backward crawling that Elizabet...It wasn't only backward crawling that Elizabeth Randolph thought was diagnostic of "AD." She wrote:<br /><br />"Inability to do the developmental movements, particularly with pressing to all fours, rolling from back to front by reaching, and backward crawling seem to be particularly common among children with AD, and are only very rarely seen in children who don’t have AD."<br /><br />I think it was 2001 that I attended a presentation by Randolph. She brought onto the stage a teenage girl with "AD" and had the girl demonstrate all the things she was physically unable to do. Randolph also claimed that people with AD are unable to swing their arms when they walk, and the girl demonstrated that, as well. After a break in the conference, the lawyer sitting next to me said she saw the girl walking outside, walked around...and swinging her arms with no problem.<br /><br />What concerns me is the prevalence of belief in the existence of Attachment Disorder (but usually referred to as RAD) and how it tends to paint adopted and foster children, who are allegedly commonly afflicted with the disorder, as potentially dangerous. It almost seems like criminal profiling.<br /><br />And another thing. It appears that parents of adopted or foster children will use the RADQ, or similar checklists, to diagnose their children themselves. LindaRosaRNhttp://www.scienceinmedicine.orgnoreply@blogger.comtag:blogger.com,1999:blog-2743746633913926150.post-34900049304930628902012-11-09T09:29:04.860-05:002012-11-09T09:29:04.860-05:00The ethics guidelines adopted by the American Psyc...The ethics guidelines adopted by the American Psychological Association specifically prohibit psychologists from doing both the therapy and the evaluations that will be used in court for an individual or family-- the intention of the guidelines is to keep the psychologist from inadvertently paying too much attention to issues he or she sees from a personal rather than an objective point of view. As far as I can see, social workers have no specific prohibition of this kind, although their ethical guidelines caution them that they should clarify with every member of the family exactly what their (the social workers') roles are. <br /><br />If you're talking about choosing a therapist to work with children or with the whole family, I would say that a psychologist is a good deal more likely to have had training in the facts of child development than a social worker is (although there are obviously psychologists who have concentrated entirely on adult life, and some social workers who have looked closely at child and adolescent development).<br /><br />Psychologists are also more likely as a group to be aware of the need for evidence-based treatments, although some social workers are now supporting this idea.<br /><br />I don't know whether many years of clinical experience make so much difference in the quality of care if the practitioner has not continued to be trained in methods that are supported by good research. Of course, this would be true for psychologists as well as for SWs. Jean Mercerhttps://www.blogger.com/profile/14619393019771381980noreply@blogger.comtag:blogger.com,1999:blog-2743746633913926150.post-74510199258734562002012-11-08T21:11:32.948-05:002012-11-08T21:11:32.948-05:00Interesting that you say "he’s a social worke...Interesting that you say "he’s a social worker; a psychologist would not be permitted to wear two hats like this." I don't know enough about the two professions to understand why that's true. Is the reason because of different codes of ethics?<br /><br />Is it better, in general, for parents to choose a psychologist over a social worker for therapy, even if the social worker has many years of clinical experience?Marianne Miltonnoreply@blogger.com