Lark Eshleman's "Becoming A Family": Approach With Caution

A Pennsylvania school psychologist, Lark Eshleman, published in 2003 a book called “Becoming a Family: Promoting Healthy Attachments With Your Adopted Child”. Although Ms. Eshleman is eager to be helpful and has written an enthusiastic volume, looking through the book unfortunately reveals misunderstandings that could easily lead to inappropriate treatment of adopted children.

Ms . Eshleman quickly focuses on the idea that adopted children are likely to suffer from Reactive Attachment Disorder and presents two definitions of “what RAD looks like”. She does not appear to notice that these “clinical definitions” (as she puts it) have little to do with each other.

Looking at discussion of Reactive Attachment Disorder in the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association, Eshleman quotes the following description:

“Reactive Attachment Disorder (RAD) is a complex psychiatric condition that affects a small number of children. It is characterized by problems with the formation of emotional attachments to others that are present before age five. A parent or physician may first notice problems in attachment with the caregiver that ordinarily forms in the latter part of the first year of the child’s life. The child with RAD may appear detached, unresponsive, inhibited or reluctant to engage in age-appropriate social interactions. Alternatively, some children with RAD may be overly or inappropriately social or familiar, even with strangers. The social and emotional problems associated with RAD may persist, as the child grows older.” [I haven’t checked for the accuracy of this quotation. It seems a bit clumsy, but nobody ever said psychiatrists had to be engaging writers.]

Next, apparently with the intention of reinforcing the comments above, Eshleman proceeds to quote the Association for Treatment and Training of Attachment in Children (ATTACh, a hybrid parent-professional group that has in recent years offered credentialing to those trained in their perspective on attachment issues):

“ Attachment disorder is a treatable condition in which there is a significant dysfunction in an individual’s ability to trust or engage in reciprocal, loving, lasting relationships. An attachment disorder occurs due to traumatic disruption or other interferences with the caregiver-child bond during the first years of life. It can distort future stages of development and impact a person’s cognitive, neurological, social and emotional functioning. It may also increase the risk of other serious emotional and behavioral problems.”

Let’s examine these two statements point by point and see to what extent they are in agreement with each other.
The APA statement refers to a specific diagnosis, Reactive Attachment Disorder, which has been listed in DSM for a couple of decades and which originally referred to a type of feeding problem of infants. The ATTACh statement speaks instead of “attachment disorder”, a general term that could be applied to less-than-ideal attachment styles that are nevertheless well within the normal range.
The APA statement makes no comment about treatability of RAD, while ATTACh introduces the idea of treatment before even describing the problem.
The APA statement describes observable behaviors that are part of the disorder and which presumably could be noted by parents and teachers as well as by psychiatrists, psychologists, or social workers. The ATTACh statement refers to vaguely-described problems such as the “ability to trust” or to “engage in reciprocal, loving, lasting relationships” which are not observable, but can only be inferred from behavior that is not described.
The APA statement refers to problems that can be observed beginning in the latter part of the first year of life. The ATTACh statement points to causation by events that occur in the first years (not otherwise specified), but does not cite behavior that occurs early.
The APA description notes that the social and emotional problems of concern, such as detachment and reluctance for social interaction, may persist rather than be “outgrown” as the child gets older. ATTACh warns that attachment disorder can “distort future stages of development”, a different and more serious matter than persistence of early problematic behavior. In addition, ATTACH speaks of impacts on “cognitive, neurological, social and emotional functioning”. The APA description is entirely focused on the social and emotional eccentricities that are the basis for a diagnosis of Reactive Attachment Disorder and never refers to either cognitive or neurological effects.

Following her quotations from APA and ATTACh, Eshleman goes on to add a description of a girl who is said to have some type of attachment disorder. This girl, in her early teens, is described as aggressive, destructive, jealous, and controlling, and steal from the family as well as shoplifting. At this point in her narrative, Eshleman introduces the idea that the girl shows “many of the typical features of RAD”, and cites these as lying, inability to trust, oppositional, acting-out behavior, engaging in dangerous behavior, apparent desire to keep others at a distance, and hypervigilance. None of these, please note, were mentioned as characteristic of Reactive Attachment Disorder in the APA description.

Eshleman appears to disagree on almost every point with the APA concept of Reactive Attachment Disorder. Between her quotation from ATTACh and the conclusions drawn from her case description, Eshleman has provided a view of Reactive Attachment Disorder that thoroughly contradicts that of the APA description.

Why, then, did she include the APA description to begin with? I can only attribute this to a sort of “showing the flag” by citing a conventional professional organization’s views. Or perhaps we might call it “sweetening the well” as the opposite of the persuasive technique of “poisoning the well”. By quoting the American Psychiatric Association, Eshleman claims for herself a modicum of orthodox authority and thus prepares the reader to accept her later statements. As Eshleman and similar authors well know, naïve or careless readers are not likely to say, “Wait… what? That’s not what you said before”, but are likely to read straight on and conflate the two contradictory statements with each other.

When a book displays so many contradictions in a few pages, readers need to be cautious about accepting the content. Even though some material is correct, it would be silly to assume that all of it can be trusted.

Steve Jobs and That Primal Wound

Once a myth gets into circulation, it’s awfully hard to get it out again. What “everybody knows” comes to be regarded as just common sense, even though it’s actually common nonsense. A case in point: the recent discussion of Steve Jobs’ difficult personality and its attribution to his having been adopted.

Maureen Dowd’s op-ed column in the New York Times on October 26, entitled “Limits of Magical Thinking”, did not claim that Jobs’ conduct was caused by his adoption history, but did quote two other people who thought so. The mother of his more-or-less-abandoned oldest child stated that being adopted had left Jobs “full of broken glass”. His friend Andy Hertzfeld said that Jobs’ cruel behavior toward others “goes back to being abandoned at birth”. Although they did not use those words, both these people seem to be believers in the Primal Wound idea-- that separation from the birth mother, even in the early days of life, causes long-term misery, rage, and grief.

Given the Primal Wound concept, it’s easy to focus on a single possible factor and neglect to consider the thousands of other events that shape a personality. It’s particularly easy to confine oneself to looking at early childhood and to forget that the circumstances of adulthood also contribute to mood and behavior. It’s easy, too, to neglect to consider the Zeitgeist—the spirit of the times-- and the extent to which reprehensible behavior was excused or even admired.

Let’s have a look at the interpersonal behavior of some non-adopted people in the ‘70s, ‘80s, and even more recent times:

1. The famous Newt Gingrich hospital visit to tell his very sick wife he was divorcing her

2. The Roman Polanski drug ‘em and leave ‘em approach to a girl in her early teens

3. Woody Allen-- need I say more?

4. John Edwards and his out of-wedlock child

5. Jesse Jackson and his ditto

Without naming names, I can also mention personal acquaintances from the time when Jobs did his child-abandoning-- non-adopted, non-celebrity people who were enraged at the idea of child support, who insisted that a handicapped adopted child be “given back” as “too much trouble”, or who proposed that a handicapped 18-month-old alternate 6 months with the father and with a mentally-ill mother in another state.

There are a couple of important issues here. One is that there are plenty of non-adopted people who—whether or not they are “full of broken glass” (or any other substance)-- excel at making the world full of broken glass for those who are dependent on them. If Jobs’ sins are to be blamed on his adoption, what do we blame those people’s bad behavior on? Do both adoption and non-adoption create the same outcomes? If so, it’s hardly worth discussing the matter.

A second point is that fame and fortune provide opportunities for bad behavior that may not be available to those who are just soldiering on in ordinary life. Those who sport entourages can count on those entourages to cover their tracks. Those who live outside the rules of employment and family life can leave for distant spots and make sure their paths do not cross with those boring and annoying “exes” and children.

And a third point: there have been periods of time when “going with the flow” and “following your bliss” were widely-accepted goals. The ‘70s and ‘80s were periods when irresponsible behavior of men toward women and children was to some extent admired in the United States. Having shifted toward a greater emphasis on fathers’ responsibilities (for example, couples who say, with social if not biological accuracy, “we’re pregnant”), we find it shocking to look back at a not-so-distant period when that was not the situation. In considering Steve Jobs’ life, it’s easy to forget that he would have been influenced by the prevailing attitudes of the time, in addition to multiple other factors, not omitting his life with his adoptive family. The attitudes that prevailed during his youth may have helped shape his personality development in ways that conflict with today’s popular value system.

Children adopted in the early weeks or months of life have been shown to have no more and no fewer emotional problems than non-adopted children, by extensive research on large populations of children. It would be foolish to expect that no adopted child would behave badly, exhibit mood disturbances, or even have serious psychopathology. Non-adopted children have these problems too, and in about the same proportions as those adopted early in their lives. The two groups share these characteristics, so it makes no sense to say that in one group the problems are caused by adoption and in the other they are not. (Such an argument would require us to claim that the group of adopted children is genetically superior to the group of non-adopted children, and the adoptive parents are better parents than the non-adoptive parents, so that the only remaining cause of problems is the adoption itself. )

No doubt proponents of the Primal Wound myth will add Steve Jobs’ story to their repertoire of evidence that adoption is in itself harmful. Those who think through the facts of early development and of research on adopted children will reject that viewpoint, and will realize that Jobs’ behavior was comparable to that of many other famous, but non-adopted, people, as well as to actions of the less famous.

Incidentally, Nancy Verrier, the author who has drawn attention to the Primal Wound concept, has never answered the questions in my open letter of some time ago.

Authority versus Evidence: Arguing About Adoption and Psychological Interventions

Off and on for a couple of years, but especially in the last few months, I’ve found myself upholding the idea that there must be an evidence basis for treatment, against others who believe that statements by people who claim authority are the most powerful of all arguments. I’ve referred to this conflict as a “culture war”, and I am convinced that it is an argument between ideological, a priori assumptions about the world, on the one hand, and positions based on systematic observations and evidence, on the other-- same old Plato versus Aristotle, if you like.

Von and other adoption bloggers argue strongly for a Primal Wound, on the basis of their own experience and on the authority of Nancy Verrier (who, incidentally, has not yet answered the questions I asked a month or so ago). They reject the systematic research evidence provided by Michael Rutter and the English-Romanian Adoptees Project or by other investigators, showing that most adopted children, even those adopted late and after intense social deprivation, do quite well in the long run. For Von and friends, the vividness of personal experience and the statement of an authority establish a set of assumptions that do not need to be tested against other evidence. For Rutter and other researchers, evidence is to be explored carefully as a test of existing assumptions.

Valle Oberg, a proponent of Ronald Federici’s methods of dealing with post-institutionalized children, also appeals to authority as the foundation of her argument. She states (in comments on this blog) that Federici has worked with thousands of children (although the arithmetic on this does not seem to work out very well) and has “saved” them, and that her own children were among those. Therefore, she argues, what she says, and what Federici has said, must be correct. In addition, she proposes that peer-reviewed publication of outcome research is not evidence that methods are effective. Oberg dismisses the view that Federici needs to report his evidence to the public before his methods are said to be effective.

While mulling over these disagreements, I came across a letter to the editor published in Science in 2004 (a silent testimony to the number of papers on my desk). That LTE was in response to discussion at that time about hormone replacement therapy and the way it failed to provide the benefits to heart health that had been expected of it. The authors, Philip Guzelian and Christopher Guzelian, pointed out that it was not surprising or anomalous that the predicted results did not occur. They commented that the outcome was a “dramatic example of the difference between authority-based conclusions (arising from opinion, experience, intuition, judgment, and scientific inference)… and evidence-based conclusions (derived from an objective, unbiased, and systematic analysis of scientific knowledge)… The lesson is quite generalizable. Uncritical acceptance of authority-based opinions as conclusive evidence is pervasive, even though top authorities unsuccessfully predict what scientific knowledge will be preserved as ‘fact’ “. Guzelian and Guzelian noted that there are times when decisions need to be made without adequate scientific evidence, but warn against confusing them with evidence-based conclusions and propose that “the obvious solution is to explicitly acknowledge when shortcomings in the amounts or quality of evidence necessitate a reversion to authority”.

An important point in the contribution of Guzelian and Guzelian is the acknowledgment that evidence-based conclusions are not always available. Those authors were not talking about psychological interventions, but that acknowledgement is an important one in discussion of psychological treatment, where design and implementation of research can be extraordinarily challenging. Although Guzelian and Guzelian did not mention levels of evidence (the idea that some forms of research offer stronger arguments than others), they did imply the need to balance evidence and authority differently in different situations. When evidence is strong, it should be weighed far more heavily than authority; when evidence is weak or non-existent, authority and personal experience are better to rely on than flipping a coin or casting the I Ching.

Perhaps the most important message in the Guzelians’ letter is the need for explicit statement that in the absence of systematic evidence, one is appealing to authority for support of a claim. This is only appropriate, of course, if there is no evidence or if the existing evidence is weak or open to interpretation, and if the maker of the claim can show that this is the case. It is not sufficient to do as Von, Valle Oberg, and many others have done-- to ignore the existing evidence and put forward instead a contradictory claim based on authority, and not only authority, but the authority whose views are welcome.

But, of course, if your way of thinking is to appeal to authority, this will make sense to you only if stated by an authority of your choice.

An Open Letter to Nancy Verrier

Dear Nancy:

As you probably know, some of your strong supporters are very mad at me for contradicting the idea that adoptees suffer from a lasting emotional trauma that you have called the Primal Wound. I’m told by people who know you that you are a sensible and friendly person and a supportive, helpful therapist. I wonder whether you might be willing to answer some questions for me. They are more challenging questions than I suppose you often get, but I am asking them in a genuine spirit of inquiry after reading some of your work. I am curious about unconventional theories and have been working on a book that examines some of the ideas shared by such theories and the therapies that are associated with them, and that work is the source of some of my questions. In addition, I believe that better understanding of these issues could facilitate mutual understanding between the “pro-PW” and “anti” groups.

1. Why do you accept and use the idea of cellular consciousness or memory? I’m sure you know that conventional views attribute consciousness and memory to the functioning of cells of the nervous system and not to other types of cells. Are there aspects of memory that you feel are better explained by cellular memory than by the conventional perspective?


2. Do you think personality development can be explained in terms of natural, material events, or would you say that some non-material/spiritual factors are needed for an explanation?


3. It seems that different adoptees have different feelings about their adoptions. What do you think are the factors that lead them to have one opinion or another?


4. What are some examples of what you call biological mirroring, ways people look or behave that you say have special meaning for biologically-related children? What are your reasons for thinking they have special meaning?


5. You have been involved for some time with the organization APPPAH, which in turn has connections with primal therapy and other “primal” ideas. I assume that this connection
is why you chose the term Primal Wound. Do you share beliefs with Arthur Janov and earlier contributors like Frank Lake and Francis Mott? Do you consider their LSD and “breathwork” experiences to give an accurate depiction of the experiences of an unborn baby?

6. Do you recommend that adoptees use any of the “primal” or “rebirthing”therapies to help with distress that they consider a result of adoption? Would you say there are other treatments that are helpful?



I think the answers to some of these questions might help explain the very intense commitment of some adoptees to the Primal Wound concept. It’s possible that the attractiveness of this idea to its proponents may have to do with a broader set of beliefs, not just with the single idea-- that discussions of this issue are culture wars in miniature. If that’s the case, discussing the “real problem” might be the beginning of a way for well-intentioned people concerned about adoption to come together for good purposes rather than attacking and blaming each other.


I hope you will take the time to answer at least some of my questions, not necessarily all at once. I would be grateful for your help on this, and I believe readers of this blog would also appreciate it.

Yours sincerely.
Jean Mercer


[9/1/2011 Nancy Verrier has kindly responded that she will be answering these questions in the near future. ]

Examining Unconventional Theories: More on the "Primal Wound"

Like many other unorthodox belief systems, Nancy Verrier’s “Primal Wound” theory just keeps on keeping on in spite of clear evidence that it can’t be correct. For those who are just coming in, the Primal Wound idea is the entirely speculative notion that babies adopted in the first days or weeks of life are deeply troubled by separation from the birth mother, and that this disturbance causes psychological difficulties that continue to be experienced right into adulthood.

An interview with Verrier at http://blog.adoptionmosaic.org/interview-with-nancy-verrier/ shows a continuing emphasis on some easily refutable points.

The first of these is the assumption that infants are psychologically more vulnerable in the period soon after birth than they are later. This belief depends on a logical fallacy; it’s based on the idea that if childhood is a vulnerable period, and people in later life are less psychologically vulnerable, then earlier and earlier developmental periods are times of greater and greater vulnerability. In fact, though, both physical and psychological vulnerability have schedules in which a somewhat later period is more sensitive than the earliest time. As an example, the probability of birth defects from exposure to rubella is much less right after conception than it is 6 weeks later.

Critical periods in development, when normal events are more easily disturbed by trauma or disease, are different for different aspects of developmental change. Emotional attachment to a caregiver has not developed at birth and is not apparent until 6 months or so later. Think about this a bit-- what has there been for the baby to attach to, before birth? In the interview with Verrier, she says the baby knows nothing but that mother. In fact, though, the baby knows nothing but the inside of that mother, not the outside.

Are we to assume that newborn babies are grieving for the taste of the amniotic fluid and for the sound of the mother’s stomach rumbling, not to mention other less socially-acceptable noises? If not, what are we to think they miss? Is it the “psychological connection” mentioned by Verrier, which she says is not severed with the umbilical cord? What was that connection? Are we actually talking about a telepathic communication between mother and baby, as posited by the ‘50s psychoanalyst Nandor Fodor? If so, why doesn’t such a connection continue after birth-- is it somehow dependent on physical transmission through the cord? There seems to be quite a confusion of material and non-material events here.

Verrier argues that babies remember not only birth but prenatal events back to conception because of cellular consciousness. This idea, that experiences are imprinted on cells and need not be represented in the nervous system, has been popular among Scientologists for many decades (see Janet Reitman’s recent history of Scientology). It has also much been much favored among advocates of Janov’s primal therapy, including the Australian physician Graham Farrant, who believed that there were memories from the egg and sperm stages too (see http://primals./org/articles/farrant3.html). There is certainly no evidence that this type of memory exists or that either subjective experience or recall can occur without the functioning of high levels of the nervous system; this also applies, by the way, to the “body memory” idea much discussed by Bessell van der Kolk. Once again, this belief seems to involve a confusion between functions of cells and some posited non-material component of the personality.

Now let’s consider Verrier’s idea of “biological mirroring”, which seems to be the experience of observing others who share some of one’s genetically-determined behavior traits. I wonder whether Verrier is aware that human infants don’t even recognize themselves in the mirror until 15-18 months of age? How are they then to compare their own more subtle behavior characteristics with those of others until a much more advanced age? And when they do notice differences, what does this mean--- would we see psychological problems caused by being the only girl in a large family of boys, or the blue-eyed child of heterozygous brown-eyed parents? As for genetically-determined behavior traits, I would be at a loss to name even one that is obvious and is inherited according to a dominant-recessive pattern (we can’t expect tongue-rolling or tasting certain chemicals to be easily observed). Instead, behavior traits like temperament are determined by combinations of genes and environment. The big similarities in behavior of some separated twins, so much emphasized by the media, need to be considered in the context of other separated pairs who have little in common. Before arguing for the positive impact of “biological mirroring”, Verrier needs to present evidence that children in families where there are strong resemblances are somehow psychologically healthier than those in families where the roll of the genetic dice has produced varying temperaments and appearances.

The Sunday New York Times (Aug. 28, 2011) this week carried an obituary whose details reminded me strongly of Verrier’s claims. This was the obituary of Budd Hopkins, an abstract expressionist painter-- and, more to the point, the instigator of the “alien-abduction movement”. According to the Times, “Many who shared their stories with Mr. Hopkins had no conscious memory of their abductions at first. But they had lived for years, he said, with the nagging feeling that somewhere, something in their lives had gone horribly wrong….. by his reckoning, 1 in 50 Americans has been abducted by an alien and simply does not know it.” Here is a theory of emotional discomfort that is as much supported by evidence as the theory of the Primal Wound. Is there the slightest reason why anyone should accept either of these ideas?

RAD on Youtube; or, Caveat Spectator

“Open source” mental health information on Wikipedia is problematic enough, as I’ve written elsewhere, but at least it tends to be watched and corrected (or perhaps just edited) by interested editors and Wiki admins, and citation of sources is supposed to be required. Youtube productions can present a more serious problem, because no one can make corrections by editing within a video; the best they can do is to make their own video and strive to correct any misconceptions that may have been caused by the original presentation. In addition, it’s up to the contributor to decide whether any source of information should be cited-- and often none is given

I’ve been looking at Youtube material that purports to discuss Reactive Attachment Disorder, and a depressing job it’s been. I can’t possibly talk about everything I’ve seen that’s wrong, especially that old TV melodrama “Child of Rage”! However, I do want to comment on two of these gems, http://www.youtube.com/watch?v=dCgb4iu-k8o, whose authorship is not clear, and http://www.youtube.comwatch?v=WV6d1nAgBNI, created by the Association for Treatment and Training of Attachment in Children (ATTACh). Each of these is full of inaccuracies, inconsistencies, and downright errors (it’s a trivial point, but the creator of the anonymous video apparently believes that Mary Salter Ainsworth was a man).

The anonymous video (uploaded by one vsulley) commits the very worrisome error of conflating Reactive Attachment Disorder (RAD) as described in the Diagnostic and Statistical Manual of the American Psychiatric Association with the notional problem sometimes called just “Attachment Disorder” (AD for short). Reactive Attachment Disorder is characterized by age-inappropriate social behavior, especially with respect to familiar caregivers. Children may be unusually aloof, independent, and willing to interact with strangers for their age, or unusually clingy and demanding of adult attention for their age. The RAD diagnosis can be given in either of these cases, but only if the behavior began before age 5 years and if there is a history of poor care. AD has nothing to do with symptoms of RAD, and the manual for the Randolph Attachment Disorder Questionnaire, a test intended to detect AD and cited in this video, actually states that it is not intended to diagnose RAD. Speculative discussion of AD, whose existence is not supported by systematic evidence, claims that symptoms of the disorder include a fascination with blood and gore, cruelty to animals and younger children, refusal to make eye contact on adult terms, “crazy lying”, and so on. These are obviously very different symptoms than those associated with RAD (not to mention the lack of evidence that such a disorder exists or is related to attachment in any way). But the anonymous video treats RAD and AD as equivalent and cites a very weak 2003 Journal of Psychology article by Hall and Geher as a major source. On the positive side, this video does not support the use of holding therapy and notes the lack of evidence that HT is effective, neglecting, however, to state its potential harmfulness.

The ATTACh video, posted by the parent-professional organization that has for many years promulgated the idea that adopted children are likely to suffer from mental health problems associated with attachment, takes a different approach. It rejects the DSM description of Reactive Attachment Disorder as an insufficient diagnosis for the posited problems of adopted children, but rather than referring to AD (once a major tenet of ATTACh’s belief system), the video emphasizes the Developmental Trauma Disorder proposed by Bessell van der Kolk but not included as a diagnostic category in the work on the upcoming DSM-V edition. The ATTACh video fails to state that a lack of systematic evidence for the disorder suggested by van der Kolk is the reason why DTD will not be included in the new revision.

The ATTACh video re-emphasizes a position long taken by the organization-- that Reactive Attachment Disorder in childhood develops into serious personality disorders, antisocial personality, depression, anxiety, and suicidal thinking. The video completely omits any discussion of longitudinal research by Michael Rutter and his colleagues, showing how few children adopted from Romania had later mental health problems. I’ve discussed this research at www.childmyths.blogspot.com/2011/01/urban-legend-about-Russian-orphans.html and included the comment of the developmental scientist Megan Gunnar that so-called attachment problems may not be associated with attachment at all.

There are two other interesting points about the ATTACh video, and both of them require some explanation for those who cannot “read between the lines”. One is a startling acknowledgement of the influence of Foster Cline on the organization and the continuing importance of his views of attachment and related disorders. Foster Cline is an M.D. who was strongly influenced by Robert Zaslow, a psychologist who developed an intense and intrusive form of holding therapy in the 1970s. Cline learned Zaslow’s methods and applied them during the ‘80s and ‘90s, during which time he compared holding therapy to chemotherapy as a painful and frightening but necessary treatment that should not be avoided in spite of its dangers (it was eventually associated with a number of child deaths). Cline stated that “all bonding is trauma bonding”. Both Zaslow and Cline surrendered their professional licenses after disciplinary actions following injuries to patients. It is quite remarkable to me that ATTACh continues to state its Cline connection in contradiction to its efforts to become a kinder, gentler organization following the 2000 death of Candace Newmaker during a therapy session.

A second point, and one surprising to me, is the appearance in this video of the psychologist Michael Trout. Trout, at one time a highly-respected clinician, has in the last 15 years become greatly involved with the Association for Pre- and Perinatal Psychology and Health (APPPAH), a group committed to the idea that babies remember their gestations (perhaps even conceptions) and births and will sometimes spontaneously report on these. APPPAH attributes much emotional disturbance to prenatal and birth trauma and supports massage of neonates by individuals like William Emerson, who claims to release birth trauma by pressure on infants’ heads and necks. In the video, Trout specifically refers to the mantra “baby can remember” on which much APPPAH thinking is based.

Rather than providing reliable facts about childhood mental health issues, the ATTACh video gives some revealing information about the direction ATTACh seems to be going. A connection with APPPAH is a remarkable step away from the “mainstream” status once aspired to by this group. The ATTACh video is thus remarkably informative about ATTACh-- but not so much about Reactive Attachment Disorder.

Adoptive Parents Feeding Survey

The SPOON Foundation has asked me to invite any readers who are adoptive parents to take a quick survey about foods you used to help the transition from your child's past experience to your ordinary family diet. It's at http://www.surveymonkey.com/s/LZYBK9C.

Do give them a hand, and if you want to talk about it further I'd like to hear your comments.

From Oneborneveryminute.com: Adoption and the Corpus Callosum (no kidding)

There’s a most remarkable interview at http://www.growninmyheart.com/an-alternative-therapy-for-the-child-who-has-been-adopted. If you consider the treatment they describe there to be plausible, I have a nice bridge to offer you at a reasonable price. The person who is interviewed, one Susan McCrossin, specializes in or perhaps has invented a treatment called Brain Integration Technique (BIT). This treatment, she says, deals with stressed brain circuits, which develop when blood leaves the brain to go to the extremities and enable flight or fighting, a situation resulting from a frightening experience like meeting someone who is in a bad mood. As a result of this, the cortex with its reasoning capacities turns off. The same thing will happen when you meet that person again, even if now he or she is in a good mood, and only your emotional functions will be left working. Although this all sounds as if brain functions turn on and off again (someone correct me if I’ve become confused), McCrossin apparently feels that a turn-off can be permanent or at least long-term. She states that for adopted children, the “abandonment factor” (not defined) turns off the corpus callosum and affects the brain’s development, causing (?) the amygdala to become overactivated. By touching your head in three places, waiting for the pulses to synchronize, and… something else involving acupuncture points and energy… McCrossin can fix this and raise your brain’s stress tolerance. On her website www.crossinology.com she provides some unpublished research reports in which she tested people, touched their heads etc., and tested them again, and not only did they do better on tests, they also all said they could learn better afterwards. (I don’t know whether they learned not to get involved in this kind of thing any more. That would be a step in the right direction.) Asked whether insurance would pay for her services, McCrossin opined that because this was an alternative technique, insurance companies might not have heard of it yet. Let’s examine “Crossinology” under a strong light. The first issue, I think, is to decide whether these statements about brain functions are meant literally or metaphorically. One of the difficulties is the fact that the cortex has a lot of functions-- thinking and reasoning are only some of them. Vision, hearing, the skin senses, and motor control are all associated with parts of the cortex. Turning off the cortex would mean loss of a great deal more than impaired reasoning, so unless McCrossin can support what she has said, her perspective can’t be dealing literally with brain functioning. I’m willing to accept it as a metaphorical approach, but I don’t see that it adds anything to what we could say quite simply and parsimoniously: if you get really scared, it’s hard to think straight. If someone or something scared you enough, you’ll remember that on another occasion and probably find your thoughts somewhat confused as a result. I know that’s not such a scienterrific way to put the matter, but it’s a lot more accurate and thus leads to fewer untrustworthy and speculative associations about how people’s brains work. What about the adoption issue? First of all, let me repeat what I’ve said in other posts: this “abandonment factor”, if it means distress about separation as I think it does, will not be present until the baby is at least six months old. It’s irrelevant to early-adopted children. Second: the corpus callosum. I would like to save myself some trouble and just say “you’re kidding”, but I know this foolish idea is still out there after half a century or more. Yes, the corpus callosum plays an important role in transmitting information from one side of the brain to the other in most people. However, there are several other “bridges” like the structure of the optic nerve that allow information to be available to both sides simultaneously. In the case of hearing, there are 8 or 9 crossover points between the cochlea and the auditory cortex. In addition, there are people born without a corpus callosum, but whose functioning is perfectly normal. There are many aspects of the brain where back-up systems make sure that important tasks are done, and this may be one of them. I have no idea what speculation brought the amygdala into this picture. However, the idea that the callosum plays some critical role in functioning dates back quite a way. It was involved with the belief that mixed hand and eye dominance would cause reading difficulties (actually, about 50% of people have mixed dominance, and far fewer have trouble reading.) In the 1960s, Robert Zaslow, who invented Attachment Therapy, published a report linking left-handedness (which involves less strong dominance) to resistance and non-compliance in children. The attachment therapist Elizabeth Randolph stated in a self-published book about ten years ago that she could diagnose Reactive Attachment Disorder be seeing whether children were able to crawl backward on command, an ability she related to the corpus callosum. Therapeutic techniques using the “cross-crawl”, which I recently mentioned on this blog, are without supportive evidence and are again related to the belief that the callosum plays some extraordinary part in personality and behavior. How about the touching-your-head treatment? In order to believe this could have an effect, McCrossin must be convinced that she is able not only to detect an unidentified life energy within each person, but that in some way her touch alters that energy. In other words, she and her followers posit some form of event that is outside the study of the physical and biological sciences-- what one can only call a supernatural event. Acceptance of such an idea puts McCrossin’s practice into the realm of religious ritual rather than of methods whose effectiveness can be investigated scientifically. One more point. Do insurance companies fail to pay for things because they didn’t hear of them “yet”? Actually, they are fairly careful about making these decisions. Look at the Aetna website, for example, and you’ll see discussion of the evidence about specific practices and the decisions that are made about paying for them. I’m no more a fan of these corporations than anyone else, but I believe it’s deceptive to represent them as failing to pay just because they haven’t caught up with progress. The Brain Integration Technique presented by McCrossin appears to be nothing more nor less than nonsense based on popular misunderstandings of brain functioning and of the emotional life of children. If you have an adopted child whose mental health is problematic, there are some excellent, evidence-based interventions that can actually help you. Please don’t fall for the idea that magic touches can fix real problems.

Pseudosymmetry: Adoption, Attachment, Vaccination, and Misinformation

Pseudosymmetry is a useful word, invented by the anthropologist Christopher Toumey some years ago, and used to describe a maddening journalistic phenomenon. It’s a way of reporting news that gives the false impression that opinion is divided on topics that have little or no scientific support on one side and plenty on the other. “Symmetry” suggests that there are arguments of equal weight on both sides; “pseudosymmetry” suggests the practice of making arguments appear equal when they are actually far from equally supported.

We wouldn’t put up with pseudosymmetry in areas where there is immediate danger and where it makes a good deal of difference whether we make one decision or another. What would you think of an article about the Japanese nuclear reactors that described bad possible outcomes, but added that some nuclear scientists thought there was no problem? There well may be some such people-- suffering from dementia, or recently too ill to have seen what is happening-- but it would be deceptive to suggest that their existence means there is any real disagreement about the reactor problems. We would lose all confidence in a news source that gave this false impression.

When the danger is less immediate, though, we are not surprised when a news source gives the “other side” even though few knowledgeable people accept it. In those cases, some may even give credit for high moral standards to people who strive to tolerate someone’s right to unsupported beliefs. Any report about global warming in the popular media will be attacked for unfairness if it omits to say that there are non-believers-- even though the proportion of global warming believers to non-believers among scientists is probably 1000:1 at best.

We are also used to seeing “controversiality” (a word that is a red flag for pseudosymmetry nearby) introduced in any media report on child development. I remember being asked by a reporter at the time of the Candace Newmaker trial, after the child died under the ministrations of Attachment Therapy practitioners: “what do you think about this controversial therapy?” I replied, “it’s not controversial”, and I explained that it couldn’t be controversial if practically no clinical psychologist had ever heard of it, and those who had heard of it rejected it wholeheartedly. “Controversy” is a term that suggests that there are two schools of thought of equal weight, and therefore two opinions that are equally legitimate. When this is not true, “controversy” is a word that gives a false impression-- but it’s so often used by reporters who don’t want to be told they’re unfair, and do want to convey excitement about their topic. Saying something is controversial when it isn’t is a kind of pseudosymmetry.

I suppose one of the reasons for pseudosymmetry in discussions of early development is the idea that it will be a long time before children grow up. Therefore, we needn’t worry about any immediate problem even if we give the wrong impression about an issue-- if we suggest that a well-supported statement is only tentative by including an unsupported opinion shared by a very small number of people. Journalists may decide in these cases that to appear fair by including unsupported beliefs is more important than taking care not to delude readers or judging the likelihood of one of two opinions.

I have pseudosymmetry on my mind because of a recent e-argument with an organization in upstate New York. I won’t name names because, although I believe these people are in the wrong, they politely listened to my concerns and made an effort to discuss a pseudosymmetrical matter. Here was the deal: a communications professor at a small college became involved in the development of a series of public education videos about adoption. Professor knew nothing about the topic and depended on contributors to make the content acceptable. One contributor, an adoption agency staff member, provided an interview on attachment with an “adoption therapist” as a segment on attachment issues in adoption.

The attachment segment is the part of the series that brings up the issue of pseudosymmetry. The “adoption therapist”-- a marriage and family therapist whose information on the Internet suggests that he is also a homeopathic practitioner—concentrated on the role of grief in adoption and attributed this to the emotional attachment he believes to occur prenatally; this view, of course, is quite opposite to the conventional and evidence-based idea that emotional attachment of infant to adult occurs at some time in the second six months of life. The therapist also alluded to the existence of auras as an indication of personality and emotional concerns, a belief that is certainly no part of conventional psychotherapy or personality study. While none of the therapist’s practical suggestions were harmful or out of line with ordinary practice, the belief system he communicated was one with implications that could well lead adoptive parents to wrong assumptions and expectations.

So, why do I connect this matter with pseudosymmetry? Why don’t I just say they were wrong and should not have been spending public money this way? Here’s what the professor told me in an e-mail: “We decided that this issue was one that appears to have some validity in spite of the perspective and that [the therapist] didn’t present the matter as though there was only one, valid perspective. [Our medical adviser] pointed out that a similar situation exists in the medical field in regards to immunizations.”

In other words, professor believes that the presentation is acceptable because it does not present the matter as if there is only one, valid perspective. The fact that indeed there is only one substantiated perspective, and that the other material presented was factually incorrect, is seen as irrelevant. To top off the pseudosymmetrical efforts, he quotes an individual who draws a parallel between this and views of vaccination, an area in which there is one perspective with clear scientific support and another that is factually incorrect and rife with fraudulent and self-aggrandizing counterclaims. Pseudosymmetry apparently demands that we give equal time to opponents of vaccination and to reliable evidence supporting vaccination, and uses that model to declare that unsupported claims about the thoroughly-researched subject of attachment should be included along with evidence-based information.

To be tolerant and kind to other people who have different ways from ours is a good idea-- indeed, we would do well to do more than tolerate, and encourage those cultural differences. But that is a far cry from tolerating the promulgation of claims that are well-known to be wrong. What is it all about, anyway? Why is pseudosymmetry so beloved of journalists and others? Part of it, I’m sure, is the belief that it’s “not nice” to criticize or to suggest that someone else’s work or beliefs could use some fine-tuning. Another part-- and a far less admirable one-- may be plain old mental laziness. Why try to think through a difficult problem when it’s easier to avoid it and you also get moral credit that way? It’s hard work to examine the facts, and it’s also hard to summon the ego strength to deal with others’ objections to your decision that one idea is more supportable than the other.

Pseudosymmetry is an easy way out of the dilemma, if you don’t mind thinking that adoptive families may have troubles, or children may die of contagious disease, because you have created a false impression.

Comparing Families: "Between" and "Within"

A person commenting on this blog recently complained about the suggestion she felt I’d made, that adoptive and non-adoptive families are “just alike”. Of course they aren’t because no two groups of families are just alike. There are large differences between families, just as there are large differences between individuals.

But here’s the tricky part: the differences between families are actually smaller than the differences WITHIN families! Figuring out all the differences between groups and individuals shows that the average difference between two children in a family is bigger than the average difference between children of two different families. (Please note that I’m talking about the average difference; choose your families or your children, and of course you can find families that are very different, and brothers and sisters who are very similar.)

How can this be? Don’t we blame-- or credit-- families for making people who they are? How can one family make children who are very different, but different families not have such a big impact?

The answer is that it’s a mistake to assume that family experiences in and of themselves are the sole, or even the primary, shapers of human personality. This is the case even when the family experience includes a factor we think of as unusual and powerful, such as separation from the birth parents. Michael Rutter, a leading researcher whose group has investigated the development of children adopted to England from the appalling Romanian orphanages, wrote in 2002 that “it is clear that parental loss or separation carries quite mild developmental risks unless the loss leads to impaired parenting or other forms of family maladaptation”. Although severe neglect or abuse in families can influence children’s development, the many “good enough” (though different) ways to care for young human beings do not seem to have specifically different outcomes.

One reason that family experiences alone seem to have fewer predictable effects than you would expect is that children bring something to the table too. Individual differences between children mean different ways of responding to the same experiences. For example, firm discipline may work very well with most children, but may be so overwhelming to the unusually sensitive child that he or she learns nothing but to be frightened. Children within a given family may respond quite differently to the parents’ preferred approach; they can be different to begin with, and their different responses (although to the same treatment) can make them even more different than they were .

Children’s individual differences include differences in temperament, a term that describes personality characteristics that have biological causes. For example, children who have perfectly normal activity levels may still be quite different from each other, with some much higher and others much lower in their preferred amounts of activity. Depending on the family and its circumstances, either a high or a low activity level can make for either a good or a poor developmental outcome. One important factor is what is called “goodness of fit” between the child’s temperament and those of the parents. Active, sports-oriented parents may be very pleased with a lively child, but it’s possible that quiet, scholarly parents will find it easier to get along with a less active son or daughter, and would find themselves scolding and disapproving of a more active child, even against their own intentions.

The temperaments and past experiences of child and of parent can make a major difference to their understanding of each other’s communications. For instance, in the American Psychologist for February-March 2011, an issue focused on infant mental health, Ed Tronick and Marjorie Beeghly show a series of photographs of an interaction between a mother and baby. Mother bends down to tickle the baby with her hair, and the baby grabs the hair and won’t let go. Mother raises her head with a brief, unintentional expression of anger and pain, and baby flings its hands across its face in a gesture as if to ward off attack. In a few seconds, they are both smiling and returning to normal. But what if the baby’s temperament was such that it took more than a few seconds to recover from the “threat”? Mother might become discouraged about playing, and be less likely to start a play sequence. What if mother’s temperament made it easy for her to interpret the baby’s “attack” as intentional, so she continued to look angry for several seconds? Baby might become wary of interactions that led to scary situations. In both cases, a member of the pair might misinterpret the other’s communication, and their attitudes toward each other would change. Such very brief interchanges can establish better or worse ways of thinking about each other and getting along.

Psychological and behavioral differences can create different experiences for both children and parents. But it’s important to remember that while people live in families, families live in houses or apartments, that are in neighborhoods, in countries, and in economic circumstances. Just as the quieter parents may scold the lively child, so may parents living in an upstairs apartment scold the child who disturbs the neighbors, and the father who works the night shift may have a different attitude toward rough and tumble play than the one who can count on sleeping at night. Active parents with a big house in a mild climate, and plenty of time and money for sports, have different attitudes toward their active children than quiet parents living in a crowded apartment with crotchety relatives, especially if the neighborhood is not safe for playing outside. Poverty brings down punishment on the heads of children who are careless about possessions, while affluent parents may not find it worthwhile to fuss.

No, adoptive and birth families are not just alike, but neither are two random birth families or two adoptive families. They can’t be just alike, because the initial differences between parents and babies are woven into greater and greater individuality within the families. A long list of factors helps to determine how babies and parents develop their relationships. As is so often said in infant mental health circles, it’s not rocket science-- it’s a lot more complicated than that.

Is It Kin, or Is It Skin? Conclusions About Skin-to-Skin Contact for Low-Birth-Weight Babies

The Huffington Post blogger Jennifer Lauck has done a piece arguing that separation of very young babies from their mothers is traumatic for the babies, and that, therefore, adoption policies need to be changed dramatically (see http://www.huffingtonpost.com/jennifer-lauck/adoption-myth-buster-what_b_822175.html). (And thank you to J.P. for giving me a noodge about this post.) Lauck refers to her own children as evidence for her position, but she also cites a study by the South African physician Nils Bergman (http://www.ncbi.nlm.nih.gov/pubmed/1524427).

The Bergman study took 34 low-birth-weight babies and randomized them to two groups shortly after birth. Half of the babies were randomly assigned to incubator care, the standard method of caring for them. The other babies were placed skin-to-skin with their mothers. The incubator babies did less well in terms of breathing and heart rate and were more likely to experience low body temperatures (which, incidentally, can trigger a cascade of harmful events in LBW or even average babies).

So far, so good. Bergman’s study agrees with much older work that the ordinary isolette is not best-suited for premature or LBW infants. Other researchers, like Tiffany Field, have shown the advantages of devices like water beds or sheepskin pads for these small infants. Human skin-to- skin contact has a whole list of advantageous characteristics—skin is not only warm, but movement of the adult and the baby can make sure that as much of the baby’s skin is kept warm as possible; a human caregiver will shift position from time to time, keeping persistent pressure from being uncomfortable to the baby as it might be if the baby were lying on a firm surface; human voices provide a background of mild stimulation that works better for the baby than quiet; human breathing and heartbeat help entrain the baby’s breathing into appropriate rhythms. It’s all good. But is it about the mother?

Lauck and Bergman both seem convinced that the birthmother is the important factor here. Lauck uses the study to draw conclusions about adoption reform. Bergman says “The cardio-respiratory instability seen in separated infants… is consistent with mammalian ‘protest-despair’ biology, and with ‘hyper-arousal and dissociation’ response patterns described in human infants: newborns should not be separated from their mothers.” In both cases, the conclusion seems to be that the birthmother plays a role that cannot be performed in any other way.

I’m sure most readers will see where I’m going with this. Both Lauck and Bergman are having trouble interpreting confounded variables. They are confusing the effect of skin-to-skin contact with the effect of separation from the birthmother specifically. This confusion is present because Bergman did not design the study to discriminate between experiences of warmth, movement, and good breath and heart patterns, and experiences of being with the mother (what Lauck calls “bonding”). Even more confusingly, Bergman uses terms like “protest-despair” and “dissociation” that imply subjective experiences rather than the objective measures of body temperature, breathing, and heart rate that were actually measured. These terms are especially questionable when applied to low-birth-weight babies who may have had many other developmental problems, as such babies often do. The Bergman study does not support either Lauck’s conclusions, or the implications that the researcher suggests. It’s neither good science nor good policy to jump to conclusions that have little to do with what was studied.

Let me hasten to point out that I am all for whatever makes life more pleasing for both babies and mothers. I spent some time many years ago studying the painful procedures used with pre-term babies and collecting evidence that even babies born at less than 30 weeks’ gestational age showed reactions to pain. In the course of those studies, I reported that procedures were often much longer and more painful than they sounded. (In one case, I observed a heel-stick for a blood sample that took 17 minutes and more than half a dozen sticks to get a few drops of blood.) I noticed that some NICUs were very cautious about keeping things quiet and dimly lighted, and staff spoke in low voices to each other and to the babies. In others, bright lights, loud voices, and constant alarm bells provided exactly the wrong situation for babies trying to live and parents trying to understand and help with medical care. I will always remember seeing a nurse vigorously clean and diaper a pre-term baby with a horrible diaper rash, then perch the agitated baby on her knee and thrust a bottle into her mouth while talking to another adult.

I remain very concerned that babies, full term or pre-term, be treated with as much care as we can manage in all cases, and left primarily to their parents’ care whenever that is possible. There are many reasons why this is beneficial, and some of the reasons gave rise to the British “care-by-parent” pediatric unit several decades ago. But it is not to anyone’s benefit that we exaggerate the role of the birthmother in necessary care or that we draw less-than-warranted conclusions about family relationships, including adoption.

Adult Adoptee Unhappiness: An Alternative to Primal Wounds

Much discussion over the last several months has been devoted to the Primal Wound idea. A number of adult adoptees have stated that because they are unhappy with family relationships now, and because they were separated from their birthmothers, the unhappiness must have been caused by the separation. I, on the other hand, have suggested some other factors that could have the same effect and that I believe to be much more likely than Primal Wounds. I also expressed concern for adoptive parents who are given the idea that their children have an almost untreatable emotional scar.

Neither side has convinced the other, and I really wasn’t going to mention this matter again, but today I read a very relevant article about an issue for adoptive families, and I want to summarize and quote some parts of it. The article is in the January 2011 issue of “Zero to Three” and is by Eda Spielman of the Center for Early Relationship Support in Boston. The title is “Post-Adoption Depression: Clinical Windows on an Emerging Concept” (pp. 35-40). Spielman discusses in detail this possible cause for difficulties in adoptive relationships.

Spielman notes the many experiences of powerlessness that accompany the decision to adopt and the process of adoption, and describes the physical and emotional reactions that June Bond has n called post-adoption depression syndrome. These reactions, which Spielman calls “a salient descriptor of a significant minority of newly adoptive parents”, have many parallels to the perinatal mood disorders sometimes experienced by birth parents. The parents’ emotional reactions can be both caused by the challenges of parenting, and themselves causes of challenging developmental difficulties.

Spielman mentions as a particularly challenging area the use of abilities for mentalization or reflective function. These abilities have to do with a person’s capacity to observe another’s experience, to know that experience is separate from one’s own, and to be interested in the experience and thoughts that lie behind behavior. Spielman suggests that these functions may be particularly difficult for adoptive parents: “To fully consider the early experience of their child is to ‘think about the unthinkable’-- namely, what it may feel like to be abandoned, given up, or left by a birth parent; what the early period of life may have been like; and, possibly, what it may feel like to then leave again the orphanage or foster home that was home for weeks, months, or years.”

Commenting on adoptive parents who do not feel depressed but irritable and disconnected, Spielman notes, ”These parents can be seen as particularly vulnerable to acting out on their feelings because they have no perspective on them.” She goes on to say, “Other adoptive parents are haunted by their imaginings of their child’s past to the point of preoccupation and confusion about whose experiences belong to whom. They may have difficulty finding the boundary between being open to considering potentially painful questions and assuming the meanings and reverberations of these early experiences, An adoptive mother sought help around sleep problems. She had her own early loss issues and was overwhelmed by the pain she imagined her child felt at having been abandoned at 3 months of age. If she put him down to sleep and he expressed any distress, she felt she was repeating his early abandonment. She found herself preoccupied with thoughts of his early suffering and felt paralyzed with fear that she was causing him more anguish. The challenge of mentalizing is to balance empathic understanding and separateness, to feel for the other but know one’s own experience as distinct from that: “I will try to understand your feelings but know they are not my feelings.’ “ (Nor, I may add, are the infant’s feelings the same as the feelings the adult would have if now placed in the same situation.)

Post-adoptive depression, and the constraints it puts on parent-infant interaction, may have impacts on the development of communication, social relationships, and attitudes toward other people and toward the self. As more is understood about this problem, it’s to be hoped that vulnerability to depression in adoptive parents can be detected early and support systems can be put in place, just as we would try to do for a birthmother with signs of a perinatal mood disorder. One useful step that could take place right now is to stop claiming that Primal Wounds curse all or many adoptive families-- a piece of disinformation that may be more than a parent with post-adoption depression can cope with.

Parole for an Adoptive Mother: Whose Fault Was the Child's Death?

The Utah Board of Pardons and Parole has decided to parole Jennete Killpack, who was convicted in 2006 of the child abuse homicide of her 4-year-old adopted daughter Cassandra several years previously. This disturbing case opens many questions about the responsibility of therapists whose advice to parents leads to tragedy.

Part of the Killpack story can be read at http://www.deseretnews.com/article/635174544/Killpack-receives-prison-sentence.html.
In 2002, four-year-old Cassandra Killpack died when her parents, who claim they were following the advice of therapists from the Cascade Center for Family Growth in Orem, Utah (who had been implicated in another child’s death), allegedly forced her to drink an excessive amount of water. Cassandra died at the home of her adoptive parents, Richard and Jennette Killpack, after the first week of a two week “intensive” holding therapy treatment regimen. In the six days prior to her death, Cassandra had been subjected to 15 or more hours of coercive procedures, including restraint and forced exercise.

Cassandra was first evaluated at the clinic by a former therapist whose license had been revoked in Oregon following his use of holding therapy and related practices . Oregon officials had described his behavior as “egregious and reprehensible” He was denied a license in Utah and claims to have been doing “pastoral counseling” after becoming an ordained minister through the Internet site http://www.ulc.org. This practitioner informed the Killpacks that Cassandra had severe Reactive Attachment Disorder and prescribed a two week “intensive”.

The Killpacks described the first five days of the “intensive” treatment as follows: Sessions were held daily, Monday through Friday, and were also scheduled for the following week. Each session lasted approximately three hours. Normally at least four adults were present, the two parents and two therapists or “support staff.”

Treatment in the “intensive” sessions alternated between holding therapy restraint methods and forced physical activity. Cassandra was restrained on the floor by the adults. The Killpacks say the therapists yelled at the child and told her to fight back, in an effort to purge her allegedly repressed feelings. When holding therapy was not being done, Cassandra was forced to perform repetitive physical activity such as kicking the wall, jumping jacks, running in place , and so forth. Cassandra’s older sister witnessed some of the sessions and described them to investigators, saying that the younger child was repeatedly yelled at during both the restraint and the physical activity .

The Killpacks say they were instructed to continue this manner of treatment toward Cassandra at home in order to facilitate a “breakthrough”. They say they were told by one therapist that if Cassandra did something wrong, like “stealing” food, they were to use a “paradoxical intervention”, forcing her to repeat the infraction over and over. They claim that one therapist said that Cassandra should be forced to drink water as a consequence for misbehavior.

The Killpacks apparently felt compelled to continue the harsh treatment during the two week “intensive” because they had been told that if they gave in to Cassandra’s “manipulation” she would not have the desired “breakthrough.” They claim they were told that if the two week “intensive” did not work, Cassandra would grow up to be a prostitute, drug addict, or school shooter and possibly murder her parents or family members. Furthermore, according to the Killpacks, they were told that if they followed through with the recommended course of treatment they were assured a “one hundred percent success rate.”

The Killpacks claim they were taught to force Cassandra to be completely dependent upon her adopted mother, Jennette, in order to bond with her. Cassandra was required to obtain permission from her mother for virtually everything, including food, drink, and use of the bathroom.

However, Cassandra took some of her sister’s drink without permission from her mother. As a “consequence” (punishment), Jennette forced Cassandra to sit on a bar stool and drink a large amount of water. When Cassandra became weak and semi-responsive, her parents interpreted this as manipulation and defiance. Believing Cassandra to be on the verge of the supposed “breakthrough” predicted by the therapists, the parents persisted in their treatment. With Cassandra’s hands tied behind her back, they restrained Cassandra, tilting her head back, and forcing more water down her throat, using sufficient force that the autopsy showed cutting and bruising of her lips. Mrs. Killpack was apparently the primary actor in this, but she had one of her older children help her.

Cassandra vomited a foamy substance and collapsed on the floor. The Killpacks told her to get a towel to clean up her mess. When she did not get up, they again interpreted her behavior as defiance and persisted in their demands. When the Killpacks finally realized that Cassandra was unconscious, they attempted to revive her and called 911. In the recorded 911 call, Richard Killpack explained to the dispatcher that Cassandra had a lot of “emotional problems”. He said, “she’s very, very sneaky … we gave her a lot of water.” He told the emergency room physician that they “forced the girl to drink lots of water as therapy.”

Cassandra died hours later at the hospital. The cause of death was determined to be hyponatremia, also known as water intoxication.

Mrs. Killpack was convicted in 2006 and sentenced to between one and 15 years imprisonment. At her sentencing, it was noted that she took no responsibility for what she had done. However, the parole decision, and her planned release in January 2012 , are to some extent based on her statement that she understands better what are her triggers that might lead her to lose control in dealing with a child.

Was Cassandra’s death Mrs. Killpack’s fault? Yes, of course it was, in ways both subtle and obvious. Her agreement to adopt Cassandra appears to have been made without common sense judgment about her ability to care successfully for more young children than she already had. In addition, she was unable to consider the nature of the advice she was receiving and to realize that the recommended actions were cruel and potentially dangerous. She may have had little insight into her own anger and frustration and the fact that these could lead her to go too far in doing what she had been told to do. She surely lacked reflection on her actions when she engaged her older daughter, then seven years old, in torturing Cassandra.

But was anyone else at fault here? The reasons that Mr. Killpack was not convicted in Cassandra’s death most probably had to do with the four living Killpack children and the consequences for them if both parents went to prison. He must bear a burden of responsibility for failing to consider and deal with what was being done to Cassandra, but imprisonment may not have been necessary.

There are, however, some responsible parties whose involvement in Cssandra’s death have gone unpunished. Among these are the staff of the Cascade Center for Family Growth, whose dire warnings about the need to treat Cassandra brutally were a direct cause of Mrs.Killpack’s lethal actions. As we have seen in other cases, the therapists, who were not present at child deaths or injuries, watch from a position of comfort while the parents who took their advice are imprisoned. In the Cascade case, an action to revoke the professional license of a leading therapist, Lawrence van Bloem, was in preparation, but he was killed in a car accident before this took place. Other staff members have left Utah and then come back to work in various guises such as massage therapy, in which their activities are not carefully monitored.

Somewhere, too, there are one or two responsible individuals who made a decision in 1990 to invite to Utah some Colorado holding therapists who offered training to state employees and essentially made this approach officially acceptable.

It is hardly practical to pass and enforce laws about specific types of therapy. There have been some efforts to do this, but the results have been weak; in any case, if the issue is how parents treat their children at home, there has been little success in monitoring any aspect of this.

But where, I ask, are the licensing boards and state professional organizations in these situations? National organizations like the National Association of Social Workers have made some attempts at adopting policies rejecting methods like holding therapy, and that is much appreciated by concerned persons. However, it is at the state level that decisions are made to reprimand professionals whose behavior is wrong. Licensing actions have a power that is found nowhere else, but it is not being used. It is time to change all this and protect the public by monitoring psychotherapists and “consultants” who give dangerous advice.

The Urban Legend About the Russian Orphans

I thought I would have a peaceful breakfast this snowy morning, January 9, 2011, with the Times Sunday Styles section. What could be in there to bother me, except maybe pictures of people in high-fashion camouflage clothing, an oxymoron to my mind?

But there was something bothersome, and it was on the first page. One Nicole Hardy had written a piece called “Single, Female, Mormon, Alone”, and although what she had to say was interesting, insightful, and well-written, and I wish her all the best, it took only a few paragraphs before my myth alarm went off loudly. Ms. Hardy wanted to find a good metaphor to convey how isolated she felt as a celibate adult, and how she felt she hadn’t been able to really grow up as an “old” virgin, so here’s what she compared herself to: “like the Russian orphans I’d read about whose lack of physical contact altered their neurobiology and prevented them from forming emotional bonds.”

It would seem that everybody now knows these things: Russian orphans can’t form emotional bonds . It’s because they didn’t get much physical contact when they were babies. That changed their neurobiology. They’re not like you and me or other human beings any more.

As is the case with other urban legends, the only trouble with this one is that it isn’t true. None of the parts we can unpack from Ms. Hardy’s statement is a demonstrable fact. I’ve discussed recent research on these issues at www.childmyths.blogspot.com/2010/12/when-romanian-orphans-grow-up-recent.html. Michael Rutter and other researchers of the English and Romanian Adoptees study have been following over 300 children adopted from Romanian orphanages in the early 1990s. These orphanages had appalling conditions, probably for many of these children the worst that could be experienced and still have the child survive; they were certainly worse than present Russian orphanages, so if there are many bad outcomes from poor early care, we would expect those outcomes from the Romanian adoptees.

Here are some points from Rutter’s research that are relevant to the urban legend Ms. Hardy chooses as her metaphor:

1. “Orphans from Eastern Europe can’t form emotional bonds”
In fact, in the Rutter research, most of the children had normal relationships with their adoptive families. Those who seemed unusual in their relationships (and there were more in the adopted group than in a non-adopted comparison group) were overly friendly and more likely than is usual to approach strangers or wander away. The developmental scientist Megan Gunnar, commenting on this in the Society for research in Child Development monograph “Deprivation-Specific Psychological Patterns: Effects of Institutional Deprivation” (Rutter et al, 2010), pointed out: “we should not be focused on garden variety attachment problems but ones that fit within the ‘disinhibited’ framework [excessive friendliness—JM]. There are still plenty of questions about whether [disinhibited attachment] is primarily a disorder of the attachment relationship… Though some [disinhibited attachment] behaviors do deal with failure to check back with the parent in anxiety-provoking situations, most deal with disinhibited behavior or lack of social reserve with strangers… it is not just that these children are really overly friendly with strangers; rather, they seem to have problems with social boundaries” (p. 243). Gunnar’s comments suggest that a failure to form emotional bonds is not the issue.

2. “The reason they have problems is a lack of physical contact.”

Although it is undoubtedly true that few, if any, of the Romanian group were cuddled or kissed the way we expect family babies to be, there is no reason to choose that deprivation as the cause of any problems that may occur. They were also both underfed and malnourished in terms of receiving appropriate nutriments. Some were confined to their cribs almost indefinitely, and were cleaned by being squirted with garden hoses. To choose a lack of physical contact as the major problem out of this menu of deprivations is arbitrary and misleading.

3. “Their experiences changed their neurobiology”.

While this is an important issue, too little evidence presently exists about brain-behavior connections to be able to make this statement. For discussion, see www.santiagodeclaration.org.

Poor Ms. Hardy. She was just looking for a good metaphor to use in communicating some of the peculiarities of her life, and she stumbled into a major controversy. I can’t really blame her for picking up this urban legend--- that’s almost what urban legends are, things people pick up unquestioningly-- but I would have liked it if she hadn’t added this one more brick to the wall that keeps people from seeing through a legend that has caused a lot of trouble to a lot of children and their adoptive parents.

When the Romanian Orphans Grow Up: The Recent Report

What happens when children from severely-deprived institutional backgrounds are adopted into caring families? Adoption has been described as one of the most successful interventions, but how good a job does it do?

We are finding some answers to these questions bit by bit, as the English and Romanian Adoptees (ERA) Study continues to follow a group of over 300 children adopted from Romanian orphanages in the early 1990s. The ERA researchers are in the process of comparing the Romanian adoptees to non-adopted children as well as to adopted children who never had institutional care. This work is enormously time-consuming and complex, and involves repeated measurements and interviews at different ages, plus delays associated with analyzing, writing, and publishing the results of each phase of the investigation.

A recent presentation of the children’s characteristics up to age 15 has been published by Michael Rutter and co-authors as Deprivation-specific psycholkogical patterns: Effects of institutional deprivation (Monographs of the Society for Research in Child Development, Serial No. 295, Vol.75, No. 1, 2010). The 252 pages of this monograph are absolutely packed with information, some leading to conclusions, some not. I am going to try to pull out some points that may be of particular interest to readers.

An aspect of the monograph that will be of interest to many is the question raised in the title: whether there are psychological patterns that follow severe social and other deprivation in early life. The ERA investigated a group of characteristics that seemed more likely to occur in post-institutional children than in other adoptees. The following items were included:

1. Quasi-autism: A behavior pattern not identical with autism, but including rocking, self-injurious behavior like hair-pulling, unusual and exaggerated sensory responses, and tantrums in response to changes in routine, as reported in parent interviews (Gindis, B. [2008]. Institutional autism in children adopted internationally: Myth or reality? International Journal of Special Education, 23, 118-123).

2. Disinhibited attachment, as shown in unusual friendliness toward strangers and failure to show strong preferences for familiar people in threatening circumstance. The monograph describes disinhibited attachment as including “inappropriate approach to unfamiliar adults, a failure to check back with a caregiver in unfamiliar settings, and willingness to accompany a stranger and wander away from a familiar caregiver. It is often associated with a lack of appropriate physical boundaries, so that children may interact with strangers intrusively and even seek out physical contact… there is sometimes inappropriate affectionate behavior with strangers and undue physical closeness” ( Monograph, p. 58) .

3. Cognitive impairment, including problems with “mentalization” or the ability to understand what other people might believe or feel about a situation.

4. Inattention and overactivity similar to attention-hyperactivity disorders.

While by no means all children who had come from institutions displayed these problems, even those who had spent more than 6 months in a Romanian orphanage, the ERA group reported that over 90% of those who still showed the behaviors at age 15 had spent more than 6 months in severe deprivation. Those who persisted to age 15 with these problems had often improved (for example, become more likely to be helpful or comforting to others), but odd behaviors still occurred. Some children “annoyed other people but did not know why, and difficulties making or keeping friends were common… In a few cases, … inappropriate remarks included excessively outspoken sexualized use of language” ( Monograph, p. 86). Some children were reported as fascinated with collections, including those of “useless rubbish” like chocolate wrappers.

Can we generalize from the ERA children to other adoptees? While it’s useful for potential adoptive parents to have some idea of the types of problems they may see, it’s important to keep in mind some differences between the ERA group and many other adoptees. Members of the ERA group were aged 42 months or younger at the time of adoption, and most of them had gone to the institution shortly after birth. The Romanian orphanages were characterized by extremely severe deprivation, including confinement to cribs and bathing with water squirted from hoses, conditions unlike those in most other child-care institutions. Children with different histories may be quite different from the ERA group.

In addition to the possible effects of differences in background, the following facts are noted by the monograph: “A striking finding at all ages was the heterogeneity in outcome. Thus, even with the children who had the most prolonged experience of institutional care, there were some who at age 11 showed no indication of abnormal functioning on any of the domains we assessed. Conversely, there was a substantial proportion of children who showed impairments in multiple domains of functioning.” (p. 14). It would be a mistake for potential adoptive parents to assume that they can predict which outcome will belong to a given child.

Federici v. Mercer: The Story Behind the Lawsuit

A phone call this morning alerted me to the fact that the Virginia psychologist Ronald S. Federici is suing me and other critics in Fairfax, VA (CL10-16657, filed Nov. 24). As of today, I have not yet been served in this matter, but I assume that his complaint is that I have defamed him and interfered with his business, as he already brought such a suit in Small Claims Court and lost it, but is allowed to appeal.

What is behind this suit? The event that seems to have triggered it is that I published on my former Psychology Today blog a piece which I will present below. This piece, which I entitled “The Hungry Boy”, was based on a published opinion of the North Carolina Court of Appeals (www.aoc.state.nc.us/www/public/coa/opinions/pdf/090504-1.pdf), which discussed Federici’s involvement in an adoptive family situation that resulted in the incarceration of both parents for felony child abuse. The COA opinion quotes testimony Federici gave during the trial as well as the statements of the abused boy. (After writing “The Hungry Boy”, I obtained the transcript of the original trial, which does not counter in any way the statements in the COA opinion.)

Shortly after the publication of “The Hungry Boy”, Federici complained to and filed suit against me, Psychology Today, and other persons. Psychology Today took down “The Hungry Boy” and told me not to mention Federici’s name again. Although Psychology Today was served with a summons to appear in Fairfax, VA to answer the suit, and although I warned them that they should not default, they did not send a representative to appear in court and as a result a judgment for $5000 was given against them. I appeared and had a chance to see that Federici did not present evidence that he had been harmed by what I wrote nor that what I wrote was untrue (both necessary for a successful defamation case in the United States). As a result, the judge found for me.

Over the following several weeks, I did not mention Federici’s name on my blog, as instructed, but I did mention that I had been in court in a defamation case. Psychology Today responded to this by freezing my account on the grounds that I had broken an agreement with them, and I moved my blogging to http://www.childmyths.blogspot.com/.

Having lost his case in Small Claims Court, Federici had the option of an appeal to a higher court, and he filed this appeal against me and some other people. (He apparently came to some agreement with Psychology Today.) However, after some weeks, he decided on a “non-suit”-- to drop the case for the time being but to keep the option of reviving it. This revival is what he has apparently done as of Nov. 24, 2010.

What did “The Hungry Boy” say that was so disturbing to Federici? I’ll show you by posting the piece below.



The Hungry Boy: An Adoption Story, With Comments

Is starvation the key to good discipline and loving relationships in adoptive families?

In several posts on this blog, and in print publications over the last ten years, I have alluded to the suggestion by unconventional therapists that withholding food from adopted children is an effective way to shape desirable attitudes and behavior. Today, I’d like to tell some of the story of adoptive parents who took this advice, the consequences for themselves and their adopted child--- and the absence of consequences for the therapist who acknowledged in court that he had provided the treatment plan. I draw my information about this case from a document of the North Carolina Court of Appeals, issued Jan.19, 2010, and available at http://www.aoc.state.nc.us/ , as well as from a document prepared for the defense in this appeal and available at http://www.ncids.org/.

Here is the basic story. Paul and Leslie Salvetti adopted in the 1990s a little boy who had been born in Russia in 1993. Leslie later died, Paul re-married, and the new wife, Debbie, became mother to the boy, known as “Pesha”. At some point, the family’s functioning became less than ideal; “Pesha” reported to social services that Debbie had hit him with a frying pan and baseball bat, among other complaints, but it is not clear whether this was investigated.

According to the appeals court documents, Paul and Debbie felt that “Pesha” was “umanageable” by the time he was 13. In about February, 2007, the Salvettis consulted Ronald Federici, a clinical psychologist with a Psy.D. degree, licensed in Virginia, about their problems with “Pesha”. (The fee for this consultation was $5200 for three days of work.) Federici made a number of recommendations about appropriate treatment of “Pesha”, including the suggestion that ordinary meals should be contingent on improved behavior, but that “Pesha” should be provided with bologna sandwiches and fruit in any case.

The Salvettis also confined “Pesha” to his bedroom, where they covered the windows and removed most furniture , and these were the circumstances of his life for three months. “Pesha” later described himself as “cold and hungry” during this time. “Pesha” eventually escaped from the house and made his way to the authorities; at this time he was hospitalized for a week, during which time he gained 10 pounds. The Salvettis pled guilty to felony child abuse (intentionally inflicting physical injury, starvation) and in 2008 were sentenced to a period of imprisonment.

During the Salvettis’ trial, Ronald Federici testified on their behalf, and, unusually for a psychologist, commented on medical and genetic issues as well as psychological concerns; expert witnesses are generally expected to speak within their area of professional expertise. It is of particular interest that Federici testified to his belief that “Pesha” had not been substantially deprived of food. Federici and the defense attorney appear to have taken refuge in the ambiguity of the English language and to have interpreted the term “withheld food” to mean “withheld all food and liquid” rather than “reduced the amount and type of food available”. The defense argued that because some food had been provided, food had therefore not been withheld.

In addition, Federici testified to his opinion that children’s rage could cause them to lose weight, and that this, rather than food deprivation, was the cause of “Pesha”s” condition. (Although the implications of this statement were not discussed in the court documents that are available, I should point out that there is no known evidence to support Federici’s opinion.)
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So, what can we conclude from this case? Is starvation the key to good discipline and loving relationships? If not, what are its consequences? In this case, the consequence for “Pesha” was a terrifying experience and the loss of the home he knew. For Paul and Debbie Salvetti, the consequence was a period of imprisonment. For Ronald Federici , the consequence of his many activities has been popularity with the media, including a recent interview with National Public Radio in which he commented on the latest Russian adoptee scandal. Others who give similar recommendations have also found them lucrative.

If you are a member of an adoptive family, please note that you are not one of the people likely to benefit from using the withholding of food as a child-rearing technique.


*** That’s the end of “The Hungry Boy”. If you’re not sure whether my statements were accurate, you can read the North Carolina Court of Appeals opinion on line. Incidentally, the appeal in this case had nothing to do with any facts about what had actually happened, or any discussion of the appropriateness of Federici’s advice to the parents. The appeal had to do with the type of plea made by the parents in order to avoid trial, and whether they had actually understood that they would go to prison.

The Raising-a-Psychopath Blog

A reader asked me to comment on the blog “Raising a Psychopath” ( http://raising-a-psychopath.blogspot.com/). For those who haven’t seen it, this blog appears to be by the adoptive father of a child who was adopted at age 6 after many experiences of neglect, abuse, and change of caregiver, and who at age 11 is regarded with fear and anger by the parents and has been in residential treatment for periods of time. The blogger, whom I’ll call FRP (for Father Raising a Psychopath), as his blog title suggests, considers the child to be psychopathic as well as to have Reactive Attachment Disorder. Many of the posts present arguments that FRP has put forward to support his view of the child, “Lucas”.

I have some general comments about the material contained in this blog, but I need to emphasize that I have no reliable information about “Lucas’ or his parents. I have no way of knowing whether the statements on “Raising a Psychopath” are true, or whether there is omitted material that would put a different spin on the statements that are made. Even if I were sure about the veracity and completeness of the blog, I would not want either to praise or to criticize the actions of the parents, therapists, teachers, social workers, etc. It’s too easy to talk a game that you don’t have to walk, as we can see from many of the comments, both positive and negative, on FRP’s statements.

That said, here are some thoughts I had while reading “Raising a Psychopath”.

1. The psychopath thing:
It appears that from the beginning of the blog, FRP identified “Lucas”, who was then about 9, as a psychopath-- he chose this title for the blog, and in one of his posts predicted a timeline of more and more serious misbehavior. Whether or not this was a self-fulfilling prophesy is difficult to say with the information we have. We can ask, however, why FRP was so quick and so sure about this diagnosis. What are the advantages of labeling a boy “psychopath” rather than staying with more ordinary childhood problems like Conduct Disorder or Oppositional and Defiant Disorder? The advantages would seem to be the possibility of declaring the child beyond help and incapable of living in the family home, removing any responsibility the adoptive parents might have, as well as the possibility of focusing all blame or negative evaluation on the child himself.

Many of FRP’s posts describe his thoughts about the evaluation of “Lucas” with Robert Hare’s PCL-YV (Psychopathy Check List-- Youth Version). FRP discusses each of the check list items in detail, and, not surprisingly, concludes that he has a genuine psychopath on his hands. But although he mentions the limitations of the PCL-YV briefly, he evidently has not taken them seriously.

The first limitation is that the check list is not intended for the use of parents. It is to be given by an experienced clinician who can compare an adolescent to many other adolescents seen previously, and who will ideally use an objective approach in which both positive and negative evidence is carefully assembled and combined before a decision is made. No parent can be genuinely objective about their own child-- indeed, if they were, it would be a cause for concern. In addition, FRP already decided that “Lucas” was a psychopath some time ago, so it would be surprising if he did not seek evidence to confirm this belief.

The second limitation of the PCL-YV is that it has been standardized on and is intended to be used with adolescents from 12 to 18 years old. “Lucas” was 11 or less at the time of FRP’s assessment efforts. Yes, of course, 11 is almost 12, but it is not 12-- and at a period when the rapid changes of puberty begin, a few months may make enormous differences in an individual’s abilities and motivations. FRP judges “Lucas” to have unstable personal relationships based on the adoptive mother’s report that “girlfriends” “break up” with him quickly-- at 11 years of age, a period when the more advanced reproductive maturity of girls makes relations between boys and girls labile to say the least.

On this “psychopath” thing, by the way, there are several general points to be made. One is that there are not very many psychopaths, so the validation of a brief check list is a difficult matter. Individual differences in a small group make it hard to establish a general set of criteria. In addition, there seems to be a common confusion between individuals who are sadists and take pleasure, often sexual, in the pain of others, and the psychopath or sociopath who does not care about causing pain, but does so only when it’s convenient--- for example, if a bystander to a robbery might identify the perpetrator and therefore “must” be killed. Finally, the frequent identification of violent offenders with individuals who are sensation-seekers is paradoxical; a reader’s comment on “Raising a Psychopath” says that a psychopath lacks empathy, but enjoys the sensation when another person is hurt, which for me raises the question, if he has no empathy, how does he enjoy the other person’s distress?

Reactive Attachment Disorder
Early in the blog’s appearance, a reader advised FRP that “Lucas” must have Reactive Attachment Disorder because his behavior was problematic and he had a history of separation, neglect, and abuse. FRP immediately fell for the view of Walter Buenning and others, that this disorder can be diagnosed easily by use of a check list (conveniently on line), and that its symptoms include failure to make eye contact, “crazy lying”, preoccupation with blood and gore, etc., etc., all of which, untreated, will culminate in serial killing by boys and prostitution by girls (but apparently not the other way around).

This check list is neither standardized for age differences nor validated against any other method of diagnosing Reactive Attachment Disorder. Examination of the criteria for Reactive Attachment Disorder in the Diagnostic and Statistical Manual of the American Psychiatric Association shows no overlap between the established criteria and the check list used by Buenning and others.

FRP’s discussion of “Lucas’s” history suggests that while “Lucas” may be quite insecure after his confused and painful beginnings, he is not without attachment or the capacity for attachment. For example, when FRP and his wife had their first meeting with “Lucas”, while he was in a foster home, they noticed that he was not eager to socialize with them. When they took him back to the foster home, they felt he was much happier to be with the foster parents than with them (FRP and wife), and commented that the foster parents were more like grandparents-- while FRP did not explain this statement, I would guess that it meant affectionate and easy-going. “Lucas” showed a preference for those foster parents and appeared more comfortable with them than when away from them; in other words, he exhibited emotional attachment which he had developed over some months in a nurturing foster home. Whatever his difficulties, they are not due to an inability to develop a positive relationship with a caregiver.

Plain old ignorance
FRP’s description of their decision to adopt “Lucas”, and of their feelings as the adoption date approached, suggests to me that these parents share with many others a serious lack of understanding of early development and of the role of relationships in children’s lives. Like many participants in the Zero-to-Three/Civitas Benchmark Study, FRP and Mrs.FRP seem to have been especially ignorant about emotional development. I say this because, like all too many adoptive parents, they felt they could save themselves a lot of trouble--- diapers, night feedings, and all that-- by staying out of the picture until a child was 5 or 6 years old. Then, they thought, they would walk in and adopt, and that adopted child would be EXACTLY like their friends’ children who had been loved and cared for from birth to age 6. FRP and Mrs. FRP could do everything they liked to do, just as they did before, but there would be living in their house an attractive, sociable, charming, and self-reliant child who would play with them when they felt like it.

I’m sorry, but this was idiotic. It was not even realistic from the viewpoint of thinking what their friends’ children are actually like.

FRP’s comments on the blog also suggest that he and his wife did not think it was a problem to bring into their home a child whom they did not actively want or feel sure about. They seem to have been naïve about their own emotions, not to speak about the impact on the child of having his lot cast with caregivers who were unclear about what they were doing. And with respect to this, I must also point out the ignorance or indifference shown by caseworkers who did not pursue this couple’s hesitation and make sure all was clear before proceeding. Was it not understood that the couple did not know important things about early development? Or, is it possible that the caseworkers didn’t know those things either?

Well. That’s about enough for now. Just let me repeat (to myself as well as to readers) that for all I know, nothing on “Raising a Psychopath” is true, or just as likely, it’s true but so are a lot of other things.