RAD Foolishness at Huffington Post

The Huffington Post columnist Lisa Belkin deplores the deadly results of child abuse, and well she may. But in her remarks at www.huffingtonpost.com/lisa-belkin/adoption-spanking-childabuse_b_1081617.html , she falls heavily for an idea associated with an eccentric view of child mental health--- the belief that emotional disturbance can cause an inability to feel pain. Belkin says that Reactive Attachment Disorder is “essentially the inability not only to bond, but to feel… these children can have elevated levels of the hormone cortisol, which increases their tolerance for pain… Some speculate that … spanking can spiral out of control” because the children do not respond to normal levels of painful stimulation.

Let’s parse this remarkable statement.

Do “some” speculate on this idea and claim that children with Reactive Attachment Disorder (or adopted children-- the two are sometimes spoken of in the same breath) are not very responsive to pain? Yes, “some” certainly do. Here are a couple of examples. At www.attachmentdisorder.net?Letter_to_Teacher.htm, we are told that “RAD kids can walk around in significant physical pain from real injuries”. At www.adopting.org/DrArt/diagnosisrad.html, the social worker Arthur Becker-Weidman, the soi-disant “Dr. Art”, provides one of those do-it-yourself RAD checklists, including the item “My child ‘shakes off’ pain when hurt, refusing to let anyone provide comfort”.

These statements confuse the actual response to pain with the seeking of comfort from the “right” people, and ignore the possibility that the child does not find particular adults (or adults in general) to be very comforting people. Belkin, however, accepts the idea that children diagnosed with Reactive Attachment Disorder may have an increased tolerance for pain-- by which I assume she means a raised threshold, requiring a higher level of painful stimulation before the child experiences pain.

Is it possible for this to happen? Yes, as Belkin states, changes in stress hormone levels can make a difference to pain tolerance. Physical stimulation can result in changes in pain threshold called stimulus-induced analgesia. People with diseases of the peripheral or central nervous systems such as leprosy can lose skin sensitivity of all kinds in some parts of the body. Studies of soldiers during World War II showed that wounds treated at front-line dressing stations required much less morphine than similar injuries due to surgery. A very few people are congenitally insensitive to pain and are frequently injured as a result (for example, being unaware that a hand is on a hot stove until they smell charred flesh). A few others, afflicted by harmful genetic factors, mutilate themselves by chewing their lips and tongues and do not seem to find this painful-- but can learn not to do it when subjected to painful electric shocks.

Is there any documentation of the claim that children who have been given the RAD diagnosis are in fact less responsive to pain than other children? This could be ascertained through standard laboratory tests of pain thresholds, or by systematic observation of toleration of dental work or medical procedures like immunization. No one has done this, so in fact the idea of higher pain thresholds (better pain tolerance) remains entirely hypothetical. The DSM description of Reactive Attachment Disorder certainly mentions no such symptom.

Let’s look at Belkin’s suggestion in another way. Does ordinary child guidance depend on experiences of pain? If a child felt little or no pain, would he or she then be untrainable? Although many parents do use spanking (a few blows with the open hand, no weapon) as a disciplinary method for preschool children, it is also common and effective to use timeout, isolation in the child’s room, scolding, or deprivation of treats-- all useful methods without physical pain. An ordinary spanking itself, when applied through a layer or two of clothing, involves intimidation much more than pain. In fact, it is not necessary for punishment to be painful in order to be effective . (The use of aversive treatments like electric shock-- certainly a painful experience-- is ethically limited to situations when a child will put himself in danger of real harm if he does not comply with instructions. ) If indeed children with Reactive Attachment Disorder had high tolerance for pain, there is no reason to think that this would affect their response to ordinary discipline one iota.

This line of discussion leads to another claim, one not made by Belkin but common among the people whose work she seems to have been reading. This is the idea that children with Reactive Attachment Disorder are unable to learn cause and effect connections, as stated by the “Evergreen Consultants in Human Behavior” at http://attachmenttherapy.com/ad.htm and many others. This bizarre belief appears to have come from someone being frightened by Piaget at an early age. In fact, learning to associate cause and effect begins in the first months of life, and is shown in thousands of daily behaviors such as becoming toilet-trained and using a spoon to eat with. The belief that Reactive Attachment Disorder necessitates severe parenting methods and high levels of child discomfort appears to be based on this entirely hypothetical inability to associate cause and effect. Children who attend school, dress and feed themselves, and do household chores all are demonstrating evidence of cause and effect learning, but they may for quite other reasons fail to learn to display affection or gratitude to their caregivers, or to make the caregivers feel that they have achieved the family relations they wanted.

Belkin associates Reactive Attachment Disorder with an “inability to feel”-- perhaps deriving this idea from the claimed lack of responsiveness to pain. Yet even the attachment therapists from whom she seems to have adopted ideas would point to the children’s rage and grief about separation from their original caregivers, even in cases where there was not enough time for an attachment to have occurred. The real issue appears to be that the children do not feel what their adoptive families want them to feel, or if they do, they do not display their feelings as is expected of them.

Belkin’s suggestion that children are abused because they are insensitive to pain and do not “feel” emotions is simply not tenable. This is not a matter of parents who must escalate physical punishment because without pain the children will not learn; it’s clear that children, adopted or not, do learn without pain. There was something else going on in the child deaths associated with “To Train Up a Child”. What was it? There were undoubtedly different factors and combinations of factors in the three known cases, but here’s a short list of possibilities:

The belief that the child’s eternal damnation or salvation rests on present obedience.

The belief that physical punishment is traditional, Christian, or in some way linked to a set of “family” values.

The belief that it’s a child’s job to make a family happy.

The belief that isolation of the family from the surrounding community is desirable.

The belief that adopted children are different from others in essential ways (a belief, by the way, fostered by Belkin’s comments on this subject).

The belief that there is an undefined process called “bonding” that may be undertaken by children and which is different in its nature from emotional attachment.


These factors could all be part of the lives of fairly ordinary adoptive parents. When we add in the possibility of serious mental illness in parents or in children (sorry, RAD doesn’t count), we multiply enormously the possibility of child abuse, injury, even death. The hypothesis that adopted children have a high tolerance for pain is not only unsupported, but an unnecessary addition to the discussion. Stressing that hypothetical factor is just another way to say, “the child made me do it.”

Adoption, Trust, Complacency, and the Barahona Case

While most of the nation was intensely involved with the trial of Casey Anthony in Florida, another case in the same state got much less attention in spite of its seriously disturbing nature. In that case, a grand jury investigated the death of Nubia Barahona and the serious injury of her twin, Victor, apparently at the hands of their adoptive parents, Carmen and Jorge Barahona. The death and injury followed a series of reports of child abuse, including complaints from Nubia’s teachers that she seemed to be very hungry and that she was nervous and afraid to go home. Other complaints stated that the twins were bound with duct tape, locked in the bathroom, left to sleep in the bathtub, and fed on bread and milk once a day. The Barahonas took the children out of school and said they were homeschooling them. Following the pattern of the all-too-familiar-story, caseworkers had not succeeded in seeing the children, but had accepted Carmen Barahona’s statement that they were fine. Then, on Feb. 14, 2011, Nubia was discovered dead and rolled up in a carpet in Mr. Barahona’s truck; her brother was there too, badly hurt.

The Miami-Dade County grand jury that indicted Carmen and Jorge Barahona filed a final report that is of great interest (http://media.miamiherald.com/smedia/2011/07/25/14/27/1aTHrq.So.56.pdf). In this report, while acknowledging all the many problems of caseworkers, including poor training and heavy caseloads, the jury members emphasized a problem that is prevalent but rarely mentioned. They referred to it as a bias of trust and complacency.

The bias of trust stressed by the grand jury report is the assumption on the part of the social work profession that adoptive parents are by definition good people, and that they cannot be the source of harm to the children in their care. Without wishing to accuse an entire professional group, I must agree strongly that this belief characterizes many adoption caseworkers and the staffs of adoption agencies. All adoptive homes are described as loving and nurturing, as if adoption were synonymous with excellent child-rearing. Adoption-oriented web sites describe adoptive parents as “awesome moms”. When adoptive families are functioning poorly, there is haste to say that someone, somewhere, did not tell the truth about the children, who are considered the causes of any trouble. These common beliefs may be the basis for the caseworkers’ bias of trust in adoptive parents which the grand jury report points to so explicitly.

Come, let us reason together about this. Why should adoptive parents be uniformly “awesome”, wholly loving and nurturing, and worthy of the unquestioning trust of society, when birth parents as a group do not meet these standards? Some would assume that adoptive parents must be excellent because they must have wanted the children; these people attribute child abuse to being saddled with unwanted offspring and resenting them. But, in fact, birth parents too may abuse children whom they wanted and even planned. (Shockingly, the grand jury report suggested that the investigation of the Barahona case would have been more careful if the children had been with their birth parents.)

Others who think adoptive parents are always good rely on screening and evaluation of adoptive parents to mean that only those who can do a good job are allowed to adopt. It’s true that screening makes it much less likely that people who are physically ill will be allowed to adopt, or that those living in poverty or substandard housing will become adoptive parents. Those with florid mental illnesses are also likely to be screened out. But in actuality there is no screening that will allow us to know exactly how a person will behave toward a particular child, and that is why post-adoption monitoring by an independent observer should be an essential part of the adoption process.

It would be a grave mistake to attribute cruelty and abuse to all adoptive parents, most of whom manage their families’ relationships in such a way that their children grow up as healthy, competent, successful contributors to society. It is an equally grave mistake, however, to assume that adoptive parents must not be the cause of evident problems in their children-- problems as serious as constant hunger, bruising, and fearfulness of going home. Adoptive parents are human beings; human beings can do wrong. If we are to do right by vulnerable children, we cannot let this be forgotten.

Is it too difficult for caseworkers who have known adoptive and foster parents for years, who may have been involved in the placement of children with them, to approach these families without bias? Is it too important to some caseworkers to be the friends of adoptive parents and to feel their approval? We can hardly blame the caseworkers if these things are true. Human beings trust people they have known for a long time, and human beings don’t enjoy being disliked by the people they work with. So, can we trust caseworkers to avoid that “bias of trust” when they have been involved with screening parents or placing children? It may well be that we cannot, and that the solution is to change the system so that strangers do the monitoring.

The Miami-Dade County grand jury report is a remarkable document. I congratulate the grand jury members for their ability to cut through the bureaucracy and to suppress temporarily the distress they must have experienced at the details of the Barahona story. By homing in on the trust issue, they have pointed out an essential flaw in our efforts to prevent abuse of adopted children in the United States. I would hope that this report will become required reading for all social work students and social services staff.

What About the Fathers? The Anthony Case and Danieal Kelly

I confess that I winced away from watching the Casey Anthony trial and only inadvertently picked up information from people who wanted to tell me about it. Now that the trial is over, though, I find myself thinking about an aspect that rated some sidebars: what about the father?

The Internet remains full of discussion of who the child’s father might have been, whether he’s alive, why he hasn’t come forward. A woman in New England has even declared that her son is the father, carrying family solidarity and maternal pride (?) to unheard-of levels. The comments on this issue are a melange of different types of disapproval, ranging from the idea that the father might have saved the little girl’s life if he had been paying attention, to the concern that anyone putting himself forward at this juncture is merely acting in hopes of cashing in on the selling of the Anthony story.

Not many people have mentioned the possibility that an identified biological father may have some legal responsibility in the child’s death and the mother’s subsequent ill-judged actions. I don’t know what the Florida law is, or what prosecutorial intentions might be, but a somewhat parallel case in Philadelphia shows that a father may be found guilty of various offenses in connection with the death of a child with whom he has no contact.

A lengthy legal process has tried several people for their culpability in the 2006 death of Danieal Kelly (see http://articles.philly.com/2011-07-12/news/2976489_1_danieal-kelly-mickal-kamuvaka-kelly-household). Danieal, who was physically very much impaired by cerebral palsy, died at age 14, weighing 42 pounds and covered with bedsores. She essentially starved to death. Her mother, Andrea Kelly, is already serving a prison term, but a few days ago, after trial, the social workers who had failed to respond to the child’s condition, and Daniel Kelly, Sr., Danieal’s father, were convicted of charges in this case. Daniel Kelly, who had at one time had custody of his children, returned them to their mother, who, he claimed, denied him access to Danieal. He did not report the matter to authorities or make any effort to be sure that Danieal’s special needs were met. He has been convicted of child endangerment and may be sentenced to as much as 7 years in prison.

Would Daniel Kelly have been convicted if he had never seen Danieal, or if he did not know he was her biological father? It’s possible-- even likely-- that he would not even have been tried under those circumstances. As it was, having spent some time living with Danieal, he was well aware of her physical incapacity and her special needs for physical care and for educational services. He must have had some idea of the degree of danger involved in leaving her to the sole care of her mother, although he also may have legitimately assumed that the social work service would oversee what was happening to Danieal. Nevertheless, some will object to his conviction for events that occurred when he wasn’t fully aware of the situation, and might well argue that if he had never known there was a baby, he would not have been at all responsible for Danieal’s death.

Daniel Kelly’s conviction is a message to some disengaged fathers of their minimal responsibility toward their children; even if they never provide a meal or pay child support, they must be sure that their children are receiving the basic care they need. But what is the message to those who never saw the baby, or even paid enough attention to know there was a pregnancy? What are the legal implications for those men of coming forward at a later time? Generally, unknown fathers are thought to lie low in order to avoid paying child support, but where a child has been harmed or killed, such men might also have possible concerns about charges of child endangerment.

This situation is fraught with ethical and practical dilemmas. On the one hand, it seems completely unfair to bring serious charges against someone who didn’t know what was going on-- but is Daniel Kelly’s “failure to know” any more or less culpable than the failure of a man to know that he impregnated a woman? And what would happen if unknown (but later identified) fathers of abused children were charged with endangerment? Would this encourage such men to take responsibility for their children’s well-being-- or would it encourage them to withhold their identities from partners and avoid serious relationships?

Perhaps the various candidates for Casey Anthony’s impregnator should think over their positions before they rush to declare themselves and sell their stories.

Chewing Off the Hand: Demonizing Nathaniel Craver

The Virginia psychologist Ronald Federici has found a new and scary way to blame adopted children for their own injuries. Commenting on the death of a western Pennsylvania boy who had been adopted from Russia, he has referred to another child who “chewed off his own hand” and to children with no sense of pain (http://www.washingtonpost.com/wp-dyn/content/article/2010/10/20/AR2010102004021.html and many other Internet sites). Federici and the defense attorneys for the adoptive parents, Michael and Nanette Craver, argued that the child, re-named Nathaniel, had injured himself fatally. An Associated Press article stated the Cravers’ argument that Nathaniel had suffered from Reactive Attachment Disorder, which, according to the article, “includes a tendency to injure oneself. “

Let’s consider each of these statements. Is it possible for someone to chew off his hand or to feel no pain? Individuals with the genetic disorder Lesch-Nyhan syndrome do chew off their lips and tongues as well as having movement and other problems. Schizophrenic patients have been known to gouge out their own eyes or break off teeth. And there are genetic disorders in which people unfortunately have no sense of pain and accidentally injure themselves as a result, for instance by failing to notice they are touching a hot stove until they smell burning flesh. Individuals with Hansen’s disease (leprosy) lose sensitivity in affected body parts and injure themselves by accident.

In all these situations, the sufferer shows many behavioral and physical symptoms in addition to self-mutilation or frequent accidental injuries. And, it’s clear, none of these problems is caused by adoption, although there’s a minute chance that a child adopted in infancy could have a disorder that is not yet noticeable. By the time any child reached Nathaniel’s age, seven years, ordinary observation and well-child care would have detected a set of problems that were not limited to self-injury, and which don’t seem to be mentioned at the trial . So, when the irrelevant statement about hand-chewing is brought into the discussion of Nathaniel’s death , our response should be, “what do the two things have to do with each other?” In my opinion, the purpose of this scary example is simply to distract attention from the real evidence about the events that led to this boy’s death. The “he did it himself” defense has been seen before in these cases; it was claimed that 2-year-old David Polreis beat himself to death with a wooden spoon, and even the very public videotaped death of Candace Newmaker was claimed by some to have been a deliberate act on the child’s part, for the purpose of punishing her therapists.

To continue the analysis: Is there any truth whatsoever to the statement that Reactive Attachment Disorder involves “a tendency to injure oneself”? Reactive Attachment Disorder is, of course, described in the Diagnostic and Statistical Manual of the American Psychiatric Association. But, no, no such behavior as self-injury is linked with RAD in DSM volumes of any vintage, nor is any such change predicted for DSM-V. This is proof by assertion at work. The Cravers and their attorney have made this statement without the slightest foundation in evidence, which they get to do in their efforts to be acquitted; it’s now up to the prosecution to ask the questions that will reveal that there is no truth to the statement, and the jury to pay attention to the facts.

In an interview with the Harrisburg Patriot-News , Federici also stated that Reactive Attachment Disorder is only a symptom “of a much larger and deeper disturbance”. This statement, like the previous one, would come as a considerable surprise to the committees that work hard to revise DSM periodically. While it’s presumably true that any behaviors, desirable or undesirable, are indications of underlying characteristics, it’s further proof by assertion and further distracting scare tactics to claim that the symptoms of Reactive Attachment Disorder indicate a nameless badness beyond DSM’s ken.

Let’s resist these attempts to depict Nathaniel as a demonic child, one of a group of terrifying, inhuman children who mutilate themselves horribly and cause unfair accusations of their loving caregivers. Let’s focus instead on the reality of this child’s life and the likelihood that he injured and malnourished himself.

And let’s hope the jury focuses on those issues, too.