I’ve had a lot to say recently about suggestions that children’s food supply should be contingent on their behavior. Many parents may feel a little uneasy about this topic, because most of us have used dessert as a negotiable item in efforts to get children to stop dawdling or to use reasonable table manners. Of course, when I refer to withholding food as a way to discipline children,I’m not just talking about whether they get a piece of lemon meringue pie tonight or not. I’m talking about reducing the available food to a small number of items and a smaller number of calories than the child usually consumes, with normal types and amounts of food given only if the child complies with parents’ wishes, and continuing that regimen for weeks or months. The effects of this kind of food withholding come on gradually but are very real.
If a child misses some food on one day-- as a punishment or because of a tummy-ache-- he or she generally makes up for it the next day. There’s no real need for food, or food intake, to be “balanced” over a 24-hour period, and there’s no long-term effect if it isn’t.
But a long period of time with less food than normal, as well as fewer nutrients than normal, is a different matter. This condition has been referred to as semi-starvation by some nutritionists. The starving person does not die within a week, as would be the case if all food and liquids were withheld, but gradually experiences both physical and mental effects.
Understanding the effects of gradual starvation is a matter that requires some tricky research approaches. Although all too many people in the real world are suffering from being underfed, most of them have other health problems-- contagious and chronic diseases, parasites, untreated injuries--- all of which may affect them physically and mentally in ways that are easily confused with the effects of lack of food. There are few circumstances in which experimental work can be carried out on the impact of semi-starvation; only adult volunteers could be used in this kind of investigation. The most famous experimental investigation of semi-starvation took place toward the end of World War II and used volunteers who were conscientious objectors to the war (Keys, A., et al. [1950] The biology of human starvation. University of Minnesota Press; Kalm, L.M., & Semba, R.D. [2005]. They starved that others be better fed: Remembering Ancel Keys and the Minnesota experiment. Journal of Nutrition, Vol. 135, pp. 1347-1352). These healthy young volunteers agreed to be subjected to months of calorie restriction and continuing physical exercise. They became emaciated, irritable, apprehensive, and moody, and were preoccupied with food; some ended up eating garbage or items like raw rutabagas, even though they were strongly committed to the program in terms of what its data could do to help people who were involuntarily starving in war zones. Not only were their bodies affected in complex ways beyond simple weight loss, but personality changes appeared.
Of course no experimental work of this kind would be done on children. But there is some related information which was secretly collected in the Warsaw ghetto, again during World War II. A lecture by Myron Winick on this sad topic can be found at www.columbia.edu/cu/epic/winick_lecture_2005.pdf. Winick reports the studies of what was called “hunger disease” in Jewish children confined and semi-starved in a section of Warsaw. Obviously, weight loss and growth failure resulted from their experience, but there were other effects as well. Low blood pressure and other cardiovascular effects were a consequence of slow starvation, as were cataracts (changes in the lens of the eye that prevent light from entering). The children reported being always cold.
It’s well known that infants, toddlers, and preschoolers, if subjected to poor nutrition for a period of time, are likely to be badly affected. Kwashiorkor, a nutritional deficiency disease resulting from lack of protein, causes slowing of brain development, among other things. Malnourished young children are reduced in stature and brain size.
These physical effects are all excellent reasons for avoiding the use of serious, long-term food withholding as a technique for disciplining children. But let’s consider the mental and personality effects in addition. Parents who consider using these techniques are usually concerned with what they consider to be serious behavioral problems. They may be dealing with an emotionally disturbed child whose irritability, aggressiveness, or tantrum behavior are trying or even frightening. They may begin a regimen that makes a normal amount of food dependent on behaving well-- but if the child is really not able to improve, or if other aspects of the environment reward the behavior, semi-starvation may go on for many weeks. Then what can we expect to happen? Looking at the World War II study of adult volunteers, we see that characteristically, this food regimen made them more irritable, apprehensive, and moody. If this effect generalizes to children-- and we might plausibly predict that the effect would actually be greater in children than in adults-- the impact of a period of reduced food intake would be to worsen the undesirable behavior that triggered this form of discipline to begin with.
Making a normal diet depend on a child’s behavior may cause behavior to get worse over time, and is certainly potentially dangerous from the physical viewpoint. But this doesn’t mean that negotiating behavior with the help of that slice of pie is necessarily a bad idea, if it seems to work in your family. If you’re worried about using that method too much, make sure that the pie-less child can have seconds on the main course if still hungry, and you can be sure that nobody is semi-starving.
Thursday, July 8, 2010
Tuesday, July 6, 2010
Child Death By A Thousand Cuts in California
Not long before the return of the Russian adoptee to his homeland, an event that received enormous media attention, another foreign-born child died at the hands of her foster parents—and almost nothing has been said about this. In February, Lydia Schatz, an almost-8-year-old child from Liberia, died an appalling death, whipped for hours with a thin plastic plumbing supply line until vital organs were damaged by the effects of muscle damage. Lydia’s “mother” held her down while her “father” applied this punishment for a minor mistake in English. More details about this matter can be seen at www.icrawl.org/44034264874-jane-schatz-8-yo-paradise-ca, or on the web site of the Paradise (CA) Post, although you’ll have to pay to get at the archives of the latter.
I don’t want to dwell on this child’s experience, as anyone with the slightest imagination will be able to envision her pain and terror all too clearly. What I want to do in this post is to consider the sources of these parents’ actions, which were not impulsive but instead were based on a philosophy of child discipline. It appears that Lydia’s guardians were followers of the Tennessee fundamentalist child-rearing gurus, Debi and Michael Pearl. The Pearls are authors of “To Train Up a Child”, a publication whose first part appears on line at www.gospeltruth.net/children/pearl_tuac.htm. I have discussed the Pearls’ book in detail in my article “Destructive trends in alternative infant mental health approaches”, Scientific Review of Mental Health Practice, 2007, Vol 5(2), 44-58.
While Lydia’s guardians certainly must take full responsibility for their decision to whip the child, it is also important for people concerned with child welfare to note that there are sources of bad advice that are never forced to take any esponsibility. The Pearls are among these. They share the view I mentioned in a post a few days ago, that children are basically bad and must be forced into obedience; like some other authors since the early days of this country, the Pearls put this belief into a religious context so that it becomes the parents’ responsibility to make children submit utterly to adult expectations.
The Pearls advise that submission to parental wishes should be forced in infants as young as four months of age (these babies, by the way, would be too young to be able to sit up unsupported or to recognize their names when spoken). The primary method for achieving submission is pain, and this is produced by whipping either with the old-fashioned willow switch or with quarter-inch-diameter plastic plumbing supply line. Whipping is advised as a way to make children stop crying or to persuade them to do something that is wanted, or to refrain from doing something unwanted. For example, Debi Pearl recounts a situation in which a toddler was left in her care for a few hours-- the first separation from his mother this child had ever experienced. Although other children were playing around him, the little boy did not eat or play, even though Mrs. Pearl offered him a roller skate and showed him how the wheels spun. When she told him directly to play with the wheels, he “defied” her and did not do so. She whipped him on the leg, but he still did not obey; this continued for ten whippings, until he did put his hand on the wheel, and was described as content now that he had yielded to someone higher than himself.
The Pearls advise that whipping should be done without any indication of anger and with a friendly facial expression, an extraordinarily confusing situation for young children who use social referencing-- checking of faces and voices-- to understand the intentions of adults. Although their stress is on whipping, there are other physical punishments they approve, for example, yanking the hair of a nursing baby if he or she bites the mother.
No doubt the Pearls will say that they never told anyone to whip a child to death, or even to continue whipping for hours. However, advising that pain is the major tool in child discipline opens the door to such actions, particularly when the pain is not to be withdrawn until the child obeys and/or stops crying. The Pearls’ advice, when combined with the belief that children can obey but are wickedly choosing not to, sets the stage for a frustrated or mentally ill adult to injure or kill the child who is being “disciplined”. Such an outcome may seem justified to those who are convinced of the religious value of these actions.
I challenge both mainstream and fundamentalist religious groups to come forward and make clear their rejection of the Pearls’ methods. Some fundamentalist organizations have done this in a quiet way, but a loud shout is needed. I also challenge neighbors and police to be aware of the Pearls’ advice and to try to prevent child injury and death that might otherwise result from systematic whipping.
I don’t want to dwell on this child’s experience, as anyone with the slightest imagination will be able to envision her pain and terror all too clearly. What I want to do in this post is to consider the sources of these parents’ actions, which were not impulsive but instead were based on a philosophy of child discipline. It appears that Lydia’s guardians were followers of the Tennessee fundamentalist child-rearing gurus, Debi and Michael Pearl. The Pearls are authors of “To Train Up a Child”, a publication whose first part appears on line at www.gospeltruth.net/children/pearl_tuac.htm. I have discussed the Pearls’ book in detail in my article “Destructive trends in alternative infant mental health approaches”, Scientific Review of Mental Health Practice, 2007, Vol 5(2), 44-58.
While Lydia’s guardians certainly must take full responsibility for their decision to whip the child, it is also important for people concerned with child welfare to note that there are sources of bad advice that are never forced to take any esponsibility. The Pearls are among these. They share the view I mentioned in a post a few days ago, that children are basically bad and must be forced into obedience; like some other authors since the early days of this country, the Pearls put this belief into a religious context so that it becomes the parents’ responsibility to make children submit utterly to adult expectations.
The Pearls advise that submission to parental wishes should be forced in infants as young as four months of age (these babies, by the way, would be too young to be able to sit up unsupported or to recognize their names when spoken). The primary method for achieving submission is pain, and this is produced by whipping either with the old-fashioned willow switch or with quarter-inch-diameter plastic plumbing supply line. Whipping is advised as a way to make children stop crying or to persuade them to do something that is wanted, or to refrain from doing something unwanted. For example, Debi Pearl recounts a situation in which a toddler was left in her care for a few hours-- the first separation from his mother this child had ever experienced. Although other children were playing around him, the little boy did not eat or play, even though Mrs. Pearl offered him a roller skate and showed him how the wheels spun. When she told him directly to play with the wheels, he “defied” her and did not do so. She whipped him on the leg, but he still did not obey; this continued for ten whippings, until he did put his hand on the wheel, and was described as content now that he had yielded to someone higher than himself.
The Pearls advise that whipping should be done without any indication of anger and with a friendly facial expression, an extraordinarily confusing situation for young children who use social referencing-- checking of faces and voices-- to understand the intentions of adults. Although their stress is on whipping, there are other physical punishments they approve, for example, yanking the hair of a nursing baby if he or she bites the mother.
No doubt the Pearls will say that they never told anyone to whip a child to death, or even to continue whipping for hours. However, advising that pain is the major tool in child discipline opens the door to such actions, particularly when the pain is not to be withdrawn until the child obeys and/or stops crying. The Pearls’ advice, when combined with the belief that children can obey but are wickedly choosing not to, sets the stage for a frustrated or mentally ill adult to injure or kill the child who is being “disciplined”. Such an outcome may seem justified to those who are convinced of the religious value of these actions.
I challenge both mainstream and fundamentalist religious groups to come forward and make clear their rejection of the Pearls’ methods. Some fundamentalist organizations have done this in a quiet way, but a loud shout is needed. I also challenge neighbors and police to be aware of the Pearls’ advice and to try to prevent child injury and death that might otherwise result from systematic whipping.
Any Treatment Is Better Than No Treatment At All
“Any treatment is better than no treatment at all.” I’ve drawn that quotation from the published work of an unconventional therapist who shall be nameless. It’s not just his idea-- plenty of people believe that this is a true statement about psychotherapies. It’s common to think that those who “seek help” always get help, rather than hindrance. But is it true?
Let’s just consider the logic of the whole thing. There are three logical possibilities for the outcome of psychotherapy. One is that the person being treated gets much better, and is both happier and more effective in his or her life. Another is that there’s really no change-- the patient is neither better nor worse during or following the therapy. And the third is that the treatment has an effect opposite from what was wanted: the person who was treated ends up in worse condition than before.
The clinical psychologist Scott Lilienfeld and others have referred to this third possibility as a matter of “potentially harmful treatments” (PHTs). Although a PHT may not harm everyone who experiences it, there is clear evidence that some persons treated in that way have suffered real worsening of their situations-- in some cases even dying as a result. It’s not too difficult to see that physical treatments could have harmful effects, because although medications may benefit people, they can also have adverse effects. Chelation therapy for autism and restraint therapies for “attachment disorders” are understandably potentially harmful. But people may have more trouble understanding how a non-physical psychotherapy of any kind could be a potentially harmful treatment. Cynics are far more likely to expect psychotherapies to be useless than to think they might cause emotional or other damage.
“Recovered memory’ treatments are a very good example of psychotherapies that are potentially harmful. When therapists suggest to patients that their symptoms must be the result of some long-repressed memory of abusive treatment or even of “Satanic rituals”, and when the patients then “recover” such memories with therapist encouragement--- in the absence of confirming evidence, or even the presence of disconfirming evidence----- harm to the individual, friends, and family can be very real. There are many substantiated cases of patients who “recovered memories” that accused family members of horrendously abusive behavior, followed by family alienation, divorce, criminal charges, and so on--- and in some cases eventually followed by the patient’s awareness that in fact the memory had been suggested by the therapist, not actually “recovered”. The potential for harm in this kind of treatment has become pretty clear over the years, although it was not necessarily obvious to the first therapists and patients who used it.
Programs like “boot camps” and “Scared Straight” programs, which lack evidence of effectiveness, may also be PHTs because of their deliberately traumatic components. It’s curious, isn’t it, that our society currently has so much concern with post-traumatic stress disorders, yet we accept some treatment programs based on trauma! It’s especially curious that we want young people from backgrounds of poverty and family dysfunction, who have already been exposed to emotional trauma in many cases and may be sensitized to it, to attend “boot camps” where programs will intentionally frighten and disturb them. (Surely the closest analogy would be a situation where traumatized combat veterans would be exposed to more fear and stress in the bizarre expectation that their original trauma would be defused by this.)
If adults want to choose PHTs, they have the right to do so. Under the First Amendment, advocates of PHTs have the right to state what they consider the strong points of their treatments, and those of us who oppose those treatments can only exercise our own First Amendment rights to state what we consider the problems of those treatments. When it comes to PHTs for children and adolescents, the matter is more complicated. Adults who make choices or recommendations about psychotherapy for children need to remember that they have a fiduciary responsibility-- not one that necessarily involves money, but one that involves guardianship or stewardship of a child’s developmental pathway. Choosing for another, dependent person, who may suffer from our mistakes, feels much more difficult to most of us than choices that affect ourselves alone. One of the first steps in such a choice should involve making sure that PHTs are not among the options we are considering.
In fact, some treatments for mental health problems appear to be potentially worse than no treatment at all, and not all psychotherapies are therapeutic. Let’s not fall for the idea that anything described as an intervention must either do good or do nothing.
Let’s just consider the logic of the whole thing. There are three logical possibilities for the outcome of psychotherapy. One is that the person being treated gets much better, and is both happier and more effective in his or her life. Another is that there’s really no change-- the patient is neither better nor worse during or following the therapy. And the third is that the treatment has an effect opposite from what was wanted: the person who was treated ends up in worse condition than before.
The clinical psychologist Scott Lilienfeld and others have referred to this third possibility as a matter of “potentially harmful treatments” (PHTs). Although a PHT may not harm everyone who experiences it, there is clear evidence that some persons treated in that way have suffered real worsening of their situations-- in some cases even dying as a result. It’s not too difficult to see that physical treatments could have harmful effects, because although medications may benefit people, they can also have adverse effects. Chelation therapy for autism and restraint therapies for “attachment disorders” are understandably potentially harmful. But people may have more trouble understanding how a non-physical psychotherapy of any kind could be a potentially harmful treatment. Cynics are far more likely to expect psychotherapies to be useless than to think they might cause emotional or other damage.
“Recovered memory’ treatments are a very good example of psychotherapies that are potentially harmful. When therapists suggest to patients that their symptoms must be the result of some long-repressed memory of abusive treatment or even of “Satanic rituals”, and when the patients then “recover” such memories with therapist encouragement--- in the absence of confirming evidence, or even the presence of disconfirming evidence----- harm to the individual, friends, and family can be very real. There are many substantiated cases of patients who “recovered memories” that accused family members of horrendously abusive behavior, followed by family alienation, divorce, criminal charges, and so on--- and in some cases eventually followed by the patient’s awareness that in fact the memory had been suggested by the therapist, not actually “recovered”. The potential for harm in this kind of treatment has become pretty clear over the years, although it was not necessarily obvious to the first therapists and patients who used it.
Programs like “boot camps” and “Scared Straight” programs, which lack evidence of effectiveness, may also be PHTs because of their deliberately traumatic components. It’s curious, isn’t it, that our society currently has so much concern with post-traumatic stress disorders, yet we accept some treatment programs based on trauma! It’s especially curious that we want young people from backgrounds of poverty and family dysfunction, who have already been exposed to emotional trauma in many cases and may be sensitized to it, to attend “boot camps” where programs will intentionally frighten and disturb them. (Surely the closest analogy would be a situation where traumatized combat veterans would be exposed to more fear and stress in the bizarre expectation that their original trauma would be defused by this.)
If adults want to choose PHTs, they have the right to do so. Under the First Amendment, advocates of PHTs have the right to state what they consider the strong points of their treatments, and those of us who oppose those treatments can only exercise our own First Amendment rights to state what we consider the problems of those treatments. When it comes to PHTs for children and adolescents, the matter is more complicated. Adults who make choices or recommendations about psychotherapy for children need to remember that they have a fiduciary responsibility-- not one that necessarily involves money, but one that involves guardianship or stewardship of a child’s developmental pathway. Choosing for another, dependent person, who may suffer from our mistakes, feels much more difficult to most of us than choices that affect ourselves alone. One of the first steps in such a choice should involve making sure that PHTs are not among the options we are considering.
In fact, some treatments for mental health problems appear to be potentially worse than no treatment at all, and not all psychotherapies are therapeutic. Let’s not fall for the idea that anything described as an intervention must either do good or do nothing.
Thursday, June 24, 2010
Fires in Crowded Theaters
A few days ago I appeared in court to defend myself against a suit claiming that I had defamed and interfered with the business of a clinical psychologist in another state. It was true that I had stated in pointed fashion my disapproval of the advice my opponent has given to parents-- advice that I consider potentially dangerous and without any evidence basis. I “won” the lawsuit, in the sense that the other person was unable to show evidence that any injury had been done, but did not have a chance to show that my statements had been based on fact.
This experience brought back to my mind an article I co-authored some years ago (Kennedy, S.S., Mercer, J., Mohr, W., & Huffine, C. [2002]. Snake oil, ethics, and the First Amendment. American Journal of Orthopsychiatry, Vol. 72, 5-15). In that paper, we discussed the responsibilities of psychologists, nurses, physicians, and other professionals with respect to speaking out against practices they deem dangerous or lacking in validation.
Professionals have the same First Amendment rights as other citizens, and may exercise freedom of speech within reasonable limits. A common example of boundaries on freedom of speech is that people should not shout “Fire!” in a crowded theater when there is no fire. Neither should professionals say “X treatment can kill you” when there is no evidence that this is true. Although only the situation in the crowded theater is likely to prove tragic, harm can also be done by making unsupported negative statements about other professionals’ practices. There is always a trade-off or balance to be calculated between the rights of the individual and the rights of the community. Even commercial speech is protected to a considerable extent. These matters have been debated at length in the search for some slackening of the tension between individual and group rights.
We often forget that people who have rights also have obligations to their community. The two are alternative ways of looking at the relationship between the individual and the social group. Citizens share obligations like paying taxes and obeying traffic laws. But what about professionals? Do professional groups take on additional obligations to their community, by reason of the unusual rights and privileges they enjoy? Is there something professionals should do in response to those whose cries of “fire” take the form of fraudulent statements and may lead others to avoid conventional treatments or seek potentially dangerous ones?
An initial point to be considered is that professionals have a fiduciary responsibility. This term, although it is often used to refer to financial dealings, actually has a much broader application. A fiduciary responsibility involves any position of trust or stewardship in which one makes decisions for the good of another person. Professionals, who are by definition likely to be much better-versed in their own subject than their clients are, make or contribute to decisions that are intended for the good of the client, who cannot decide so effectively for herself.
This fiduciary role involves a special group of rights and obligations, beginning with the famous “first, do no harm”. But we need to ask the following question: does doing no harm include preventing harm from being done? Does it mean acting in a way that protects the public from potentially dangerous treatments? And, if this is the case, how should that be done? Is it possible for professionals to manage this task without the negative consequences associated with unfavorable publicity or litigation (of the type I mentioned at the beginning of this post-- or worse)? Can the job be done in an effective, comprehensive manner rather than the current case-by-case, ad hoc style, carried out by a small number of concerned people?
It could be done, yes-- but only if large organizations pulled together to support public debate on the question of harmfulness. Such actions would be fiduciary indeed in their protection of the public and of individual professionals too. Yet they do not happen, except in the case of very occasional resolutions vaguely condemning isolated practices.
As a psychologist and student of child welfare issues, I believe I see one problem standing in the way of the comprehensive response that should be organized by national groups like the American Psychological Association. This is the view, almost endemic to the helping professions, that it’s “not nice” to say things that are “not nice”. On the whole, neither individual professionals nor professional organizations want to get caught being critical of colleagues who are assumed to be well-intentioned and competent. Neither does anyone want to decide how to deal with the professional who proved to be not well-intentioned, or not competent--- unless some form of sexual activity was involved, which leads to a quick decision. Like a defense attorney I came across recently, who argued that abusive treatment of a child was trivial because there was no sexual abuse, professional organizations are (justifiably) quick to condemn sexual contact with a client, but (unjustifiably) very slow to recognize other ways in which harm can be done.
Until mental health and child welfare professionals correct these problems, we are in a position where we may see that the theater is smoldering, but we have no way of evacuating the place before someone gets burned. It’s “not nice” for professionals or the public to get singed just because we have failed to develop an organized response.
This experience brought back to my mind an article I co-authored some years ago (Kennedy, S.S., Mercer, J., Mohr, W., & Huffine, C. [2002]. Snake oil, ethics, and the First Amendment. American Journal of Orthopsychiatry, Vol. 72, 5-15). In that paper, we discussed the responsibilities of psychologists, nurses, physicians, and other professionals with respect to speaking out against practices they deem dangerous or lacking in validation.
Professionals have the same First Amendment rights as other citizens, and may exercise freedom of speech within reasonable limits. A common example of boundaries on freedom of speech is that people should not shout “Fire!” in a crowded theater when there is no fire. Neither should professionals say “X treatment can kill you” when there is no evidence that this is true. Although only the situation in the crowded theater is likely to prove tragic, harm can also be done by making unsupported negative statements about other professionals’ practices. There is always a trade-off or balance to be calculated between the rights of the individual and the rights of the community. Even commercial speech is protected to a considerable extent. These matters have been debated at length in the search for some slackening of the tension between individual and group rights.
We often forget that people who have rights also have obligations to their community. The two are alternative ways of looking at the relationship between the individual and the social group. Citizens share obligations like paying taxes and obeying traffic laws. But what about professionals? Do professional groups take on additional obligations to their community, by reason of the unusual rights and privileges they enjoy? Is there something professionals should do in response to those whose cries of “fire” take the form of fraudulent statements and may lead others to avoid conventional treatments or seek potentially dangerous ones?
An initial point to be considered is that professionals have a fiduciary responsibility. This term, although it is often used to refer to financial dealings, actually has a much broader application. A fiduciary responsibility involves any position of trust or stewardship in which one makes decisions for the good of another person. Professionals, who are by definition likely to be much better-versed in their own subject than their clients are, make or contribute to decisions that are intended for the good of the client, who cannot decide so effectively for herself.
This fiduciary role involves a special group of rights and obligations, beginning with the famous “first, do no harm”. But we need to ask the following question: does doing no harm include preventing harm from being done? Does it mean acting in a way that protects the public from potentially dangerous treatments? And, if this is the case, how should that be done? Is it possible for professionals to manage this task without the negative consequences associated with unfavorable publicity or litigation (of the type I mentioned at the beginning of this post-- or worse)? Can the job be done in an effective, comprehensive manner rather than the current case-by-case, ad hoc style, carried out by a small number of concerned people?
It could be done, yes-- but only if large organizations pulled together to support public debate on the question of harmfulness. Such actions would be fiduciary indeed in their protection of the public and of individual professionals too. Yet they do not happen, except in the case of very occasional resolutions vaguely condemning isolated practices.
As a psychologist and student of child welfare issues, I believe I see one problem standing in the way of the comprehensive response that should be organized by national groups like the American Psychological Association. This is the view, almost endemic to the helping professions, that it’s “not nice” to say things that are “not nice”. On the whole, neither individual professionals nor professional organizations want to get caught being critical of colleagues who are assumed to be well-intentioned and competent. Neither does anyone want to decide how to deal with the professional who proved to be not well-intentioned, or not competent--- unless some form of sexual activity was involved, which leads to a quick decision. Like a defense attorney I came across recently, who argued that abusive treatment of a child was trivial because there was no sexual abuse, professional organizations are (justifiably) quick to condemn sexual contact with a client, but (unjustifiably) very slow to recognize other ways in which harm can be done.
Until mental health and child welfare professionals correct these problems, we are in a position where we may see that the theater is smoldering, but we have no way of evacuating the place before someone gets burned. It’s “not nice” for professionals or the public to get singed just because we have failed to develop an organized response.
Taking a Little Walk: What Factors Make a Difference to Toddlers?
The “Question” feature in the New York Times Science Times section today focused on an issue about babies’ early attempts at walking alone. A reader inquired whether what she had been told was true-- that babies could actually walk much earlier, except that their vestibular systems were not developed enough to control their balance until about a year of age. The “Question” editor, C. Claiborne Ray, reported on the inquiries he had made and noted the need for development of the nervous system and its control of the leg muscles.
There’s actually a lot more to walking than that answer implies. Perhaps the first point to examine involves the facts about development of the vestibular system. This system, embedded in the skull near the inner ear, and sending messages along the 8th cranial nerve as the auditory system does, is actually one of the first sensory systems to come “on line” in the course of development. It’s a primitive system which we share with some fairly simple living creatures, and essentially it signals information about the pull of gravity and about the movement of the head. Lean forward or tip your head sideways, and the changed direction of the pull of gravity on parts of the vestibular system signals parts of the brain about the new position. Turn your head, or undergo rotation as you do when going around a corner in a car, and that information is also detected and sent. There is little or no conscious awareness of vestibular activity, but messages from the system enable the body to stay upright by changing muscle tension to counteract accidental movement. They also enable us to know when an object is really moving in front of our eyes, and when an image is moving across the eyes because of head or body rotation. A great deal of vestibular function is already present at birth, and you can see it at work if you hold a young baby in a horizontal position and suddenly move her downward a few inches. The Moro reflex, a movement pattern governed by vestibular activity, causes the baby to fling her arms outward in a grabbing movement.
So , we see that the newborn has almost-mature vestibular function, but she can’t walk (though she can display a stepping reflex when held in the right position). What’s the problem? Why can’t the baby bear her own weight on her legs? Part of the difficulty is the factor mentioned in the Times “Question”: the immaturity of the myelin coating of nerves in the lower part of the body makes conduction of messages poor, and signals from the brain do not effectively control muscle contraction and relaxation. Like other aspects of development, this one follows a cephalocaudal pattern, with the head end maturing more rapidly than the “tail” end. It’s usually about a year before the baby has voluntary control over the legs (and by the way, that developmental pattern also means that toilet-training is not really possible in the first year of life, because voluntary control over the lower part of the body is needed for that purpose).
We haven’t finished yet. There are more factors that enter into the walking equation. One important one would be obvious to us if we were talking about adults, but we tend to forget that it works for babies too: muscle strength. Young babies don’t have strong leg muscles. For them, as for adults, muscle strength increases with exercise. Chances to push with the feet or pull to stand help to strengthen the leg muscles until they have the power to support the weight of the body. In fact, the late and much-respected developmental scientist Esther Thelen showed that a “baby treadmill” that exercised the legs could improve the age at which Down syndrome babies walked-- an event that is ordinarily delayed for these children.
Even when independent walking is achieved, we can see from watching toddlers that they do not yet have a mature gait. Their large heads and relatively short legs make it hard for them to keep their balance when walking, and they compensate by bending their knees a bit and placing their feet far apart to lower the center of gravity and stabilize their position. As their ankles are not yet very strong, toddlers often keep the foot extended and hurtle, from place to place on tip-toe, a gait that has its problems but helps compensate for ankle weakness. (Ideally, they get to use and strengthen those muscles by walking barefoot rather than in hard, unbending “baby shoes”.)
Their first walking experiences have enormous fascination for small children-- so much so that they may not even notice painful results. I have a vivid memory of seeing my older son at 11 months, prancing barefoot over painfully prickly holly leaves, then a month later, when the excitement had worn off, yelping when he stepped on one. That joy of early mastery must be included as one of the factors that helps walking emerge as a new skill.
There’s actually a lot more to walking than that answer implies. Perhaps the first point to examine involves the facts about development of the vestibular system. This system, embedded in the skull near the inner ear, and sending messages along the 8th cranial nerve as the auditory system does, is actually one of the first sensory systems to come “on line” in the course of development. It’s a primitive system which we share with some fairly simple living creatures, and essentially it signals information about the pull of gravity and about the movement of the head. Lean forward or tip your head sideways, and the changed direction of the pull of gravity on parts of the vestibular system signals parts of the brain about the new position. Turn your head, or undergo rotation as you do when going around a corner in a car, and that information is also detected and sent. There is little or no conscious awareness of vestibular activity, but messages from the system enable the body to stay upright by changing muscle tension to counteract accidental movement. They also enable us to know when an object is really moving in front of our eyes, and when an image is moving across the eyes because of head or body rotation. A great deal of vestibular function is already present at birth, and you can see it at work if you hold a young baby in a horizontal position and suddenly move her downward a few inches. The Moro reflex, a movement pattern governed by vestibular activity, causes the baby to fling her arms outward in a grabbing movement.
So , we see that the newborn has almost-mature vestibular function, but she can’t walk (though she can display a stepping reflex when held in the right position). What’s the problem? Why can’t the baby bear her own weight on her legs? Part of the difficulty is the factor mentioned in the Times “Question”: the immaturity of the myelin coating of nerves in the lower part of the body makes conduction of messages poor, and signals from the brain do not effectively control muscle contraction and relaxation. Like other aspects of development, this one follows a cephalocaudal pattern, with the head end maturing more rapidly than the “tail” end. It’s usually about a year before the baby has voluntary control over the legs (and by the way, that developmental pattern also means that toilet-training is not really possible in the first year of life, because voluntary control over the lower part of the body is needed for that purpose).
We haven’t finished yet. There are more factors that enter into the walking equation. One important one would be obvious to us if we were talking about adults, but we tend to forget that it works for babies too: muscle strength. Young babies don’t have strong leg muscles. For them, as for adults, muscle strength increases with exercise. Chances to push with the feet or pull to stand help to strengthen the leg muscles until they have the power to support the weight of the body. In fact, the late and much-respected developmental scientist Esther Thelen showed that a “baby treadmill” that exercised the legs could improve the age at which Down syndrome babies walked-- an event that is ordinarily delayed for these children.
Even when independent walking is achieved, we can see from watching toddlers that they do not yet have a mature gait. Their large heads and relatively short legs make it hard for them to keep their balance when walking, and they compensate by bending their knees a bit and placing their feet far apart to lower the center of gravity and stabilize their position. As their ankles are not yet very strong, toddlers often keep the foot extended and hurtle, from place to place on tip-toe, a gait that has its problems but helps compensate for ankle weakness. (Ideally, they get to use and strengthen those muscles by walking barefoot rather than in hard, unbending “baby shoes”.)
Their first walking experiences have enormous fascination for small children-- so much so that they may not even notice painful results. I have a vivid memory of seeing my older son at 11 months, prancing barefoot over painfully prickly holly leaves, then a month later, when the excitement had worn off, yelping when he stepped on one. That joy of early mastery must be included as one of the factors that helps walking emerge as a new skill.
Wednesday, December 2, 2009
Curriculum Vitae
CURRICULUM
VITAE
JEAN
MERCER*
134 E. Main St., Moorestown, NJ 08057
E-mail: Jean.Mercer@stockton.edu
EDUCATION:
Mt.
Holyoke College, 1959-1961
EMPLOYMENT:
Assistant
Professor, Wheaton
College Norton ,MA
Assistant
Professor, State University College Buffalo , NY
Assistant
Professor, Richard
Stockton College Pomona , NJ
Associate
Professor, Professor, Richard
Stockton College Pomona NJ
Professor
of Psychology, Richard
Stockton College Pomona , NJ
Professor Emerita of Psychology, Richard Stockton
College
PROFESSIONAL ACTIVITIES:
Consulting
reader, Infants and Young Children,1992-
Editor, The
Phoenix
Nurture
Notes (NJAIMH Newsletter), 2000-2001.
Vice President,
New Jersey
Association for Infant Mental Health, 1996-2000
President, New Jersey
Association for Infant Mental Health, 2000-2005
Past
president, ex officio Board of Directors member, NJAIMH, 2005-
Member,
Prevention and Early Intervention Committee, New Jersey Community
Mental Health Board, 2000-
Consulting
editor, Scientific Review of Mental Health Practice, 2002-
Member, New Jersey Better Baby
Care Campaign Advisory Committee, 2002-3
Fellow, Council for Scientific Medicine and Mental Health,
2003-
Faculty member,
Youth Consultation Services Institute for Infant and Preschool Mental Health,
2003-
Chair, Board of
Professional Advisors, Advocates for Children in Therapy, 2003--
Expert witness,
Utah Division of Occupational and Professional Licensing, 2005
(license revocation matter)
[*Name was legally changed from Gene Alice Lester, May,
1977]
Expert witness,
Middlesex NJ Family Court, 2005 (best interest hearing)
Member, "Critical Pathways"
teleconference on training and credentials (formed after ZTT/Mailman Foundation Infant Mental Health Systems
Development Summit Conference, September 2005)
Expert witness, Thibault
vs. Thibault, Pasco County, Florida, 2006 (child custody and discipline matter)
Expert witness, California vs. Sylvia
Jovanna Vasquez, Santa Barbara County, CA, 2007
(child abuse matter)
Reviewer, American Journal of Orthopsychiatry,
2008.
Testimony, Robertson
vs. Mannion, Montgomery County, PA, 2008 (child custody matter)
Founding member,
Institute for Science in Medicine, 2009—
Reviewer, Choice:
Current Reviews for Academic Libraries, 2009-
Board of Directors, Delaware Valley Group of WAIMH, 2010—
PUBLICATIONS:
Lester, G., & Morant, R. (1967). Sound localization
during labyrinthian stimulation.
Proceedings
of the 75th Annual Convention of the American Psychological
Association,
1,19-20.
Lester, G. (1968). The case for efferent change during
prism adaptation. Journal of
Psychology,
68, 9-13.
Lester, G. (1968). The rod-and-frame test: Some comments
on methodology. Perceptual
and
Motor Skills, 26, 1307-1314.
Lester, G. (1969). Comparison of five methods of
presenting the rod-and-frame test.
Perceptual
and Motor Skills, 29, 147-151.
Lester, G. (1969). The role of the felt position of the
head in the audiogyral illusion. Acta
Psychologica,
31, 375-384.
Lester, G. (1969). Disconfirmation of an hypothesis about
the Mueller-Lyer illusion.
Perceptual
and Motor Skills, 29, 369-370.
Lester, D., & Lester, G. (1970). The problem of the
less intelligent student in the introductory
psychology course. The Clinical Psychologist, 23(4), 11-12.
Lester, G., & Lester, D. (1970). The fear of death,
the fear of dying, and threshold differences
for death words and neutral words. Omega,1, 175-180.
Lester, G. (1970). Haidinger’s brushes and the perception
of polarization. Acta
Psychologica,
34, 107-114.
Lester, G., & Morant, R. (1970). Apparent sound
displacement during vestibular stimulation.
American Journal of Psychology, 83, 554-566.
Lester, G. (1971). Vestibular stimulation and auditory
thresholds. Journal of General
Psychology,
85, 103-105.
Lester, G. (1971). Subjects’ assumptions and scores on the
rod-and-frame test.
Perceptual
and Motor Skills, 32, 205-206.
Lester, G., & Lester, D. (1971). Suicide: The
gamble with death. Englewood
Cliffs, NJ:
Prentice-Hall.
Lester, D., & Lester, G. (1975). Crime of passion:
Murder and the murderer. Chicago :
Nelson-Hall.
Lester, G., & Rando, H. (1975). No correlation between
rod-and-frame and visual
normalization
scores. Perceptual and Motor Skills, 40, 846.
Lester, G., Bierbrauer, B., Selfridge, B., &
Gomeringer, D. (1976). Distractibility,
intensity
of reaction, and nonnutritive sucking. Psychological Reports, 39, 1212-1214.
Lester, G. (1977). Size constancy scaling and the apparent
thickness of the shaft in the
Mueller-Lyer
illusion. Journal of General Psychology, 97, 307-398.
Mercer, J. (1979). Small people: How children develop
and what you can do about it.
Mercer, J. (1979). Personality development and the
principle of reciprocal interweaving.
Perceptual
and Motor Skills, 48, 186.
Mercer, J. (1979). Guided observations in child
development. Washington , D.C. America
Mercer, J., & Russ, R. (1980). Variables affecting
time between childbirth and the establishment
of lactation. Journal of General Psychology, 102, 155-156.
Mercer, J., & McMurphy, C. (1985). A stereotyped
following behavior in young children.
Journal
of General Psychology, 112, 261-265.
Mercer, J. (1991). To everything there is a season:
Development in the context of the
lifespan.
Lanham , MD America .
Mercer, J.,& Gonsalves, S. (1992). Parental experience
during treatment of very small
preterm
infants: Implications for mourning and for parent-infant relationships.
Illness,
Crisis, and Loss, 2, 70-73.
Gonsalves, S., & Mercer, J. (1993). Physiological
correlates of painful stimulation in preterm
infants. Clinical Journal of Pain, 9, 88-93.
Mercer, J. (1998). Infant development: A
multidisciplinary introduction. Belmont ,
CA
Brooks/Cole.
Mercer, J. (1999). ‘Psychological parenting” explained
(letter). New Jersey
Mercer, J. (2000/2001). Letter.Zero to Three, 21(3),
39.
Mercer, J. (2001). Warning: Are you aware of “holding
therapy?” (letter). Pediatrics, 107, 1498.
Mercer, J. (2001). “Attachment therapy” using deliberate
restraint: An object lesson on the
identification of unvalidated treatments. Journal of Child and Adolescent
Psychiatric
Nursing, 14(3), 105-114. This paper is posted at
http://www.bpkids.org/learning/reference/articles/index.htm#journals_#
with
permission of the publisher to the Child and Adolescent Bipolar
Foundation.
Mercer, J. (2002). Surrogate motherhood. In N. Salkind (Ed.), Child Development
(pp.
399). New York :
Macmillan Reference USA .
Mercer, J. (2002). Child psychotherapy involving physical
restraint: Techniques used in four
approaches. Child and Adolescent Social Work Journal, 19(4), 303-314.
Kennedy, S.S., Mercer, J., Mohr, W., & Huffine, C.W.
(2002). Snake oil, ethics, and the First
Amendment: What’s a profession to do? American Journal of
Orthopsychiatry,
72(1), 5-15.
Mercer, J. (2002). Attachment therapy: A treatment without
empirical support. Scientific
Review of Mental Health Practice, 1(2), 9-16.
Reprinted in S.O. Lilienfeld, J. Ruscio, & S.J. Lynn (Eds.), Navigating the mindfield: A user’s guide to
distinguishing science from pseudoscience (pp. 435-453). Amherst, NY:
Prometheus Books.
Mercer, J. (2002). The difficulties of double blinding
(letter). Science,297, 2208.
Mercer, J. (2002) Attachment therapy. In M.Shermer (Ed.), The
Skeptic Encyclopedia of
Pseudoscience
(pp. 43-47) .Santa Barbara ,
CA
Mercer, J., & Rosa, L. (2002). Letter on Attachment
Therapy. New Jersey
School
Psychologist,
24 (8), 16-18.
Mercer, J., Sarner, L., & Rosa, L. (2003). Attachment
therapy on trial: The torture
and
death of Candace Newmaker. Westport ,
CT
Mercer, J. (2003). Letter to the editor. APSAC
Advisor,15(3), 19.
Mercer, J. (2003) Attachment therapy and adopted children:
A caution. Readers’
Forum. Contemporary
Pediatrics, 20(10), 41.
Mercer, J. (2003). Violent
therapies: The rationale behind a potentially harmful child
psychotherapy and its
acceptance by parents. Scientific
Review of Mental Health
Practice, 2(1), 27-37.
Mercer, J. (2003). Media Watch: Radio and television
programs approve of Coercive Restraint
Therapies. Scientific Review of Mental Health Practice, 2(2).(see also letters in subsequent issues)
Mercer, J. (2004). The dangers of Attachment Therapy:
Parent education needed.
Mercer, J. (2005). Bubbles, bottles, baby talk, and
basketty. Early Childhood Health Link
(Newsletter
of Healthy Child Care New Jersey ), 4(1),
1-2.
Mercer, J. (2005). Coercive Restraint Therapies: A
dangerous alternative mental health intervention.
Medscape General Medicine, 7(3). (see also letters in subsequent issue).
http://www.medscape.com/viewarticle/508956.
Mercer, J. (2006).
Understanding attachment: Parenthood, child care, and emotional development. Westport , CT
Mercer, J. (2006).
IEPs and Reactive Attachment Disorder: Recognizing and addressing misinformation. Scope (Newsletter of
the Washington State
Mercer, J., Misbach,
A., Pennington, R., & Rosa, L. (2006). Letter to the editor (age regression definition). Child
Maltreatment, 11, 378.
Mercer, J. (2007).
Behaving yourself: Moral development in the secular family. In D..McGowan (Ed.), Parenting beyond belief (pp.
104-112). New York :
Amacom Books.
Mercer, J., &
Pignotti, M. (2007). Letter to the editor (neurofeedback research critique). International
Journal of Behavioral and Consultation therapy, 3 (2), 324-325 (http://www.behavior-analyst-today.com/BAR2007/BAR-VOL-2.pdf
).
Pignotti, M., & Mercer, J. (2007). Holding Therapy and Dyadic
Developmental Psychotherapy are not
supported, acceptable social work interventions: A systematic research synthesis revisited. Research on
Social Work Practice, 17 (4),
513-519.
Mercer, J. (2007). Systematic child maltreatment: Connections with
unconventional parent and
professional education. Society for Child and Family Policy and Practice Advocate
(Division 37 of APA), 30 (2),
pp.5-6.
Mercer, J. ( 2007).Media
Watch: Wikipedia and "open source" mental health information. Scientific Review of Mental Health Practice. 5(1),
88-92.
Mercer, J. (2007)
Destructive trends in alternative infant mental health approaches. Scientific Review of Mental Health
Practice, 5(2), 44-58.
Mercer, J.,
& Pignotti, M. (2007). Shortcuts
cause errors in Systematic Research Syntheses: Rethinking evaluation of
mental health interventions. Scientific Review
of Mental Health Practice, 5(2), 59-77.
Mercer, J. (2008). Minding controls in curriculum study
(letter). Science, 319, 1184.
Mercer, J. (2009).Child
Development: Myths and Misunderstandings.Los Angeles,CA: Sage.
Mercer, J., Pennington,
R.S., Pignotti, M., & Rosa, L. (2009). Dyadic Developmental Psychotherapy
is not "evidence-based": Comments in response to Becker-Weidman and Hughes (2009). Child and Family Social Work, 15, 1-5. http://www.wiley.com/bw/journal.asp?ref=1356-7500
. DOI:10.1111/j.1365-2206.2009.00609.x.
Mercer, J. (2009). Child
custody evaluations, attachment theory, and an attachment measure: The science
remains limited. Scientific Review of
Mental Health Practice, 7(1), 37-54.
Mercer, J. (2010). Themes
and variations in development: Can nanny-bots act like human caregivers? Interaction Studies, 11(2), 233-237.
Mercer, J. (2011). Attachment theory and its
vicissitudes: Toward an updated theory. Theory
and Psychology, 21, 25-45.
Mercer, J. (2011). The
concept of psychological regression: Metaphors, mapping, Queen Square, and
Tavistock Square. History of Psychology,14,
174-196.
Mercer, J. (2011). Some
aspects of CAM mental health interventions: Regression, recapitulation, and “secret
sympathies”. Scientific Review of Mental
Health Practice, 8, 36-55.
Mercer, J. (2011). Book
review: Rachel Stryker’s (2010) The road
to Evergreen. Scientific Review of Mental Health Practice, 8, 69-74.
Mercer.J. (2011). Martial
arts research: Weak evidence. (Letter). Science,
334, 310-311.
Mercer, J. (2012). Reply
to Sudbery, Shardlow, and Huntington: Holding therapy. British Journal of Social Work,
42, 556-559 . DOI:
10.1093/bjsw.bcr078.
Mercer, J. (2013). Child development: Myths and misunderstandings,
2nd ed. Los Angeles, CA: Sage.
Mercer, J., (2013).
Deliverance, demonic possession, and mental illness: Some considerations for
mental health professionals. Mental
Health, Religion, and Culture 16(6), 596-611. DOI:10.1080.13674676.2012.707272.
Mercer, J. (2012).
Attachment in children and adolescents. (Childhood Studies section). H.
Montgomery (Ed.), Oxford Bibliographies Online. www.oxfordbibliographies.com.
Mercer, J. (2013, in
press). Attachment therapies. In R. Cautin & S.O. Lilienfeld (Eds.), Encyclopedia of clinical psychology. New York: Wiley-Blackwell.
Mercer, J. (2013, in
press). Controversial therapies. In R. Cautin & S.O.Lilienfeld (Eds.), Encyclopedia of Clinical Psychology. New
York:Wiley-Blackwell.
Mercer, J. (2013). Holding
Therapy in Britain: Historical background, recent events, and ethical concerns.
Adoption & Fostering, 37(2),
144-156. .
Mercer, J. (2013). Holding
therapy: A harmful alternative mental health intervention. Focus on Alternative and Complementary Therapies, 18(2), 70-76.
Mercer, J. (2013). Giving
parents information about Reactive Attachment Disorder: Some problems. Brown University Child and Adolescent
Behavior Letter, 29 (8), 1, 6-7.
UNPUBLISHED/ IN PREPARATION:
Lester, G. (1968). Some investigations of the audiogyral
illusion. Unpublished Ph.D. thesis, Brandeis University
Mercer, J. (1993) The successful single parent.
Unpublished book-length ms.
Mercer, J. The
developing child in
changing
times: Infancy through adolescence Unpublished book-length ms.
Invited comments on the New Jersey Children’s Initiative
proposal (March 10, 2000 );
with
Gerard Costa and Elaine Herzog.
Invited comments on the U.S. Bright Futures children’s
mental health proposal (July
5, 2000 ); with Gerard
Costa.
Mercer, J. (2000). Notes on Attachment Therapy: Relevant
Research and Theory. Prepared for use by
the prosecution in the trial of Connell
Watkins , Colorado
Sarner, L., & Mercer, J. (2003). Statement to Human
Resources Subcommittee of House Ways and Means
Committee. http://
waysandmeans.house.gov/hearings.asp?formmode+view&id+1342.
Mercer, J. (January, 2005). Expert witness report. State
of Utah
Division of Occupational and
Professional Licensing. Case number 2002-223.
Mercer, J. (April, 2005). Expert witness report. Child custody case, Middlesex Family Court,
New Brunswick, NJ.
Mercer, J. (October, 2006). Expert witness report. Child
custody case, Pasco County ,
Florida
BLOGS AND OTHER INTERNET MATERIALS:
“Attachment therapies and associated parenting
techniques.” www.scienceinmedicine.org/policy/papers/AttachmentTherapy.pdf.
“Critical thinking and the mastery of child development
concepts.” www.thelizlibrary.org/liz/critical-thinking.html.
RECENT PRESENTATIONS:
Various presentations on child development and parenting
issues to parent groups and
training
workshops, including CASA.
“Law, policy, and attachment issues”; presentation at the
Second Annual Conference on Attachment
of the New Jersey Psychological Association. June 9, 2000 , Newark , NJ
“Custody changes and their effect on children’s
development”; presentation at New Jersey
State Child Placement Advisory Council conference, April, 2001.
“Bad language: How the professions confuse each other with
words,” welcoming address at
conference on Attachment, New Jersey Association for Infant Mental Health,
“That cranky, crying baby”; presentation at National
Association for Education of Young Children Conference on Health in Child Care,
Princeton, NJ, May, 2002; repeated
May, 2003, May, 2004.
“Warning Signals: When parents consider unusual mental
health treatments for their children”;
presentation at Third Annual Multicultural Health Conference, Richard Stockton College, Pomona, NJ, Sept. 2002.
“Misuse and abuse of attachment theory”; keynote speech at
2002 Annual Meeting, New Jersey
Association for Infant Mental Health, Piscataway, NJ, Nov. 2002.
“Attachment Therapy: Science adversaries appeal to
scientific evidence.” Institute of Contemporary
British History conference, “Science, Its Advocates and Adversaries”, London ,
July 7-9, 2003 .
“Analyzing Attachment Therapy”, at “Right From the Start:
Supporting the Earliest Relationships
and their Impact on Later Years,” professional conference presented by Youth Consultation Services Institute for Infant and Preschool Mental
Health, Newark, Sept. 24-25, 2003
(continuing professional education credit-bearing).
“Principles of Infant Mental Health”, at “What Does Infant
Mental Health Mean to Me?”, professional
conference sponsored by New Jersey Association for Infant Mental Health, Gateway Maternal-Child Health
Consortium, Northwest Maternal-Child Health
Consortium, Piscataway, NJ, Nov. 13, 2003 (continuing professional education credit-bearing).
“Attachment and Attachment Therapy: The Good, the Bad, and
the Ugly”, at annual meeting, Gateway Maternal-Child Health Consortium. East Orange , NJ March 25, 2004 (Continuing professional education
credit).
“Attachment.” Annual conference of New Jersey Association
for Education of Young Children, East
Brunswick, NJ, Oct. 16, 2004 (continuing professional education
credit)
Discussion of Attachment Therapy. “All in the Mind”,
Australian Broadcasting Company, Dec. 18, 2004 . Transcript available at http://abc.net.au/rn/science/mind.
“Attachment: Social and Emotional Development from Birth
to Preschool.” Conference of Coalition of Infant and Toddler Educators,
East Brunswick, NJ, March 18, 2005.
“Attachment Therapy: Concerns on Unvalidated Treatments.”
Institute for Infant and Preschool
Mental Health Didactic Series, Youth Consultation Service, East Orange, NJ, May 12, 2005.
"Violent therapies
with children: History and theory.” 9th International Family Violence Research
Conference, Portsmouth , NH July 11, 2005 .
Invited state delegate and
New Jersey
presenter, Infant Mental Health Systems Development Summit conference,
sponsored by Mailman Foundation/Zero to Three. Washington DC Sept. 22-24, 2005 .
New Jersey Perinatal Mood
Disorders training program presentations, 2005-2006.
“Dangerous therapies”,
with Alan Misbach. LCSW. Independent
Educational Consultants Association conference, Philadelphia , Nov. 14, 2005 .
"Attachment
Therapy". Institute for Infant and Preschool Mental Health Didactic
Series, Youth Consultation Service, East
Orange , NJ April 27, 2006 .
"Attachment
Therapy" comments, Paula Zahn show, CNN, Nov. 14, 2006 .
"Attachment
Therapy" comments, Court TV, Nov. 27, 2006 .
"Understanding attachment." Delaware Valley
Group, WAIMH. Dec. 1, 2006 .
"Strategies for picky eaters." Jan 31, 2007 , NJ WIC
training, Ewing , NJ
"Just the facts,
ma'am: Asking and answering the right questions about evidence-based
treatment." May 17,
2007 . Florida
Association for Infant Mental Health, Ft. Lauderdale
Panel on secular
parenting, moderated by Dale McGowan. Atheist Alliance International,
annual conference, Arlington , VA Sept. 29, 2007 .
"Circumstantial
Evidence: Evaluating Design and Details of Outcome Research" (poster
presentation). Dec. 1, 2007. Zero to Three National Training Institute, Orlando , Florida
"Theory of Mind: A
New Approach to Attachment." Conference of Coalition of Infant and Toddler
Educators, New Brunswick , NJ March 14, 2008 .
"Novel Unsupported
Therapies: Pseudoscientific and Cult-like". With Monica Pignotti and James
Herbert. International Cultic Studies Association conference, Philadelphia , June 27, 2008 .
"Attachment Theory,
Evidence-based Practice, and Rogue Therapies: Using and Misusing the Concept of
Attachment." With R.S. Pennington, L. Rosa, and L. Sarner. Wisconsin
School Psychologists Association conference, LaCrosse, WI, Oct. 29, 2008 .
"Are There
Research-based Child Custody Evaluations? An Ongoing Case and an Ongoing
Discussion." Annual Conference, New Jersey Association
for Infant Mental Health, Dec.
12, 2008 , North Brunswick ,
NJ
“A Problematic Parenting
Pattern Associated With Child Deaths.” Eastern Psychological Association,
March7, 2009, Pittsburgh, PA.
“Personalities and Power
Struggles: Discipline, Temperament, and Attachment.” Coalition of Infant and
Toddler Educators Annual Conference, March 14, 2009, Somerset, NJ.
“Don’t Be So [Un]critical!
Using Critical Thinking to Foster Mastery of Child development Concepts.” Developmental Science Teaching Institute,
Society for Research in Child Development, April 1, 2009, Denver, CO.
“Psychological Concepts
and Measures in the Family Court”. Judicial Orientation, Essex Vicinage (NJ).
Princeton, NJ, Oct. 2, 2009. (With Michelle DeKlyen, Ph.D.)
“Are There Research-Based
Child Custody Evaluations?”. Conference on Infants and Children in the Courts,
sponsored by Youth Consultation Service and NJAIMH; Clara Maass Medical Center,
Belleville, NJ, March 19, 2010.
“Unconventional
Psychotherapies: Some Questions About Their History.” Eastern Psychological
Association, March 11, 2011, Cambridge, MA.
“Myths and Misunderstandings.”
Conference of the Delaware Valley Group of the World Association for Infant
Mental Health, Feb. 3, 2012, Philadelphia, PA.
Comments on Attachment
Therapy and treatment of Russian adoptees. “Life with Mikhail Zelensky”,
Rossiya-1 TV, Feb. 21, 2013.
“Fetal Psychology in
Psychohistory.” Eastern Psychological Association, March 2, 2013, New York.
“Jirina Prekopova’s
holding therapy: Scientifically founded or otherwise?” Conference of the
International Working Group on Abuse in Child Psychotherapy, April 20, 2013,
London.
“ ‘Nancy Thomas parenting’ in the U.S. and
Russia: Another part of the holding therapy problem.” With Yulia Massino. Conference of the International
Working Group on Abuse in Child Psychotherapy, April 20, 2013, London.
Friday, May 15, 2009
Humans and animals: "Free will", or not?
An intriguing statement appeared in the journal Science a few days ago. Writing about the way humans experience the decision to move and act, Patrick Haggard said the following: "Every day we make actions that seem to depend on our 'free will' rather than on any obvious external stimulus. This capacity not only differentiates humans from other animals, but also gives us the clear sense of controlling our bodies and our lives" (p. 731).
It is difficult to know whether this remarkable statement was or was not intended to be provocative, but it raises many questions.
Certainly human beings have a sense of free will, and many of them will fight fiercely to maintain that they have not only the sense of free will, but free will itself. The achievement of a feeling of autonomy is one of the great motivating forces of several stages of human development, and the feeling of being controlled is one that is often associated with anxiety and shame at an existential level, as if loss of control is equivalent to loss of being. In addition, some religious traditions stress the role of free will for human beings, who in order to achieve salvation must make conscious decisions to love God, obey commandments, submit to authority, and so on. For persons committed to such traditions, the absence of free will implies a universe without meaning or pattern, in which salvation is granted in an arbitrary way like that proposed by Calvin.
When free will is perceived as related to religious belief and to the ultimate fate of souls, animals are generally seen as lacking in both souls and free will-- even in all conscious experience, as the Jansenist system claimed. Thinkers with this perspective equate a soul (the part of personality they consider to survive the death of the body) to be the same as a mind, and therefore to be necessary for experiencing any events, internal or external to the person. If a dog had conscious experience or free will, they argue, it would have a soul, and its soul would have the same potential fates of salvation or damnation as a human being, which would not be an acceptable idea.
It is not clear whether Haggard wants to say that humans are different from animals in that they feel they have free will-- their actions "seem to depend on our 'free will'-- or are different because they actually do have free will. The latter question goes far beyond what scientific evidence can answer and involves the differences between natural and supernatural events. The former question is not as profound, but is not answerable by any methods we presently have. How could we know whether a cat or dog or camel thinks it has free will? Given that human beings who have not given the issue much thought generally believe that they have free will, it seems likely that animals, insofar as they are even capable of posing the question, would also believe this.
Until we can teach an animal to communicate in symbols we can understand, we won't know the answer to the question of animal beliefs or experiences. But if an animal did learn complex communication-- would what they told us also be true of the experiences of non-talking animals? No wonder we tend to pay more attention to brain functions than to the really difficult topics!
Haggard, P. (2009). The sources of human volition. Science, 324, 731-733.
It is difficult to know whether this remarkable statement was or was not intended to be provocative, but it raises many questions.
Certainly human beings have a sense of free will, and many of them will fight fiercely to maintain that they have not only the sense of free will, but free will itself. The achievement of a feeling of autonomy is one of the great motivating forces of several stages of human development, and the feeling of being controlled is one that is often associated with anxiety and shame at an existential level, as if loss of control is equivalent to loss of being. In addition, some religious traditions stress the role of free will for human beings, who in order to achieve salvation must make conscious decisions to love God, obey commandments, submit to authority, and so on. For persons committed to such traditions, the absence of free will implies a universe without meaning or pattern, in which salvation is granted in an arbitrary way like that proposed by Calvin.
When free will is perceived as related to religious belief and to the ultimate fate of souls, animals are generally seen as lacking in both souls and free will-- even in all conscious experience, as the Jansenist system claimed. Thinkers with this perspective equate a soul (the part of personality they consider to survive the death of the body) to be the same as a mind, and therefore to be necessary for experiencing any events, internal or external to the person. If a dog had conscious experience or free will, they argue, it would have a soul, and its soul would have the same potential fates of salvation or damnation as a human being, which would not be an acceptable idea.
It is not clear whether Haggard wants to say that humans are different from animals in that they feel they have free will-- their actions "seem to depend on our 'free will'-- or are different because they actually do have free will. The latter question goes far beyond what scientific evidence can answer and involves the differences between natural and supernatural events. The former question is not as profound, but is not answerable by any methods we presently have. How could we know whether a cat or dog or camel thinks it has free will? Given that human beings who have not given the issue much thought generally believe that they have free will, it seems likely that animals, insofar as they are even capable of posing the question, would also believe this.
Until we can teach an animal to communicate in symbols we can understand, we won't know the answer to the question of animal beliefs or experiences. But if an animal did learn complex communication-- would what they told us also be true of the experiences of non-talking animals? No wonder we tend to pay more attention to brain functions than to the really difficult topics!
Haggard, P. (2009). The sources of human volition. Science, 324, 731-733.
Monday, May 11, 2009
Eye contact? Part 2
"Eye contact", or prolonged mutual gaze, is something adults do when they want to communicate some emotional information. They may stare in order to try to intimidate another person, who looks back in resistance or drops her eyes in submissive response. They may gaze in order to flirt with an attractive companion, who may avoid the gaze, make repeated brief eye contact in a coy way, and perhaps finally permit a long mutual gaze as he or she acknowledges interest. Strangers who want to play with a baby they meet in public may keep on trying to catch the baby's gaze-- but for babies of 8-10 months old or older, this action is alarming, and the more the stranger tries, the more the baby avoids the look or even begins to cry. Lovers walking toward each other in public maintain their mutual gaze, and so do parents and toddlers as they approach each other, but acquaintances only glance at each other periodically, and even when standing together and talking will make and break eye contact frequently.
So, eye contact indicates the nature of a relationship or of the attitude of one person toward another. But, does eye contact actually cause the relationship, as would be suggested by popular beliefs about parents gazing into babies' eyes? Is the attachment of a toddler to a parent based on past experience of eye contact?
When several factors seem to work together, or have mutual effects on each other, it's quite hard to tell which cause determines which outcome. This is especially true when we can only look at natural events rather than doing experimentation. Sometimes, fortunately, natural events provide us with some information that can rule out an explanation.
Considering the connection between eye contact and attachment, it turns out that we do have some natural events that tell us that eye contact is at most one of several causes of attachment. There are some babies for whom a typical experience of eye contact is not possible. There are babies who are born blind or who lose their vision very early in life, and there are sighted babies who have blind parents. In either case, the baby and its parents did not spend time making "eye contact", although up to a few months of age a blind baby may appear to be doing so. Nevertheless, blind babies do develop attachment to their parents, provided they have opportunities for consistent caregiving experiences and social interactions like vocalization or mutual touch.
The fact of attachment without the opportunity for eye contact suggests that the cause and effect connection may be the other way around: that is, toddlers make eye contact with their parents because they are attached to them, not vice-versa.
What about autism? One of the most common ideas about autistic children is that they avoid eye contact and therefore fail to learn the ways of emotional communication which typical humans use with each other. It does seem to be the case that autistic toddlers don't show the "joint attention" behavior of shifting the gaze from someone's eyes to an interesting object and back again, nor do they use eye contact to try to get an adult to do something for them. A typically-developing toddler who wants help to open a container will make eye contact with an adult and hold the container out to the person; an autistic toddler does not gaze at the adult's eyes, but reaches for the person's hand and tries to put it on the container. However, recent research suggests that autistic children can actually pay attention to things they are not apparently "looking at", so questions about their gaze may need a lot more work.
So, eye contact indicates the nature of a relationship or of the attitude of one person toward another. But, does eye contact actually cause the relationship, as would be suggested by popular beliefs about parents gazing into babies' eyes? Is the attachment of a toddler to a parent based on past experience of eye contact?
When several factors seem to work together, or have mutual effects on each other, it's quite hard to tell which cause determines which outcome. This is especially true when we can only look at natural events rather than doing experimentation. Sometimes, fortunately, natural events provide us with some information that can rule out an explanation.
Considering the connection between eye contact and attachment, it turns out that we do have some natural events that tell us that eye contact is at most one of several causes of attachment. There are some babies for whom a typical experience of eye contact is not possible. There are babies who are born blind or who lose their vision very early in life, and there are sighted babies who have blind parents. In either case, the baby and its parents did not spend time making "eye contact", although up to a few months of age a blind baby may appear to be doing so. Nevertheless, blind babies do develop attachment to their parents, provided they have opportunities for consistent caregiving experiences and social interactions like vocalization or mutual touch.
The fact of attachment without the opportunity for eye contact suggests that the cause and effect connection may be the other way around: that is, toddlers make eye contact with their parents because they are attached to them, not vice-versa.
What about autism? One of the most common ideas about autistic children is that they avoid eye contact and therefore fail to learn the ways of emotional communication which typical humans use with each other. It does seem to be the case that autistic toddlers don't show the "joint attention" behavior of shifting the gaze from someone's eyes to an interesting object and back again, nor do they use eye contact to try to get an adult to do something for them. A typically-developing toddler who wants help to open a container will make eye contact with an adult and hold the container out to the person; an autistic toddler does not gaze at the adult's eyes, but reaches for the person's hand and tries to put it on the container. However, recent research suggests that autistic children can actually pay attention to things they are not apparently "looking at", so questions about their gaze may need a lot more work.
Sunday, May 10, 2009
Eye contact with babies-- how important is it?
People have believed for centuries that the human gaze had remarkable powers. In the distant past, most people thought that rays came out of the eyes and explored the world, carrying information about objects back to the brain. (Some still believe this-- even college freshmen.)
One of the important abilities attributed to gazing involved the mutual gaze, or "eye contact", where two people look into each other's eyes and feel as if they are communicating powerful emotions. "Eye contact" is often said to play a critical role in interactions between adults and babies, and even to help create emotional attachment in early life. A related idea is that breastfeeding mothers and babies gaze intently into each other's eyes and thus establish an emotional connection.
Let's examine some of these ideas. Do babies see well when very young, and do they spend time in mutual gaze with their caregivers?
Newborn babies have vision, but it still has to develop for quite a while before it's as good as an older child's. Newborns (infants in the first month of life) can only see clearly at certain limited distances. They are well adapted to looking at a face from about 10-18 inches from their eyes, which would be a typical distance if an adult held the baby in his or her arms. Babies are more interested in some things they can look at than in others. They like things that are shiny, that move around, and that have patterns rather than just a blank surface. Of course, this set of characteristics describes human eyes-- they are moist and reflect light, they move as we examine something we're looking at, and they have white, colored, and dark parts, as well as eyelashes and lids that move. So, babies with normal vision do look at eyes when they get a chance. What this means to the baby, we can't tell, but it is very exciting and gratifying for the adult when "eye contact" is made.
A curious thing about young babies' eye contact is that blind babies do it too. How? They listen to the adult voice, then move their gaze so they are "looking" in the right direction. It appears to the adult that the baby is looking at him or her, and the adult may not even realize that the baby can't see.
What about the breastfeeding baby? Does he or she gaze into the mother's eyes while nursing? Actually, no; young babies, especially, usually squeeze their eyes tight shut while they nurse. In any case, because the baby has to turn its face toward the breast to take the nipple, it would have to work hard to be able to look up at the face at the same time. Older babies (8 months or so) may have figured out how to hold the nipple in their mouths while turning to look up at the mother or at someone else in the room, and they may let go the nipple and play or babble to the mother for a little while before nursing again. But an intense mutual gaze during breastfeeding is pretty infrequent. (And remember, breastfeeding mothers are not necessarily gazing at the infant. They may be eating, drinking, talking on the phone, or reading to an older child.)
As babies get a few months older, they can see better, and they also begin to use their eyes in a way that gives signals to an adult. For example, suppose you are playing with a baby and the baby gets tired, or maybe you have just come on a little too strong and been too stimulating. The baby turns the gaze away from your face, gets quiet for a moment, and just withdraws to have a little rest. The averted gaze works to tell a sensitive adult that the baby needs to back off for a bit. Then, rested up, the baby looks back at your eyes, smiles, and shows readiness to play some more. This slightly older baby gazes at the adult sometimes, but has the mature capacity to be able to stop looking. A baby who gazed at its caregiver's eyes a great deal of the time would not be showing the level of development we would expect by 3-6 months of age.
In the second half of the first year, babies begin to show a new use of the gaze for communication. They develop the ability for an important skill called "joint attention." The baby sees something interesting like puppies playing-- watches intently-- then turns to "catch the eye" of an adult, and looks back at the puppies again. Babies will do this several times until they get the adult to look at the puppies. Just like an adult, the older baby can use the gaze to point, as a pointing finger would be used. Also like an adult, the older baby wants to share the fun with a loved person, and wants to look at the puppies together with someone else. At the end of the sequence, the two look at each other and smile. (Notice that the baby does not do this in order to get the adult to do anything other than share the interesting sight. This is not a way to get fed, or picked up, or even carried over to see the puppies.) Again, mutual gaze or "eye contact" is only a part of the communication the adult and baby carry out with their eyes.
*** Readers, if you have found this post in your search for current material about eye contact and autism, please look at my post for Nov. 7, 2013,which discusses the Nature article by Warren Jones and Ami Klin.
One of the important abilities attributed to gazing involved the mutual gaze, or "eye contact", where two people look into each other's eyes and feel as if they are communicating powerful emotions. "Eye contact" is often said to play a critical role in interactions between adults and babies, and even to help create emotional attachment in early life. A related idea is that breastfeeding mothers and babies gaze intently into each other's eyes and thus establish an emotional connection.
Let's examine some of these ideas. Do babies see well when very young, and do they spend time in mutual gaze with their caregivers?
Newborn babies have vision, but it still has to develop for quite a while before it's as good as an older child's. Newborns (infants in the first month of life) can only see clearly at certain limited distances. They are well adapted to looking at a face from about 10-18 inches from their eyes, which would be a typical distance if an adult held the baby in his or her arms. Babies are more interested in some things they can look at than in others. They like things that are shiny, that move around, and that have patterns rather than just a blank surface. Of course, this set of characteristics describes human eyes-- they are moist and reflect light, they move as we examine something we're looking at, and they have white, colored, and dark parts, as well as eyelashes and lids that move. So, babies with normal vision do look at eyes when they get a chance. What this means to the baby, we can't tell, but it is very exciting and gratifying for the adult when "eye contact" is made.
A curious thing about young babies' eye contact is that blind babies do it too. How? They listen to the adult voice, then move their gaze so they are "looking" in the right direction. It appears to the adult that the baby is looking at him or her, and the adult may not even realize that the baby can't see.
What about the breastfeeding baby? Does he or she gaze into the mother's eyes while nursing? Actually, no; young babies, especially, usually squeeze their eyes tight shut while they nurse. In any case, because the baby has to turn its face toward the breast to take the nipple, it would have to work hard to be able to look up at the face at the same time. Older babies (8 months or so) may have figured out how to hold the nipple in their mouths while turning to look up at the mother or at someone else in the room, and they may let go the nipple and play or babble to the mother for a little while before nursing again. But an intense mutual gaze during breastfeeding is pretty infrequent. (And remember, breastfeeding mothers are not necessarily gazing at the infant. They may be eating, drinking, talking on the phone, or reading to an older child.)
As babies get a few months older, they can see better, and they also begin to use their eyes in a way that gives signals to an adult. For example, suppose you are playing with a baby and the baby gets tired, or maybe you have just come on a little too strong and been too stimulating. The baby turns the gaze away from your face, gets quiet for a moment, and just withdraws to have a little rest. The averted gaze works to tell a sensitive adult that the baby needs to back off for a bit. Then, rested up, the baby looks back at your eyes, smiles, and shows readiness to play some more. This slightly older baby gazes at the adult sometimes, but has the mature capacity to be able to stop looking. A baby who gazed at its caregiver's eyes a great deal of the time would not be showing the level of development we would expect by 3-6 months of age.
In the second half of the first year, babies begin to show a new use of the gaze for communication. They develop the ability for an important skill called "joint attention." The baby sees something interesting like puppies playing-- watches intently-- then turns to "catch the eye" of an adult, and looks back at the puppies again. Babies will do this several times until they get the adult to look at the puppies. Just like an adult, the older baby can use the gaze to point, as a pointing finger would be used. Also like an adult, the older baby wants to share the fun with a loved person, and wants to look at the puppies together with someone else. At the end of the sequence, the two look at each other and smile. (Notice that the baby does not do this in order to get the adult to do anything other than share the interesting sight. This is not a way to get fed, or picked up, or even carried over to see the puppies.) Again, mutual gaze or "eye contact" is only a part of the communication the adult and baby carry out with their eyes.
*** Readers, if you have found this post in your search for current material about eye contact and autism, please look at my post for Nov. 7, 2013,which discusses the Nature article by Warren Jones and Ami Klin.
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