In recent months, I seem to have been embroiled in a number of arguments that basically turn on issues about knowing--- how we know, and how we know that we know. A recent one of these is at http://marginalperspectives.com/2011/01/silence-no-harm-seriously.html.
Contributors to that blog took me to task for having said that there had been no reported harm as a result of unusual childhood experiences like those of the much-discussed “practice babies” of the ‘50s and that this was a meaningful fact. They attributed to me the belief that if something cannot be measured, it must not exist. (This is, by the way, a point often discussed by proponents of complementary-and-alternative therapies; see M. Kane [2002], Research made easy in complementary and alternative medicine. London: Elsevier).
Actually, my position, like that of most scientifically-trained psychologists, is that if something cannot be measured, it may or may not exist. We may simply not have developed the right measurement techniques yet. Similarly, if something is said to have been measured, it also may , or may not exist; mistakes may have occurred in the measurement process.
So why would we measure, if neither measurement or the absence of measurement gives us a clear answer? The reason is simple: measurement by agreed-on methods is the only way we can share experience with other people and ask them to confirm our impressions. The whole point of scientific method is that it allows information to be made public, and for each person’s report to be checked by many other people who use the same measurement techniques as the initial observer.
When information is checked against other reports, there are many cases in which later observers fail to confirm the first observations. A famous example is the “Piagetian reach”. This was a phenomenon described by the famous developmentalist Jean Piaget. He reported that when a baby first started reaching for objects, she would look at the object, then at her hand, then at the object, and so on, as she brought her hand closer to the goal. Makes sense, of course-- but it turns out that no one else has ever seen such a thing. It took a while for anyone to realize that the Piagetian reach doesn’t seem to exist, because at first people were embarrassed that they were not as good observers as M. Piaget. Today, improved measurement and recording devices have shown a very different pattern in early reaching than the one Piaget thought he had seen.
Measurement lets us check and re-check what we think we know, and allows scientific evidence to be self-correcting-- although that process of self-correction is admittedly slow and clumsy at times, it can work well.
What’s the rival way of knowing? It’s an approach shared by Oprah, Ralph Waldo Emerson, and many of today’s bloggers. We might call it “personal truth”. Emerson spoke of it as Reason-- defined as knowledge shared with God or the “World-Soul” and present in all souls-- as opposed to Understanding based on systematic observation. (“Personal truths” may be claimed to be based on unsystematic observation, of course.) In this approach, what one person experiences as being true IS true, because it comes from Reason, and there is no need to check and re-check against the observations of others, or to use measurements that can be shared by others. No observation or argument from another person can shake commitment to a “personal truth”, and here we have yet another reason why Jenny McCarthy will not be convinced by the Wakefield scandal.
I support the approach to knowledge that uses measurement and public scrutiny to support or fail to support an idea. Having given some thought to the complexities of measurement and public communication, I find these issues too humbling and challenging for me to ignore. I do not put my “personal truths” (and of course I have some) forward and insist that others should agree to them, but neither am I willing to accept others’ “personal truths” without question.
Neither of these ways of knowing is any guarantee of being right. The emphasis on repeated measurement has a great advantage in the face of challenges, however: it contains ways to figure out what is wrong and to strive for correction. “Personal truth”, on the other hand, simply becomes more definite when challenged. If a matter affected me alone,I might venture to follow "personal truth", but when more people may be affected, I think it's only fair to invite others to check my claims.
Friday, January 21, 2011
Thursday, January 20, 2011
Attachment, the New Imperialistic Schema?
Several decades ago, Sandra Bem, a social psychologist interested in gender issues, referred to gender as an “imperialistic schema”. By this term, she meant that gender had become a concept that was strongly linked to other concepts, and that dominated them. For example, a person thinking about gender would automatically also think about how other characteristics of a person-- even of the world-- would line up as either “like males” or “like females”. Stereotypically, people would think of aggressiveness as “male”, peacefulness as “female”; of strength as “male” and weakness as “female”; of angularity as “male” and “curviness” as female; even of the sun as “male” and the moon as “female”. Other concepts that really had nothing to do with gender were somehow (probably because of repetition) hitched on to the gender schema and could hardly be separated from its “empire”.
Stereotyping of ethnic or class differences also gives examples of imperialistic schemas at work. Schema imperialism can cause us to make mistakes, but it also saves us a lot of cognitive effort, and we lazy humans tend to prefer not to have to think too hard.
I’d like to nominate another concept as a rising imperialistic schema. It has come to imply many more related factors than it was ever intended to mean, and as a result, like gender, it conveys much different information than a dictionary definition might suggest.
The new imperialistic schema candidate is, of course, attachment. This term, in its original formulation by John Bowlby and a few of his colleagues, referred to a young child’s strong preference for familiar caregivers and distress when separated from them at times of perceived threat. But when we read how the term attachment is popularly used today, we see it aligned with and almost inextricably connected with other concepts. Here are some common ideas that connect attachment to other concepts and can lead to confused thinking about family relationships:
1. Attachment is a concept that includes all early mother-child interactions, possibly including those occurring before birth; attachment does not really involve fathers.
2. Attachment includes all positive responses to another person, including recognition of voice or face, or interest in prolonging an interaction.
3. Attachment is connected with all positive aspects of personality development from infancy through adulthood, including obedience, respect, and affection for other people.
4. Separation from familiar caregivers is associated with all negative aspects of personality development, including psychopathy, with any displeasing behavior such as disobedience or sexual promiscuity, and with adult depression or prolonged unhappiness. (A few die-hards would still include autism in this list.)
5. Because adoption usually involves separation from the first mother (see #1, above), the concept of adoption can also be brought into the “empire” of attachment, making all these concepts connected to adoption as well as to attachment.
Allowing attachment to become an imperialistic schema (and to associate it with the gender schema!) means that we lose track of the most basic meaning of the term, and that is what’s happened as the list I’ve just given came into being. When Bowlby formulated his attachment theory, he was talking about specific events in development and their probable outcomes, not about everything that happens in the course of development or about every aspect of interpersonal relations. He was concerned that children who had poor early care would become antisocial, but his work on this involved juvenile thieves, not murderers. Reading about attachment as it is discussed in the blogosphere today, it appears that the specifics of Bowlby’s work have melted away, leaving nothing but a general view that bad developmental outcomes of all kinds are the result of the separation of children from their mothers. The imperialistic schema has taken over a wide range of factors that should be considered independently.
Can we ever fight our way back to the original definition of attachment, or make ourselves use other words to describe other aspects of the interaction between infants and adults? Of course we can-- if we want to. But wanting to change will mean being transparent about the agenda that has driven the attachment schema imperialism. That will be the hard part for many.
[Incidentally, next month’s issue of the journal Theory & Psychology will include an article in which I discuss ways in which attachment theory has been supported by the evidence and ways in which it has not.]
Stereotyping of ethnic or class differences also gives examples of imperialistic schemas at work. Schema imperialism can cause us to make mistakes, but it also saves us a lot of cognitive effort, and we lazy humans tend to prefer not to have to think too hard.
I’d like to nominate another concept as a rising imperialistic schema. It has come to imply many more related factors than it was ever intended to mean, and as a result, like gender, it conveys much different information than a dictionary definition might suggest.
The new imperialistic schema candidate is, of course, attachment. This term, in its original formulation by John Bowlby and a few of his colleagues, referred to a young child’s strong preference for familiar caregivers and distress when separated from them at times of perceived threat. But when we read how the term attachment is popularly used today, we see it aligned with and almost inextricably connected with other concepts. Here are some common ideas that connect attachment to other concepts and can lead to confused thinking about family relationships:
1. Attachment is a concept that includes all early mother-child interactions, possibly including those occurring before birth; attachment does not really involve fathers.
2. Attachment includes all positive responses to another person, including recognition of voice or face, or interest in prolonging an interaction.
3. Attachment is connected with all positive aspects of personality development from infancy through adulthood, including obedience, respect, and affection for other people.
4. Separation from familiar caregivers is associated with all negative aspects of personality development, including psychopathy, with any displeasing behavior such as disobedience or sexual promiscuity, and with adult depression or prolonged unhappiness. (A few die-hards would still include autism in this list.)
5. Because adoption usually involves separation from the first mother (see #1, above), the concept of adoption can also be brought into the “empire” of attachment, making all these concepts connected to adoption as well as to attachment.
Allowing attachment to become an imperialistic schema (and to associate it with the gender schema!) means that we lose track of the most basic meaning of the term, and that is what’s happened as the list I’ve just given came into being. When Bowlby formulated his attachment theory, he was talking about specific events in development and their probable outcomes, not about everything that happens in the course of development or about every aspect of interpersonal relations. He was concerned that children who had poor early care would become antisocial, but his work on this involved juvenile thieves, not murderers. Reading about attachment as it is discussed in the blogosphere today, it appears that the specifics of Bowlby’s work have melted away, leaving nothing but a general view that bad developmental outcomes of all kinds are the result of the separation of children from their mothers. The imperialistic schema has taken over a wide range of factors that should be considered independently.
Can we ever fight our way back to the original definition of attachment, or make ourselves use other words to describe other aspects of the interaction between infants and adults? Of course we can-- if we want to. But wanting to change will mean being transparent about the agenda that has driven the attachment schema imperialism. That will be the hard part for many.
[Incidentally, next month’s issue of the journal Theory & Psychology will include an article in which I discuss ways in which attachment theory has been supported by the evidence and ways in which it has not.]
Monday, January 17, 2011
Practice Babies, Wet Nurses, Kibbutzim,and Boarder Babies: Are Humans "Omnicarous"?
A lot of concern is being expressed on various blogs about the history of “practice babies”, as described in Lisa Grunwald’s novel The Irresistible Henry House. Those babies, as probably everyone knows by now, were orphans who were cared for by “domestic science” students in colleges and who had many caregivers, in most cases before going to an adoptive family. The “practice babies” usually experienced multiple caregivers during the second half of their first year, a period of time that is associated with the development of attachment behaviors and which might be a time of vulnerability for emotional development.
However, there seems to be no obvious evidence that these children, who had also had multiple caregivers in their orphanages, were emotionally disturbed later in their lives. (Of course, it may well be that there is no such evidence because no one has looked for it, but it seems to me rather likely that adoptive parents would have complained if the babies they received were troubled, and that attention would have been called to the situation. Maybe not, though.)
On the basis of what’s usually said about attachment, we would expect those “practice babies” to be in a lot of trouble because of the absence of a small number of consistent attachment figures from their lives. But… could it be that our present emphasis on attachment is typical of Western culture in this period of history, and not a human universal as John Bowlby suggested it was? Humans are well known to be omnivorous and to thrive on a wide range of different diets, some of them pretty disgusting to those who are not familiar with them. Could they also be “omnicarous”? Forgive this made-up word, but I’m using it to mean capable of thriving on a variety of different infant care “diets”. Of course, human diets do have to contain certain essential components for survival and good health, and infant care “diets” may also have to contain certain essentials. But it may be that those essentials could be embedded in a wide variety of experiences-- not just the ones that we in industrialized Western countries regard as important.
A 1988 book by Valerie Fildes, Wet Nursing, describes a historically-common care method which is disturbing to many modern readers. Fildes traces the history of wet nursing, the practice of having a baby breast-fed by a woman other then the biological mother. Wet nurses received a salary for their services, those services being possible over a long period because human lactation does not have to be “freshened” by repeated pregnancy as is the case for cows, for example. Wet nurses have been used in many ways, sometimes living-in with wealthy families, and in the early 20th century being employed in hospitals to feed babies. Fildes also tells the fascinating and relevant story of the French bureaucracy associated with wet nursing in the 19th century. The demand for wet nurses was high in parts of France where women had skilled jobs in the textile industry and their husbands and families did not want to lose their income for a nursing period of perhaps two years. These families hired a wet nurse who was certified by the government; the wet nurse came to town, picked up the baby, and went back to her own village, where she might have 4 or 5 other infants and toddlers to care for, most of them being at least partially breast-fed. The babies’ families might or might not visit from time to time. Quite a few of these babies died while with the nurse, but the survivors would be brought home at about two years of age. Various sources record that they were frightened of the biological parents, treated them as if they were strangers, and strove to stay near the nurse. One feels terribly sorry for these terrified little people, forced into this abrupt separation-- but again, there seems to be no particular evidence that the thousands of children who went through this experience later showed unusual emotional or personality characteristics.
Much as I hate to quote Bruno Bettelheim, his book about kibbutz children, Children of the Dream, gives a relevant description of the lack of one-to-one child-to-adult social interaction in the original kibbutz culture. Although things are done differently today, one of the goals of the early kibbutzim was to break the emotional connection between children and parents and to make the children feel a primary loyalty to the group. The small number of overworked adult caregivers could not provide individual comfort or play, and children were expected to and did form their major emotional ties to others in their age group. But, again, no unusual number of mental health problems seems to have resulted from a situation which was far from ideal in terms of Bowlby’s theory of attachment.
One group of babies who may give us some insight into the essentials of the infant care “diet” is the “boarder babies”. These infants may be cared for for months in the hospital where they were born because legal tangles make their placement impossible. Informal observations suggest that these babies, at a time in their lives when they might be expected to have strong preferences for familiar people and maintain interactions with them, are instead friendly in a shallow way to everyone. They smile responsively but are not good at carrying on a longer interaction, and this is thought to be because everyone passing the room has stopped to smile and say hello, but then has left very quickly. The long-term effect of this are not yet known, but it’s possible that the boarder baby infant care “diet” does not contain all the essential emotional “nutrients”.
Our impulse to try to protect babies from unhappiness in every way is probably healthy and calculated to assure optimal development. But it’s possible that we have overdone the idea that good emotional development must follow a single pattern and involve the kinds of mother-child experience that we imagine to be “traditional” or even “natural”. To achieve a real understanding of the essential infant care emotional “diet”, we need to consider the whole range of ways in which humans have successfully reared children who grew to be good-enough humans.
However, there seems to be no obvious evidence that these children, who had also had multiple caregivers in their orphanages, were emotionally disturbed later in their lives. (Of course, it may well be that there is no such evidence because no one has looked for it, but it seems to me rather likely that adoptive parents would have complained if the babies they received were troubled, and that attention would have been called to the situation. Maybe not, though.)
On the basis of what’s usually said about attachment, we would expect those “practice babies” to be in a lot of trouble because of the absence of a small number of consistent attachment figures from their lives. But… could it be that our present emphasis on attachment is typical of Western culture in this period of history, and not a human universal as John Bowlby suggested it was? Humans are well known to be omnivorous and to thrive on a wide range of different diets, some of them pretty disgusting to those who are not familiar with them. Could they also be “omnicarous”? Forgive this made-up word, but I’m using it to mean capable of thriving on a variety of different infant care “diets”. Of course, human diets do have to contain certain essential components for survival and good health, and infant care “diets” may also have to contain certain essentials. But it may be that those essentials could be embedded in a wide variety of experiences-- not just the ones that we in industrialized Western countries regard as important.
A 1988 book by Valerie Fildes, Wet Nursing, describes a historically-common care method which is disturbing to many modern readers. Fildes traces the history of wet nursing, the practice of having a baby breast-fed by a woman other then the biological mother. Wet nurses received a salary for their services, those services being possible over a long period because human lactation does not have to be “freshened” by repeated pregnancy as is the case for cows, for example. Wet nurses have been used in many ways, sometimes living-in with wealthy families, and in the early 20th century being employed in hospitals to feed babies. Fildes also tells the fascinating and relevant story of the French bureaucracy associated with wet nursing in the 19th century. The demand for wet nurses was high in parts of France where women had skilled jobs in the textile industry and their husbands and families did not want to lose their income for a nursing period of perhaps two years. These families hired a wet nurse who was certified by the government; the wet nurse came to town, picked up the baby, and went back to her own village, where she might have 4 or 5 other infants and toddlers to care for, most of them being at least partially breast-fed. The babies’ families might or might not visit from time to time. Quite a few of these babies died while with the nurse, but the survivors would be brought home at about two years of age. Various sources record that they were frightened of the biological parents, treated them as if they were strangers, and strove to stay near the nurse. One feels terribly sorry for these terrified little people, forced into this abrupt separation-- but again, there seems to be no particular evidence that the thousands of children who went through this experience later showed unusual emotional or personality characteristics.
Much as I hate to quote Bruno Bettelheim, his book about kibbutz children, Children of the Dream, gives a relevant description of the lack of one-to-one child-to-adult social interaction in the original kibbutz culture. Although things are done differently today, one of the goals of the early kibbutzim was to break the emotional connection between children and parents and to make the children feel a primary loyalty to the group. The small number of overworked adult caregivers could not provide individual comfort or play, and children were expected to and did form their major emotional ties to others in their age group. But, again, no unusual number of mental health problems seems to have resulted from a situation which was far from ideal in terms of Bowlby’s theory of attachment.
One group of babies who may give us some insight into the essentials of the infant care “diet” is the “boarder babies”. These infants may be cared for for months in the hospital where they were born because legal tangles make their placement impossible. Informal observations suggest that these babies, at a time in their lives when they might be expected to have strong preferences for familiar people and maintain interactions with them, are instead friendly in a shallow way to everyone. They smile responsively but are not good at carrying on a longer interaction, and this is thought to be because everyone passing the room has stopped to smile and say hello, but then has left very quickly. The long-term effect of this are not yet known, but it’s possible that the boarder baby infant care “diet” does not contain all the essential emotional “nutrients”.
Our impulse to try to protect babies from unhappiness in every way is probably healthy and calculated to assure optimal development. But it’s possible that we have overdone the idea that good emotional development must follow a single pattern and involve the kinds of mother-child experience that we imagine to be “traditional” or even “natural”. To achieve a real understanding of the essential infant care emotional “diet”, we need to consider the whole range of ways in which humans have successfully reared children who grew to be good-enough humans.
Sunday, January 16, 2011
Prenatal Listening: It's Complicated
A New Yorker “Annals of Psychology” article by the columnist-pundit David Brooks, entitled “Social Animal”, appeared in the Jan. 17, 2011 issue of that magazine. I have to say that it was a fairly feeble article, apparently drawn largely from a Psych 101 textbook of several years ago. However, Brooks” article contained a little discussion of a topic that deserves careful consideration-- whether unborn babies learn from the voices that penetrate the uterus and come to their ears. Brooks stated: “Even when he was in the womb, [the infant] was listening for his mother’s voice, and being molded by it. French babies cry differently from babies who’ve heard German in the womb, because they’ve absorbed French intonations before birth. Fetuses who have been read “The Cat in the Hat” while in the womb suck rhythmically when they hear it again after birth, because they recognize the rhythm of the poetry.”
I certainly do not want to say that none of this is true, but I believe that the important implications of such early learning make it essential for us to examine with care the research behind the claims Brooks is making. The research report stating that French and German babies cry differently is by B. Mampe, A.D. Friederici, A. Christophe, and K. Wermke (“Newborns’ cry melody is shaped by their native language”),and was published in Current Biology in 2009 (Vol.19, pp. 1994-1997). Mampe and her colleagues recorded cries from 60 babies 2-5 days of age (half born of French-speaking mothers, half born of German-speaking mothers) while they were interacting with their own mothers-- having their diapers changed, preparing for feeding, or being soothed when spontaneously fussing. The cries were not the characteristic high-pitched pain cry of the young infant and were not recorded at times when there was a clear reason for pain like a heel-stick for a blood sample.
Mampe and her colleagues analyzed the ways the sound frequencies of these cries changed over the brief period involved in one exhalation of breath. Like adults, infants change their sound production rapidly in ways that can produce a rising tone or a falling one. The researchers were able to analyze each cry and create a graph indicating its pattern, and later to statistically compare all the babies of French mothers and all the babies of German mothers on their cry “shapes”, whether rising or falling. This was of interest because sound production by French speakers involves more rising tones than do the sounds produced by German speakers.
Because there is no reason to suppose that French people have different vocal anatomy than German people, it appears that those different sound patterns must be learned through experience. But when does that experience begin to have an effect? Mampe and her colleagues suggest that the babies must have learned prenatally to use the sound pattern of their mother’s language.
Of course this is a possibility. However, there are some details about this study that need to be examined before rushing to a conclusion. Mampe’s group reported statistical comparisons between the French-background group and the German-background group’s cries, but it’s not quite clear how they did all the steps in their analysis. When there is more than one cry from each baby, and not necessarily the same number of cries from each, there are particular ways to do a statistical analysis; most statistical tests are designed to work on one score or reading from each participant. The Mampe paper does not make it clear how this problem was solved. In addition, the graphic display of the results shows a very considerable overlap between the sound patterns produced by the two groups, with some “German-listening” babies crying with the French-like rising tones. Whatever was happening here, it would seem that whether or not hearing experience made a difference, there were some unidentified factors at work too.
There is a more obvious issue as well, having to do with the basic research design. When the babies’ cries were recorded, they were interacting in some way with their own mothers. Each French-experienced baby was with a French-speaking mother, and each German-experienced baby was with a German-speaking mother. Whether the baby continued to cry or stopped depended in part on the mother’s response. It’s also possible that how the baby managed its rising or falling tone also depended on the mother’s response. Possibly (but of course we can’t tell on the basis of Mampe’s research), a French-speaking mother responded to “French-like” cries, with their rising tone, as if she recognized the sound as language, and to “German-like” cries, with their falling tone, as if this was a vocalization but not related to speech. German-speaking mothers would reverse this, but in both cases the mothers might become more attentive, change facial expression, and speak when they heard the sounds that resembled their own speech, thus rewarding and prolonging a particular sound pattern. To really know about this we would need to switch German-speaking mothers to briefly caring for French babies, and French-speaking mothers to briefly caring for German babies. We might find out that because of her interest in understanding a baby’s intentions, a mother does things that shape even very early sound production.
Let me switch back for a minute to Brooks’ New Yorker article and that final claim that babies suck rhythmically because they recognize the rhythm of the poetry. This statement is presumably based on the well-known study by DeCaspar and Spence in which unborn babies were allowed to hear either readings of the Dr. Seuss classic “The Cat in the Hat” or an alternative with simple but different rhymes. After they were born, the babies were given a nipple device, like a pacifier. If they sucked in one way (long rests between sucks) they would hear one of the readings; if they sucked another way (short rests between sucks), they would hear the other. The babies tended to suck in the way that would let them hear the familiar verse. But… it did not matter whether the person reading the verses was the baby’s mother or someone else. They sucked in a particular pattern in order to hear the familiar verse, not to hear their mother’s voice. And, contrary to what Brooks implies, the babies did not imitate the rhythm of the verse with their sucking rhythms; they just used sucking as a way to choose what they listened to.
The moral of this story, I suppose, is that year by year we learn more about how young humans develop. It’s not easy to find this out-- we have to discover clever ways to get babies to tell us about themselves. A study that seems very definite in its results can suddenly be seen to need substantial follow-up. Regrettably, much of what’s written about children (like Brooks’ New Yorker article) does not include the essential thinking that’s needed before conclusions are drawn. Caveat lector!
I certainly do not want to say that none of this is true, but I believe that the important implications of such early learning make it essential for us to examine with care the research behind the claims Brooks is making. The research report stating that French and German babies cry differently is by B. Mampe, A.D. Friederici, A. Christophe, and K. Wermke (“Newborns’ cry melody is shaped by their native language”),and was published in Current Biology in 2009 (Vol.19, pp. 1994-1997). Mampe and her colleagues recorded cries from 60 babies 2-5 days of age (half born of French-speaking mothers, half born of German-speaking mothers) while they were interacting with their own mothers-- having their diapers changed, preparing for feeding, or being soothed when spontaneously fussing. The cries were not the characteristic high-pitched pain cry of the young infant and were not recorded at times when there was a clear reason for pain like a heel-stick for a blood sample.
Mampe and her colleagues analyzed the ways the sound frequencies of these cries changed over the brief period involved in one exhalation of breath. Like adults, infants change their sound production rapidly in ways that can produce a rising tone or a falling one. The researchers were able to analyze each cry and create a graph indicating its pattern, and later to statistically compare all the babies of French mothers and all the babies of German mothers on their cry “shapes”, whether rising or falling. This was of interest because sound production by French speakers involves more rising tones than do the sounds produced by German speakers.
Because there is no reason to suppose that French people have different vocal anatomy than German people, it appears that those different sound patterns must be learned through experience. But when does that experience begin to have an effect? Mampe and her colleagues suggest that the babies must have learned prenatally to use the sound pattern of their mother’s language.
Of course this is a possibility. However, there are some details about this study that need to be examined before rushing to a conclusion. Mampe’s group reported statistical comparisons between the French-background group and the German-background group’s cries, but it’s not quite clear how they did all the steps in their analysis. When there is more than one cry from each baby, and not necessarily the same number of cries from each, there are particular ways to do a statistical analysis; most statistical tests are designed to work on one score or reading from each participant. The Mampe paper does not make it clear how this problem was solved. In addition, the graphic display of the results shows a very considerable overlap between the sound patterns produced by the two groups, with some “German-listening” babies crying with the French-like rising tones. Whatever was happening here, it would seem that whether or not hearing experience made a difference, there were some unidentified factors at work too.
There is a more obvious issue as well, having to do with the basic research design. When the babies’ cries were recorded, they were interacting in some way with their own mothers. Each French-experienced baby was with a French-speaking mother, and each German-experienced baby was with a German-speaking mother. Whether the baby continued to cry or stopped depended in part on the mother’s response. It’s also possible that how the baby managed its rising or falling tone also depended on the mother’s response. Possibly (but of course we can’t tell on the basis of Mampe’s research), a French-speaking mother responded to “French-like” cries, with their rising tone, as if she recognized the sound as language, and to “German-like” cries, with their falling tone, as if this was a vocalization but not related to speech. German-speaking mothers would reverse this, but in both cases the mothers might become more attentive, change facial expression, and speak when they heard the sounds that resembled their own speech, thus rewarding and prolonging a particular sound pattern. To really know about this we would need to switch German-speaking mothers to briefly caring for French babies, and French-speaking mothers to briefly caring for German babies. We might find out that because of her interest in understanding a baby’s intentions, a mother does things that shape even very early sound production.
Let me switch back for a minute to Brooks’ New Yorker article and that final claim that babies suck rhythmically because they recognize the rhythm of the poetry. This statement is presumably based on the well-known study by DeCaspar and Spence in which unborn babies were allowed to hear either readings of the Dr. Seuss classic “The Cat in the Hat” or an alternative with simple but different rhymes. After they were born, the babies were given a nipple device, like a pacifier. If they sucked in one way (long rests between sucks) they would hear one of the readings; if they sucked another way (short rests between sucks), they would hear the other. The babies tended to suck in the way that would let them hear the familiar verse. But… it did not matter whether the person reading the verses was the baby’s mother or someone else. They sucked in a particular pattern in order to hear the familiar verse, not to hear their mother’s voice. And, contrary to what Brooks implies, the babies did not imitate the rhythm of the verse with their sucking rhythms; they just used sucking as a way to choose what they listened to.
The moral of this story, I suppose, is that year by year we learn more about how young humans develop. It’s not easy to find this out-- we have to discover clever ways to get babies to tell us about themselves. A study that seems very definite in its results can suddenly be seen to need substantial follow-up. Regrettably, much of what’s written about children (like Brooks’ New Yorker article) does not include the essential thinking that’s needed before conclusions are drawn. Caveat lector!
Friday, January 14, 2011
Autism, Vaccines, and the Wakefield Study: III: Why Jenny McCarthy Still Believes
Over the last ten days, two articles by the investigative reporter Brian Deer, published in the British Medical Journal, have shown that the research purported to connect vaccination of children with development of autism was not only incorrectly done, but fraudulent in its conclusions. Are you thinking that True Believers will not be convinced by this information, but will go on believing that vaccination causes autism? Yes, you’re perfectly right.
According to the New York Daily News of Jan. 12, Jenny McCarthy, the Joan of Arc of the anti-vax forces, stated that “this hoopla made us a little stronger, and even more determined to fight for the truth”, by which she meant a connection between vaccination and autism, not Brian Deer’s investigation. (And by the way, thanks to Jane Sarwin of Gateway Maternal Child Health for passing this on to me!)
Why does Jenny say this? How can it be that she’s MORE convinced than ever when she receives information that says Wakefield was wrong? In fact, this is exactly what often happens when the facts contradict strongly-held beliefs. The first real demonstration of this phenomenon was described in a 1956 book, When Prophecy Fails, by the social psychologists Leon Festinger, Henry Riecken, and Stanley Schachter. Festinger and his co-authors studied a cult of UFO believers who were convinced that a flood would destroy the world and they alone would be rescued by a ship from another planet. The psychologists had to infiltrate the group, whose members were secretly preparing for their rescue by giving away their property. Of course, the predicted time arrived, and the world did not end. Most of us would have guessed that the cult members would go home in disgust, after telling the leaders in no uncertain terms what they thought of them and feeling thoroughly embarrassed at having been fooled this way. But no, the opposite was true. The believers became more thoroughly committed than ever and began to publicize their beliefs, to seek converts, and to provide flattering explanations for the failure of the prophecy. Similarly, we can expect Jenny McCarthy and her followers to become more active than ever in their support of Andrew Wakefield’s claims.
Sometimes, thank goodness, people do change their minds when new information shows they have been mistaken. Intensified belief seems to occur only under particular circumstances--- and those circumstances are present for Jenny McCarthy and other Wakefield supporters
The first necessary circumstance is that the belief is deeply held and that it is associated with some real-world behavior; the believer acts in ways dictated by the belief. (This is certainly true of the beliefs about vaccination and autism. Like most beliefs about our children, they involve serious commitment. This belief also dictates not only decisions about vaccination, but spoken and written opinions expressed in public ways.)
Second, the believer must have committed himself by an action that would be difficult to undo. (Public statements of support for the anti-vax cause, leadership in the cause, the collection or donation of money to support that cause-- all these are commitments that are so public and well-known that they can hardly be recanted. At least one person in this group even made death threats against the noted vaccine researcher Paul Offit. )
Third, the belief must be specific and related to real world events, so it’s possible for those events clearly to contradict the believer’s expectations. (This condition is present in the vaccination-autism case, but not in such a clear form as occurred for the UFO group. Understanding the evidence for cause and effect in the present case requires more sophisticated thought than simply noticing whether the earth has been destroyed by a flood.)
Contradictory evidence must occur and be noticed by the believer. (Publicity about Brian Deer’s investigation must be making it almost impossible for anti-vax believers to be unaware of the report.)
Finally, the believer must have the social support of other believers-- if social support is missing, an isolated believer is more likely to yield to the evidence. (Organizations and groups of committed individuals have provided social support to anti-vax believers for a decade and a half.)
As we see, then, the circumstances are nearly perfect for an intensification of anti-vax belief on the part of Jenny McCarthy and others who believe that vaccination causes autism. Paradoxically, the overwhelming case put together by Brian Deer makes McCarthy’s group more strongly biased against vaccination at the same time that it convinces those of us who were neutral or opposed to Wakefield’s claims.
If this seems hard to understand, consider what it would mean to Wakefield believers, what they would need to accept about themselves, if they were to accept the investigative report -- that they have essentially made fools of themselves in public, and that they must therefore be foolish people as well as mistaken; that they have been defrauded by someone they sincerely admired and trusted, and that therefore their judgment is poor; that they have risked their children’s health by mistaken choices and are therefore bad parents. Adopting the belief that the report is a tissue of lies or a fraud perpetrated by the pharmaceutical companies is a far more attractive position for believers to take, and it appears to be the position that Jenny McCarthy will espouse.
According to the New York Daily News of Jan. 12, Jenny McCarthy, the Joan of Arc of the anti-vax forces, stated that “this hoopla made us a little stronger, and even more determined to fight for the truth”, by which she meant a connection between vaccination and autism, not Brian Deer’s investigation. (And by the way, thanks to Jane Sarwin of Gateway Maternal Child Health for passing this on to me!)
Why does Jenny say this? How can it be that she’s MORE convinced than ever when she receives information that says Wakefield was wrong? In fact, this is exactly what often happens when the facts contradict strongly-held beliefs. The first real demonstration of this phenomenon was described in a 1956 book, When Prophecy Fails, by the social psychologists Leon Festinger, Henry Riecken, and Stanley Schachter. Festinger and his co-authors studied a cult of UFO believers who were convinced that a flood would destroy the world and they alone would be rescued by a ship from another planet. The psychologists had to infiltrate the group, whose members were secretly preparing for their rescue by giving away their property. Of course, the predicted time arrived, and the world did not end. Most of us would have guessed that the cult members would go home in disgust, after telling the leaders in no uncertain terms what they thought of them and feeling thoroughly embarrassed at having been fooled this way. But no, the opposite was true. The believers became more thoroughly committed than ever and began to publicize their beliefs, to seek converts, and to provide flattering explanations for the failure of the prophecy. Similarly, we can expect Jenny McCarthy and her followers to become more active than ever in their support of Andrew Wakefield’s claims.
Sometimes, thank goodness, people do change their minds when new information shows they have been mistaken. Intensified belief seems to occur only under particular circumstances--- and those circumstances are present for Jenny McCarthy and other Wakefield supporters
The first necessary circumstance is that the belief is deeply held and that it is associated with some real-world behavior; the believer acts in ways dictated by the belief. (This is certainly true of the beliefs about vaccination and autism. Like most beliefs about our children, they involve serious commitment. This belief also dictates not only decisions about vaccination, but spoken and written opinions expressed in public ways.)
Second, the believer must have committed himself by an action that would be difficult to undo. (Public statements of support for the anti-vax cause, leadership in the cause, the collection or donation of money to support that cause-- all these are commitments that are so public and well-known that they can hardly be recanted. At least one person in this group even made death threats against the noted vaccine researcher Paul Offit. )
Third, the belief must be specific and related to real world events, so it’s possible for those events clearly to contradict the believer’s expectations. (This condition is present in the vaccination-autism case, but not in such a clear form as occurred for the UFO group. Understanding the evidence for cause and effect in the present case requires more sophisticated thought than simply noticing whether the earth has been destroyed by a flood.)
Contradictory evidence must occur and be noticed by the believer. (Publicity about Brian Deer’s investigation must be making it almost impossible for anti-vax believers to be unaware of the report.)
Finally, the believer must have the social support of other believers-- if social support is missing, an isolated believer is more likely to yield to the evidence. (Organizations and groups of committed individuals have provided social support to anti-vax believers for a decade and a half.)
As we see, then, the circumstances are nearly perfect for an intensification of anti-vax belief on the part of Jenny McCarthy and others who believe that vaccination causes autism. Paradoxically, the overwhelming case put together by Brian Deer makes McCarthy’s group more strongly biased against vaccination at the same time that it convinces those of us who were neutral or opposed to Wakefield’s claims.
If this seems hard to understand, consider what it would mean to Wakefield believers, what they would need to accept about themselves, if they were to accept the investigative report -- that they have essentially made fools of themselves in public, and that they must therefore be foolish people as well as mistaken; that they have been defrauded by someone they sincerely admired and trusted, and that therefore their judgment is poor; that they have risked their children’s health by mistaken choices and are therefore bad parents. Adopting the belief that the report is a tissue of lies or a fraud perpetrated by the pharmaceutical companies is a far more attractive position for believers to take, and it appears to be the position that Jenny McCarthy will espouse.
Thursday, January 13, 2011
Autism, Vaccines, and the Wakefield Study: II. The Apparent Motives
In my last post, I described some important reasons for the rejection of Andrew Wakefield’s 1998 paper that claimed a causal link between the MMR vaccine, the development of autism in young children, and gastrointestinal disease. Information about those reasons came from a remarkable investigation by the British reporter Brian Deer and was published on Jan. 5, 2011, in the British Medical Journal.
Deer also looked into the motives that seem to have been behind Wakefield’s publication of distorted data, and published a discussion of these in the British Medical Journal on Jan 12 (“How the vaccine crisis was meant to make money”). I’ll summarize some of the points Deer described, but this is a long story, and I would strongly recommend that interested readers read the BMJ article for all the disturbing details.
Before the study even began, Wakefield had patented a test for measles virus in bowel tissue and products. Claiming that certain bowel diseases could be diagnosed by detection of measles virus, Wakefield proposed starting a company that would manufacture testing materials and calculated that such materials would bring in over 70 million pounds a year from Britain and America. This income would depend in part on government health administrations and on governmental legal aid funds for patients suffering from bowel diseases. This business proposal was followed by a patent for a single measles vaccine (rather than the usual combination of measles, mumps,and rubella) and the suggestion that there was a connection between measles vaccine, bowel disease, and autism-- a posited syndrome Wakefield called “autistic enterocolitis”. Among the participants in the ensuing business plan were Wakefield, a venture capitalist, and the father of one of the children in the 1998 Lancet study. Also involved was an entity called Freemedic, the commercial section of the merged Royal Free Hospital and the University College (London) Medical School, which later resisted strongly Brian Deer’s attempts to untangle these matters.
Wakefield’s plan thus appears to have been that he and a few others would reap enormous financial benefits from his patented tests and vaccines, and that much of their income would be derived from litigation by parents of sick children. This did not happen, and in fact neither the test nor the measles vaccine had their efficacy demonstrated by later research. (Although Wakefield was directed by his superior to do a controlled study to replicate his research claims, he did not do so.)
What did happen, instead, was that parents became frightened of vaccination and began to resist conventional medical advice about protection from contagious disease. Immunization rates in Britain and other countries dropped and there was an increase in the occurrence of diseases like measles, mumps, rubella, and pertussis, which had been almost non-existent in industrialized countries for some years.
In addition, we have seen the growth of an anti-vaccination community devoted to Wakefield’s cause, and so determined that they must oppose vaccination that they have made serious threats and filed lawsuits against respected vaccine researchers like Paul Offit. My crystal ball tells me that these people will consider Brian Deer’s meticulous investigation to be a pack of lies, like all the other “lies” told about vaccination. In that, they will be very little different from the people who opposed smallpox vaccination over a hundred years ago and suggested that since the smallpox vaccine was derived from cows (vaca, that is), vaccinated individuals would take on cow-like characteristics.
So, those were the real results of Wakefield’s efforts. Wakefield and his friends are disgraced in the eyes of all but the anti-vax crowd, who undoubtedly regard them as martyrs. Children got sick, and sometimes very sick, when they did not need to. And what was it all about? Money, folks, lots of money--- money out of your pocket and mine.
And what about autism? Well, here’s how it is. If your child is vaccinated against common childhood diseases, he or she may become autistic. If your child is not vaccinated, he or she may still become autistic , and he or she may also catch a contagious disease, and as a result of that disease there will be a small but real chance that he or she may die, lose hearing, become mentally retarded, or suffer a number of other lifelong handicaps.
With stakes like that, will you let your decision be dictated by an offshoot of venture capitalism?
Deer also looked into the motives that seem to have been behind Wakefield’s publication of distorted data, and published a discussion of these in the British Medical Journal on Jan 12 (“How the vaccine crisis was meant to make money”). I’ll summarize some of the points Deer described, but this is a long story, and I would strongly recommend that interested readers read the BMJ article for all the disturbing details.
Before the study even began, Wakefield had patented a test for measles virus in bowel tissue and products. Claiming that certain bowel diseases could be diagnosed by detection of measles virus, Wakefield proposed starting a company that would manufacture testing materials and calculated that such materials would bring in over 70 million pounds a year from Britain and America. This income would depend in part on government health administrations and on governmental legal aid funds for patients suffering from bowel diseases. This business proposal was followed by a patent for a single measles vaccine (rather than the usual combination of measles, mumps,and rubella) and the suggestion that there was a connection between measles vaccine, bowel disease, and autism-- a posited syndrome Wakefield called “autistic enterocolitis”. Among the participants in the ensuing business plan were Wakefield, a venture capitalist, and the father of one of the children in the 1998 Lancet study. Also involved was an entity called Freemedic, the commercial section of the merged Royal Free Hospital and the University College (London) Medical School, which later resisted strongly Brian Deer’s attempts to untangle these matters.
Wakefield’s plan thus appears to have been that he and a few others would reap enormous financial benefits from his patented tests and vaccines, and that much of their income would be derived from litigation by parents of sick children. This did not happen, and in fact neither the test nor the measles vaccine had their efficacy demonstrated by later research. (Although Wakefield was directed by his superior to do a controlled study to replicate his research claims, he did not do so.)
What did happen, instead, was that parents became frightened of vaccination and began to resist conventional medical advice about protection from contagious disease. Immunization rates in Britain and other countries dropped and there was an increase in the occurrence of diseases like measles, mumps, rubella, and pertussis, which had been almost non-existent in industrialized countries for some years.
In addition, we have seen the growth of an anti-vaccination community devoted to Wakefield’s cause, and so determined that they must oppose vaccination that they have made serious threats and filed lawsuits against respected vaccine researchers like Paul Offit. My crystal ball tells me that these people will consider Brian Deer’s meticulous investigation to be a pack of lies, like all the other “lies” told about vaccination. In that, they will be very little different from the people who opposed smallpox vaccination over a hundred years ago and suggested that since the smallpox vaccine was derived from cows (vaca, that is), vaccinated individuals would take on cow-like characteristics.
So, those were the real results of Wakefield’s efforts. Wakefield and his friends are disgraced in the eyes of all but the anti-vax crowd, who undoubtedly regard them as martyrs. Children got sick, and sometimes very sick, when they did not need to. And what was it all about? Money, folks, lots of money--- money out of your pocket and mine.
And what about autism? Well, here’s how it is. If your child is vaccinated against common childhood diseases, he or she may become autistic. If your child is not vaccinated, he or she may still become autistic , and he or she may also catch a contagious disease, and as a result of that disease there will be a small but real chance that he or she may die, lose hearing, become mentally retarded, or suffer a number of other lifelong handicaps.
With stakes like that, will you let your decision be dictated by an offshoot of venture capitalism?
Autism,Vaccines, and the Wakefield Study: I. Reasons to Reject Wakefield's Report
Early in 2010, there was an excited reaction to the retraction by the British journal Lancet of an article published by Andrew Wakefield and a number of colleagues in 1998. That article had claimed that research evidence supported the hypothesis that vaccination for some childhood diseases played a causal role in the development of autism. Wakefield’s paper has been a major focus of the anti-vaccine movement and has encouraged parents to refuse vaccination of their children-- with some predictable results in terms of disease and even death of children.
Now in the early weeks of 2011, the British Medical Journal has published two articles by Brian Deer, the Times reporter whose investigation has done so much to clarify the errors in Wakefield’s work. The first of these articles, “How the case against the MMR vaccine was fixed”, appeared on Jan. 5. A second piece, “How the vaccine crisis was meant to make money”, was published Jan. 12.
Lancet's retraction of the Wakefield 1998 paper received attention from bloggers, journalists, scientists, and concerned parents, as we might expect. I’ll summarize some of the criticisms, as they are discussed by Brian Deer in the Jan. 5 article and elsewhere.
The majority of the critiques focus on the ethical errors in Wakefield’s work. Indeed, there were ethical errors by the carload. Wakefield failed to disclose his financial interests in vaccine protocols or in a relevant lawsuit where he was acting as a consultant; he procured blood samples from children whom he knew personally, thus making it awkward for the children or their parents to hesitate to consent to the procedure; he ordered unnecessary and intrusive tests for some children. All these ethical errors would be reasons for reprimands, for the withdrawal of job opportunities, for ordering Wakefield to attend an ethical training program. His withholding of financial disclosure would be good reason for a journal to refuse publication, to print a correction if the article was already published, or in some cases to retract the published material.
However, repellant as Wakefield’s ethical conduct may be, it is not in itself sufficient to support the decision that an article’s conclusion is wrong. A researcher might fail to document informed consent, might intimidate parents and children to get them to participate, and might secretly be on the salaried staff of a corporation with strong related business interests, but if his or her conduct of research, collection of data, and analysis of data were beyond criticism, the research itself could still be of value. Another researcher might follow all rules about informed consent and financial disclosure, but if he or she failed to do a good job in designing and carrying out a study, the conclusions drawn from that study would be worthless. Ethical errors raise questions about the researcher’s integrity in collecting and handling data, but are not necessarily evidence that the basic work has been done incorrectly. Compliance with ethical rules suggests that the researcher approaches his or her tasks with integrity, but adds no credibility to data or conclusions when it’s clear that these do not follow design guidelines. Journals refuse or retract papers when ethical errors are evident, but this is not because their action assures the publication of good material only; it’s because success or failure in publication are the major carrots and sticks available to enforce compliance with ethical rules.
I have seen very few comments about the design flaws of Wakefield’s retracted paper, so I will briefly list some. A major problem with the paper is the small number of children studied. Errors due to chance are much more likely to occur when a study involves twelve children than when it includes 120 children. Such errors might give the impression that an effect is much larger than it really is, but they could also make it appear that it is much smaller than it would appear to be with more data to consider. This is an especially important point in the light of other studies looking at many thousands of children and failing to reach the conclusions reported by Wakefield.
A second major problem has to do with Wakefield’s method of ascertaining what symptoms children showed, and at what times in their lives. Rather than using objective records like notes or videotapes dating from the children’s early years, Wakefield asked parents to recall events that had occurred eight years or more earlier. In taking this approach, he ignored the fact that human memory reconstructs past events rather than plucking them intact from some sort of bookcase of internal recordings. Previous and subsequent events help to determine how, or even if, reconstruction takes place. Memory research dating back almost a hundred years has shown that memories are influenced by expectation and motivation, and that repeated recall, rehearsal, discussion, and consideration of events change the way memories are experienced. These problems are real reasons why Wakefield’s study cannot be considered to provide evidence genuinely supportive of the conclusion drawn and much promulgated.
According to Deer’s investigation, however, there were far more serious problems than flaws in research design. Interviews Deer carried out with parents of children who participated in Wakefield’s study indicated that details reported about their children were not correct. (Because the number of children was so small, parents were able to recognize which case numbers actually represented their own children.) In one case, an American father stated that the child’s autistic symptoms occurred months earlier than the report stated, and in fact began before he received the vaccine. In other cases, there appeared to be no child in the report whose background as described by interviewed parents matched the reported histories. Several of the children had developmental delays and physical problems that were apparent before vaccination occurred. Of nine children described as having “regressive autism” (rather than autistic symptoms existing from early in life), three had in fact not even been diagnosed as autistic.
Deer’s investigation has made it clear that Wakefield’s work was not only sloppy, but involved apparently intentional distortions of the data. Why would Wakefield “fudge” his work? In a second post, I’ll discuss the reasons that Deer has shown.
Now in the early weeks of 2011, the British Medical Journal has published two articles by Brian Deer, the Times reporter whose investigation has done so much to clarify the errors in Wakefield’s work. The first of these articles, “How the case against the MMR vaccine was fixed”, appeared on Jan. 5. A second piece, “How the vaccine crisis was meant to make money”, was published Jan. 12.
Lancet's retraction of the Wakefield 1998 paper received attention from bloggers, journalists, scientists, and concerned parents, as we might expect. I’ll summarize some of the criticisms, as they are discussed by Brian Deer in the Jan. 5 article and elsewhere.
The majority of the critiques focus on the ethical errors in Wakefield’s work. Indeed, there were ethical errors by the carload. Wakefield failed to disclose his financial interests in vaccine protocols or in a relevant lawsuit where he was acting as a consultant; he procured blood samples from children whom he knew personally, thus making it awkward for the children or their parents to hesitate to consent to the procedure; he ordered unnecessary and intrusive tests for some children. All these ethical errors would be reasons for reprimands, for the withdrawal of job opportunities, for ordering Wakefield to attend an ethical training program. His withholding of financial disclosure would be good reason for a journal to refuse publication, to print a correction if the article was already published, or in some cases to retract the published material.
However, repellant as Wakefield’s ethical conduct may be, it is not in itself sufficient to support the decision that an article’s conclusion is wrong. A researcher might fail to document informed consent, might intimidate parents and children to get them to participate, and might secretly be on the salaried staff of a corporation with strong related business interests, but if his or her conduct of research, collection of data, and analysis of data were beyond criticism, the research itself could still be of value. Another researcher might follow all rules about informed consent and financial disclosure, but if he or she failed to do a good job in designing and carrying out a study, the conclusions drawn from that study would be worthless. Ethical errors raise questions about the researcher’s integrity in collecting and handling data, but are not necessarily evidence that the basic work has been done incorrectly. Compliance with ethical rules suggests that the researcher approaches his or her tasks with integrity, but adds no credibility to data or conclusions when it’s clear that these do not follow design guidelines. Journals refuse or retract papers when ethical errors are evident, but this is not because their action assures the publication of good material only; it’s because success or failure in publication are the major carrots and sticks available to enforce compliance with ethical rules.
I have seen very few comments about the design flaws of Wakefield’s retracted paper, so I will briefly list some. A major problem with the paper is the small number of children studied. Errors due to chance are much more likely to occur when a study involves twelve children than when it includes 120 children. Such errors might give the impression that an effect is much larger than it really is, but they could also make it appear that it is much smaller than it would appear to be with more data to consider. This is an especially important point in the light of other studies looking at many thousands of children and failing to reach the conclusions reported by Wakefield.
A second major problem has to do with Wakefield’s method of ascertaining what symptoms children showed, and at what times in their lives. Rather than using objective records like notes or videotapes dating from the children’s early years, Wakefield asked parents to recall events that had occurred eight years or more earlier. In taking this approach, he ignored the fact that human memory reconstructs past events rather than plucking them intact from some sort of bookcase of internal recordings. Previous and subsequent events help to determine how, or even if, reconstruction takes place. Memory research dating back almost a hundred years has shown that memories are influenced by expectation and motivation, and that repeated recall, rehearsal, discussion, and consideration of events change the way memories are experienced. These problems are real reasons why Wakefield’s study cannot be considered to provide evidence genuinely supportive of the conclusion drawn and much promulgated.
According to Deer’s investigation, however, there were far more serious problems than flaws in research design. Interviews Deer carried out with parents of children who participated in Wakefield’s study indicated that details reported about their children were not correct. (Because the number of children was so small, parents were able to recognize which case numbers actually represented their own children.) In one case, an American father stated that the child’s autistic symptoms occurred months earlier than the report stated, and in fact began before he received the vaccine. In other cases, there appeared to be no child in the report whose background as described by interviewed parents matched the reported histories. Several of the children had developmental delays and physical problems that were apparent before vaccination occurred. Of nine children described as having “regressive autism” (rather than autistic symptoms existing from early in life), three had in fact not even been diagnosed as autistic.
Deer’s investigation has made it clear that Wakefield’s work was not only sloppy, but involved apparently intentional distortions of the data. Why would Wakefield “fudge” his work? In a second post, I’ll discuss the reasons that Deer has shown.
Tuesday, January 11, 2011
Mothers Superior: Does Amy Chua Have the Secret to Child-Rearing Success?
“Why Chinese Mothers Are Superior”: this is the startlingly confident title of a piece by Amy Chua in the Jan.8 Wall Street Journal. And, in case you think there’s no cultural conflict at work here, the subheading: “Can a regimen of no playdates, no TV, no computer games, and hours of music practice create happy kids? And what happens when they fight back?” In this article, Ms. Chua explains all the things she doesn’t allow her daughters to do, and the fact that she doesn’t allow them to complain about not doing them. She rejects common Western concerns about self-esteem and individuality, and states instead what she considers to be the Chinese philosophy of child-rearing. Here are some important parts of that philosophy:
1. Success comes from hard work. If a child is doing poorly at a task, it is because he or she has not practiced often enough or intensely enough.
2.If someone is doing poorly at an activity, it is not because he or she lacks talent, but because of laziness, and it’s advisable to tell a lazy child he or she is lazy.
3.Activities become “fun” when you master them. Nothing will really be fun until you’ve worked at it enough to experience success.
4.Children owe their parents obedience and behavior that will make the parents proud. The child has to repay the parent for birth and care.
(You'll notice that the "happy children" of the subheading are not mentioned here.)
Chua recounts a knock-down, drag-out fight with one of her daughters about a difficult piano piece, a fight that got somewhat physical and that involved threats that the girl would get nothing to eat, nothing to drink, no Christmas, no Chanukkah, etc., until she got back to work. She did go back, she worked hard, she mastered the piece and was thrilled with her success and later snuggled and giggled in bed with her mother. She was, it seemed, a happy child at that point,and with a kind of happiness that Chua felt would give her a foundation for life-long accomplishment and satisfaction.
So what about all this? Is Chua right and Western parents wrong about how to treat children? I have to say that there are a lot of things that are right in her article!
For one thing, it’s true that the Western preoccupation with unearned self-esteem is useless at best and may even be harmful. There’s a myth that claims that high self-esteem causes high academic achievement, and as a result of this belief both parents and teachers have for some years concentrated on making kids “feel good about themselves” rather than on facilitating learning. The problem, as so often occurs, is that there is a correlation between high grades and high self-esteem, but this does not necessarily mean that the second causes the first. It makes just as much sense, if not more, that getting good grades could improve a child’s self-esteem. It can also be the case that other factors, like good health and good family functioning, can make for both good schoolwork and high self-esteem, especially for elementary school children. We should also keep in mind that there is in the United States a whole “self-esteem industry” providing toys, workbooks, and exercises that are supposed to increase you-know-what (see Humphrey,N. [2004]. The death of the feel-good factor? Self-esteem in the educational context. School Psychology International, 25, pp.347-360), and that industry makes it harder for parents or teachers to step back and take a common-sense look at the self-esteem concept. (It’s hard for people even to remember that 50 or 60 years ago, to say someone had high self-esteem was NO compliment .) I don’t want to suggest that we insult our children at regular intervals, but constructive criticism or instructions are not to be feared as detrimental to personality development. They may not be nearly as detrimental as constant cries of “good job!” and stickers for every accomplishment right down to breathing.
Chua is also right about the Western attitude that “talent” rather than hard work is responsible for success. We easily buy into the argument that someone “just can’t do math” or “just can’t learn languages”, rather than considering whether better instruction or more serious practice might be helpful. Of course it’s true that at the highest levels of performance there are gifted individuals who can do things no one else could do even if they did nothing but practice. Most of us will never win the Putnam Prize, sing at the Met, translate “The Tale of Genji”, or dance with the Bolshoi. But this does not mean that we can’t master the multiplication tables, learn to sing with the children’s choir, memorize French verb forms, or do anything else we have the general intelligence and physical capacity to manage. It’s hardly fair to any child to let her grow to adulthood unable to make change because we think she, a normal primary school pupil, “can’t do math”. Chua, in fact, says that if parents really care about their child they won’t let anything like that happen.
What’s wrong with Chua’s approach, if anything? I’d say that I do have questions about the article itself. Does it really represent family life in Chua’s household? What’s actually the proportion of time spent in hand-to-hand combat, and the proportion of ordinary cheerful family time? Chua writes such a vivid account of the fight over the piano lesson that it distracts us from anything else, but I can only think that if the conflict weren’t pretty unusual Chua would not have made it the centerpiece of her article. There has to be a lot more going on-- the parents’ marriage, the father’s relationship to the girls, Chua’s work, the sisters’ play together, meals, laundry, and all the rest of life. And did Chua really mean the girl couldn't eat or drink until she practiced and learned?
Beyond that issue, I see a couple of concerns. One is simply that brute force and threats are not the only way to encourage a child to do a frustrating task. Dividing the task into parts-- something children are not good at doing for themselves-- can be a great help that parents and teachers can easily provide. The child wails, “oh, I have to write such a long essay about our class trip-- it will take forever-- I don’t know how to do it!”. Rather than yelling at the frustrated child, a parent can suggest one of the steps needed for a beginning-- maybe “can you write a list of five things that you saw?”. Often the real problem with frustration is the child’s developmentally-based trouble with formulating a series of smaller tasks and attacking them one by one. With guided practice, he or she learns that there are ways to do this and develops strategies for cutting a job into manageable pieces.
As for excluding all the social events and school plays that Chua lists, I think that approach deprives children of chances to learn some important social skills, ways of thinking about others, and ways of thinking about themselves. One of the developmental tasks of childhood is to begin the mastery of the social rules that help us work as well as play with others, and although this achievement begins in the home, it can’t end there. Adult life requires us to deal with people other than our nuclear families and to figure out what they think and what they want. We don’t have time to learn how to do this when we grow up and embark on our careers and our own families, and we need a chance for this kind of learning in childhood.
I can’t imagine applying Chua’s whole program as she describes it-- but I’m not so sure that she applies it either. Perhaps the better approach (and maybe what Chua and her husband actually do) is what we might call conscious parenting with plenty of reflection on what we choose to do, and why, and where we and our children are trying to go.
1. Success comes from hard work. If a child is doing poorly at a task, it is because he or she has not practiced often enough or intensely enough.
2.If someone is doing poorly at an activity, it is not because he or she lacks talent, but because of laziness, and it’s advisable to tell a lazy child he or she is lazy.
3.Activities become “fun” when you master them. Nothing will really be fun until you’ve worked at it enough to experience success.
4.Children owe their parents obedience and behavior that will make the parents proud. The child has to repay the parent for birth and care.
(You'll notice that the "happy children" of the subheading are not mentioned here.)
Chua recounts a knock-down, drag-out fight with one of her daughters about a difficult piano piece, a fight that got somewhat physical and that involved threats that the girl would get nothing to eat, nothing to drink, no Christmas, no Chanukkah, etc., until she got back to work. She did go back, she worked hard, she mastered the piece and was thrilled with her success and later snuggled and giggled in bed with her mother. She was, it seemed, a happy child at that point,and with a kind of happiness that Chua felt would give her a foundation for life-long accomplishment and satisfaction.
So what about all this? Is Chua right and Western parents wrong about how to treat children? I have to say that there are a lot of things that are right in her article!
For one thing, it’s true that the Western preoccupation with unearned self-esteem is useless at best and may even be harmful. There’s a myth that claims that high self-esteem causes high academic achievement, and as a result of this belief both parents and teachers have for some years concentrated on making kids “feel good about themselves” rather than on facilitating learning. The problem, as so often occurs, is that there is a correlation between high grades and high self-esteem, but this does not necessarily mean that the second causes the first. It makes just as much sense, if not more, that getting good grades could improve a child’s self-esteem. It can also be the case that other factors, like good health and good family functioning, can make for both good schoolwork and high self-esteem, especially for elementary school children. We should also keep in mind that there is in the United States a whole “self-esteem industry” providing toys, workbooks, and exercises that are supposed to increase you-know-what (see Humphrey,N. [2004]. The death of the feel-good factor? Self-esteem in the educational context. School Psychology International, 25, pp.347-360), and that industry makes it harder for parents or teachers to step back and take a common-sense look at the self-esteem concept. (It’s hard for people even to remember that 50 or 60 years ago, to say someone had high self-esteem was NO compliment .) I don’t want to suggest that we insult our children at regular intervals, but constructive criticism or instructions are not to be feared as detrimental to personality development. They may not be nearly as detrimental as constant cries of “good job!” and stickers for every accomplishment right down to breathing.
Chua is also right about the Western attitude that “talent” rather than hard work is responsible for success. We easily buy into the argument that someone “just can’t do math” or “just can’t learn languages”, rather than considering whether better instruction or more serious practice might be helpful. Of course it’s true that at the highest levels of performance there are gifted individuals who can do things no one else could do even if they did nothing but practice. Most of us will never win the Putnam Prize, sing at the Met, translate “The Tale of Genji”, or dance with the Bolshoi. But this does not mean that we can’t master the multiplication tables, learn to sing with the children’s choir, memorize French verb forms, or do anything else we have the general intelligence and physical capacity to manage. It’s hardly fair to any child to let her grow to adulthood unable to make change because we think she, a normal primary school pupil, “can’t do math”. Chua, in fact, says that if parents really care about their child they won’t let anything like that happen.
What’s wrong with Chua’s approach, if anything? I’d say that I do have questions about the article itself. Does it really represent family life in Chua’s household? What’s actually the proportion of time spent in hand-to-hand combat, and the proportion of ordinary cheerful family time? Chua writes such a vivid account of the fight over the piano lesson that it distracts us from anything else, but I can only think that if the conflict weren’t pretty unusual Chua would not have made it the centerpiece of her article. There has to be a lot more going on-- the parents’ marriage, the father’s relationship to the girls, Chua’s work, the sisters’ play together, meals, laundry, and all the rest of life. And did Chua really mean the girl couldn't eat or drink until she practiced and learned?
Beyond that issue, I see a couple of concerns. One is simply that brute force and threats are not the only way to encourage a child to do a frustrating task. Dividing the task into parts-- something children are not good at doing for themselves-- can be a great help that parents and teachers can easily provide. The child wails, “oh, I have to write such a long essay about our class trip-- it will take forever-- I don’t know how to do it!”. Rather than yelling at the frustrated child, a parent can suggest one of the steps needed for a beginning-- maybe “can you write a list of five things that you saw?”. Often the real problem with frustration is the child’s developmentally-based trouble with formulating a series of smaller tasks and attacking them one by one. With guided practice, he or she learns that there are ways to do this and develops strategies for cutting a job into manageable pieces.
As for excluding all the social events and school plays that Chua lists, I think that approach deprives children of chances to learn some important social skills, ways of thinking about others, and ways of thinking about themselves. One of the developmental tasks of childhood is to begin the mastery of the social rules that help us work as well as play with others, and although this achievement begins in the home, it can’t end there. Adult life requires us to deal with people other than our nuclear families and to figure out what they think and what they want. We don’t have time to learn how to do this when we grow up and embark on our careers and our own families, and we need a chance for this kind of learning in childhood.
I can’t imagine applying Chua’s whole program as she describes it-- but I’m not so sure that she applies it either. Perhaps the better approach (and maybe what Chua and her husband actually do) is what we might call conscious parenting with plenty of reflection on what we choose to do, and why, and where we and our children are trying to go.
Sunday, January 9, 2011
The Urban Legend About the Russian Orphans
I thought I would have a peaceful breakfast this snowy morning, January 9, 2011, with the Times Sunday Styles section. What could be in there to bother me, except maybe pictures of people in high-fashion camouflage clothing, an oxymoron to my mind?
But there was something bothersome, and it was on the first page. One Nicole Hardy had written a piece called “Single, Female, Mormon, Alone”, and although what she had to say was interesting, insightful, and well-written, and I wish her all the best, it took only a few paragraphs before my myth alarm went off loudly. Ms. Hardy wanted to find a good metaphor to convey how isolated she felt as a celibate adult, and how she felt she hadn’t been able to really grow up as an “old” virgin, so here’s what she compared herself to: “like the Russian orphans I’d read about whose lack of physical contact altered their neurobiology and prevented them from forming emotional bonds.”
It would seem that everybody now knows these things: Russian orphans can’t form emotional bonds . It’s because they didn’t get much physical contact when they were babies. That changed their neurobiology. They’re not like you and me or other human beings any more.
As is the case with other urban legends, the only trouble with this one is that it isn’t true. None of the parts we can unpack from Ms. Hardy’s statement is a demonstrable fact. I’ve discussed recent research on these issues at www.childmyths.blogspot.com/2010/12/when-romanian-orphans-grow-up-recent.html. Michael Rutter and other researchers of the English and Romanian Adoptees study have been following over 300 children adopted from Romanian orphanages in the early 1990s. These orphanages had appalling conditions, probably for many of these children the worst that could be experienced and still have the child survive; they were certainly worse than present Russian orphanages, so if there are many bad outcomes from poor early care, we would expect those outcomes from the Romanian adoptees.
Here are some points from Rutter’s research that are relevant to the urban legend Ms. Hardy chooses as her metaphor:
1. “Orphans from Eastern Europe can’t form emotional bonds”
In fact, in the Rutter research, most of the children had normal relationships with their adoptive families. Those who seemed unusual in their relationships (and there were more in the adopted group than in a non-adopted comparison group) were overly friendly and more likely than is usual to approach strangers or wander away. The developmental scientist Megan Gunnar, commenting on this in the Society for research in Child Development monograph “Deprivation-Specific Psychological Patterns: Effects of Institutional Deprivation” (Rutter et al, 2010), pointed out: “we should not be focused on garden variety attachment problems but ones that fit within the ‘disinhibited’ framework [excessive friendliness—JM]. There are still plenty of questions about whether [disinhibited attachment] is primarily a disorder of the attachment relationship… Though some [disinhibited attachment] behaviors do deal with failure to check back with the parent in anxiety-provoking situations, most deal with disinhibited behavior or lack of social reserve with strangers… it is not just that these children are really overly friendly with strangers; rather, they seem to have problems with social boundaries” (p. 243). Gunnar’s comments suggest that a failure to form emotional bonds is not the issue.
2. “The reason they have problems is a lack of physical contact.”
Although it is undoubtedly true that few, if any, of the Romanian group were cuddled or kissed the way we expect family babies to be, there is no reason to choose that deprivation as the cause of any problems that may occur. They were also both underfed and malnourished in terms of receiving appropriate nutriments. Some were confined to their cribs almost indefinitely, and were cleaned by being squirted with garden hoses. To choose a lack of physical contact as the major problem out of this menu of deprivations is arbitrary and misleading.
3. “Their experiences changed their neurobiology”.
While this is an important issue, too little evidence presently exists about brain-behavior connections to be able to make this statement. For discussion, see www.santiagodeclaration.org.
Poor Ms. Hardy. She was just looking for a good metaphor to use in communicating some of the peculiarities of her life, and she stumbled into a major controversy. I can’t really blame her for picking up this urban legend--- that’s almost what urban legends are, things people pick up unquestioningly-- but I would have liked it if she hadn’t added this one more brick to the wall that keeps people from seeing through a legend that has caused a lot of trouble to a lot of children and their adoptive parents.
But there was something bothersome, and it was on the first page. One Nicole Hardy had written a piece called “Single, Female, Mormon, Alone”, and although what she had to say was interesting, insightful, and well-written, and I wish her all the best, it took only a few paragraphs before my myth alarm went off loudly. Ms. Hardy wanted to find a good metaphor to convey how isolated she felt as a celibate adult, and how she felt she hadn’t been able to really grow up as an “old” virgin, so here’s what she compared herself to: “like the Russian orphans I’d read about whose lack of physical contact altered their neurobiology and prevented them from forming emotional bonds.”
It would seem that everybody now knows these things: Russian orphans can’t form emotional bonds . It’s because they didn’t get much physical contact when they were babies. That changed their neurobiology. They’re not like you and me or other human beings any more.
As is the case with other urban legends, the only trouble with this one is that it isn’t true. None of the parts we can unpack from Ms. Hardy’s statement is a demonstrable fact. I’ve discussed recent research on these issues at www.childmyths.blogspot.com/2010/12/when-romanian-orphans-grow-up-recent.html. Michael Rutter and other researchers of the English and Romanian Adoptees study have been following over 300 children adopted from Romanian orphanages in the early 1990s. These orphanages had appalling conditions, probably for many of these children the worst that could be experienced and still have the child survive; they were certainly worse than present Russian orphanages, so if there are many bad outcomes from poor early care, we would expect those outcomes from the Romanian adoptees.
Here are some points from Rutter’s research that are relevant to the urban legend Ms. Hardy chooses as her metaphor:
1. “Orphans from Eastern Europe can’t form emotional bonds”
In fact, in the Rutter research, most of the children had normal relationships with their adoptive families. Those who seemed unusual in their relationships (and there were more in the adopted group than in a non-adopted comparison group) were overly friendly and more likely than is usual to approach strangers or wander away. The developmental scientist Megan Gunnar, commenting on this in the Society for research in Child Development monograph “Deprivation-Specific Psychological Patterns: Effects of Institutional Deprivation” (Rutter et al, 2010), pointed out: “we should not be focused on garden variety attachment problems but ones that fit within the ‘disinhibited’ framework [excessive friendliness—JM]. There are still plenty of questions about whether [disinhibited attachment] is primarily a disorder of the attachment relationship… Though some [disinhibited attachment] behaviors do deal with failure to check back with the parent in anxiety-provoking situations, most deal with disinhibited behavior or lack of social reserve with strangers… it is not just that these children are really overly friendly with strangers; rather, they seem to have problems with social boundaries” (p. 243). Gunnar’s comments suggest that a failure to form emotional bonds is not the issue.
2. “The reason they have problems is a lack of physical contact.”
Although it is undoubtedly true that few, if any, of the Romanian group were cuddled or kissed the way we expect family babies to be, there is no reason to choose that deprivation as the cause of any problems that may occur. They were also both underfed and malnourished in terms of receiving appropriate nutriments. Some were confined to their cribs almost indefinitely, and were cleaned by being squirted with garden hoses. To choose a lack of physical contact as the major problem out of this menu of deprivations is arbitrary and misleading.
3. “Their experiences changed their neurobiology”.
While this is an important issue, too little evidence presently exists about brain-behavior connections to be able to make this statement. For discussion, see www.santiagodeclaration.org.
Poor Ms. Hardy. She was just looking for a good metaphor to use in communicating some of the peculiarities of her life, and she stumbled into a major controversy. I can’t really blame her for picking up this urban legend--- that’s almost what urban legends are, things people pick up unquestioningly-- but I would have liked it if she hadn’t added this one more brick to the wall that keeps people from seeing through a legend that has caused a lot of trouble to a lot of children and their adoptive parents.
Saturday, January 8, 2011
To http://etfamilies.websitetoolbox.com: A message
Dear etfamilies administrators:
A number of readers have come to my blog from yours over the last several days, so I went to have a look at your blog, where I see I have been the subject of discussion. I would like to comment on an inaccurate statement having to do with my Psychology Today blog, but I find that I can't register. My user name doesn't meet standards, I'm told, but there is no description of the standards and no way to communicate with anyone without being registered. I am hoping that you or one of your readers will see this and let me know what to do to register.
As it is, a completely inaccurate statement about me can be read by all, and I have no way to correct it.
By the way, I am wondering whether you check on the identities of your contributors.I would hazard the guess that one of the contributors to that thread is in fact one of the people the thread discusses.
Best regards,
Jean Mercer
A number of readers have come to my blog from yours over the last several days, so I went to have a look at your blog, where I see I have been the subject of discussion. I would like to comment on an inaccurate statement having to do with my Psychology Today blog, but I find that I can't register. My user name doesn't meet standards, I'm told, but there is no description of the standards and no way to communicate with anyone without being registered. I am hoping that you or one of your readers will see this and let me know what to do to register.
As it is, a completely inaccurate statement about me can be read by all, and I have no way to correct it.
By the way, I am wondering whether you check on the identities of your contributors.I would hazard the guess that one of the contributors to that thread is in fact one of the people the thread discusses.
Best regards,
Jean Mercer
Saturday, January 1, 2011
When Restraint Should Be "Prescription Only"
Those of us who from time to time speak out against the use of inappropriate physical restraint of children can expect certain criticisms in response. We are told that we are naïve, inexperienced, professionally untrained, and that physical restraint is essential to protect adults from wild children, children from each other, and children from themselves. We even hear from a very small proportion of clinical psychologists and social workers that when children are upset and out of control, physical restraint has a beneficial therapeutic effect. Some therapists recommend to parents that they use “take-downs” and physical restraint in order to ensure the obedience of their children.
There is a tiny grain of truth in these criticisms. It is, of course, correct to say that there may be times with any child when physical restraint is the best and quickest way to prevent some sort of disaster, and no one has said otherwise. (The same is true for adults--- what if you see that your friend is about to walk into an unmarked glass door?) But the criticisms also contain many grains of falsehood, especially with respect to a speculated therapeutic effect of restraint, an outcome which is unsupported by any systematic evidence, in spite of the publication of several papers that make related claims.
So, why do people so easily accept the idea that physical restraint is a method of dealing with children that should be left unregulated? It’s possible that part of the thinking about this comes from the experiences most of us have had as parents or caregivers for infants and toddlers. Almost anyone who has cared for a toddler will have on one or more occasions picked up that resistant little person and carried her away for a diaper change (whoever said babies cry to have their diapers changed?!), a bath, a nap-- whatever needs to be done and is unwanted by little Ms. or Mr. Autonomy Stage. When we think about an older child who is resistant or aggressive, it’s easy for us to imagine the situation as parallel to what we’ve done ourselves, with physical restraint or coercion definitely being done for the child’s own good.
But, regrettably, this is often not the case. In too many situations, physical restraint left to the judgment of institutional caregivers results in tragedy. Although I am not given to sensational or “journalistic” language, I cannot find more descriptive words for some of these events than “torture” and “murder”.
I am going to describe a case of this kind, the death of Angellika Arndt in Wisconsin in 2006. Her death and its subsequent investigation have been described by Disability Rights Wisconsin at http://caica.org/Angie%20-%20Seclusion%20Paper.pdf. (Disability Rights Wisconsin has not copyrighted this paper and invites interested people to distribute parts or all of it.)
Angellika Arndt was 7 years old when she died following chest compression asphyxia at a facility of the Northwest Counseling and Guidance Clinic. She had been removed from the home of her biological parents at age 3 because of abuse and had been in foster care and later in the residential treatment center. She was diagnosed with a number of cognitive and emotional disabilities, including an attention deficit disorder and an oppositional disorder. It was reported that she could not remember the day of the week five minutes after it was told to her.
Angellika’s caregivers at the residential treatment center employed two notable approaches to her. The first was for the child to be placed in a “cool down” room where she was expected to sit straight in her chair with her feet on the floor and her hands in her lap for 15 minutes. Timing did not begin until she was in the required position, and if she fidgeted, the time started over. If she continued to fidget, she was placed in prone restraint for a period of time. According to the Disability Rights Wisconsin report, Angellika in the few weeks before her death spent 20 hours in “cool down” and 14 hours in prone restraint-- a face-down restraint on the floor that lasted as long as an hour and a half.
Here is a description of Angellika’s first day at the residential treatment center, from the DRWI report: “…less than two hours into the program, Angie was placed in the time-out room for hitting her own chin with her hand. No self-injury was noted in the record and she stopped this behavior within five minutes. When she continued to fidget in her chair she was threatened with a physical control hold if she didn’t stop. This was the standard admonition given by … staff in response to the occurrence of any behavior to be discouraged, along with the admonition ‘you know what the expectations are’. When Angie didn’t stop, eventually kicking off her right shoe, she was immediately placed in a prone restraint for 85 minutes. By the end of her first day…, Angie had spent 5 hours either isolated in time-out or being restrained, and less than 2 hours engaged in actual activities.” Over the next several weeks, she was to experience similar treatment for “disruptive” activities like having her hood on, talking baby talk, and gargling milk.
During some of her many prone restraints, Angellika vomited or appeared to fall asleep. On the final occasion, she was thought to have fallen asleep while restrained, but eventually a staff member noticed that her lips were blue and she was not breathing. She had died while pressed against the floor by several staff members, kept there despite her complaints of pain and nausea.
Deaths like Angellika’s are a rare but very possible result of the use of physical restraint by professional caregivers whose actions are poorly supervised and regulated, and whose training has been superficial. Given a powerful weapon to control children who are annoying them, they deploy it at once rather keeping it as a safety measure. Indeed, their constant resorting to restraint serves to exacerbate children’s mood problems, to increase resistance, and to limit the cognitive ability the child can bring to bear on a problem. Torturing the child by repeated threats and demands for impossible levels of compliance, they pave the way for a response that ends in death.
The people who killed Angellika Arndt were professionally trained caregivers, but still appear to have been incapable of making appropriate judgments about restraint of this child, whose attention deficits and emotional history made her less capable of compliance than many children. When medications have the potential for causing painful and tragic outcomes, they are legally available only on prescription. We need to awaken to the fact that serious physical harm can result from methods that adults are taught or advised to use, and that rather than letting caregivers decide how to use dangerous techniques, those techniques also need to be “prescribed” in schools or treatment centers as they are in hospital settings.
We need to give similar consideration to situations where parents are given brief training or reading material, and advised by certain therapists to use physical restraint in their daily interactions with their children. Those parents and their children are put in a potentially dangerous position and should question the advice they receive, as any resulting tragedy will harm the family and leave the advising therapist without legal responsibility. As for the therapists who give this kind of advice, I challenge them to show the public systematic evidence that these practices are effective and safe-- or to change their ways.
There is a tiny grain of truth in these criticisms. It is, of course, correct to say that there may be times with any child when physical restraint is the best and quickest way to prevent some sort of disaster, and no one has said otherwise. (The same is true for adults--- what if you see that your friend is about to walk into an unmarked glass door?) But the criticisms also contain many grains of falsehood, especially with respect to a speculated therapeutic effect of restraint, an outcome which is unsupported by any systematic evidence, in spite of the publication of several papers that make related claims.
So, why do people so easily accept the idea that physical restraint is a method of dealing with children that should be left unregulated? It’s possible that part of the thinking about this comes from the experiences most of us have had as parents or caregivers for infants and toddlers. Almost anyone who has cared for a toddler will have on one or more occasions picked up that resistant little person and carried her away for a diaper change (whoever said babies cry to have their diapers changed?!), a bath, a nap-- whatever needs to be done and is unwanted by little Ms. or Mr. Autonomy Stage. When we think about an older child who is resistant or aggressive, it’s easy for us to imagine the situation as parallel to what we’ve done ourselves, with physical restraint or coercion definitely being done for the child’s own good.
But, regrettably, this is often not the case. In too many situations, physical restraint left to the judgment of institutional caregivers results in tragedy. Although I am not given to sensational or “journalistic” language, I cannot find more descriptive words for some of these events than “torture” and “murder”.
I am going to describe a case of this kind, the death of Angellika Arndt in Wisconsin in 2006. Her death and its subsequent investigation have been described by Disability Rights Wisconsin at http://caica.org/Angie%20-%20Seclusion%20Paper.pdf. (Disability Rights Wisconsin has not copyrighted this paper and invites interested people to distribute parts or all of it.)
Angellika Arndt was 7 years old when she died following chest compression asphyxia at a facility of the Northwest Counseling and Guidance Clinic. She had been removed from the home of her biological parents at age 3 because of abuse and had been in foster care and later in the residential treatment center. She was diagnosed with a number of cognitive and emotional disabilities, including an attention deficit disorder and an oppositional disorder. It was reported that she could not remember the day of the week five minutes after it was told to her.
Angellika’s caregivers at the residential treatment center employed two notable approaches to her. The first was for the child to be placed in a “cool down” room where she was expected to sit straight in her chair with her feet on the floor and her hands in her lap for 15 minutes. Timing did not begin until she was in the required position, and if she fidgeted, the time started over. If she continued to fidget, she was placed in prone restraint for a period of time. According to the Disability Rights Wisconsin report, Angellika in the few weeks before her death spent 20 hours in “cool down” and 14 hours in prone restraint-- a face-down restraint on the floor that lasted as long as an hour and a half.
Here is a description of Angellika’s first day at the residential treatment center, from the DRWI report: “…less than two hours into the program, Angie was placed in the time-out room for hitting her own chin with her hand. No self-injury was noted in the record and she stopped this behavior within five minutes. When she continued to fidget in her chair she was threatened with a physical control hold if she didn’t stop. This was the standard admonition given by … staff in response to the occurrence of any behavior to be discouraged, along with the admonition ‘you know what the expectations are’. When Angie didn’t stop, eventually kicking off her right shoe, she was immediately placed in a prone restraint for 85 minutes. By the end of her first day…, Angie had spent 5 hours either isolated in time-out or being restrained, and less than 2 hours engaged in actual activities.” Over the next several weeks, she was to experience similar treatment for “disruptive” activities like having her hood on, talking baby talk, and gargling milk.
During some of her many prone restraints, Angellika vomited or appeared to fall asleep. On the final occasion, she was thought to have fallen asleep while restrained, but eventually a staff member noticed that her lips were blue and she was not breathing. She had died while pressed against the floor by several staff members, kept there despite her complaints of pain and nausea.
Deaths like Angellika’s are a rare but very possible result of the use of physical restraint by professional caregivers whose actions are poorly supervised and regulated, and whose training has been superficial. Given a powerful weapon to control children who are annoying them, they deploy it at once rather keeping it as a safety measure. Indeed, their constant resorting to restraint serves to exacerbate children’s mood problems, to increase resistance, and to limit the cognitive ability the child can bring to bear on a problem. Torturing the child by repeated threats and demands for impossible levels of compliance, they pave the way for a response that ends in death.
The people who killed Angellika Arndt were professionally trained caregivers, but still appear to have been incapable of making appropriate judgments about restraint of this child, whose attention deficits and emotional history made her less capable of compliance than many children. When medications have the potential for causing painful and tragic outcomes, they are legally available only on prescription. We need to awaken to the fact that serious physical harm can result from methods that adults are taught or advised to use, and that rather than letting caregivers decide how to use dangerous techniques, those techniques also need to be “prescribed” in schools or treatment centers as they are in hospital settings.
We need to give similar consideration to situations where parents are given brief training or reading material, and advised by certain therapists to use physical restraint in their daily interactions with their children. Those parents and their children are put in a potentially dangerous position and should question the advice they receive, as any resulting tragedy will harm the family and leave the advising therapist without legal responsibility. As for the therapists who give this kind of advice, I challenge them to show the public systematic evidence that these practices are effective and safe-- or to change their ways.
Thursday, December 23, 2010
A Quiet Lunch: Baby-feeding May Not Go Well at Parties
A friend was recently telling me about her new grandbaby, a plump but hungry little girl born by Caesarean section not long ago. The grandmother described how the young mother was worried about breastfeeding and fretting that the baby was not getting enough milk. She also told me of the scene at the new baby’s house when both grandmothers, friends, and various other visitors were all there, and the mother tried-- without much success-- to nurse the baby while socializing with the company.
Naturally, the difficulty she had with this nursing was disturbing to the mother. Like most mothers inexperienced with breastfeeding, she was afraid she wasn’t making enough milk and that the baby was starving. And the tenser she was, the more difficult it was for her to nurse the baby. Breastfeeding requires not only the “manufacture” of milk in the breasts, but a reflexive response to the baby’s sucking, the let-down or ejection reflex, that actually squirts milk out of the nipples. (This water-pistol effect is definitely part of the humorous side of breastfeeding!) Babies don’t just draw milk out of the breast as you’d suck lemonade through a straw, and if milk is not ejected, the baby will get only a few drops at a time rather than a mouthful. First-time mothers, especially, may find their milk does not “let down” easily when there is a lot of commotion or tension to deal with. Whether you’re particularly modest or not, you may find it awkward to nurse the baby when a lot is going on around you. From that point of view, it’s not surprising that my friend’s daughter-in-law had trouble breastfeeding while visitors were there.
But there’s another important point about this situation. The other half of the breastfeeding team, the baby, can also have trouble with exciting surroundings. This is so much the case that bottle-fed babies, too, may have trouble feeding when there are visitors-- and the bottle does not share the mother’s problems with letting down milk, of course.
Some years ago I was at a large party where a young mother had brought her toddler son and 6-week-old baby girl. The mother was longing to talk to all the people, many of them her cousins and friends she hadn’t seen for some time. She was trying to give the baby a bottle while she conversed, but guess what, the baby wasn’t having any; she would suck for a minute or so and then let go of the nipple, fretting. I guessed that everything was too exciting for this baby and offered to have a try. We went to a quiet room, sat down and snuggled and talked for a few minutes, then I offered the bottle and the baby slurped up every drop.
What was this all about? Did I have some kind of experienced-mother magic that I applied to this baby? No, but I was aware that even at the advanced age of six weeks, babies may have trouble organizing their feeding if there is something to distract them. In order to suck from breast or bottle, a baby needs to time properly her sucking, which brings milk into the mouth, and her swallowing. This seems simple to adults-- we even have the ability to swallow voluntarily, as in taking pills, or to take food into the mouth and hold it there without swallowing. But for the young baby sucking and swallowing are still primarily reflexive, and they have to occur at the right times and in the right order. Otherwise, the baby will choke on an excessive amount of milk, or the milk will run out of the sides of the mouth rather than going down.
So, what is the connection? Why should hearing people talk interfere with the baby’s coordination of sucking and swallowing? The problem is that a baby’s movements, breathing, sucking, and so on, are easily “entrained” to events in the environment. Entrainment means that the rhythm of actions begins to follow the rhythm of other things that are going on. It’s like adults dancing to music-- the movements of our feet follow the rhythms of the music. As adults, we can decide not to dance, or we can even dance to a different rhythm than the music that’s playing (though it’s hard to do that). Babies don’t seem to have any choice about entrainment. The rhythms of speech and movements around them can take over the rhythms of sucking and swallowing and make it difficult or impossible to do these things in the necessary pattern.
Young mothers may feel very out of things when they need to go away and be alone with the baby in order to nurse. But this may be exactly what’s needed for both parties. The mother may feel hassled and tense in a group of people, even though she wants to be there. The young baby is quite likely to be disorganized when talk, laughter, and movement take over her rhythms. A quiet place gives mother and child their best situation for feeding by breast or by bottle.
Naturally, the difficulty she had with this nursing was disturbing to the mother. Like most mothers inexperienced with breastfeeding, she was afraid she wasn’t making enough milk and that the baby was starving. And the tenser she was, the more difficult it was for her to nurse the baby. Breastfeeding requires not only the “manufacture” of milk in the breasts, but a reflexive response to the baby’s sucking, the let-down or ejection reflex, that actually squirts milk out of the nipples. (This water-pistol effect is definitely part of the humorous side of breastfeeding!) Babies don’t just draw milk out of the breast as you’d suck lemonade through a straw, and if milk is not ejected, the baby will get only a few drops at a time rather than a mouthful. First-time mothers, especially, may find their milk does not “let down” easily when there is a lot of commotion or tension to deal with. Whether you’re particularly modest or not, you may find it awkward to nurse the baby when a lot is going on around you. From that point of view, it’s not surprising that my friend’s daughter-in-law had trouble breastfeeding while visitors were there.
But there’s another important point about this situation. The other half of the breastfeeding team, the baby, can also have trouble with exciting surroundings. This is so much the case that bottle-fed babies, too, may have trouble feeding when there are visitors-- and the bottle does not share the mother’s problems with letting down milk, of course.
Some years ago I was at a large party where a young mother had brought her toddler son and 6-week-old baby girl. The mother was longing to talk to all the people, many of them her cousins and friends she hadn’t seen for some time. She was trying to give the baby a bottle while she conversed, but guess what, the baby wasn’t having any; she would suck for a minute or so and then let go of the nipple, fretting. I guessed that everything was too exciting for this baby and offered to have a try. We went to a quiet room, sat down and snuggled and talked for a few minutes, then I offered the bottle and the baby slurped up every drop.
What was this all about? Did I have some kind of experienced-mother magic that I applied to this baby? No, but I was aware that even at the advanced age of six weeks, babies may have trouble organizing their feeding if there is something to distract them. In order to suck from breast or bottle, a baby needs to time properly her sucking, which brings milk into the mouth, and her swallowing. This seems simple to adults-- we even have the ability to swallow voluntarily, as in taking pills, or to take food into the mouth and hold it there without swallowing. But for the young baby sucking and swallowing are still primarily reflexive, and they have to occur at the right times and in the right order. Otherwise, the baby will choke on an excessive amount of milk, or the milk will run out of the sides of the mouth rather than going down.
So, what is the connection? Why should hearing people talk interfere with the baby’s coordination of sucking and swallowing? The problem is that a baby’s movements, breathing, sucking, and so on, are easily “entrained” to events in the environment. Entrainment means that the rhythm of actions begins to follow the rhythm of other things that are going on. It’s like adults dancing to music-- the movements of our feet follow the rhythms of the music. As adults, we can decide not to dance, or we can even dance to a different rhythm than the music that’s playing (though it’s hard to do that). Babies don’t seem to have any choice about entrainment. The rhythms of speech and movements around them can take over the rhythms of sucking and swallowing and make it difficult or impossible to do these things in the necessary pattern.
Young mothers may feel very out of things when they need to go away and be alone with the baby in order to nurse. But this may be exactly what’s needed for both parties. The mother may feel hassled and tense in a group of people, even though she wants to be there. The young baby is quite likely to be disorganized when talk, laughter, and movement take over her rhythms. A quiet place gives mother and child their best situation for feeding by breast or by bottle.
Monday, December 6, 2010
When the Romanian Orphans Grow Up: The Recent Report
What happens when children from severely-deprived institutional backgrounds are adopted into caring families? Adoption has been described as one of the most successful interventions, but how good a job does it do?
We are finding some answers to these questions bit by bit, as the English and Romanian Adoptees (ERA) Study continues to follow a group of over 300 children adopted from Romanian orphanages in the early 1990s. The ERA researchers are in the process of comparing the Romanian adoptees to non-adopted children as well as to adopted children who never had institutional care. This work is enormously time-consuming and complex, and involves repeated measurements and interviews at different ages, plus delays associated with analyzing, writing, and publishing the results of each phase of the investigation.
A recent presentation of the children’s characteristics up to age 15 has been published by Michael Rutter and co-authors as Deprivation-specific psycholkogical patterns: Effects of institutional deprivation (Monographs of the Society for Research in Child Development, Serial No. 295, Vol.75, No. 1, 2010). The 252 pages of this monograph are absolutely packed with information, some leading to conclusions, some not. I am going to try to pull out some points that may be of particular interest to readers.
An aspect of the monograph that will be of interest to many is the question raised in the title: whether there are psychological patterns that follow severe social and other deprivation in early life. The ERA investigated a group of characteristics that seemed more likely to occur in post-institutional children than in other adoptees. The following items were included:
1. Quasi-autism: A behavior pattern not identical with autism, but including rocking, self-injurious behavior like hair-pulling, unusual and exaggerated sensory responses, and tantrums in response to changes in routine, as reported in parent interviews (Gindis, B. [2008]. Institutional autism in children adopted internationally: Myth or reality? International Journal of Special Education, 23, 118-123).
2. Disinhibited attachment, as shown in unusual friendliness toward strangers and failure to show strong preferences for familiar people in threatening circumstance. The monograph describes disinhibited attachment as including “inappropriate approach to unfamiliar adults, a failure to check back with a caregiver in unfamiliar settings, and willingness to accompany a stranger and wander away from a familiar caregiver. It is often associated with a lack of appropriate physical boundaries, so that children may interact with strangers intrusively and even seek out physical contact… there is sometimes inappropriate affectionate behavior with strangers and undue physical closeness” ( Monograph, p. 58) .
3. Cognitive impairment, including problems with “mentalization” or the ability to understand what other people might believe or feel about a situation.
4. Inattention and overactivity similar to attention-hyperactivity disorders.
While by no means all children who had come from institutions displayed these problems, even those who had spent more than 6 months in a Romanian orphanage, the ERA group reported that over 90% of those who still showed the behaviors at age 15 had spent more than 6 months in severe deprivation. Those who persisted to age 15 with these problems had often improved (for example, become more likely to be helpful or comforting to others), but odd behaviors still occurred. Some children “annoyed other people but did not know why, and difficulties making or keeping friends were common… In a few cases, … inappropriate remarks included excessively outspoken sexualized use of language” ( Monograph, p. 86). Some children were reported as fascinated with collections, including those of “useless rubbish” like chocolate wrappers.
Can we generalize from the ERA children to other adoptees? While it’s useful for potential adoptive parents to have some idea of the types of problems they may see, it’s important to keep in mind some differences between the ERA group and many other adoptees. Members of the ERA group were aged 42 months or younger at the time of adoption, and most of them had gone to the institution shortly after birth. The Romanian orphanages were characterized by extremely severe deprivation, including confinement to cribs and bathing with water squirted from hoses, conditions unlike those in most other child-care institutions. Children with different histories may be quite different from the ERA group.
In addition to the possible effects of differences in background, the following facts are noted by the monograph: “A striking finding at all ages was the heterogeneity in outcome. Thus, even with the children who had the most prolonged experience of institutional care, there were some who at age 11 showed no indication of abnormal functioning on any of the domains we assessed. Conversely, there was a substantial proportion of children who showed impairments in multiple domains of functioning.” (p. 14). It would be a mistake for potential adoptive parents to assume that they can predict which outcome will belong to a given child.
We are finding some answers to these questions bit by bit, as the English and Romanian Adoptees (ERA) Study continues to follow a group of over 300 children adopted from Romanian orphanages in the early 1990s. The ERA researchers are in the process of comparing the Romanian adoptees to non-adopted children as well as to adopted children who never had institutional care. This work is enormously time-consuming and complex, and involves repeated measurements and interviews at different ages, plus delays associated with analyzing, writing, and publishing the results of each phase of the investigation.
A recent presentation of the children’s characteristics up to age 15 has been published by Michael Rutter and co-authors as Deprivation-specific psycholkogical patterns: Effects of institutional deprivation (Monographs of the Society for Research in Child Development, Serial No. 295, Vol.75, No. 1, 2010). The 252 pages of this monograph are absolutely packed with information, some leading to conclusions, some not. I am going to try to pull out some points that may be of particular interest to readers.
An aspect of the monograph that will be of interest to many is the question raised in the title: whether there are psychological patterns that follow severe social and other deprivation in early life. The ERA investigated a group of characteristics that seemed more likely to occur in post-institutional children than in other adoptees. The following items were included:
1. Quasi-autism: A behavior pattern not identical with autism, but including rocking, self-injurious behavior like hair-pulling, unusual and exaggerated sensory responses, and tantrums in response to changes in routine, as reported in parent interviews (Gindis, B. [2008]. Institutional autism in children adopted internationally: Myth or reality? International Journal of Special Education, 23, 118-123).
2. Disinhibited attachment, as shown in unusual friendliness toward strangers and failure to show strong preferences for familiar people in threatening circumstance. The monograph describes disinhibited attachment as including “inappropriate approach to unfamiliar adults, a failure to check back with a caregiver in unfamiliar settings, and willingness to accompany a stranger and wander away from a familiar caregiver. It is often associated with a lack of appropriate physical boundaries, so that children may interact with strangers intrusively and even seek out physical contact… there is sometimes inappropriate affectionate behavior with strangers and undue physical closeness” ( Monograph, p. 58) .
3. Cognitive impairment, including problems with “mentalization” or the ability to understand what other people might believe or feel about a situation.
4. Inattention and overactivity similar to attention-hyperactivity disorders.
While by no means all children who had come from institutions displayed these problems, even those who had spent more than 6 months in a Romanian orphanage, the ERA group reported that over 90% of those who still showed the behaviors at age 15 had spent more than 6 months in severe deprivation. Those who persisted to age 15 with these problems had often improved (for example, become more likely to be helpful or comforting to others), but odd behaviors still occurred. Some children “annoyed other people but did not know why, and difficulties making or keeping friends were common… In a few cases, … inappropriate remarks included excessively outspoken sexualized use of language” ( Monograph, p. 86). Some children were reported as fascinated with collections, including those of “useless rubbish” like chocolate wrappers.
Can we generalize from the ERA children to other adoptees? While it’s useful for potential adoptive parents to have some idea of the types of problems they may see, it’s important to keep in mind some differences between the ERA group and many other adoptees. Members of the ERA group were aged 42 months or younger at the time of adoption, and most of them had gone to the institution shortly after birth. The Romanian orphanages were characterized by extremely severe deprivation, including confinement to cribs and bathing with water squirted from hoses, conditions unlike those in most other child-care institutions. Children with different histories may be quite different from the ERA group.
In addition to the possible effects of differences in background, the following facts are noted by the monograph: “A striking finding at all ages was the heterogeneity in outcome. Thus, even with the children who had the most prolonged experience of institutional care, there were some who at age 11 showed no indication of abnormal functioning on any of the domains we assessed. Conversely, there was a substantial proportion of children who showed impairments in multiple domains of functioning.” (p. 14). It would be a mistake for potential adoptive parents to assume that they can predict which outcome will belong to a given child.
Federici v. Mercer: The Story Behind the Lawsuit
A phone call this morning alerted me to the fact that the Virginia psychologist Ronald S. Federici is suing me and other critics in Fairfax, VA (CL10-16657, filed Nov. 24). As of today, I have not yet been served in this matter, but I assume that his complaint is that I have defamed him and interfered with his business, as he already brought such a suit in Small Claims Court and lost it, but is allowed to appeal.
What is behind this suit? The event that seems to have triggered it is that I published on my former Psychology Today blog a piece which I will present below. This piece, which I entitled “The Hungry Boy”, was based on a published opinion of the North Carolina Court of Appeals (www.aoc.state.nc.us/www/public/coa/opinions/pdf/090504-1.pdf), which discussed Federici’s involvement in an adoptive family situation that resulted in the incarceration of both parents for felony child abuse. The COA opinion quotes testimony Federici gave during the trial as well as the statements of the abused boy. (After writing “The Hungry Boy”, I obtained the transcript of the original trial, which does not counter in any way the statements in the COA opinion.)
Shortly after the publication of “The Hungry Boy”, Federici complained to and filed suit against me, Psychology Today, and other persons. Psychology Today took down “The Hungry Boy” and told me not to mention Federici’s name again. Although Psychology Today was served with a summons to appear in Fairfax, VA to answer the suit, and although I warned them that they should not default, they did not send a representative to appear in court and as a result a judgment for $5000 was given against them. I appeared and had a chance to see that Federici did not present evidence that he had been harmed by what I wrote nor that what I wrote was untrue (both necessary for a successful defamation case in the United States). As a result, the judge found for me.
Over the following several weeks, I did not mention Federici’s name on my blog, as instructed, but I did mention that I had been in court in a defamation case. Psychology Today responded to this by freezing my account on the grounds that I had broken an agreement with them, and I moved my blogging to http://www.childmyths.blogspot.com/.
Having lost his case in Small Claims Court, Federici had the option of an appeal to a higher court, and he filed this appeal against me and some other people. (He apparently came to some agreement with Psychology Today.) However, after some weeks, he decided on a “non-suit”-- to drop the case for the time being but to keep the option of reviving it. This revival is what he has apparently done as of Nov. 24, 2010.
What did “The Hungry Boy” say that was so disturbing to Federici? I’ll show you by posting the piece below.
The Hungry Boy: An Adoption Story, With Comments
Is starvation the key to good discipline and loving relationships in adoptive families?
In several posts on this blog, and in print publications over the last ten years, I have alluded to the suggestion by unconventional therapists that withholding food from adopted children is an effective way to shape desirable attitudes and behavior. Today, I’d like to tell some of the story of adoptive parents who took this advice, the consequences for themselves and their adopted child--- and the absence of consequences for the therapist who acknowledged in court that he had provided the treatment plan. I draw my information about this case from a document of the North Carolina Court of Appeals, issued Jan.19, 2010, and available at http://www.aoc.state.nc.us/ , as well as from a document prepared for the defense in this appeal and available at http://www.ncids.org/.
Here is the basic story. Paul and Leslie Salvetti adopted in the 1990s a little boy who had been born in Russia in 1993. Leslie later died, Paul re-married, and the new wife, Debbie, became mother to the boy, known as “Pesha”. At some point, the family’s functioning became less than ideal; “Pesha” reported to social services that Debbie had hit him with a frying pan and baseball bat, among other complaints, but it is not clear whether this was investigated.
According to the appeals court documents, Paul and Debbie felt that “Pesha” was “umanageable” by the time he was 13. In about February, 2007, the Salvettis consulted Ronald Federici, a clinical psychologist with a Psy.D. degree, licensed in Virginia, about their problems with “Pesha”. (The fee for this consultation was $5200 for three days of work.) Federici made a number of recommendations about appropriate treatment of “Pesha”, including the suggestion that ordinary meals should be contingent on improved behavior, but that “Pesha” should be provided with bologna sandwiches and fruit in any case.
The Salvettis also confined “Pesha” to his bedroom, where they covered the windows and removed most furniture , and these were the circumstances of his life for three months. “Pesha” later described himself as “cold and hungry” during this time. “Pesha” eventually escaped from the house and made his way to the authorities; at this time he was hospitalized for a week, during which time he gained 10 pounds. The Salvettis pled guilty to felony child abuse (intentionally inflicting physical injury, starvation) and in 2008 were sentenced to a period of imprisonment.
During the Salvettis’ trial, Ronald Federici testified on their behalf, and, unusually for a psychologist, commented on medical and genetic issues as well as psychological concerns; expert witnesses are generally expected to speak within their area of professional expertise. It is of particular interest that Federici testified to his belief that “Pesha” had not been substantially deprived of food. Federici and the defense attorney appear to have taken refuge in the ambiguity of the English language and to have interpreted the term “withheld food” to mean “withheld all food and liquid” rather than “reduced the amount and type of food available”. The defense argued that because some food had been provided, food had therefore not been withheld.
In addition, Federici testified to his opinion that children’s rage could cause them to lose weight, and that this, rather than food deprivation, was the cause of “Pesha”s” condition. (Although the implications of this statement were not discussed in the court documents that are available, I should point out that there is no known evidence to support Federici’s opinion.)
.
So, what can we conclude from this case? Is starvation the key to good discipline and loving relationships? If not, what are its consequences? In this case, the consequence for “Pesha” was a terrifying experience and the loss of the home he knew. For Paul and Debbie Salvetti, the consequence was a period of imprisonment. For Ronald Federici , the consequence of his many activities has been popularity with the media, including a recent interview with National Public Radio in which he commented on the latest Russian adoptee scandal. Others who give similar recommendations have also found them lucrative.
If you are a member of an adoptive family, please note that you are not one of the people likely to benefit from using the withholding of food as a child-rearing technique.
*** That’s the end of “The Hungry Boy”. If you’re not sure whether my statements were accurate, you can read the North Carolina Court of Appeals opinion on line. Incidentally, the appeal in this case had nothing to do with any facts about what had actually happened, or any discussion of the appropriateness of Federici’s advice to the parents. The appeal had to do with the type of plea made by the parents in order to avoid trial, and whether they had actually understood that they would go to prison.
What is behind this suit? The event that seems to have triggered it is that I published on my former Psychology Today blog a piece which I will present below. This piece, which I entitled “The Hungry Boy”, was based on a published opinion of the North Carolina Court of Appeals (www.aoc.state.nc.us/www/public/coa/opinions/pdf/090504-1.pdf), which discussed Federici’s involvement in an adoptive family situation that resulted in the incarceration of both parents for felony child abuse. The COA opinion quotes testimony Federici gave during the trial as well as the statements of the abused boy. (After writing “The Hungry Boy”, I obtained the transcript of the original trial, which does not counter in any way the statements in the COA opinion.)
Shortly after the publication of “The Hungry Boy”, Federici complained to and filed suit against me, Psychology Today, and other persons. Psychology Today took down “The Hungry Boy” and told me not to mention Federici’s name again. Although Psychology Today was served with a summons to appear in Fairfax, VA to answer the suit, and although I warned them that they should not default, they did not send a representative to appear in court and as a result a judgment for $5000 was given against them. I appeared and had a chance to see that Federici did not present evidence that he had been harmed by what I wrote nor that what I wrote was untrue (both necessary for a successful defamation case in the United States). As a result, the judge found for me.
Over the following several weeks, I did not mention Federici’s name on my blog, as instructed, but I did mention that I had been in court in a defamation case. Psychology Today responded to this by freezing my account on the grounds that I had broken an agreement with them, and I moved my blogging to http://www.childmyths.blogspot.com/.
Having lost his case in Small Claims Court, Federici had the option of an appeal to a higher court, and he filed this appeal against me and some other people. (He apparently came to some agreement with Psychology Today.) However, after some weeks, he decided on a “non-suit”-- to drop the case for the time being but to keep the option of reviving it. This revival is what he has apparently done as of Nov. 24, 2010.
What did “The Hungry Boy” say that was so disturbing to Federici? I’ll show you by posting the piece below.
The Hungry Boy: An Adoption Story, With Comments
Is starvation the key to good discipline and loving relationships in adoptive families?
In several posts on this blog, and in print publications over the last ten years, I have alluded to the suggestion by unconventional therapists that withholding food from adopted children is an effective way to shape desirable attitudes and behavior. Today, I’d like to tell some of the story of adoptive parents who took this advice, the consequences for themselves and their adopted child--- and the absence of consequences for the therapist who acknowledged in court that he had provided the treatment plan. I draw my information about this case from a document of the North Carolina Court of Appeals, issued Jan.19, 2010, and available at http://www.aoc.state.nc.us/ , as well as from a document prepared for the defense in this appeal and available at http://www.ncids.org/.
Here is the basic story. Paul and Leslie Salvetti adopted in the 1990s a little boy who had been born in Russia in 1993. Leslie later died, Paul re-married, and the new wife, Debbie, became mother to the boy, known as “Pesha”. At some point, the family’s functioning became less than ideal; “Pesha” reported to social services that Debbie had hit him with a frying pan and baseball bat, among other complaints, but it is not clear whether this was investigated.
According to the appeals court documents, Paul and Debbie felt that “Pesha” was “umanageable” by the time he was 13. In about February, 2007, the Salvettis consulted Ronald Federici, a clinical psychologist with a Psy.D. degree, licensed in Virginia, about their problems with “Pesha”. (The fee for this consultation was $5200 for three days of work.) Federici made a number of recommendations about appropriate treatment of “Pesha”, including the suggestion that ordinary meals should be contingent on improved behavior, but that “Pesha” should be provided with bologna sandwiches and fruit in any case.
The Salvettis also confined “Pesha” to his bedroom, where they covered the windows and removed most furniture , and these were the circumstances of his life for three months. “Pesha” later described himself as “cold and hungry” during this time. “Pesha” eventually escaped from the house and made his way to the authorities; at this time he was hospitalized for a week, during which time he gained 10 pounds. The Salvettis pled guilty to felony child abuse (intentionally inflicting physical injury, starvation) and in 2008 were sentenced to a period of imprisonment.
During the Salvettis’ trial, Ronald Federici testified on their behalf, and, unusually for a psychologist, commented on medical and genetic issues as well as psychological concerns; expert witnesses are generally expected to speak within their area of professional expertise. It is of particular interest that Federici testified to his belief that “Pesha” had not been substantially deprived of food. Federici and the defense attorney appear to have taken refuge in the ambiguity of the English language and to have interpreted the term “withheld food” to mean “withheld all food and liquid” rather than “reduced the amount and type of food available”. The defense argued that because some food had been provided, food had therefore not been withheld.
In addition, Federici testified to his opinion that children’s rage could cause them to lose weight, and that this, rather than food deprivation, was the cause of “Pesha”s” condition. (Although the implications of this statement were not discussed in the court documents that are available, I should point out that there is no known evidence to support Federici’s opinion.)
.
So, what can we conclude from this case? Is starvation the key to good discipline and loving relationships? If not, what are its consequences? In this case, the consequence for “Pesha” was a terrifying experience and the loss of the home he knew. For Paul and Debbie Salvetti, the consequence was a period of imprisonment. For Ronald Federici , the consequence of his many activities has been popularity with the media, including a recent interview with National Public Radio in which he commented on the latest Russian adoptee scandal. Others who give similar recommendations have also found them lucrative.
If you are a member of an adoptive family, please note that you are not one of the people likely to benefit from using the withholding of food as a child-rearing technique.
*** That’s the end of “The Hungry Boy”. If you’re not sure whether my statements were accurate, you can read the North Carolina Court of Appeals opinion on line. Incidentally, the appeal in this case had nothing to do with any facts about what had actually happened, or any discussion of the appropriateness of Federici’s advice to the parents. The appeal had to do with the type of plea made by the parents in order to avoid trial, and whether they had actually understood that they would go to prison.
Thursday, November 25, 2010
The Raising-a-Psychopath Blog
A reader asked me to comment on the blog “Raising a Psychopath” ( http://raising-a-psychopath.blogspot.com/). For those who haven’t seen it, this blog appears to be by the adoptive father of a child who was adopted at age 6 after many experiences of neglect, abuse, and change of caregiver, and who at age 11 is regarded with fear and anger by the parents and has been in residential treatment for periods of time. The blogger, whom I’ll call FRP (for Father Raising a Psychopath), as his blog title suggests, considers the child to be psychopathic as well as to have Reactive Attachment Disorder. Many of the posts present arguments that FRP has put forward to support his view of the child, “Lucas”.
I have some general comments about the material contained in this blog, but I need to emphasize that I have no reliable information about “Lucas’ or his parents. I have no way of knowing whether the statements on “Raising a Psychopath” are true, or whether there is omitted material that would put a different spin on the statements that are made. Even if I were sure about the veracity and completeness of the blog, I would not want either to praise or to criticize the actions of the parents, therapists, teachers, social workers, etc. It’s too easy to talk a game that you don’t have to walk, as we can see from many of the comments, both positive and negative, on FRP’s statements.
That said, here are some thoughts I had while reading “Raising a Psychopath”.
1. The psychopath thing:
It appears that from the beginning of the blog, FRP identified “Lucas”, who was then about 9, as a psychopath-- he chose this title for the blog, and in one of his posts predicted a timeline of more and more serious misbehavior. Whether or not this was a self-fulfilling prophesy is difficult to say with the information we have. We can ask, however, why FRP was so quick and so sure about this diagnosis. What are the advantages of labeling a boy “psychopath” rather than staying with more ordinary childhood problems like Conduct Disorder or Oppositional and Defiant Disorder? The advantages would seem to be the possibility of declaring the child beyond help and incapable of living in the family home, removing any responsibility the adoptive parents might have, as well as the possibility of focusing all blame or negative evaluation on the child himself.
Many of FRP’s posts describe his thoughts about the evaluation of “Lucas” with Robert Hare’s PCL-YV (Psychopathy Check List-- Youth Version). FRP discusses each of the check list items in detail, and, not surprisingly, concludes that he has a genuine psychopath on his hands. But although he mentions the limitations of the PCL-YV briefly, he evidently has not taken them seriously.
The first limitation is that the check list is not intended for the use of parents. It is to be given by an experienced clinician who can compare an adolescent to many other adolescents seen previously, and who will ideally use an objective approach in which both positive and negative evidence is carefully assembled and combined before a decision is made. No parent can be genuinely objective about their own child-- indeed, if they were, it would be a cause for concern. In addition, FRP already decided that “Lucas” was a psychopath some time ago, so it would be surprising if he did not seek evidence to confirm this belief.
The second limitation of the PCL-YV is that it has been standardized on and is intended to be used with adolescents from 12 to 18 years old. “Lucas” was 11 or less at the time of FRP’s assessment efforts. Yes, of course, 11 is almost 12, but it is not 12-- and at a period when the rapid changes of puberty begin, a few months may make enormous differences in an individual’s abilities and motivations. FRP judges “Lucas” to have unstable personal relationships based on the adoptive mother’s report that “girlfriends” “break up” with him quickly-- at 11 years of age, a period when the more advanced reproductive maturity of girls makes relations between boys and girls labile to say the least.
On this “psychopath” thing, by the way, there are several general points to be made. One is that there are not very many psychopaths, so the validation of a brief check list is a difficult matter. Individual differences in a small group make it hard to establish a general set of criteria. In addition, there seems to be a common confusion between individuals who are sadists and take pleasure, often sexual, in the pain of others, and the psychopath or sociopath who does not care about causing pain, but does so only when it’s convenient--- for example, if a bystander to a robbery might identify the perpetrator and therefore “must” be killed. Finally, the frequent identification of violent offenders with individuals who are sensation-seekers is paradoxical; a reader’s comment on “Raising a Psychopath” says that a psychopath lacks empathy, but enjoys the sensation when another person is hurt, which for me raises the question, if he has no empathy, how does he enjoy the other person’s distress?
Reactive Attachment Disorder
Early in the blog’s appearance, a reader advised FRP that “Lucas” must have Reactive Attachment Disorder because his behavior was problematic and he had a history of separation, neglect, and abuse. FRP immediately fell for the view of Walter Buenning and others, that this disorder can be diagnosed easily by use of a check list (conveniently on line), and that its symptoms include failure to make eye contact, “crazy lying”, preoccupation with blood and gore, etc., etc., all of which, untreated, will culminate in serial killing by boys and prostitution by girls (but apparently not the other way around).
This check list is neither standardized for age differences nor validated against any other method of diagnosing Reactive Attachment Disorder. Examination of the criteria for Reactive Attachment Disorder in the Diagnostic and Statistical Manual of the American Psychiatric Association shows no overlap between the established criteria and the check list used by Buenning and others.
FRP’s discussion of “Lucas’s” history suggests that while “Lucas” may be quite insecure after his confused and painful beginnings, he is not without attachment or the capacity for attachment. For example, when FRP and his wife had their first meeting with “Lucas”, while he was in a foster home, they noticed that he was not eager to socialize with them. When they took him back to the foster home, they felt he was much happier to be with the foster parents than with them (FRP and wife), and commented that the foster parents were more like grandparents-- while FRP did not explain this statement, I would guess that it meant affectionate and easy-going. “Lucas” showed a preference for those foster parents and appeared more comfortable with them than when away from them; in other words, he exhibited emotional attachment which he had developed over some months in a nurturing foster home. Whatever his difficulties, they are not due to an inability to develop a positive relationship with a caregiver.
Plain old ignorance
FRP’s description of their decision to adopt “Lucas”, and of their feelings as the adoption date approached, suggests to me that these parents share with many others a serious lack of understanding of early development and of the role of relationships in children’s lives. Like many participants in the Zero-to-Three/Civitas Benchmark Study, FRP and Mrs.FRP seem to have been especially ignorant about emotional development. I say this because, like all too many adoptive parents, they felt they could save themselves a lot of trouble--- diapers, night feedings, and all that-- by staying out of the picture until a child was 5 or 6 years old. Then, they thought, they would walk in and adopt, and that adopted child would be EXACTLY like their friends’ children who had been loved and cared for from birth to age 6. FRP and Mrs. FRP could do everything they liked to do, just as they did before, but there would be living in their house an attractive, sociable, charming, and self-reliant child who would play with them when they felt like it.
I’m sorry, but this was idiotic. It was not even realistic from the viewpoint of thinking what their friends’ children are actually like.
FRP’s comments on the blog also suggest that he and his wife did not think it was a problem to bring into their home a child whom they did not actively want or feel sure about. They seem to have been naïve about their own emotions, not to speak about the impact on the child of having his lot cast with caregivers who were unclear about what they were doing. And with respect to this, I must also point out the ignorance or indifference shown by caseworkers who did not pursue this couple’s hesitation and make sure all was clear before proceeding. Was it not understood that the couple did not know important things about early development? Or, is it possible that the caseworkers didn’t know those things either?
Well. That’s about enough for now. Just let me repeat (to myself as well as to readers) that for all I know, nothing on “Raising a Psychopath” is true, or just as likely, it’s true but so are a lot of other things.
I have some general comments about the material contained in this blog, but I need to emphasize that I have no reliable information about “Lucas’ or his parents. I have no way of knowing whether the statements on “Raising a Psychopath” are true, or whether there is omitted material that would put a different spin on the statements that are made. Even if I were sure about the veracity and completeness of the blog, I would not want either to praise or to criticize the actions of the parents, therapists, teachers, social workers, etc. It’s too easy to talk a game that you don’t have to walk, as we can see from many of the comments, both positive and negative, on FRP’s statements.
That said, here are some thoughts I had while reading “Raising a Psychopath”.
1. The psychopath thing:
It appears that from the beginning of the blog, FRP identified “Lucas”, who was then about 9, as a psychopath-- he chose this title for the blog, and in one of his posts predicted a timeline of more and more serious misbehavior. Whether or not this was a self-fulfilling prophesy is difficult to say with the information we have. We can ask, however, why FRP was so quick and so sure about this diagnosis. What are the advantages of labeling a boy “psychopath” rather than staying with more ordinary childhood problems like Conduct Disorder or Oppositional and Defiant Disorder? The advantages would seem to be the possibility of declaring the child beyond help and incapable of living in the family home, removing any responsibility the adoptive parents might have, as well as the possibility of focusing all blame or negative evaluation on the child himself.
Many of FRP’s posts describe his thoughts about the evaluation of “Lucas” with Robert Hare’s PCL-YV (Psychopathy Check List-- Youth Version). FRP discusses each of the check list items in detail, and, not surprisingly, concludes that he has a genuine psychopath on his hands. But although he mentions the limitations of the PCL-YV briefly, he evidently has not taken them seriously.
The first limitation is that the check list is not intended for the use of parents. It is to be given by an experienced clinician who can compare an adolescent to many other adolescents seen previously, and who will ideally use an objective approach in which both positive and negative evidence is carefully assembled and combined before a decision is made. No parent can be genuinely objective about their own child-- indeed, if they were, it would be a cause for concern. In addition, FRP already decided that “Lucas” was a psychopath some time ago, so it would be surprising if he did not seek evidence to confirm this belief.
The second limitation of the PCL-YV is that it has been standardized on and is intended to be used with adolescents from 12 to 18 years old. “Lucas” was 11 or less at the time of FRP’s assessment efforts. Yes, of course, 11 is almost 12, but it is not 12-- and at a period when the rapid changes of puberty begin, a few months may make enormous differences in an individual’s abilities and motivations. FRP judges “Lucas” to have unstable personal relationships based on the adoptive mother’s report that “girlfriends” “break up” with him quickly-- at 11 years of age, a period when the more advanced reproductive maturity of girls makes relations between boys and girls labile to say the least.
On this “psychopath” thing, by the way, there are several general points to be made. One is that there are not very many psychopaths, so the validation of a brief check list is a difficult matter. Individual differences in a small group make it hard to establish a general set of criteria. In addition, there seems to be a common confusion between individuals who are sadists and take pleasure, often sexual, in the pain of others, and the psychopath or sociopath who does not care about causing pain, but does so only when it’s convenient--- for example, if a bystander to a robbery might identify the perpetrator and therefore “must” be killed. Finally, the frequent identification of violent offenders with individuals who are sensation-seekers is paradoxical; a reader’s comment on “Raising a Psychopath” says that a psychopath lacks empathy, but enjoys the sensation when another person is hurt, which for me raises the question, if he has no empathy, how does he enjoy the other person’s distress?
Reactive Attachment Disorder
Early in the blog’s appearance, a reader advised FRP that “Lucas” must have Reactive Attachment Disorder because his behavior was problematic and he had a history of separation, neglect, and abuse. FRP immediately fell for the view of Walter Buenning and others, that this disorder can be diagnosed easily by use of a check list (conveniently on line), and that its symptoms include failure to make eye contact, “crazy lying”, preoccupation with blood and gore, etc., etc., all of which, untreated, will culminate in serial killing by boys and prostitution by girls (but apparently not the other way around).
This check list is neither standardized for age differences nor validated against any other method of diagnosing Reactive Attachment Disorder. Examination of the criteria for Reactive Attachment Disorder in the Diagnostic and Statistical Manual of the American Psychiatric Association shows no overlap between the established criteria and the check list used by Buenning and others.
FRP’s discussion of “Lucas’s” history suggests that while “Lucas” may be quite insecure after his confused and painful beginnings, he is not without attachment or the capacity for attachment. For example, when FRP and his wife had their first meeting with “Lucas”, while he was in a foster home, they noticed that he was not eager to socialize with them. When they took him back to the foster home, they felt he was much happier to be with the foster parents than with them (FRP and wife), and commented that the foster parents were more like grandparents-- while FRP did not explain this statement, I would guess that it meant affectionate and easy-going. “Lucas” showed a preference for those foster parents and appeared more comfortable with them than when away from them; in other words, he exhibited emotional attachment which he had developed over some months in a nurturing foster home. Whatever his difficulties, they are not due to an inability to develop a positive relationship with a caregiver.
Plain old ignorance
FRP’s description of their decision to adopt “Lucas”, and of their feelings as the adoption date approached, suggests to me that these parents share with many others a serious lack of understanding of early development and of the role of relationships in children’s lives. Like many participants in the Zero-to-Three/Civitas Benchmark Study, FRP and Mrs.FRP seem to have been especially ignorant about emotional development. I say this because, like all too many adoptive parents, they felt they could save themselves a lot of trouble--- diapers, night feedings, and all that-- by staying out of the picture until a child was 5 or 6 years old. Then, they thought, they would walk in and adopt, and that adopted child would be EXACTLY like their friends’ children who had been loved and cared for from birth to age 6. FRP and Mrs. FRP could do everything they liked to do, just as they did before, but there would be living in their house an attractive, sociable, charming, and self-reliant child who would play with them when they felt like it.
I’m sorry, but this was idiotic. It was not even realistic from the viewpoint of thinking what their friends’ children are actually like.
FRP’s comments on the blog also suggest that he and his wife did not think it was a problem to bring into their home a child whom they did not actively want or feel sure about. They seem to have been naïve about their own emotions, not to speak about the impact on the child of having his lot cast with caregivers who were unclear about what they were doing. And with respect to this, I must also point out the ignorance or indifference shown by caseworkers who did not pursue this couple’s hesitation and make sure all was clear before proceeding. Was it not understood that the couple did not know important things about early development? Or, is it possible that the caseworkers didn’t know those things either?
Well. That’s about enough for now. Just let me repeat (to myself as well as to readers) that for all I know, nothing on “Raising a Psychopath” is true, or just as likely, it’s true but so are a lot of other things.
Wednesday, November 24, 2010
Toddler Meltdown, the Ever-Popular Thanksgiving Side Dish
Got a toddler or preschooler? Planning to celebrate Thanksgiving tomorrow? Be prepared for your little person to lack all aplomb as he or she encounters the feast that even grown-ups often dread.
The best you can hope for is that your child copes pretty well, cries only a little bit, eats a bite or two from the carefully-prepared menu, and delays tantrums until late in the day. Like some other major holidays, Thanksgiving contains many of the elements most disturbing to young children, and its family focus ensures that there will be plenty of adults and older kids who try awkwardly to cheer the little guys up, or scold them for their crankiness. This combination easily produces tears, resistance, clinginess, the biting of cousins, loud statements that the stuffing is yucky, and everything else that exhausts and humiliates parents.
What is it, anyway, that makes toddlers and holidays like Thanksgiving such a lethal mixture? Here’s a list of reasons:
1. Toddlers are creatures of habit. They eat when it’s the time they usually eat. If it’s too early or too late to eat, they don’t want to eat-- and of course we usually have the Thanksgiving meal later than lunch time and earlier than supper time, so what do we expect?
2. More habit, plus neophobia: Toddlers eat what they’re used to eating. They don’t eat new things until they’ve become familiar with them by seeing them a number of times. Even if their own family eats green beans and turkey, toddlers will instantly detect that what someone else cooked is not the right kind; it doesn’t look exactly the same and it doesn’t taste exactly the same, so the fact that it’s a green bean cuts no ice with the two-year-old. Even a turkey cooked at the toddler’s own house may not be acceptable, because Mom and Dad have done their best to make it interesting and appetizing for older people, i.e., different from what the child is used to. This problem, plus the timing of the meal, may mean that the child is hungry but can’t manage to eat.
3. Toddlers don’t manage well when they’re tired, and a holiday like Thanksgiving usually makes them tired. They may have been up late the night before while Mom and Dad were rushing around trying to get organized. In the morning, they may have had a long drive (in the course of which they fell asleep, messing up their usual sleep schedule), or there may have been a lot of commotion at their own house as someone tried to put a turkey in the oven while keeping the child from touching the hot oven door. Either at home or elsewhere, nap time was probably disrupted.
4. There are too many people to cope with. Toddlers are disorganized by large groups of large people, many of whom may be talking and laughing loudly, or alternatively starting to yell at each other. Just imagine yourself in a roomful of rambunctious 12-foot-tall people, if you want to see what the toddler experience may be like.
5. Ordinarily, toddlers depend on contact with familiar caregivers to get them through difficult situations. They make eye contact, or call out, or hold onto a parental leg until they calm down. But holidays like Thanksgiving make this difficult. There may be too much of a crowd for ordinary contact to be easy to make, and what’s more parents are likely to be distracted with cooking or with the demands of other adults for attention.
6. Toddlers pick up their parents’ feelings and are distressed when the parents are distressed. (This doesn’t mean that the child will behave differently in order to keep from upsetting a parent, though!) Parents often have reason to be anxious about family-focused holidays, and they are especially vulnerable to criticism or disapproval of their children’s behavior. This produces a vicious circle in which the fussy child draws criticism that disturbs the parent, who then becomes increasingly distressed, disturbing the child and becoming less capable of handling the disturbance. Scolding or spanking do no good at all when everyone is already in a tailspin.
All of these problems together pretty well insure that toddlers are going to behave less well on a day like Thanksgiving than they usually do. Unfortunately, most of these items are part and parcel of the holiday. It might be possible to get the dinner scheduled at something closer to toddler mealtimes, or to bring familiar food from home, and those changes might help a bit. But you won’t be able to change most of what happens.
Nothing is going to change a toddler into an adult for the day, but adults may be able to plan ahead and make sure that they themselves are as adult-like as possible. It would be an especially good idea for parents of toddlers to remind themselves that the child does not exist to make them, the parents, look good. Indirect criticism of the parents, by way of disapproval of the child, is uncomfortable to feel, but can be ignored, for the day at least.
Yes, this too shall pass. Just remind yourself that 20 years from now that toddler is going to ask why you can’t make the stuffing the way Grandma or Aunt Carol always did, completely forgetting how he used to shriek when coaxed to eat it!
The best you can hope for is that your child copes pretty well, cries only a little bit, eats a bite or two from the carefully-prepared menu, and delays tantrums until late in the day. Like some other major holidays, Thanksgiving contains many of the elements most disturbing to young children, and its family focus ensures that there will be plenty of adults and older kids who try awkwardly to cheer the little guys up, or scold them for their crankiness. This combination easily produces tears, resistance, clinginess, the biting of cousins, loud statements that the stuffing is yucky, and everything else that exhausts and humiliates parents.
What is it, anyway, that makes toddlers and holidays like Thanksgiving such a lethal mixture? Here’s a list of reasons:
1. Toddlers are creatures of habit. They eat when it’s the time they usually eat. If it’s too early or too late to eat, they don’t want to eat-- and of course we usually have the Thanksgiving meal later than lunch time and earlier than supper time, so what do we expect?
2. More habit, plus neophobia: Toddlers eat what they’re used to eating. They don’t eat new things until they’ve become familiar with them by seeing them a number of times. Even if their own family eats green beans and turkey, toddlers will instantly detect that what someone else cooked is not the right kind; it doesn’t look exactly the same and it doesn’t taste exactly the same, so the fact that it’s a green bean cuts no ice with the two-year-old. Even a turkey cooked at the toddler’s own house may not be acceptable, because Mom and Dad have done their best to make it interesting and appetizing for older people, i.e., different from what the child is used to. This problem, plus the timing of the meal, may mean that the child is hungry but can’t manage to eat.
3. Toddlers don’t manage well when they’re tired, and a holiday like Thanksgiving usually makes them tired. They may have been up late the night before while Mom and Dad were rushing around trying to get organized. In the morning, they may have had a long drive (in the course of which they fell asleep, messing up their usual sleep schedule), or there may have been a lot of commotion at their own house as someone tried to put a turkey in the oven while keeping the child from touching the hot oven door. Either at home or elsewhere, nap time was probably disrupted.
4. There are too many people to cope with. Toddlers are disorganized by large groups of large people, many of whom may be talking and laughing loudly, or alternatively starting to yell at each other. Just imagine yourself in a roomful of rambunctious 12-foot-tall people, if you want to see what the toddler experience may be like.
5. Ordinarily, toddlers depend on contact with familiar caregivers to get them through difficult situations. They make eye contact, or call out, or hold onto a parental leg until they calm down. But holidays like Thanksgiving make this difficult. There may be too much of a crowd for ordinary contact to be easy to make, and what’s more parents are likely to be distracted with cooking or with the demands of other adults for attention.
6. Toddlers pick up their parents’ feelings and are distressed when the parents are distressed. (This doesn’t mean that the child will behave differently in order to keep from upsetting a parent, though!) Parents often have reason to be anxious about family-focused holidays, and they are especially vulnerable to criticism or disapproval of their children’s behavior. This produces a vicious circle in which the fussy child draws criticism that disturbs the parent, who then becomes increasingly distressed, disturbing the child and becoming less capable of handling the disturbance. Scolding or spanking do no good at all when everyone is already in a tailspin.
All of these problems together pretty well insure that toddlers are going to behave less well on a day like Thanksgiving than they usually do. Unfortunately, most of these items are part and parcel of the holiday. It might be possible to get the dinner scheduled at something closer to toddler mealtimes, or to bring familiar food from home, and those changes might help a bit. But you won’t be able to change most of what happens.
Nothing is going to change a toddler into an adult for the day, but adults may be able to plan ahead and make sure that they themselves are as adult-like as possible. It would be an especially good idea for parents of toddlers to remind themselves that the child does not exist to make them, the parents, look good. Indirect criticism of the parents, by way of disapproval of the child, is uncomfortable to feel, but can be ignored, for the day at least.
Yes, this too shall pass. Just remind yourself that 20 years from now that toddler is going to ask why you can’t make the stuffing the way Grandma or Aunt Carol always did, completely forgetting how he used to shriek when coaxed to eat it!
Monday, November 22, 2010
Fearlessness, Empathy, and Preschoolers: That Report
The Internet is currently full of references to a doctoral dissertation done at the University of Haifa by Inbal Kivenson Bar-On, a student of the well-known child development researcher Ofra Mayseless. Bar-On reported that when she investigated the abilities and behavior of 80 preschool children, the “fearless” ones showed differences from the “fearful” (for example, at http://www.sciencedaily.com/releases/2010/11/101108140524.htm).
.
Whether the children were relatively fearful or fearless was ascertained by looking at their reactions to common events like separation from parents or the sound of a vacuum cleaner, or surprising objects like a jack-in-the-box. The operative word here is “relatively”-- it does not appear that Bar-On sought out children who were unusually fearful or fearless.( I ought to note that I have not seen the dissertation, and it looks as if everyone commenting has drawn their information from the University of Haifa press release which is on their web site; what we all say about it is very much subject to revision when we see the details.)
Pamela Paul, writing in the New York Times Sunday style section of all things, implied that the fearfulness-fearfulness dimension measured by Bar-On is equivalent to the aspect of temperament often called approach-withdrawal. Temperament is an aspect of personality that is thought to be “constitutional”, or biologically determined, and which stays basically the same from infancy through adulthood (although it naturally is expressed through different behaviors at different ages). There are half a dozen or more factors in temperament, but approach-withdrawal is a pretty obvious one, especially for children at the extremes. The approaching child tries new foods easily, goes up to the strange dog, behaves in a friendly way to strangers, and so on; the withdrawing child needs a long time to adapt to new things and avoids them as much as possible. It probably makes sense to think of approach and withdrawal as substantially related to fearlessness and fearfulness. Bar-On’s report that the fearless children were friendly also supports this view.
According to Bar-On’s study, the children who were evaluated as fearless were quite good at recognizing when other children had facial expressions of anger, surprise, happiness, or sadness, but they did not readily recognize an expression of fear. The fearful children did a better job at recognizing fear. The fearless children were also more likely to take advantage of other children, and less likely to be remorseful when they had done wrong. Bar-On reported that these differences were like constitutional differences in temperament-- they resulted from genetic variations, not from parenting effects.
However, it’s difficult to determine that normal behaviors in 3- and 4-year-olds are purely constitutional in nature. Much behavioral development is transactional in nature; whatever the basic characteristics of parent and child, they influence each other and each shapes the behavior of the other. As a relevant example, let’s look at how infants make use of fearful facial expressions shown by other people. From 8 or 9 months, babies are able to avoid a lot of trial-and-error involvement with potentially dangerous things. When they encounter a new or unusual person or thing, infants try “social referencing”-- they look at the face of a nearby familiar adult. If that person looks (or sounds) frightened, the baby backs off and avoids the strange event. If the adult looks happy, the baby gradually moves to explore. This is why well-cared-for babies don’t have nearly as many accidents as they might. The mother’s frightened face as the baby crawls toward the unguarded stairs or starts to reach for the candle flame warns most babies very effectively.
But what would happen if a particular baby were not very good at recognizing a fear-face? He or she would not back off in response to the parent’s fear. The caregiver would have to move to keep the baby safe, perhaps swooping down and grabbing the baby away from danger, or even smacking his hands in an effort to get the lesson across. The baby might then associate another person’s expression of fear with the baby’s experience of aggression. Rather than an empathic response to the other’s fear, the baby might be angered by seeing another person look fearful, and by preschool age this could be shown in instrumental aggression toward other kids and a sense that this is justified.
Of course, this is all complete speculation on my part-- I have no idea how this would really happen-- but when we put together the transactional aspect of development, the infant use of “social referencing”, and the vigorous efforts made by attentive caregivers to find ways to keep babies safe, the scenario I’ve given is not an impossible one. In addition, it’s a scenario that would be complete by the preschool period, and would not necessarily be detectable unless longitudinal research followed each child from infancy. These events would be a mechanism that combined the child’s constitutional characteristics with the effects of experience, and would suggest that it’s possible for the child to learn to behave differently. Interestingly, this possibility shows that acceptable, appropriate, even admirable parent behavior might have an effect on some children that would increase undesirable child behaviors like aggressiveness. In this, there is a resemblance to the work of Graziela Kochanska on more fearful children, showing that very ordinary levels of punishment may be so overwhelming for some children that little learning about behavior is produced.
In Pamela Paul’s Times piece, she quotes the comments of the SUNY at Buffalo developmental psychologist Jamie Ostrov on the Bar-On report (www.nytimes.com.2010/11/21/fashion/21Studied.html). I must say that these comments were the first thing to catch my eye in Paul’s column, and they raised my eyebrows instantly. Ostrov was quoted as saying that the fearless children “may be charming, but they’re also highly manipulative and skilled at getting their way-- even at age 3 or 4”. I must question what Ostrov was talking about, and the extent to which this view (so characteristic of some unconventional child psychotherapies with which I would not expect Ostrov to be involved ) is actually supported by empirical work. None of Bar-On’s material which is available to me says the fearless children were charming, although it does say they were friendly; the idea of “psychopathic charm” is one which has been pushed hard by “attachment therapists”. Ostrov’s statement that fearless preschoolers are highly manipulative and skilled at getting their way (also a tenet of “attachment therapy”) is at odds with what is known about the development of Theory of Mind, a set of abilities by which we understand what other people know, think, and want. Three-year-olds may want very much to manipulate people, but they do a poor job because they do not understand how deception works. Four-year-olds are much better and can sometimes tell a convincing lie, but they have nothing like adult skills (very fortunately for all of us parents and teachers). Why did Ostrov take this opportunity to pass on some poorly-substantiated ideas about personality and mental health in childhood? Was he simply misquoted, or was a longer explanation omitted? I really don’t know, but I’d like to have an explanation from someone.
.
Whether the children were relatively fearful or fearless was ascertained by looking at their reactions to common events like separation from parents or the sound of a vacuum cleaner, or surprising objects like a jack-in-the-box. The operative word here is “relatively”-- it does not appear that Bar-On sought out children who were unusually fearful or fearless.( I ought to note that I have not seen the dissertation, and it looks as if everyone commenting has drawn their information from the University of Haifa press release which is on their web site; what we all say about it is very much subject to revision when we see the details.)
Pamela Paul, writing in the New York Times Sunday style section of all things, implied that the fearfulness-fearfulness dimension measured by Bar-On is equivalent to the aspect of temperament often called approach-withdrawal. Temperament is an aspect of personality that is thought to be “constitutional”, or biologically determined, and which stays basically the same from infancy through adulthood (although it naturally is expressed through different behaviors at different ages). There are half a dozen or more factors in temperament, but approach-withdrawal is a pretty obvious one, especially for children at the extremes. The approaching child tries new foods easily, goes up to the strange dog, behaves in a friendly way to strangers, and so on; the withdrawing child needs a long time to adapt to new things and avoids them as much as possible. It probably makes sense to think of approach and withdrawal as substantially related to fearlessness and fearfulness. Bar-On’s report that the fearless children were friendly also supports this view.
According to Bar-On’s study, the children who were evaluated as fearless were quite good at recognizing when other children had facial expressions of anger, surprise, happiness, or sadness, but they did not readily recognize an expression of fear. The fearful children did a better job at recognizing fear. The fearless children were also more likely to take advantage of other children, and less likely to be remorseful when they had done wrong. Bar-On reported that these differences were like constitutional differences in temperament-- they resulted from genetic variations, not from parenting effects.
However, it’s difficult to determine that normal behaviors in 3- and 4-year-olds are purely constitutional in nature. Much behavioral development is transactional in nature; whatever the basic characteristics of parent and child, they influence each other and each shapes the behavior of the other. As a relevant example, let’s look at how infants make use of fearful facial expressions shown by other people. From 8 or 9 months, babies are able to avoid a lot of trial-and-error involvement with potentially dangerous things. When they encounter a new or unusual person or thing, infants try “social referencing”-- they look at the face of a nearby familiar adult. If that person looks (or sounds) frightened, the baby backs off and avoids the strange event. If the adult looks happy, the baby gradually moves to explore. This is why well-cared-for babies don’t have nearly as many accidents as they might. The mother’s frightened face as the baby crawls toward the unguarded stairs or starts to reach for the candle flame warns most babies very effectively.
But what would happen if a particular baby were not very good at recognizing a fear-face? He or she would not back off in response to the parent’s fear. The caregiver would have to move to keep the baby safe, perhaps swooping down and grabbing the baby away from danger, or even smacking his hands in an effort to get the lesson across. The baby might then associate another person’s expression of fear with the baby’s experience of aggression. Rather than an empathic response to the other’s fear, the baby might be angered by seeing another person look fearful, and by preschool age this could be shown in instrumental aggression toward other kids and a sense that this is justified.
Of course, this is all complete speculation on my part-- I have no idea how this would really happen-- but when we put together the transactional aspect of development, the infant use of “social referencing”, and the vigorous efforts made by attentive caregivers to find ways to keep babies safe, the scenario I’ve given is not an impossible one. In addition, it’s a scenario that would be complete by the preschool period, and would not necessarily be detectable unless longitudinal research followed each child from infancy. These events would be a mechanism that combined the child’s constitutional characteristics with the effects of experience, and would suggest that it’s possible for the child to learn to behave differently. Interestingly, this possibility shows that acceptable, appropriate, even admirable parent behavior might have an effect on some children that would increase undesirable child behaviors like aggressiveness. In this, there is a resemblance to the work of Graziela Kochanska on more fearful children, showing that very ordinary levels of punishment may be so overwhelming for some children that little learning about behavior is produced.
In Pamela Paul’s Times piece, she quotes the comments of the SUNY at Buffalo developmental psychologist Jamie Ostrov on the Bar-On report (www.nytimes.com.2010/11/21/fashion/21Studied.html). I must say that these comments were the first thing to catch my eye in Paul’s column, and they raised my eyebrows instantly. Ostrov was quoted as saying that the fearless children “may be charming, but they’re also highly manipulative and skilled at getting their way-- even at age 3 or 4”. I must question what Ostrov was talking about, and the extent to which this view (so characteristic of some unconventional child psychotherapies with which I would not expect Ostrov to be involved ) is actually supported by empirical work. None of Bar-On’s material which is available to me says the fearless children were charming, although it does say they were friendly; the idea of “psychopathic charm” is one which has been pushed hard by “attachment therapists”. Ostrov’s statement that fearless preschoolers are highly manipulative and skilled at getting their way (also a tenet of “attachment therapy”) is at odds with what is known about the development of Theory of Mind, a set of abilities by which we understand what other people know, think, and want. Three-year-olds may want very much to manipulate people, but they do a poor job because they do not understand how deception works. Four-year-olds are much better and can sometimes tell a convincing lie, but they have nothing like adult skills (very fortunately for all of us parents and teachers). Why did Ostrov take this opportunity to pass on some poorly-substantiated ideas about personality and mental health in childhood? Was he simply misquoted, or was a longer explanation omitted? I really don’t know, but I’d like to have an explanation from someone.
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