Adoption, Fostering, Child Care, Babysitting: Getting to Know a Baby

When we meet new adults, most of us have a whole routine we do in order to be friendly and find out whether we like each other. We ask questions of the right kinds, as convention dictates—where do you live? Do you have children? Are you interested in gardening? (et cetera--  but we save “do you come here often?” for other purposes). The new person may ask similar questions back, in a friendly way, or may not seem interested in us; either way, we find out something about them and begin to figure out what kind of relationship we have. If another adult likes or does the same kinds of things we do, that helps establish whether we’ll get along well or not.

But how do we get to know a baby who doesn’t talk at all or understand much speech? Adoptive and foster parents have this problem to deal with, and on a more limited scale so do child care providers and even new babysitters. Each of these adults needs to know “who the baby is”--  how he or she is unique, and how he or she resembles many other babies. It doesn’t necessarily work well to assume that a particular baby is a “generic baby” who can be cared for in a general “right” way; each baby has biological predispositions to behave in certain ways, and may already have had experiences that have created other personality characteristics. When adults fight against infants’ individual characteristics rather than working with them, the result is likely to be dissatisfaction for everyone involved

How do we identify those individual characteristics? Observation is our only option--  but what to observe? Where to begin? How do we find out what is unique about this baby, and what is like other babies we know?

Here are some questions you might want to ask about any baby you are trying to get to know:

1. Does the baby like to be held? Does the baby arch or stiffen his body when held? Does he or she push or pull away when held? Does the baby cry when held? Snuggle in when held? Calm down quickly when held? Act different with some people than with others?
2. Is the baby comfortable being moved? Does he or she get cranky when moved around in space, or when you change his or her body position? Does the baby cry or look fearful when moved? Does he or she tolerate or like being moved in a circle or held upside-down? Does bouncing around make the baby smile or giggle?
3. Does the baby like movement games or songs? Does the baby seem to look forward happily to someone playing games? Does he or she watch, or turn away when someone starts pat-a-cake or other games? Does he or she participate?
4. Does the baby try new ways to play? Does he or she like for you to play in new ways, or prefer familiar ones? Does the baby pay more attention to new toys or to old ones? Does he or she touch and explore toys, or turn away from them? Does the baby bang or manipulate toys?
5. Does the baby use the mouth for playing? Does he or she avoid mouthing toys or gag when putting a toy in the mouth? Stuff too many toys in the mouth? Chew on toys? Smile or laugh when mouthing toys?
6. Does the baby use the fingertips or the whole hand for play? Does he or she reach for and grab toys? Does the baby hold onto a toy for a minute or two? Does the baby cry when a toy is put into the hand or close the hand to avoid a toy?
7. Does the baby use both hands for play? Does he or she pass a toy from one hand to the other?  Does he  or she use one hand or the other but not put them together? Does he or she reach across the body for a toy or bang two toys together?
8. Does the baby eat strained or solid foods? If so, does he or she sometimes refuse to eat? Does he or she like different food textures, or cry or gag when new textures like lumpy foods are given? Does he or she have strong likes and dislikes about foods?
9. Does the baby seem to like having more than one form of stimulation going on? Does he or she seem to “tune out” if there is more than one form of stimulation, like a squeaky ball with a rough texture? Does he or she fall asleep or cry if too many things are going on?
10. Does the baby seem to like all kinds of stimulation—sights, sounds, and touches?  Does the baby avoid toys with certain textures? Does he or she seem to like to look at bright colors, or prefer to look at plain or quiet sights?
11. Does the baby go to sleep easily? Can he or she fall asleep in many different places? Does he or she need to be rocked, cuddled, or bounced for a long time before going to sleep?
12. Does the baby calm easily after an upset? Does he or she go on crying even though rocked and cuddled, and does the crying go on for an hour or more?

All these questions together will help an adult come to understand the unique individual personality of a baby. In addition, if you know the answers, you will have an idea of the baby’s normal “baseline”--  the ways he or she usually acts. Knowing that baseline will let you know whether  something unusual is going on and whether the baby is getting sick or is disturbed by some event. It also lets the adult caregiver understand that when a baby reacts negatively, this often has to do with the baby’s own personality and is not a judgment of the success or failure of the caregiver.

The answers to these questions don’t let us “prescribe” the right way of caring for a baby. However, they do let us avoid some things that cause negative reactions in the baby, and to seek out as much as possible things that lead to positive reactions. This does not mean that the baby will never in its life have to experience things it doesn’t like! It does mean, however, that we can choose as much as possible to make the baby happy and to make ourselves happy because the baby is happy—thus building the best possible emotional relationship between us.

More on Those Lying Little Liars:Maturing and Learning Until They Lie Well

A while ago, at http://childmyths.blogspot.com/2013/05/when-children-lie-evade-misrepresentor.html, I pointed out that it takes a good deal of cognitive ability for a child to tell a convincing lie. Lying is a skill that develops through a combination of maturation and learning. It is a real part of typical development and does not indicate that the child is emotionally disturbed. Naturally, parents would like their children not to evade or attempt to deceive them--  but equally naturally, they would like the children to tell appropriate social lies (“Oh, Grandma, I love these purple socks with sky-blue pink polka dots--  nobody else has anything like them!”). Lying has a conventional aspect as well as a cognitive one.

When we think about lying, it’s all too easy to confuse the cognitive skills involved in an effective lie with the moral development that forbids lies under some (but certainly not all) circumstances. When people lie, they may or not be breaking moral codes. Understanding when lying is immoral and when it is not is a complicated matter and takes experience and maturation to master. If I go to a dinner party and tell the hostess I like the salad when I actually find it disgusting, few would say that lie was an immoral one; they would be more likely to say that it was at least rude, perhaps even unnecessarily cruel (and therefore perhaps immoral), if I confessed what I really thought. On the other hand, if a friend of mine is arrested for theft, and I state that she was with me at the time even though she wasn’t, my lie, although kind to my friend, would be both illegal and immoral because it could lead to the conviction of an innocent person and other bad outcomes.  (This all just goes to show that the idea of “learning right from wrong” is an enormous over-simplification.)  

So, lying, or choosing not to lie , is partly a matter of cognitive skills that help a child decide what’s likely to be believed and what will happen if he or she is or is not believed. But development of those skills happens in parallel with the learning of conventions about lying and truth-telling and with the development of moral decision-making.

In an article in Child Development Perspectives, Kang Lee of the University of Toronto recently discussed the developmental trajectory of lying in typically-developing children (Little liars: Development of verbal deception in children. 2013, Vol. 7, pp. 85-90).  Among other things, Lee looked at existing evidence about children’s lies in two situations--  when they were caught after having done something wrong, and when they needed  to back up a lie they had already told. Only about 30% of 2-year-olds lied to cover their transgression, but by age 6 more than 80% of children did so.  When they had lied (in an experimental situation, where they had been told not to peek at a hidden toy), 2- and 3-year-olds often denied that they had peeked, but then blurted out “Barney!” (correctly) when asked what they thought the toy was. Older children got gradually better at covering up, but were initially clumsy; Lee reported that one 5-year-old said she didn’t look, but felt the toy, and it “felt purple” so she knew it was Barney.

Lee also described the nonverbal behavior of lying children, and noted that when they lie deliberately, they often mimic “truth-telling” behavior, by making direct eye contact in some situations, and by averting their eyes (as if trying to remember) in others.  These are behaviors that are likely to be much influenced by culture and convention, and Lee’s discussion emphasized the role of cultural expectations in determining how children use “white” or “social” lies. Preschoolers disapprove somewhat of social lies, but when they reach adolescence, after years of instruction and modeling by adults, they see such lies as a positive contribution to social interactions.

It’s obvious that most children lie and that skill in lying is evidence of continuing cognitive development. Paradoxically, although we say that lying is wrong and don’t like to have children do it, we may also need to think of some aspects of lying as positive signs of moral development and empathy. When lying is excessive or appears unnecessary or even foolish to adults, we need to examine the social context, the child’s understanding and intentions, and the child’s expectations based on family and cultural rules. There’s no need to jump to the conclusion that childhood lying is a symptom of mental illness or of character flaws greater than those most human beings display.

An interesting question that has not received much exploration is this: at what age do children know that we are lying to them? Does the subject make a difference?  When they discover that the story about Santa wasn’t true, and that the sick kitten did not go to live with its grandma, do they also come to suspect that other things we say are less than truthful? As is so often the case, it’s what we do rather than what we say that sets the standard.

Apples, Oranges, Red Herrings, and Russian Adoptees' Deaths

In the articles by Tina Traster that I commented on a few days ago, and in many other recent places like http://www.csmonitor.com/World/Europe/2013/0304/As-emotions-over-US-Russia-adoptions-intensify-a-rift-widens-into-a-chasm, writers have stated that the proportion of adopted children who have died of abuse or neglect in Russia is greater than the proportion of children adopted from Russia who have died similarly in the United States.

It’s very reasonable to compare those two proportions rather than simply looking at absolute numbers of deaths in the United States. It’s well understood, unfortunately, that there are some populations (like physically handicapped children) that are at greater risk for abuse or neglect than others. If we could identify Russian adoptees as such a population, we might be able to focus help and resources for their adopted families in ways that would help prevent abuse and neglect at all levels--  not just the amount that is likely to be fatal. This would be a good idea for both Russian and U.S. adoptive families.

But how do we make this comparison? First we have to decide whether a particular comparison would be looking at “apples and apples” or “apples and oranges”. This is not necessarily easy to do, and different comparisons can give us different answers.

One approach would be to look at how Russian adoptee deaths in the U.S. compare to mortality rates for all children in the U.S. There are records of adoptions from Russia to the United States , estimated at about 60,000 children over the last twenty years. Of these, 19 have been documented as dying under circumstances characterized as neglect or abuse. (I believe that it is simply sensationalism to describe such deaths as all having been “at the parents’ hands). The number of deaths considered to be from natural causes or as the result of accidental injury has not been publicized, but it is possible that in that number are “hidden” deaths that might have been more accurately assessed as due to neglect or abuse. I might point out, too, that the custom of changing adopted children’s birth certificates to show their adoptive parents as birth parents may prevent identification of a dead child as being Russian-born, and unless the parents disclose the circumstances, a child adopted as an infant may not have been known as an adoptee. In any case, given the documented cases alone, the rate appears to be about .33 deaths per 1000 adoptions. The mortality rate for children from birth to 19 years in the United States is about 18 deaths due to accident or homicide per 100,000 , or .18 per 1000 , a little over half the rate of deaths of Russian adoptees. For homicide alone, the rate is about .04 per 1000.  (The figures I am using here do not show deaths from neglect, but this is the best I can do, I think.) So, it does appear that Russian adoptees have died at a higher rate  from non-natural causes than all children in the U.S.

How about the comparison of Russian adoptee deaths in the United States to Russian adoptee deaths in Russia? Again and again, journalists have stated that 170,000 Russian children were adopted by Russian families in about the last twenty years, and that 1220 died from abuse or neglect. This would obviously be a high death rate and strikingly different from the death rate reported for Russian adoptees in the U.S. But the figure 1220 seems to have come from an erroneous or ambiguous reading of a document (http://www.usynovite.ru/f/experience/book/book.doc) that refers to records of a preliminary study on deaths of children and incidents of ill treatment of orphans, with 12 out of 1220 dying in situations where guardians or adopters were at fault. There were also 116 who were seriously harmed, with 23 of those suffering harm through the fault of their caregivers. But who were the 1220 we began with? It is far from clear whether they were a group who were all harmed in some way, or whether they were simply a population sample drawn in an attempt to understand rates of harm without investigating all 170,000 cases. Whichever it  may be, it’s clear that any calculation of rates based on these data is what we call a PFA number – Pulled From the Air. There’s no easy way to tell whether this number represents apples, oranges, or some other comparison fruit.

At the beginning of this post, I suggested that making appropriate comparisons could be a way of deciding whether groups of children were for some reason at unusually high risk for mistreatment or other problems when in adoptive families. Knowing that risk factors were present could enable us to channel extra help to those families and to perhaps to prevent some problems. But I don’t think the intentionl of various journalists has been to make comparisons in order to reach that goal. Rather than dealing with apples and oranges, I think most of this discussion has actually been about red herrings. Rather than considering why Russian adoptees have died of abuse and neglect in the United States, some journalists have done their best to distract from the real issue by concentrating on blaming the children, the orphanages, Russian adoptive families, the Magnitsky Act, etc.

Let’s get back to the actual problem. The deaths of Russian adoptees are only one facet of the problem of systematic maltreatment of children, whether adopted from abroad or from the U.S., or whether oppositional or in some other way displeasing to their parents. Such maltreatment can result from mistaken beliefs about early development like those espoused by Tina Traster. We need to stop apportioning blame and start examining with care the expectations that adoptive parents carry into their new relationships. Only in that way can we begin to prevent more family tragedies.

Tina Traster Teaches Us About the Need for Pre-Adoption Education

Tina Traster, the adoptive mother of a child from Russia, has commented a good deal on Russian adoption issues recently (e.g., http://www.northjersey.com/news/opinions/adoptions_050313.html?page=all). She describes how difficult she found it to cope with her infant daughter, but assures us that everything finally turned out well. Interestingly, she states that 20 Russian adoptees have died “at the hands” of their   American parents, but that many more have died “at the hands” of Russian adoptive parents.  This is certainly a sensational way to state the problem, but in fact it’s probably much more accurate to avoid that “at the hands” metaphor, with its implications of strangulation and fisticuffs, and to say that these children have died while in the care of American or Russian adoptive families. Although it’s true that some of the deaths appear to have been caused directly by the adoptive parents, in most of the American cases it’s more likely that a combination of preventable factors eventually culminated in the children’s deaths…  however, I grant that Traster’s journalistic instincts are right in terms of the number of people who get excited by “at the hands” talk, whether it’s correct or not.

Traster’s comments have some real value for people trying to understand problems of adoption, because she lays out carefully a whole series of beliefs and interpretations that made it more difficult for her and others like her to develop good relationships with their adopted children. In doing this, she offers us insight into the kinds of pre-adoption education that could have made these families’ experiences less worrisome.

Don’t get me wrong. I don’t mean to suggest that if you just know the right tricks, the whole thing will be a breeze for everyone. The transition to parenthood is a rocky period of life for almost everyone, and young parents blame their distress on themselves, on the baby, on the in-laws, and on whatever other targets present themselves. Having a baby by birth or by adoption, and “falling in love” with that baby, are events that alter all social dynamics--  between adult child and parents, between husband and wife, between parents and childless friends. What’s more, all those dynamics continue to change as the infant develops rapidly through the first couple of years. There seems never to be time to take a breath and look around for a bit. And in addition, the intense emotion parents feel toward infants and toddlers is astonishing to many who have not experienced it before, especially because it can, and usually does,  include some powerful negative feelings as well as love.  

But let’s look at some of the things Tina Traster thought and is now telling other people they should think, and then let’s consider the realities of infant development.

Here’s what Traster says: “…most, like me and my husband, are caught off-guard when children won’t attach. This condition is called Reactive Attachment Disorder. It is caused by early separation from  a birth mother. Babies don’t get the nurture and love they deserve… They learn, subconsciously, it’s dangerous to attach.”

Looking at Traster’s other publications (e.g., http://www.huffingtonpost.com/tina-traster/adoptive-american-parents_b_2884437.htm), we see that she seems to define “attaching” as being cuddly and accepting of an adoptive parent’s affectionate care. She says, for example, that “Nothing is more mind-boggling than trying to rock and cuddle an 8-month-old who pushes you away. I can tell you how hurtful it is when you’re trying to attach to a child who won’t let you.”

Traster, like so many others, seems completely confused about attachment. She thinks it’s only present if the child behaves in a particular way. She also thinks that her own attachment is something she can try to do, and that it is “mind-boggling” when her efforts don’t work in the way she expects them to. And the problem, she suggests, lies in the child, who “won’t let you” have the emotional experience you have envisioned.

 In addition, Traster thinks (and tells others) that the difficulties of creating an emotional relationship from scratch are equivalent to Reactive Attachment Disorder--  which, according to her, is caused by early separation from the birth mother. These claims are highly problematic, first of all because moving into new relationships is always difficult; when the birth parents care for their child, they have many months to work with the child before the child becomes capable of attachment, but adoptive parents may be jumping in feet first with an older infant. The awkwardnesses of the beginning of the relationship are very real, but they are not a matter of pathology. As to the separation from the birth mother, Traster seems to have forgotten that newly-adopted children have also been separated from familiar people, places, and routines, and must accustom themselves to and learn about a whole new world. If they were separated early from the birth mother and went to an institution or a foster family, there is no reason why they would ever have formed an attachment to the birth mother or suffered from the separation from her.    

I want to try to come to terms with a statement by Traster that does “boggle” my mind. This is the idea that infants learn “subconsciously, that it is dangerous to attach”. Traster attributes such an outcome to a lack of experience with being picked up and held, which she believes young babies yearn for. Let me try to parse these beliefs and compare them to more likely outcomes and explanations. First, of course it is true that infants who have had minimal social and physical interactions with adults in the early months are not likely to welcome such attentions with enthusiasm when someone tries to cuddle them or play with them. Babies have to learn how to enjoy being held and loved, and family-reared babies usually have many experiences in which adults “woo” and engage them in affectionate ways, and the baby learns to enjoy and respond to the adult’s advances. But it’s a big mistake to imagine that infants are born with the idea that they want to be picked up. When very young infants are uncomfortable, they communicate this, and a loving (or even liking) caregiver picks them up and goes through a repertoire of soothing actions, until either the baby settles down or the caregiver gives up. Over time, caregivers get very good at knowing what a particular baby likes or needs, and the baby comes to associate being picked up or even talked to by a familiar person with feeling better.  This doesn’t mean that the newborn is lying in the crib thinking  ”OMG, if only someone would pick me up and love me!” The tiny baby doesn’t know what love is, and has only vague ideas about “someone” and “pick up”.   Excellent development is associated with lots of attention from a small number of affectionate, engaged, engaging adults, and poor development with the absence of such attention, but that does not mean either that the baby is seeking “attachment” or that it comes to think “attachment” is dangerous. By presenting this idea, Traster is “adultomorphizing” the baby--  acting as if the baby’s thoughts are similar to an adult’s--  a popular approach, but not one that helps anyone  understand what happens in an adoptive family.

One more comment about Traster’s view of the Russian-adopted babies. She says that because they are “wired” a certain way (another problematic metaphor, in my opinion) they are potentially dangerous and can be “physically powerful”. Let me point out that older babies and toddlers are a lot stronger than we sometimes give them credit for, and all of them, adopted or not, can deliver a hearty blow to the nose or grab an earring and yank or fling their hard little heads back and smack you in the teeth. This not bad-seed-ishness, but a combination of impulsiveness and failure to understand other people’s feelings.

So, given what Traster appears to misunderstand about infants and children, what lessons could pre-adoptive education fruitfully provide? One is that attachment is not an all or nothing event, but a gradual change in a relationship. Another is that anger as well as love forms part of the intense relationship between parent and child. A third is that attachment behavior does not necessarily include cuddling and acceptance of adult affectionate gestures as desired or fantasized by the adult, but is shown by seeking to be close to the adult when frightened, sick, or distressed. A fourth, and an important one, is that an adopted child may not show the wish to be near a parent in the obvious ways the parent may expect, and the parent may have to learn to interpret subtle cues and respond to them--  and understand that when a parent cannot read the child’s cues, this does not mean that the child “won’t let them attach”.  

There has been important research on interventions that will help an adoptive relationship move forward, and Mary Dozier of the University of Delaware has developed a program that I would like to see included in all pre-adoption education. You can read about this at www.justbeginning.org/article/125, and see a lecture on it at www.youtube.com/watch?v=LEj1aFLHH1Y.

   

Maxim Kuzmin's Death: Anonymous Threats, and the Idea of a Care Autopsy

Some weeks ago, I wrote posts discussing issues about the death of Maxim Kuzmin, a preschool child adopted from Russia and found dead in the back yard by his adoptive mother (http://childmyths.blogspot.com/2013/03/the-investigation-of-death-of-maxim.html; http://childmyths.blogspot.com/2012/03/unanswered-questions-about-death-of.html ; http://childmyths.blogspot.com/2013/more-on-death-of-maxim-kuzmin-shatto.html). In these posts, I stressed the possible similarities between Maxim’s death and the deaths of a number of other children adopted both from abroad and in the United States. My concern is about the need to compare these fatalities, with the goal of identifying dangerous situations in adoptive families and preventing further tragedies.

Recently, however, one or more “Anonymous” readers have advised me that I should not be doing this. One indicated that Maxim’s adoptive mother was terribly distressed by what I had said, and although I can sympathize with objections to public discussion of private matters, I don’t think it’s reasonable or even possible to stop discussion when something so important to all of us has occurred. A second letter named three people who according to the anonymous writer had lied about Maxim’s death. I declined to post this comment, in part because I had no idea whether this was correct, and also in part because Anonymous was declining responsibility for the statement and leaving it to me to be sued for defamation as the one who posted the material.

Yesterday, an Anonymous sent this comment:

“Ma’am, I will give thought to your increasingly advanced age and warn you if you persist in believing everything you read in the media, you may find yourself out of a job or worse your university slammed into the media in a very large lawsuit being prepared based on your accusations or as you like to call it discussions. You need to take into account that some of the things you have read were written by people who have since lost their jobs, are being sued, or are in the process of losing their jobs over ethics violations, coercion, entrapment, and just plain lying to make the story better. Repeating it as if it were true to begin with just makes you look demented.”  

Now, of course I have no idea who Anonymous actually is. I had a guess, but everything in this message was spelled correctly, which is not characteristic of the person I was thinking about. On the other hand, that person has friends, and a couple of them are in Texas, and all of the group are taking an interest in Russian child welfare affairs just now. That person also likes to threaten lawsuits and even bring them (although his attorney quit on him on the last occasion I know of).  Hmm, the more I think of it, the more that phrase “slammed into the media” makes me think of this psychothreatener’s idiosyncratic writing style. The sleazy personal remarks are also characteristic of that person. But here’s the peculiar thing: unless someone was involved in Maxim’s adoption or treatment, how could any of them have legal standing to bring a lawsuit claiming defamation--  even if I had said anything defamatory, which I have not?  And, unless there is far more to this matter than meets the eye, how could they get Mr. and Mrs. Shatto to do so?  

My purpose in discussing Maxim’s death was to work toward bringing together information about a group of child deaths that appear similar in a number of ways. Creating a list of risk factors based on the similarities of such cases could serve to alert adoptive parents and adoption caseworkers to potential problems and thus possibly to prevent deaths and injuries. One such factor may be the diagnosis of Reactive Attachment Disorder coupled with misunderstanding of the nature of this disorder. Unfortunately, there is presently no way to bring together information about these cases unless local reports are picked up by journalists and given wider coverage. When this happens, the information that is provided is often limited in a way congruent with popular belief patterns, as indeed are investigations.   

I want to propose a method of investigating these cases that might be called the “care autopsy”. I base this concept on the “psychological autopsy” used both to identify cases of suicide and to implement research into causes of suicide. A “care autopsy” would trace medical care events; prescription, over-the-counter purchase, and administration of drugs; diet and eating habits; accidental and intentional self-injury; disciplinary practices; a list of all caregivers and time spent with each; sleeping and bed-time practices; toileting and toilet-training events; and parental concerns as well as physical and mental health. These data, collected for the several months preceding the death, would be displayed in calendar form, allowing a reader to note whether injuries or illness regularly followed events like punishment or like the presence of a particular caregiver.

Physicians who are involved in the care of young adopted children can be the best sources of information about causes of death or injury, but to be good sources they must make themselves fully aware of a child’s care experiences—and to do this before a “care autopsy” is necessary. One important responsibility when dealing with a poorly nourished child would be to maintain detailed height and weight charts tracing the child’s growth at weekly intervals, and using that growth trajectory to advise parents on appropriate feeding practices such as offering frequent small meals or substituting nutritionally-equivalent liked foods for disliked ones. Although the best person to offer such advice might be a highly-trained specialist, a pediatrician or pediatric nurse-practitioner will probably be the most likely good adviser an adoptive family can access. If a child dies without anyone having taken this role in his or her care, our “care autopsy” will say so and give us a possible reason why the child did not do well in the adoptive family. If someone has taken this role, the information they can provide may help pinpoint what factors contributed to the death.

I do not write about the Maxim Kuzmin case, or about any other similar cases, because I want to hassle families who have experienced tragedies. I do so because I want to prevent more tragedies from occurring. I believe systematic investigation by “care autopsy” could help in prevention. Silence about these issues will not do so.

  

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International Concerns with Holding Therapy

The following material summarizes the work of a conference that discussed Holding Therapy and similar interventions as they continue to be used and in fact spread into new territory. The report has been sent to a list of professionals and officials involved with child welfare. Readers are invited to comment and to send a link to persons who may be interested.   

                                  Summary Report of the Meeting

 of the International Working Group on Abuses in Child Psychotherapy, 20 April 2013

            All over the world, psychologists and social workers deplore child abuse and work to prevent it. Paradoxically, however, a small number of mental health practitioners choose to use a treatment that has been described as abusive and has been associated with a number of child injuries and deaths. This treatment, usually called “holding therapy” (HT) (or “attachment therapy” [AT]), uses prolonged physical restraint in various forms as a therapeutic method. HT appears to have originated in the United States but has spread internationally as a treatment for autism and for attachment disorders. In response to the spread of HT, concerned individuals from the United States, the United Kingdom, the Czech Republic, and Russia have formed the International Working Group on Abuses in Child Psychotherapy with the goal of public and professional education about HT and prevention of its use. The group met in London on 20 April 2013. This document summarizes background information and the presentations made at the conference, which without exception argued against the use of HT.

Background

            International attention was attracted to the problem of HT in 2000 when a 10-year-old American girl died in the course of treatment. Other deaths, caused by parents following the advice of therapists, have been less well publicized (Mercer, Sarner, & Rosa, 2003). In the United States, a Congressional resolution rejected the use of one component of HT; the American Psychological Association, the American Psychiatric Association, the National Association of Social Workers, and other groups joined in this opinion. In the United Kingdom, the British Association for Adoption and Fostering passed a similar resolution in 2004. The American Professional Society on Abuse of Children (APSAC) mounted a task force to investigate the use of HT and published a report (Chaffin et al., 2006) rejecting the use of the treatment or related methods. The absence of an evidence basis for HT has been noted (Mercer, 2013).

            In spite of these rejections, practitioners in several countries have continued to use or support HT in its various forms.  The U.S. organization Association for Treatment and Training of Attachment in Children (ATTACh), at one time the leading advocacy group for intrusive HT, has now redefined holding of children as a nurturing approach. In 2010,  Adam Pertman, executive director of the Evan B. Donaldson Adoption Institute, a leading U.S. adoption organization, stated approval in an Institute publication of a HT-based treatment publicized in a made-for-TV movie. In the U.K., professional publications (Howe & Fearnley, 2003; Sudbery, Shardlow, & Huntington, 2010) have argued in favor of HT, and a survivor of the treatment has come forward to describe his experiences (Chaika, 2012) . In the Czech Republic, a form of HT has been promoted by the psychologist Jirina Prekopova, who practiced the method in Germany for 20 years, and who has the support of Jaroslav Sturma of the Czech-Moravian Association of Psychologists. A Russian adoption group recently invited a well-known U.S. HT proponent to visit, and HT books have been translated into Russian.

Forms of HT and their implications

            HT exists in several forms, all of which involve physical restraint of children by adults. The original form practiced in the U.S. (Zaslow & Menta, 1975) was brutally intrusive and is known to have caused at least one adult death as well as death and injury to children. It was originally directed toward treatment of autism but later focused on disorders of attachment as defined by HT proponents. Following the 2000 child death mentioned earlier, HT advocates reworked their methods and reported that holding was done only with the child’s agreement. Both the original and the revised forms were often accompanied by parent and foster parent practices that involved withholding of food and water, limitation of toilet use, demands for hard physical tasks, and other efforts to demonstrate adult authority.

            An alternative form of HT was advocated by Welch (1989) with the encouragement of the Nobel laureate Nikolaas Tinbergen and was adopted by Jirina Prekopova. This method involves restraint of a child by the mother, either in a face-to-face embrace for smaller children or with the mother lying prone on the supine child. The period of restraint lasts an hour or more and is to be carried out every day as a treatment for autism or oppositional behavior. As far as is known, Prekopova’s method is not accompanied by the parenting practices described in the previous paragraph.

            No acceptable outcome research has provided evidence to support the use of any HT form. Use of HT methods involves risk of physical harm in some cases, and risk of a failure to treat serious emotional problems by means of evidence-based practices in all cases.

Presentations at the London conference

            At the meeting of the International Working Group in London, presentations were made by a British social worker and a British barrister, a Czech psychologist and a Czech activist, an American psychologist, and a Russian biochemist with an interest in cult-like activities. It will be notable in the summaries to follow, that two presenters chose to be identified by assumed names out of concern for professional and personal repercussions that might follow their speaking out.

1. “Anya Chaika”, a British social worker and author of Invisible England, discussed a British case in which a boy had been subjected to HT while under the care of a major provider of residential children’s homes. As a teenager, the boy was moved from the residential treatment center to foster care provided by the person who had been his therapist in the center, and was persuaded by her to change his surname to hers. “Chaika” was contacted by the now-adult former patient after becoming aware that the organization was using HT and starting a blog to try to collect information about the practice. The former patient has been able to bring a lawsuit against the children’s homes organization and this suit is in progress.
2. Lucinda Davis, a British barrister, commented on legal issues concerning child abuse of any kind, and ways in which child abuse laws could be used against the practice of HT. Discussing the differences between tort law and human rights law, she noted that British or Czech cases needed to be approached initially as involving torts, with appeal to the European Court of Human Rights possible only after all other appeals were exhausted. As is the case in all the common law countries, the practice of HT can be attacked legally in Britain only when actual harm to the child can be demonstrated or assumed. Physical restraint methods are not in themselves prohibited by law.
3. “Mrs. Alena”, a Czech autism activist, described the history of HT as performed by Jirina Prekopova and her students. Prekopova, who had practiced HT in Germany (where she worked with the alternative psychotherapist Bert Hellinger), returned to the Czech Republic in the 1990s and in 2001 developed a HT working group as part of the Czech-Moravian Psychological Society. A movement against HT began following the broadcast of a documentary film praising the method, but Prekopova has continued to receive the support of the Catholic Church, government officials, the Ministry of Education, the  “Our Child” Foundation, and the president of the Czech-Moravian Psychological Society. Prekopova has created outreach programs in Slovakia, Austria, Mexico, Venezuela, Spain, and Italy.
4. Katerina Thorova, a Czech psychologist, discussed psychological mechanisms that might lead parents to the choice of alternative psychotherapies like HT. Thorova emphasized the role of a social climate that is friendly to occult and pseudoscientific beliefs. She described a wide range of problems for which Prekopova recommends HT, including autism, attachment disorders, attention deficit hyperactivity disorder, oppositional and defiant disorder, and conduct disorder. Prekopova’s presentation of HT has cult-like features, attracts the public by manipulative techniques involving logical fallacies, “global truths”, and false analogies. HT propaganda appeals to emotion and proposes a universal solution of “love” for most problems. Because people are subject to cognitive and confirmation biases, cognitive dissonance, and the desire to comply with authority, they find it difficult to resist the appeal of HT.
5. Jean Mercer, an American psychologist, discussed claims that Prekopova’s HT method was based on scientific evidence. These claims were originally based on the support for HT given by the Nobel laureate Nikolaas Tinbergen, whose ethological studies suggested that specific experiences could direct personality development. In the 1980s, Prekopova and German colleagues published several articles concluding that HT was demonstrated to be an effective treatment, but all of the studies were inadequate in that they had small Ns, the outcome measures were vaguely defined, and the outcome measures depended on parent judgments. Scientific support for Prekopova’s HT method, like that for other HT techniques, is extremely weak, and indeed Prekopova has dropped claims about scientific evidence and today presents religious and spiritual arguments in favor of her practices.
6. On behalf of Yulia Massino, a Russian biochemist who attended by Skype, Jean Mercer discussed the intrusion of U.S. HT advocates into Russia at the invitation of some cult-like groups. The major concern of this presentation was the use of “parenting” techniques adjuvant to HT, as recommended by the HT advocate Nancy Thomas, who recommends the establishment of adult authority by parental control of a child’s food, drink, toilet use, and exposure to cold, heat, or darkness. These methods have been associated with malnutrition and in some cases with child death. Books by Thomas and other HT proponents have been translated into Russian. Nancy Thomas visited and lectured in Russia in 2012 at the invitation of an American Pentecostal minister.

Conclusion

            The International Working Group concluded that HT methods are neither safe nor effective as treatments of childhood mental illness, and that their spread internationally is an alarming phenomenon that should be recognized and countered by professional and parent groups. What can and cannot be done about this problem?

Legal challenges to HT have so far been ineffective in common law countries, where freedom of speech issues are privileged. Professional groups have opposed specific legislation about HT methods, claiming that they can regulate members of their own disciplines. In addition, it is difficult to write legislation that describes HT methods in such a way that a change of language or a minor change in methods cannot evade a prohibition. Where government appears to support HT, as in the Czech Republic, legal challenges would seem of little use.

            Professional and public education on the existence and nature of HT methods may be the most effective way to reduce the use of these treatments. However, in the U.S., efforts by professional groups occurred after a well-publicized child death and diminished within a few years. With respect to the almost-nonexistent public education about the HT problem, it should be noted that HT proponents in several countries have for years bombarded the public with propaganda in the form of television “documentaries” and films, and that journalists have contributed to these persuasive efforts by assuming that statements by HT advocates are accurate.   

            What is really needed is for professional groups to mount a proactive campaign of education about HT, rather than waiting for harm to another “poster child”. This will require the kind of political will that usually exists only when a few members of a group are convinced of the need to solve a problem. Such a campaign needs to direct accurate information to mental health professionals and to take into consideration the emotional arguments to the public that, as Dr. Thorova noted, have been effective in persuading parents to accept HT.   

            The International Working Group has taken a small step in the direction of professional and public education and is now asking mental health professionals and professional organizations to join in this work.

References

Chaffin, M., Hanson, R., Saunders, B.E., Nichols,T., Barnett, D., et al. (2006). Report of the APSAC task force on attachment therapy, Reactive Attachment Disorder, and attachment problems. Child Maltreatment, 11, 76-89.

Chaika, A. (2012). Invisible England. Charleston, South Carolina: Chalk Circle.

Howe, D., & Fearnley, S. (2003). Disorders of attachment in adopted and foster children: Recognition and treatment. Clinical child Psychology and Psychiatry, 8, 369-387.

Mercer, J., Sarner, L., & Rosa, L. (2003). Attachment therapy on trial. Westport, CT: Praeger.

Mercer, J. (2013). Holding therapy: A harmful mental health intervention. Focus on Alternative and Complementary Therapies, 18(2), 70-76..

Sudbery, J., Shardlow, S.M.,& Huntington, A.E. (2010). To have and to hold: Questions about a therapeutic service for children. British Journal of Social Work, 40, 1534-1552.

Welch, M. (1989). Holding time. New York: Fireside.

Zaslow, R., & Menta, M. (1975).The psychology of the Z-process: Attachment and activity. San Jose, CA: San Jose State University Press.

Kathryn Joyce's "The Child Catchers": International Adoption Revisited

I am writing this on an appropriate day in the church calendar, Pentecost--  a day that has connections to the topic of international adoption. What are the connections? I think I’ll save that explanation until after I review Kathryn Joyce’s new book.

The Child Catchers is a serious piece of investigative journalism, and as such follows a number of threads in its analysis of the American enthusiasm for adoption in general and adoption from abroad in particular. In the course of this analysis, Joyce reveals not only the excellent intentions of adoptive families, but the corruption that easily followed when the demand for adoptees grew and the supply of orphans did not.

Adoption, both domestic and international, has a long history. For centuries, families have cared for children who were distantly or not at all  biologically related to them, sometimes out of genuine love, sometimes with the intention of using the child’s services, sometimes in order to insure an heir to family property or position. In Western countries, adoption was formalized legally in the 19^th century and involved laws based on those governing property transfer. Those laws guaranteed that a child could have parents but not two families, just as a house cannot have two owners who are not joint owners.

This was the legal situation in the U.S. when in 1954 Harry and Bess Holt, evangelicals from Oregon, became aware of children in Korea abandoned because they were biracial offspring of non-Korean soldiers. The Holts, who adopted eight of those children themselves, encouraged and facilitated large numbers of adoptions, stating their hope that all the children would become born-again Christians and giving preference to fundamentalist parent candidates. The Holts' efforts eventually gave rise to Holt International Children’s Services, now a major adoption agency and one respected for its ethical practices. As Joyce points out, however, the Holts cut some corners and seemed unconcerned about some bad outcomes for children, as well as accusing critics of being “anti-adoption”. The Holts’ attitudes, Joyce says, began “a long-standing narrative of adoption as a battle between saviors and obstructionists who think they know better”.

This battle intensified after the turn of the 21^st century as evangelical groups in the U.S. began to foster an “adoption theology”. This approach stated an analogy between adoption of children and God’s acceptance (“adoption”) of sinners as part of a divine family. Imitation of God’s acceptance was seen as a Christ-like action and a critical part of a Christian life. The adoption theme derived in part from two important tenets of American religious fundamentalism. The first, the “Great Commission”, referred to the obligation of Christians to spread their beliefs and seek converts, not just to Christianity in general, but to Christianity as they themselves defined it. This obligation for evangelism could be partly satisfied by adopting of children whose birth families were not Christian fundamentalists, and bringing up those children in the belief system of the adoptive family. A second tenet came from the New Testament injunction to care for widows and orphans --  an injunction that was easily adapted to stress caring for orphans by adopting them, rather than providing other kinds of help to poor families. (Incidentally, such children could be counted as orphans if they were without fathers, however many other relatives were caring for them.) Some adoption proponents stated that the connection between a child and an adoptive family had been created by God before the world began, and that seeking the intended child was following divine law.       

Evangelical groups declared that there were more than 100 million orphans world-wide, and that their mission must be to bring these children “home”. The picture painted by this statement was that there were children simply waiting to be taken by adoptive families who would do the work and spend the money to get them. This, of course, turned out not to be the case. Many of the children being counted were in fact living with family members who cared for them. In particular, there were few infants or toddlers, the age group that many parent candidates would prefer to take. Some of the children being counted were street children, some already involved in crime and prostitution. Others were victims of disabilities that could not receive effective treatment in their own countries, but who often had concerned families. When children really had been abandoned, their health was sometimes so poor as to make them unlikely choices for adoption, especially for U.S parents without access to public health care programs.

As the demand for children encouraged by “adoption theology” mounted, and the supply did not, the motivation for corruption increased, and the Hague Convention  and UNICEF attempted to fight this tendency. Joyce describes in detail the problems seen in Haiti following the earthquake, as American evangelical individuals or groups tried to circumvent laws about taking children out of the country.  In Ethiopia, a later popular adoption source, difficulties and abuses arose because of communication problems. Like parents in many other cultures, too, Ethiopians had a very different view of adoption than that established in U.S. law, and neither the parents nor the children necessarily expected the visit to the U.S. to be more than a few years in length. Conflict and resistance to adoption to the U.S. soon developed. As Joyce points out, cultural differences (and perhaps observation) insured that Rwanda did not become “the next big thing” for adoption after Ethiopia.

The Child Catchers focuses on evangelical influences in international adoption because “adoption theology” codified and publicized an act that had been a private family matter in the past. But Joyce does not ignore other factors in the rise in international adoption. One of these was an alteration in attitudes toward single mothers such that few who now give birth in the U.S. relinquish their children for adoption. Changes in laws and attitudes about abortion have also had complex effects on adoption; women who do not terminate an unplanned pregnancy have usually chosen not only to have but to keep the baby, and in addition anti-abortion religious groups have been pressured to offer help to women who might otherwise abort. It may also be the case that relaxation of standards about discussing sexuality has freed infertile couples to adopt children who do not look like them, whereas in the past most sought babies who could “pass’ as biologically related and allow them to keep fertility problems private.

Joyce does not emphasize, but does refer to, abusive treatment of some internationally-adopted children. (She is planning to attend the trial of the parents whose treatment killed Hana Williams, an Ethiopian adoptee, so there may be a book on this topic in the future). Although she mentions some extremely large adoptive families, she says little about the possibilities for neglect and exploitation of children in such large family groups, or about the romanticization of large families by the press, where it’s often suggested that huge families represent some sort of Golden Age of family life and happiness. Another topic that I did not see mentioned was the outcome of the practice of keeping together sibling groups of quite young children, with whom it may be impossible for parents to have enough individual interaction for good development.

Joyce has written about evangelicals and family life in a past book, and I thought that in The Child Catchers she might discuss how adoption may provide a socially-acceptable outlet for the talents and energies of women who are not expected to work outside the home. I did not see any comment on this point and was left wondering what the author thought about it. I would have preferred that discussion to the chapter on attitudes in Korea, which was of interest in itself but did not tie in perfectly with the rest of the book.

So, what about Pentecost? The New Testament describes the first celebration of this traditional festival as including the descent of the Holy Spirit on the small number of early Christians and the giving to them of spiritual gifts shown in their “speaking in tongues”. Most mainstream Christians, and some evangelicals, consider this event to have occurred at the time, but not to be a possibility today. (Secular humanists, of course, consider it not to have happened at all, or at most to be a description of events that had natural causes.) But some evangelicals, as well as a few members of the liturgical churches, believe that the gifts of the Holy Spirit, such as speaking in tongues, discernment of  evil spirits, and deliverance (casting out of evil spirits) are possible today, and as a result they refer to themselves as Pentecostals. Like other evangelicals, Pentecostals have been involved in international adoption, and Joyce references a few of them. She does not point out, however, that Pentecostals may believe that adoption “attracts demons” and makes it likely that an adopted child will need to be “delivered” (exorcised) in order to be mentally and physically healthy. Demons are thought to be attracted to the adopted child, not because of the adoption itself, but because of offenses committed by the child’s biological parents and even grandparents, or because of grief and distress felt by them or by the child. Deliverance of the adopted child from indwelling demons may be a relatively gentle process, but it may also be physically abusive. I look forward to Kathryn Joyce’s report about the death of Hana Williams and hope it will show whether these Pentecostal beliefs about adoption were a factor.     

When Children Lie, Evade, Misrepresent,or Exercise Tact: What's Going On With This "Little Liar"?

Nobody really likes a liar. When an adult lies to us we often have a variety of unpleasant feelings and thoughts: He must think I’m a complete fool! She’s just trying to get her own way dishonestly! They must be crazy to think anybody would believe that story!  Or, more forgivingly, we think: This poor soul is completely mistaken! I should treat him very cautiously, as he must be mentally ill to believe what he’s just said!

On the other hand, we appreciate and approve some forms of lying. A neighbor asks another neighbor how she likes her quite hideous hat, and the second neighbor replies that it’s “interesting” or “really different”. We, who are glad we didn’t get asked this difficult question, may admire the evasive response, which is actually a lie: that hat isn’t interesting, it’s just horrible!

Successful lying requires quite a bit of cognitive skill. The good liar has to think about what the recipient of the lie knows or could know, about how likely the lying statement is to actually be true, and about how people act when telling the truth. He or she also has to be prepared for follow-up questions and be able to answer with verisimilitude. No wonder children are not very good at lying!

When children lie, we are relieved when they are [infrequently] just being tactful. But if it’s not tact, we have the same unpleasant feelings we’d have about an adult, and some extra ones too. In complicated ways, we are deeply disturbed by child lies. We think that children should trust us and be not just candid but transparent in their thoughts when we want to know something about them. When they tell us lies, we think that they don’t trust us, or that in some way they are “not really children”--  not the innocent creatures of our fantasies. Some of us begin to think that if a child lies, there are terrible things in store--  not just lying, but stealing and violence and of course sexual behavior. As a result, people sometimes freak out when they detect a child’s lie.

Here’s an example, sent to me by an acquaintance who is part of a Facebook group that focuses on Reactive Attachment Disorder. The example appears from context to involve an adopted or foster child:

“So the lying in our house is reaching new heights. The last couple weeks have been very interesting. I started using the suggested phrase, ‘You can do X (what we want her to do) or you can choose Y (the consequences of not doing it)’. On Monday she lied to me again and got caught thus she had to walk home from school. I was within 100 yards at all times but she did not know that. We live about 1 km from her school and she was home within 15 minutes.  She was scared poopless!! Both yesterday and today, she tried to lie to me  but I could see it all over her face and I pushed until I got the truth.  It took about 46 mins yesterday and 30 mins plus missed swimming today. She is more afraid of the trouble she will get for doing something wrong than she is of the consequences of lying. Clearly we need to step up the lying consequences!! Tonight’s conclusion got me tho. Remember she is just turning 6. Her response tonight as to why she did what she did was, “Because I wanted to and you weren’t there.” In other words, I did what I wanted regardless of what I knew I should do simply because my mom was not watching me for 2 mins. The action was beyond juvenile and reminded me of when I couldn’t leave a toddler unattended for more than 30 seconds.”

There are so many issues in this statement that I hardly know where to begin. First, when I initially skimmed this, I assumed up until almost the end that the child was 12 or 13. Instead, she is going on six, an age at which most actions are “juvenile” by definition and at which many children have the cognitive breakthroughs to Theory of Mind that let them know  how other people can be confused or distracted by what is said to them--  i.e., how to lie. It’s also an age when children have begun to discriminate between what they want and what their parents want, and to think they should get their own way sometimes. John Bowlby, the developer of attachment theory (not therapy) spoke of this period of family relationships as ideally working toward “goal-corrected partnerships”, in which parent and child negotiate or modify what they each want because they also want to maintain their relationship. It is clear that the mother of the “little liar” was not about to enter into a goal-corrected partnership, however, and my guess is that she believes that her child must submit completely to parental authority in order to “become attached” and develop normally. 

Let’s look at some other problems here. Presumably it was safe for “little liar” to walk a short distance home by herself. It might actually be a good thing for her to develop self-reliance by doing this regularly. But mother has framed this as a “consequence” (read: punishment) and therefore something to be disliked. The child is “scared poopless” as the mother announces dramatically with a couple of exclamation marks that would appear to indicate her own gratification at this. Why is the child so scared, other than the fact that she has been told walking home alone is a bad thing being done to her because she was bad? The obvious answer is that this “consequence” is essentially a threat of abandonment, and thus has terrible implications for an adopted or foster child, who has already experienced at least one abandonment. Mother has chosen something she can envision as a harmless punishment, but it is one that resonates with the child’s deepest concerns and needs--  and mother appears to congratulate herself on having found a perfectly legal way to wreak  serious pain.   

   

When people rely on punishment to manage children’s behavior--  and let’s not beat around the bush, “consequence” means punishment--  they (the parents) often paint themselves into a corner. If they find that punishment doesn’t do the job, they can only think of one alternative: to escalate the punishment. The “little liar’s” mother says so. If the child is more afraid of being caught doing something wrong than of the consequences of lying--  voila, the answer is to step up the consequences of lying. (She would certainly not want to step down whatever punishment the child is so afraid of, would she?)  Whatever punishment people use, and however effective it may be at times, the problem arises when it does not work, or the results are not as quick and complete as desired. Very few parents who are believers in punishment can think of any answer other than intensifying the ineffective punishment. Like “little liar’s” mother, they seek a level of punishment that will be truly distressing to the child, and regrettably may be satisfied by seeing that the child is miserable (“scared poopless!!”) rather than evaluating whether the desired behavior change was brought about by the parental action.

One other thing, before I yield to the temptation to become sarcastic here—what about the mother’s interpretation of the child’s statement that she wanted to do something and “you weren’t here”? Mother has read this to mean that “you must always spend all your time watching me and never have a relaxed moment.” I would suggest reframing this as meaning something like “I want to control what I do, but when there’s no caring adult here I just can’t manage it yet”. Readers who have been teachers may remember Vygotsky’s “zone of proximal development”--  when a child is beginning to master a skill but hasn’t yet got it under control, he or she may be able to do it when an interested, familiar adult is nearby to give support, but not when alone. We often think about this as applying to tying shoes or doing simple arithmetic.but it applies to “behaving well” too.

It seems that “little liar” has told her mother “I need you!” by her fear when walking alone and by her statement that she cannot behave as asked without plenty of support. The mother does not seem to have heard these messages. Instead, she has framed the relationship as a fight to the finish between the child and herself. Unfortunately, whatever the outcome in such a fight, it is the child who loses.

 

Guiding children to understand rules about lying is an important parental job. But, it can’t be done with the approach used by “little liar’s” mother. 

Systematic Maltreatment of Adopted Children: A Federal Case At Last

Many posts on this blog—as well as plenty of other sources--- have described how some adoptive parents in the United States use planful and systematic maltreatment of children in the mistaken belief that painful experiences will teach children to “behave” and to love their caregivers.

The maltreatment in question goes far beyond spanking and may cause real injury or even death. For example, some parents withhold food and drink or severely limit the amount and type of food and liquid available to the child. The same parents may under some circumstances force the child to drink large amounts of fluid or to eat food laced painfully with red pepper or hot sauce. Children may be confined to cages and have their access to toilet facilities limited. Exposure to excessive cold or heat and to hard and tedious manual work may be part of the treatment.  In some cases, beating or whipping are also practiced. This range of “parenting” methods would be judged to be torture if used in adult prisons. The parents, however, appear to be convinced that  these techniques are suitable methods of child guidance and discipline and indeed are necessary to shape acceptable behavior in adopted children from risky backgrounds.

When children are not badly hurt by these forms of maltreatment, it is likely that no one outside the family circle knows what is happening--  especially if children are homeschooled so the surrounding community does not see or hear them. When serious injuries or deaths occur, it becomes much less possible to conceal systematic maltreatment, and parents who have participated in maltreatment have in a number of cases been arrested, charged, tried, and imprisoned. In all cases known to me before now, the cases have been brought in state courts in response to the breaking of state child abuse laws. Frequently, neighbors, relatives, clergy, and social workers or therapists have testified on behalf of the adoptive parents. Over the last 15 years, there have been a number of cases in which a “RAD defense” was mounted, as defense attorneys claimed that the parents’ responsibility should be mitigated because of the challenging mental illness of the children. Without wishing to cast aspersions on state courts, I think it is reasonable to suggest that the local nature of these trials, and the level of misinformation about childhood mental illness, made it possible for public opinion to play a role in reducing the sentences of parents who had done serious harm to adopted children.

As of this last week, a case of systematic maltreatment of adopted children has resulted in the indictment in Federal court of Carolyn and John Jackson, a couple presently living in Mount Holly, NJ. The indictment (www.justice.gov/usao/nj/files/pdffiles/2013/Jackson,%20Carolyn%20and%20John%20Indictment.pdf) charges the Jacksons with one count of conspiracy to endanger the welfare of a child, 13 counts of endangering the welfare of a child, and three counts of assault. The U.S attorney, Paul Fishman, described the Jacksons’ treatment of the children as “unimaginable cruelty”, but regrettably it is all too easy to imagine for those of us who have been attentive to these issues and have seen the same methods used over and over again. The Jacksons employed all the usual ones, withholding food, water, and medical care, forcing red pepper and hot sauce ingestion, and using forced salt ingestion to increase the effect of withholding water. In addition, at least one child was beaten to the point of broken bones. In addition, as has occurred in other cases, the Jacksons’ biological children were maltreated as a result of their parents’ demand that they participate in tormenting the adopted siblings by preventing them from drinking. The children did not attend school, needless to say.

Why Federal court for the Jacksons, when ordinarily child abuse charges are the business of state courts? As it happens, John Jackson was a major in the U.S. Army, and at the time of the maltreatment of the children the family lived at the Picatinny Arsenal Installation in Morris County, NJ. Their actions were thus on Federal property and subject to Federal law. This fact provided the one desirable circumstance in this tragic situation. It is much to be hoped that a trial in Federal court, with all its related resources, will lay bare the realities of systematic maltreatment of adopted children by misguided adults.

It is, of course, probably too much to hope for, that those who advised the parents will also be pointed out to the public. But it is possible that any collusion of adoption caseworkers and the Jacksons (if any occurred) will be revealed. The Jacksons originally fostered the children and later adopted them, presumably giving caseworkers opportunities to understand their belief system before recommending adoption; approval of the adoptions suggests that caseworkers either failed to understand the Jacksons’ beliefs and methods--  or, alternatively, agreed with them. It would be a great mistake to assume that the Jacksons’ system was disapproved by all, as can be seen in the support given them over the last two years by some contributors at www.facebook.com/pages/Support-for-the-Major-John-Carolyn-Jackson-Family-of-New-Jersey/183604398328648.