The Harris Case: Attachment,Trauma, Ambiguity, and Investigation

Unless you read only the New York Times (which hasn’t mentioned a word of this), you are probably aware of the Arkansas case of Justin Harris, a state legislator, and his wife, who adopted two little girls, exorcised them, treated them with harsh “parenting” methods, and passed them along privately to another family, where one was sexually abused. The most recent discussion of this case and its background is at www.arktimes.com/arkansas/harris-therapy-controversial/Content?oid=3755237). Before writing this article, Leslie Peacock, an Arkansas Times editor, talked at length to me and to Jean Crume, a DHS social worker, as well as doing a great deal of reading and considering the testimony of the babysitter who took care of the little girls for a period while they lived with the Harrises.

When Leslie and I started our discussion, one of the first issues that came up was what some terms meant. If the Harrises were using “attachment therapy” with the girls—a method that Jean Crume says she sometimes uses—exactly what did that amount to? We looked back at the 2006 APSAC-APA Division 37 Task Force Report, and saw that in 2006 the authors had stated, “The terms attachment disorder, attachment problems, and attachment therapy, although increasingly used, have no clear, specific, or consensus definitions.”  This continues to be true a decade later, and in my opinion this is the reason why conventional treatments focusing on parent-child relationships are usually called “attachment-focused” or “attachment-based” therapies, or words to that effect, rather than “attachment therapies”. For myself, I would define “attachment therapy” as a form of intervention derived from the older Holding Therapy, and popularized at the time in the early 2000s  when the dangers of Holding Therapy were being publicized. I would add to this that “attachment therapy” is based on a conflation of child attachment with child obedience and compliance, and on the belief that re-enactment of posited infant experiences in later life causes a child to become emotionally attached to an adult caregiver.

I don’t know whether these would be Jean Crume’s definitions of the “attachment therapy” that she considers suitable in some cases. I do know, though, that as the Arkansas Times pursues its proposed investigation of DHS, terms must not be allowed to go undefined. “Attachment therapy” is an especially problematic term, because for many readers, “attachment” sounds good, and “therapy” must be good, so “attachment therapy” is definitely more than acceptable—even though some practices associated with that label would probably be rejected if they were called “isolation treatment” or “no-toys intervention”. The investigation of DHS must clarify this point.

But of course “attachment therapy” is not the only problem word. Jean Crume is quoted as calling Nancy Thomas methods “controversial”. What do people mean or understand to be meant when they use this word? My big old Webster’s says it means “debatable”, which seems not to be much of a description, as most things more complicated than the time of day are open to debate. It seems to me, however, that in fact the principles and practices of “attachment therapy”, including the “parenting” techniques, are not at all debatable. On the contrary, there are a large number of psychologists and other mental health professionals who would regard those beliefs and practices as totally wrong and unacceptable. Opposed to those thinkers are a small number of persons with various backgrounds who claim not only that “attachment therapy” is effective, but that conventional methods exacerbate children’s problems, and that even the most basic conventional ideas about attachment are incorrect. There is no debate here. These ideas are mutually exclusive. If the conventional attachment theory and treatment methods are right, “attachment therapy” approaches cannot be right, and vice-versa—if “attachment therapy” views are correct, 75 years of research on attachment must be overturned and forgotten.  Where is the controversy? Could it be that Jean Crume and others really mean, “A lot if people don’t like these ideas, but I think they’re all right, and there’s no law against the practices unless somebody really gets hurt”? If that is not what they mean by “controversial”, I can’t guess what they might mean. But I think it would be essential for any investigation to be sure what is intended.

Toward the end of Leslie Peacock’s article (linked earlier) a DHS spokesperson says that the agency is working toward educating foster parents about trauma and its role in determining children’s later behavior. She noted the focus on a “trauma informed” approach and the intention to use Trauma Focused Cognitive Based Therapy, an evidence-based treatment for children who have been sexually abused or hurt by domestic violence. But the spokesperson goes on to say. “Training has also been provided to a number of foster parents. We think a trauma-informed approach is critically important and we’ll be working…on how we can accomplish training for all foster parents.” So, investigators--  what is going on here? TF-CBT is indeed an evidence-based method, but it is taught to and used by qualified professionals. The foster parents are not going to become psychotherapists in the professional sense. What are the foster parents being taught about trauma, about what experiences have traumatic effects, on the behavioral outcomes for children, and on what methods can be helpful? I ask this question not out of general suspiciousness, but because the term “trauma” has “crept” to a much wider meaning than it originally had, just as happened years ago with “attachment”; trauma is now sometimes used to mean practically any bad thing, just as attachment came to mean all good things when present, all bad things when absent. Just a few days ago, I published a post on this blog on the subject of an adoption agency in Ontario whose website baldly stated that all adopted children have been subjected to extensive trauma because of the separation from the birthmother, to whom, it was claimed, they had developed a powerful emotional attachment during their gestation—an idea completely at odds with established research on attachment, but certainly popular with Nancy Thomas and “attachment therapy” advocates . What are the foster parents being taught? The term “evidence-based” seems to be intended to describe their training as well as the professional training, but I don’t see how that can possibly be. Investigators need to explore this, because the attitudes and expectations of foster parents are a good deal more likely to affect children than their occasional visits to therapists.

There are a lot of questions to be asked before anyone understands exactly what has been going on in Atkansas, as well as in many other states’ human services departments.

   

Attachment and Trauma Network Defends the Harrises

When anybody gets caught harming children by applying attachment therapy and parenting as proposed by Nancy Thomas, you can bet the Internet wagons will be circled quickly. This was apparent after Connell Watkins and Julie Ponder were convicted in the “rebirthing” death of Candace Newmaker in 2001. The practitioners’ supporters got on line to claim that the 10-year-old had died on purpose in order to cause trouble for the hated adults.

Now, with the latest concerns about the actions of the Arkansas legislator and his wife toward their [briefly] adopted daughters, culminating in “rehoming” and the rape of one young girl, we are beginning to see the same kind of thing. I give you for example http://blog.attachmenttraumanetwork.org/representative-harris-rehoming-controversy/ . This post begins with the mistaken claim that instead of squashing a guinea pig, a three-year-old killed the family cat--  an animal that would take a lot more work to kill than a guinea pig, and would bite and scratch effectively if hurt. (Next week: a German shepherd puppy? That’s the animal that Nancy Thomas most often claims children have killed.)

This little “mistake”, of course, escalates the whole situation and fleshes out this effort to point to the girls as well as the bureaucracy, rather than the Harrises, as the true villains. Incidentally, the former foster parents of the girls denied any such disturbing behavior, but of course a typical explanation of attachment therapy advocates would be that this simply shows how cruel and cunning they were, and how they fooled the naïve foster parents, to have their true natures appear only when the adoptive parents were in range. The ATN blog thus calls the one girl “extremely troubled” in spite of evidence against this assessment. Interestingly, the blog post is unsigned, and the site only says that posts are written by a core of volunteers.

The ATN blog, having set the stage, now takes advantage of the story not to express sympathy with the little girls, but to pity the Harrises, and to propose administrative changes to prevent such problems. They state two problems that I  too strongly agree need correction. One is the use of threats of abandonment charges when adoptive families feel overwhelmed and want to back out; I have certainly heard of such threats being used, and if they were used with the Harrises I consider that regrettable (especially as it has provided a nice red herring to distract from other issues.) The other problem is the requirement that parents relinquish parental rights in order to get state support for mental health care for their children. This is a fight that has been going on for some years and has been supported by the Bazelon Center among others. However, it is not at all clear to me what this has to do with the Harrises’ situation, unless there was some fear that relinquishment would be treated as abandonment and other children in the home would also be taken as a consequence. State laws differ on this point.

The ATN piece goes on to say that there should be uniform provision of Medicaid-paid services for children, including mental health services, and that these should “go with” the child who is placed in a different state. That’s all as may be. May the issue not actually be the wish that Medicaid would pay for the types of services the Harrises used--  attachment therapy methods of various kinds? Members of ATN, like its founder Nancy Spoolstra, are themselves proponents or practitioners of these methods. The methods are “alternative psychotherapies”, implausible, without an evidentiary foundation, and potentially harmful. Medicaid does not pay for such treatments unless practitioners bill dishonestly and give specious descriptions of their services. And Medicaid should not pay for mental health services that are not supported by strong evidence of effectiveness.

ATN has done its collective best to distract attention from the Harrises and to focus it on the claimed disturbed behavior of the girls, and the failure of the bureaucracy to support the Harrises. Let me bring back the focus to what the Harrises actually did to create the situation that led to a range of genuinely traumatic experiences for the little girls.

• They insisted on adopting the girls in spite of recommendations by the foster parents and others against placing the girls in a home with three boys.
• Although they stated their concerns about attachment disorders in the girls, and therefore presumably wanted the girls to form emotional attachments to them, neither of the Harrises appears to have spent much time with the girls. According to their babysitter’s testimony, the girls attended the Harris-owned day care center 5 days a week and had a teenage babysitter for the rest of the afternoon after they came home.
• Rather than seeking help from a knowledgeable, licensed clinical psychologist or psychiatrist, the Harrises called in exorcists and used the treatments recommended by the erstwhile dog-trainer Nancy Thomas. They apparently believed that the girls could communicate with each other telepathically, against all scientific evidence.
• Given their intention of “rehoming” secretly, the Harrises could have had an assessment of the proposed home done privately, to make sure that their judgment of the appropriateness of the parents was correct; they did not, but relied entirely on their own judgment, beliefs, and personal relationships.
• They encouraged their sons to be afraid of the girls, as shown by Justin Harris’s report that the boys came to sleep with him, and thus communicated to the girls that there was something very wrong with them.

No one could reasonably contend that children from the background the girls had would be emotionally and behaviorally the easiest to care for. Neither can anyone deny that the bureaucracy surrounding adoption is often inconsistent, prejudiced, hostile to parents, and downright Kafkaesque.  But those facts do not outweigh the reality that the Harrises insisted on having their own way, for their own reasons, and made a series of decisions contrary to what any well-educated mental health professional would have told them. They knew they were right because they knew they were right. The girls have paid and continue to pay the price for this, but that seems to be the least of the problems as far as the Harrises and the Attachment and Trauma Network are concerned.

The Primal Wound and the Trojan Horse in Ontario

Some time ago, I wrote a post about how misinformation sneaks into public thinking when braided together with accurate information (http://childmyths.blogspot.com/2014/12/mistaken-attachment-beliefs-persuasion.html). I referred to the practice of combining information with misinformation as a Trojan Horse. (I tried to work out another metaphor involving Odysseus and his men escaping from the cave by hiding under the sheep, but that didn’t seem to be what was needed--  besides, I’ve always thought those must have been awfully large sheep. Or small men.)

Jessica Pegis recently alerted me to an egregious Trojan Horse being parked outside Canadian castle walls at http://www.adoptontario.ca/childhood-trauma. This is a site run by AdoptionOntario, an organization that is partially funded by the provincial government. It presents a rather thoroughly braided group of statements, and I think it would be valuable to disambiguate them.

Let’s look at the accurate information that is given there. The site points out that very young children may be affected by traumatic events, and that they are sensitive to events that threaten their caregivers as well as threats to themselves alone. Domestic violence and natural disasters can create situations that are traumatic for young children, as can painful or frightening medical procedures or abrupt separation from familiar people. Some traumatic events occur once and never again,  but the site notes that it’s common for children who experience a traumatic event actually to  have more than one  associated traumatic experience. (A natural disaster like an earthquake, for example, is frightening and even painful in itself, but may be accompanied by the sight of injured or dead people and the confusion and distress of the adults the child usually can trust to provide safety.  ) But repeated traumatic events, like sexual abuse, are even more likely to have ill effects on children’s emotional and cognitive lives than single events are.

So far, so good. There’s nothing wrong with what adoptontario.ca has said up to this point. But on closer inspection, here’s what we find:

“Trauma for an adoptee begins at the moment of separation from a birthmother. Whether adopted from birth or later in life, all adopted children have experienced some degree of trauma. Until recently, the full impact of trauma on adopted children has not been fully understood. Since infants do not see themselves as a separate entity, it is believed they see themselves as a part of the person they physically attached and bonded to for 40 weeks. When separated, infants may naturally feel they have lost part of themselves. When an adoptee is separated from a birthmother, extensive trauma is experienced. The trauma will not be remembered, but it will stay in the subconscious as it was lived. Any event in infancy can and will stay with an individual through life.”

Later, the site states:

“Theoretically, adopted children have experienced being unwanted before they are born. In addition, they may have experienced the loss of the mutual and deeply satisfying  mother-infant bond. This experience can affect them in more than one way, including

·         Grieving the loss of their birthmother

·         Being emotionally vulnerable

·         Anger

·         Shutting people out, depression, or overcompensation” (this list is in addition to other claimed results of childhood trauma)”

With this material, we see the Trojan Horse at work. Under cover of accurate information, the web site has now brought in some completely inaccurate statements--  and even worse, a group of statements that can lead adoptive families to misinterpret normal behavior, and adopted individuals to believe that they are doomed to emotional disturbance. A quick glance at the accurate information could easily lead readers to believe that everything on the site was of equal value.

What’s wrong here? What has entered inside the Trojan Horse supplied by the correct information?

The essential point to consider is that there is no evidence that unborn infants do form emotional attachments to their mothers, or that they recognize their mothers at birth. The possibility that attachment could have started  40 weeks before birth is ludicrous--  first of all, because 40 weeks before birth is the average date of the first day of the mother’s last menstrual period before pregnancy, not the date of conception! It would be even more absurd than the rest of this stuff to assume that an ovum, ripening but unshed, and certainly unfertilized, has already begun to develop an emotional bond to a woman who may not even have intercourse during the time window that would allow for fertilization. If this were true, how tragic to think of all those unfertilized but attached ova being swept away from Mommy in the course of her next period—enough grief each month to overwhelm the cosmic plan, especially when Mom (callous bitch that she is) says to somebody, Thank goodness, I got my period, I was getting worried.

Emotional attachment of infants to familiar caregivers takes place over months of social interactions and begins to show up behaviorally at about 7 or 8 months of age in most babies, when fear of strangers and of separation first emerges. Younger babies welcome social interaction with strangers and show little distress when separated from familiar people. If some prenatal form of attachment has occurred, it certainly does not show up in infant behavior or mood, or in any other measurable way.

Okay, let’s say that the 40 weeks is just a clerical error. Let’s place the time at 38 weeks before birth. The ovum gets fertilized. Does it have a nervous system to remember or learn things with? No; but this doesn’t matter to those who believe (as seems to be a possibility for someone at adoptontario.ca) that it’s “cellular memory” that’s at work, a kind of memory in each cell that represents events in the deepest way and survives mitosis each time, so that all cells have the memory of whatever happened to that ovum. This belief is completely contrary to everything we know about learning and memory. If it’s true, all scientifically-based statements about this or false. I’m not saying there could not be such a new paradigm--  but really, what are the chances?

What about the idea that everything experienced in infancy is preserved “as it was lived” in the “subconscious”? Study after study of memory tells us that memory does not preserve material “as it was lived”. On the contrary, when memory works (which is not always), it maintains not a photograph but the gist of an event, which the rememberer then reconstructs to create a belief about what “must” have happened. The adoptontario.ca author seems to be embroiled in what has been called the “trauma-memory war”—the claim that early traumatic experiences cannot be consciously remembered, but are nevertheless directing matters from behind the cognitive scenes.

Basically, without saying so (and this is another sign of a Trojan Horse), adoptontario.ca has stated a belief in the claims of the California marriage and family therapist Nancy Verrier that every adopted individual has experienced, and continues to suffer from, a Primal Wound, from which he or she can recover only with difficulty or not at all. This belief system can be traced to the “psychohistorian” Lloyd DeMause, who presented a bizarre description of what unborn babies must really be experiencing. (DeMause was able to promulgate this for quite a while because he was quite well off and started his own journal with papers about his claims.) DeMause, and Verrier too, received much support from the Association for Pre- and Perinatal Psychology and Health (APPPAH), whose members would be in complete agreement with adoptontario.ca.

Canadians, your provincial money is going to support this unfounded material, and to contribute to beliefs that are potentially harmful to adopted people, adoptive families, and birth parents who consented to adoption! How about speaking up?

How Would a Child Feel If Told She Was Possessed by Demons?

Continuing to read about the claims that the young sisters in the Justin Harris case were possessed by demons and required exorcism (www.nydailynews.com/news/national/ark-legislator-thought-adopted-daughter-possessed-report-article-1.2146752) has made me wonder how those claims would have made the children feel, and what they would have come to believe about their actions.

It’s certainly common enough to attribute moods and behavior to natural entities other than ourselves. In Western countries, people make excuses for drunken behavior by saying, “That was the alcohol talking”, though they know full well that alcohol does not talk. When children are medicated for emotional or attentional problems, concerns are often brought up about the messages the children get from this—will they believe they cannot control their impulses without a lot of help? Will they seek drugs as ways to change their own feelings and actions? It’s easy to see how alcohol and medications can be interpreted as reasons why behavior should go in a particular direction. After all, drinkers have heard many statements about impulsiveness caused by alcohol, and children often overhear their adult discussions about their need for medication, even if adults do not tell them to their faces that medication changes them in a desirable way (and sometimes adults do tell them that).

How does all this relate to the effects of telling someone they are demon-possessed? Most of us adults would respond in ways based on our own belief in demons, or lack thereof. If we don’t believe, we would think no differently of ourselves, but might tell our informant, “You’re nuts!”. If we believe in demon possession, we would presumably comment on whether we felt that way or not, ask the other person to explain why he or she thinks so, or possibly seek help in getting rid of the demons. It’s doubtful that either believers or non-believers would change their usual behaviors  on the basis of a demon attribution.

But--  what if someone tells young children that they are demon-possessed? That age group does have a tendency to believe the stories we tell them--  Santa Claus, the Tooth Fairy—and presumably demons would be believed too, especially if the adults were serious believers, as it would appear the Harrises were. If the babysitters’ story is correct, the Harrises also believed that the girls could communicate telepathically (or perhaps they thought their demons could do so?), and this belief would also have been passed on to the girls. Once the demon concept, and the likely activities of the demons, were established in the girls’ minds--  whether by direct statement or by overheard adult conversation—the girls’ interpretation and expectation of their own behavior might be dramatically altered. Whereas a child of 6 would normally know that she was the one who decided to smack her sister or to hide unwanted food under the tablecloth, one who accepted the demon-belief system presented to her might well act on any impulses, on the assumption that the demons were doing whatever it was, and she herself had no control over what happened. At her age, she has little capacity for the “spiritual warfare” that believers consider to be the only defense against demons, and if she is possessed by “spirits of violence”, she will be violent--  this she has been told, and this she may well believe and act on. Any accidental misbehavior (that guinea pig?) would simply be woven into the belief system and taken as supporting adult statements.

It’s hard to know how many comments about demonic possession might be made to or in the presence of young children. But those who believe in demons have elaborate ideas about what demons can do and how they come to possess people. A common belief is that demons are attracted by illicit sexuality; this means that adopted children who were born out of wedlock are quite likely to be possessed, and that this is especially true if the child has been sexually abused, when “demons of lust” may cause the child’s behavior to be sexualized and even to present temptation to adults. (I have no way to find out, but I do wonder whether anyone thought that the girl who was later raped had tempted her attacker.)

The book Pigs in the parlor, published in 1973 and re-issued in 2010 by Frank and Ida Mae Hammond, gives examples of how ordinary childhood behavior is interpreted to children as the results of demonic possession.  Here is one story, told by Ida Mae Hammond: A divorced father came to the Hammonds asking for help in handling his daughter Mary, who was in his custody. She was difficult, stubborn, and rebellious, and he felt he became too angry and punished her excessively. “I said, ‘Mary, your father tells me that you know there are bad spirits.’ Her eyes widened and she began to tell me very seriously how  every night she had to make sure all the doors were locked before she could go to bed. When she got up in the night to get a drink or go to the bathroom she was afraid and had to know personally that all doors were securely locked. I said, ‘Yes, that is fear, Mary. You have demons of fear in your body. They make you afraid and I want to pray for you and make them leave your body. They have gotten inside you and when I pray they will come out of your mouth and leave.’… The Holy Spirit very plainly told me to keep my voice very quiet… Also, to consider every word hereafter that came out of Mary’s mouth to be a demon speaking or to be demon inspired.”

Mrs. Hammond thus offered Mary a reinterpretation of her own anxiety and (apparently) somewhat compulsive behavior, making her actions not an expression of her own concerns, both typical of her age and related to her parents’ divorce. Instead of worries that Mary herself could master with adult support, and whose nature she could recognize, her behavior was recast as the working of an all-powerful spiritual world, with which Mary could cope only with the help of certain adults. Even Mary’s own speech was identified as demonic in origin and not representative of her real thoughts. The natural development of autonomy and the growth of what John Bowlby called goal-corrected partnership with adults  had to be abandoned in order for Mrs.Hammond to believe that she had rescued Mary from various demons.  

Nobody seems to know (and probably nobody will ever know) exactly what messages about themselves were actually communicated to the girls the Harrises so temporarily adopted. However, these demon stories, added to the evidence about Nancy Thomas parenting, raise serious questions about the impact on the girls of their experiences, and raise additional questions about assessments of adoptive parents that omit consideration of potentially dangerous beliefs.

Reactive Adoption Disorder: A Diagnosis "Not Yet" in DSM [satire warning]

Poke around on the Internet, and you’ll find plenty of sites viewing with concern the existence of adult Reactive Attachment Disorder, listing its symptoms, and revealing with dismay the devastation it wreaks on personal relationships—all this, while it’s clear that nobody is sure how they would go about diagnosing such a disorder even in school-age children, much less in older people. Yet there is no mention of a seriously problematic disorder, causing harm to both adults and children, which (like “Attachment Disorder”) is not yet to be listed in DSM.

I speak of Reactive Adoption Disorder. This problem is not found in most adoptive or foster parents, but is conspicuous in a small population found primarily in the United States, but cropping up recently in Russia.  Reactive Adoption Disorder is an old and real problem whose name I just made up, and where it exists, families and children are subjected to traumatic experiences. Adults suffering from Reactive Adoption Disorder feel compelled to adopt large numbers of children whom they may not particularly like or have the capacity to care for. When these adults find themselves overwhelmed by one or more of the children in their care, they may “re-home” them by informally transferring them to the care of other adults. After some of the children are “re-homed”, the adults with Reactive Adoption Disorder find themselves in need of further adoptions, which they carry out with or without the help of adoption organizations, often becoming “serial adopters” and a danger to themselves and others.

Here are some common signs and symptoms of Reactive Adoption Disorder:

·         The primary symptom of the disorder is the wish to adopt large numbers of children even when infertility is not an issue, or, for some, to be involved in adoption work and to facilitate as many adoptions as possible.

·         Adults suffering from Reactive Adoption Disorder have cognitive confusion in which they conflate adopting children and bringing them up as evangelical Christians with facilitating the End Times to which they look forward as a time of their own justification.

·         Adults suffering from Reactive Adoption Disorder are lacking in self-worth and do not assign much worth to their existing birth or adopted children; a sense of worth is gained by repeatedly adopting and struggling with a family that is beyond the adults’ capacities.

·         Adults with Reactive Adoption Disorder have little sensitivity to indications of affection, and recognize that children have positive feelings for them only when the children are physically affectionate or state specifically that they love the adults.

·         Adults with Reactive Adoption Disorder are chronically angry and seek opportunities to express their anger by instigating conflict with vulnerable children.

·         Adults with Reactive Adoption Disorder demand complete control over others and are easily persuaded by suggestions that exertion of adult authority always works to children’s benefit, or that they are behaving appropriately when they arrange informally for a child to live elsewhere than the legal adoptive home.

·         Adults with Reactive Adoption Disorder confuse cause and effect when they claim that a child has forced them to use severe punishment or to seek “re-homing” for the child.

·         Adults with Reactive Adoption Disorder appear to have poorly developed consciences, as when their actions have harmed or rejected children they tend to show no remorse, but instead blame the child or other people for what they have done.

·         Adults with Reactive Adoption Disorder are fascinated with criminal or disturbed behavior and tend to interpret normal childhood behaviors as indicating severe disturbance.

Unfortunately, the moods and behaviors of adults with Reactive Adoption Disorder  make it likely that they will treat children in ways that cause the children to experience fear, anger, and helplessness. The resulting exacerbation of any existing child problems may mean that the child is placed with adults who may also mistreat or even sexually abuse him or her, or placed in a “treatment center” where medication and disturbing experiences intensify old problems and create new ones. These children may receive little education, have minimal practical experience of the world, and “age out” at 18 completely unprepared to enter adult life, as well as vulnerable to sexual and other predators.

I am sorry to say that no effective treatment for Reactive Adoption Disorder is known. However, prevention of adoption by these adults, and careful scrutiny of the work and attitudes of affected adoption workers, can at least minimize the harm done to others by the disorder. For the good of all, these people need to be stopped before they become serial adopters.

Thinking About the Justin Harris Case: Iatrogenic Effects?

As many readers will know, iatrogenic effects are problems caused by efforts at treatment of other problems. An obvious example would be a headache caused by a medication. It’s easy to think of examples of medical iatrogenic effects. But can the idea of iatrogenic problems also be applied to psychological or social interventions?

I am going to speculate about how iatrogenic effects of social intervention may have been part of a story that is getting a lot of play in some parts of the U.S. But before I try that, I’d better tell the story, as far as I am able to do so. Because this story involves the Arkansas Division of Child and Family Services, adoptive parents, foster parents, and children, there is a good deal of confidentiality involved, and I have no way to be sure that what has been written reflects what really happened (so be warned, I’m just reporting the news as it has been written so far).

This story involves an Arkansas legislator, Justin Harris, and his wife, Marsha Harris. The Harrises were the biological parents of three boys, but decided they wanted to adopt three young sisters, the oldest 6 years old at the time. The girls had been in foster care, two in the same foster home and the eldest in a “therapeutic” home. The Harrises did not keep the oldest girl very long and returned her to DCFS before the adoption was final. But before a year had gone by, they decided that they could not keep the other girls either. They stated that the oldest girl had threatened to kill them, that one of the younger girls had “crushed” a pet animal, and that their sons were sleeping with Mr. Harris because they were afraid of the girls. (This information comes from www.arktimes.com/ArkansasBlog/archives/2015/03/06/harris-blames-adoption-woes-on-department-of-human-services and other similar sources such as www.arktimes.com/ArkansasBlog/archives/2015/03/07/foster-family-disputes-key-staments-from-justin-harris [yes, it does say “staments”].)

According to Mr. Harris, when he told DCFS that he and his wife did not want to keep the girls, he was told, he says, that they could be charged with abandonment if they did not. The Harrises then elected the “rehoming” option (see http://childmyths.blogspot/com/2013/09/the-reuters-investigation-into-re.html). They informally transferred care of the girls to Stacey and Eric Francis. Eric Francis was the head teacher at a preschool, Growing God’s Kingdom preschool, owned by Justin Harris. The Harrises continued to receive adoption subsidy checks and say that they gave the money to the Francises. Unfortunately, this apparently satisfactory solution to the Harrises’ difficulties came to light and ended when Mr. Francis was charged with raping one of the girls.

The foster parents who had cared for the girls denied that the girls had shown disturbed behavior when with them, and stated that they had argued against adoption by the Harrises, on the grounds that a home with three older boys was not appropriate for the girls, one of whom had been molested.  The director of DCFS, Cecile Blucker, is speculated to have played some role in the decision for adoption placement.

So when do we get to the iatrogenic effects part? Obviously, this is speculation, especially because there is no clear information about what happened before, during, or after the girls’ stay in the Harris household.

 Harris has claimed that he and his wife were not told that the girls were disturbed (and  the foster parents, who knew them well, say they were not). My speculation is that they were indeed told, not that these particular children were disturbed, but that all adopted children suffered from some form of mental illness, and that their disturbance included attacks on people and pet animals. Such beliefs are widespread on the Internet and have been encouraged by authors like Tina Traster as well as by adoption caseworkers. The web site https://dhs.arkansas.gov/dcfs/heartgallery/suggested%20reading.htm gives an extensive reading list that includes books by writers who have advocated this point of view, including Foster Cline, Terry Orlans, and Deborah Gray, so we need not look far for evidence that the Harrises may have been encouraged in this mistaken belief by the state of Arkansas itself. If the Harrises were taught to expect that adopted children would behave dangerously and aggressively, their expectations might well cause them to interpret ordinary, age-appropriate behavior as indicative of serious disturbance. Because proponents of these beliefs about adoption also claim that untreated children will grow up to be serial killers, parents exposed to such ideas may feel that they must seek whatever treatment is available rather than just riding out temporary problems. A “crushed” pet may have been killed by accident, especially if it was small, but such an event might well be seen as evidence of a serious emotional disorder (although the foster parents noted that the girls lived happily with their dog and treated it appropriately). This sequence of events, leading to mistaken beliefs on the part of adoptive parents, would be an example of iatrogenic effects caused by an intervention. In addition, we might well expect other children in the household--  and the adoptees themselves!—to pick up on these expectations and to misinterpret normal moods and behaviors.

What treatment did the Harrises seek, when convinced that some treatment was necessary? This is not clearly stated in any of the sources I have found, but one parenting technique said to have been used was a familiar one for those of us who have paid attention to Attachment Therapy. One child had all of the belongings removed from her room and was required to “earn” them back by compliant behavior. This approach is recommended by many Attachment Therapy proponents, very much including Nancy Thomas. What is the iatrogenic aspect of treatment of this kind? Well, consider what impact this assertion of adult power actually has on a child who is struggling to adjust to a new home. Thomas, Cline, and their ilk all declare that when adults assert their authority, children become emotionally attached to them, and therefore (according to those authors) become compliant--  “responsible, respectful, and fun to be around”. However, what is far more likely is that constant power displays cause fear and anger in young children, who (like adults) are therefore less capable of rational behavior, and certainly less likely to feel affectionate toward the adults. The iatrogenic effect of these mistaken treatments is to exacerbate children’s negative moods and to interfere with development of the normal goal-corrected partnership stage of attachment.  

Am I saying that these things happened in the Harris household? No, of course I do not have the information I would need to reach such conclusions. I am saying, however, that I see a distinct possibility that adoptive parents who have mistaken beliefs and choose mistaken treatments may create problems in children who did not have them before. That they may have been encouraged to do this by a state agency raises important questions that I hope will be asked by someone in a position to do this.

I want to raise one other issue before closing. Let’s go back to the preschool, Growing God’s Kingdom, whose head teacher took the girls informally and raped one. The name of this school is more than suggestive of the owner Harris’s evangelical Christian beliefs, which are possibly related to approval of Attachment Therapy. But there is another issue here, and one that suggests that Harris may feel that his rules about various matters are above the law. At www.arktimes.com/ArkansasBlog/2011/11/03/complaint-religion-taught-in-lawmakers-tax-funded-daycare, we see that in 2011 Americans United for Separation of Church and State brought a complaint against Harris and Growing God’s Kingdom on the grounds that the preschool received $500,000 from Arkansas Better Chance for School Success, in spite of teacher contracts that required a love of Jesus, and a curriculum plan including a Christian curriculum and Bible time. A.U.’s letter pointed out that, constitutionally, tax money cannot go to support religious activities. Why would Harris, a state legislator presumably familiar with constitutional restrictions on legislation, receive this money illegally? Why, also, did he apparently continue to receive state money for the girls when they had been “rehomed”? Although I’ve argued that other people also bear responsibility for what happened to the girls, there seems to be an attitude here that fits right in with the Attachment Therapy approach of displaying power and authority in order to reach a goal.     

3/11/15  for further information about the Harrises' beliefs about the girls' demonic possession, see www.arktimes.com/ArkansasBlog/archives/2015/03/11/casting-out-demons-the-latest-on-the-justin-harris-adoption-story. (I can't figure out why this is not creating a link here).

  

No Primal Wound in France: The Exception Tests the Rule

What do you frequently hear when someone has claimed that something is true, but then the evidence shows one or more cases where it is not? What I hear is the claimant (often with a self-satisfied expression) declaring, “that’s the exception that proves the rule”.

Now, it does happen to be true that exceptions “prove rules”, but not in the sense of “prove” that is often intended. Exceptions don’t “prove rules” in the sense of showing that the rules are correct. Exceptions do test rules and show that at least under some circumstances they do not hold true. This is like the way we refer to the proof of whiskey, meaning the proportion of alcohol shown when it is tested. Because exceptions test rules, it’s important to pay attention to them, especially when unusual claims or ones that are difficult to test otherwise are made.   

Proponents of the Primal Wound theory, as it has been stated by Nancy Verrier, claim that baies have become emotionally attached to their mothers before they are born and are traumatized by being separated from their birth mothers and adopted or fostered by other people. This trauma, according to the Primal Wound belief system, stays with an individual indefinitely, causing lasting sadness and discomfort and interfering with all relationships.

Aren’t there already known exceptions to this claimed rule? Yes, occasionally people point out that they do not feel that way in spite of their family history, but on the whole those who are not committed to the Primal Wound view simply go about their normal business without taking time out to comment. In addition, when people speak up either about their sense that the Primal Wound belief is true or about their conviction that it is nonsense, it’s rare that we have any real records of what happened in the adoptee’s life, or about the thoughts of the birth parents or adopted parents (I should just say the mothers, because that’s what the Primal Wound theory focuses on, but let’s keep in mind that there are fathers as well.)

An unusual case in France provides an exception that really does test the rule, however. In this case (www.nytimes.com/2015/02/25/in-france-a-baby-switch-and-a-test-of-a-mothers-love.html?r=0), there are records of what happened and when it happened, as well as information from both birth and adoptive parents. Here’s the story. About 20 years ago, in Cannes, the baby girls of Sophie Serrano and another mother (who wants to remain anonymous), were given to each other’s mothers. Both babies had neonatal jaundice and were receiving light therapy, but because of a shortage of bassinets, they were placed nude in the same bassinet. Both babies had been given identity bracelets, but one had apparently fallen off, and the nurses accidentally gave the babies to the wrong mothers (both 18 years old at the time).

Ms. Serrano noticed that the baby she was given had more hair than she remembered her baby having had, and she questioned the nurse, who told her that phototherapy could do that. The other mother asked why her baby seemed to have less hair, and she was told that phototherapy could do that, too. Both young women accepted this explanation.

As Ms. Serrano’s baby, whom she named Manon, grew older, the mother’s partner became suspicious about his paternity. Manon’s skin color was darker than the parents’, and her hair was frizzier. By the time Manon was 10, Ms. Serrano’s partner had left--  then he demanded a paternity test because he did not want to pay child support for someone else’s child. To the astonishment of all, the results showed that Manon was biologically related to neither her putative mother or father, Ms. Serrano then remembered her questions about the baby’s hair, and she sought an investigation, which eventually revealed that Manon’s  “real” parents were living not far away, with their daughter, who of course was the biological child of Ms. Serrano and her former partner. (Too bad Gilbert and Sullivan aren’t alive to do something with this!)

Now, of course, comes the part that’s relevant to the Primal Wound. The two families met and tried to get to know each other. Manon commented, “When I first met them, I noticed how much I looked like them…But I was sitting in front of complete strangers, and I didn’t know how to position myself ”. The Times article goes on to say, “The families saw each other several times, during which Manon explored her Creole origins [her biological parents came from the island of Reunion]. But the parents and daughters had trouble building any rapport, and they eventually stopped seeing each other. In the end, after some discussion, both families preferred to keep the child they had raised, rather than taking their biological one. Ms.Serrano said, “My biological daughter looked like me, but I suddenly realized that I had given birth to a person I didn’t know, and I was no longer the mother of that child.” Ms. Serrano went on to say, “It is not the blood that makes a family…What makes a family is what we build together, what we tell each other. And I have created a wonderful bond with my nonbiological daughter”. (The young women’s attitudes were not reported in this article, but it seems unlikely that the parents could have reached these decisions without the agreement of their 20-year-old daughters. Manon commented, “The story of my birth has made me stronger”.)

Here we have a most unusual, but definitive, “test” of the Primal Wound rule. We have the responses of people who were simultaneously birth and adoptive parents, and what we see is that the relationship built through adoption was much more powerful than the relationship based on birth and genetic relationship.

Please note that none of this, or any other arguments against the existence of a Primal Wound, means that all adopted children and their parents are happy and satisfied with life. What it does mean is that where there is unhappiness, its causes need to be sought somewhere other than in early separation from the birth mother.

[By the way, the two birth mothers are suing that clinic for plenty of euros. ]   

Occupational Therapy in New York Schools: Expensive, But Not Evidence-Based

An article in yesterday’s New York Times bore the headline “Occupational Therapy Increases Sharply in New York’s Schools: Methods Improve Focus and Motor Skills” (www.nytimes.com/2015/02/18/nyregion/new-york-city-schools-see-a-sharp-increase-in occupational-therapy-cases.html). [There’s a curious contrast right there, as the article actually concentrates on the use of OT methods, not the number of “cases” that need them.]

The Times article, by Elizabeth Harris, begins by describing the “tools” of occupational therapy being used in a first-grade classroom. These were small plastic armchairs, a tight vest that provides pressure to the child’s chest, and a weighted, velvety blanket. Accompanying photographs showed a child on a trampoline and others playing Jenga, a game involving stacking wooden rods and keeping them balanced. Bumpy cushions that demand efforts to balance were mentioned later, as were other methods of strengthening specific muscles and practicing perceptual skills.

The techniques were described as a possible alternative to medication like Ritalin that may be helpful to children with real attention problems. In addition, the article quoted an educational consultant as saying that parents who were applying to private schools for their children were sometimes putting the children into occupational therapy programs as preparation. She commented, “Here [in New York] you have accelerated or demanding curriculums, so they put them in O.T.to bring them up to speed…. They want to enhance their basic skills. New York is a fast-paced city, and sometimes they don’t want to wait for the child to develop the skills they may need.”

Do children develop improved skills as a result of these or other occupational therapy methods? As evidence of the effectiveness of these methods, another photograph in the Times displayed a nine-year-old’s handwriting samples from February 2014 and May 2014, describing the second one as “after occupational therapy”. The samples looked pretty much the same, except that on the first one the child had written not only between small lines, but in much larger letters in an unlined space; the second sample showed only letters written between lines. The first sample did show a larger number of tall letters that crossed the lines above them than the second one did.

It’s not very surprising that a 9-year-old could develop somewhat improved handwriting over a two month period, whether receiving “treatment” or not, and neither is it surprising that a child might write somewhat differently at different times, even if the times were on the same day. But when people conclude that treatment must have caused any changes that occur, we see the post hoc, ergo propter hoc error so common in educational thinking--  the belief that whatever changes have occurred in a child after some experience, they have occurred because of a treatment or because of instruction, not because of the natural course of maturational change. It’s not surprising that teachers think this way, because after all it’s their job to provide instruction that is intended to bring about large, important cognitive changes, and their focus is on what they do to contribute to the child’s development. Parents too tend to concentrate on what they should or should not do.

But if we’re really to understand how development works, and what interventions are effective, we have to differentiate between the effects of treatment or instruction, and the changes that occurred during a time period because maturation continued along its normal lines whether  a treatment was taking place or not. That means that in order to know whether bumpy cushions, vests, weighted blankets, etc. change a child’s abilities and behavior, we have to investigate this in a systematic way, not just display a couple of handwriting samples. Because human beings are different from each other, we need our study to include a large number of children. Because people can respond differently to treatments they have chosen than to other treatments, we need to have children randomly assigned to treatments, not just given the ones a parent or teacher wants. Because special attention or activities may have a positive effect on a child, we need to be sure that the children in our study who are not receiving occupational therapy do get some comparable set of experiences of attention and play. Only by following these guidelines will we be able to tell whether changes that follow occupational therapy, if any, are actually caused by the treatment.

As it turns out, there have been very few studies that have met these requirements. As a result, the occupational therapy techniques discussed in the Times article have never been demonstrated to be effective. This does not mean that they have been shown to be ineffective. Nor does it mean that they have been shown to be harmful (although indirect harm is certainly done if a child is given ineffective treatment when effective treatment exists). However, the absence of supportive evidence does raise serious questions about the 58 million dollars apparently spent by the city of New York for 42,000 students, often under circumstances where a child might cope well if not required to behave like someone a year or more older.

I should point out that the techniques discussed in the Times article are not the entirety of occupational therapy. Occupational therapists do a wide variety of tasks, ranging from helping prematurely-born infants learn to nipple-feed, to working with stroke patients. The techniques mentioned above, like pressure vests and weighted blankets, are part of a treatment called Sensory Integration Therapy (SIT).

SIT is based on a theory of sensory integration offered in the 1960s by the occupational therapist A. Jean Ayres. Ayres posited that many cognitive and motor problems result from difficulty with organizing the many sources of sensory stimulation each of us experiences. She saw the organizational difficulty as resulting primarily from problems of vestibular and tactile sensitivity, which she considered to be the foundation of perceptual and motor organization. Ayres felt that providing extra or modulated tactile and vestibular experiences could guide the developing perceptual and motor system toward better integration. This was the basis of the use of weighted vests, swings, trampolines, and so on as treatments for children with various handicapping conditions. Awkwardly for SIT, the vestibular and tactile systems are the first to become myelinated and thus to have mature communication in the nervous system, and as a result are not shaped by experience in the same way as vision is. SIT is not a plausible intervention for that reason. In addition, there is little empirical evidence to support such treatments for autism, for cerebral palsy, or for attention problems--  and certainly none to support the use for attachment disorders found on some Internet sites.

One more point: the educational consultant quoted by the Times article spoke of OT methods being used to “bring children up to speed”. She presumably was referring to children well within the normal range, whose parents wanted them to match a curriculum, rather than looking for a curriculum to match the child’s needs. Can a normal child’s development be hastened in this way? There is no good evidence to suggest that it can, and if we look at other aspects of development, there seem to be suggestions that it cannot. For example, giving children extra Vitamin C has no useful effect, as the extra is excreted in the urine. Poor nutrition slows growth in height and can reduce adult stature, but extra good nutrition does not speed growth beyond the rate seen with adequate nutrition. Just as children only need “good enough” parents, they only need “good enough” nutrition or “good enough” instruction to allow them to develop at their own best rate. Children can be harmed by an environment that is not “good enough”, but if they are developing normally, extra food or instruction will not result in “extra” development.    

Mindfulness in Early Intervention, Sure; Tapping, No

The publication Zero to Three makes a point of connecting science, policy, and practice related to work with young children, and for several decades it has done a good job of this. But occasionally somebody slips, either in writing or in the review process, and something emerges that cannot be called science-based.

That has happened in an article in the January 2015 issue (Shahmoon-Shanok, R., & Stevenson, H.C. [2015]. Calmness fosters compassionate connections: Integrating mindfulness to support diverse parents, their young children, and the providers who serve them. Zero to Three, 36(3), 18-30). The authors spend pages emphasizing the role of mindfulness and calm in allowing us to be aware of the thoughts and needs of other people—and no one can argue with the idea that a person who is not calm is likely to misread others’ communications and behave in ways that are mistaken and noncompassionate. An angry or fearful caregiver can do a very poor job, especially with children whose communications are hard to understand.

But--  by page 25 it becomes clear that one of the authors has a curious take on mindfulness. Not only does she connect awareness with EMDR (Eye Movement Desensitization and Reprocessing), a form of psychotherapy based on an implausible theory and with weak empirical support, but she favors the methods of one Laurel Parnell, author of Tapping in: A step-by-step guide to activating your healing resources through bilateral stimulation. (Boulder, CO: Sounds True [sic]). And yes, this means actual physical tapping.

The Zero to Three article advises using Parnell’s technique, and describes a situation where an early intervention worker was having difficulty helping an undocumented Mexican immigrant mother who complained a great deal (and had much to complain about!). Her EI worker had been in the habit of asking the client to give more and more information about each of her complaints. But, after learning about Parnell’s technique, the EI worker instead asked the woman to describe where she felt tension in her body and guided her to breathe deeply and relax. The worker then asked for a description of a “safe place”—a time when the mother had felt safe and optimistic. Following a description of being in her grandmother’s lap, the EI worker guided the woman to remember sensations and smells she associated with the sense of safety.

And here’s where the “tapping” comes in. “Once the mother elaborated these sensory details, the worker said ‘Let’s tap this in’…, alternating tapping her feet on the floor, or her hands on her thighs. The worker smiled and said, ‘When you tap one side of your body and then the other, you make this happy memory of your yaya even stronger. This is a good place to go when you’re upset. She’s right there to help you calm down and feel better. You can practice this coming week and when I come next time, we’ll practice some more” (Shamoon-Shanok & Stevenson, 2015, p. 21).

Sounds harmless, even pleasant, doesn’t it? So why am I concerned that this practice is being presented as scientifically supported through publication in Zero to Three? The first reason is simply that there is no scientific evidence that these methods are effective. There have been lengthy arguments about EMDR, the claimed source of the “tapping” technique, and these have concluded that to the extent that EMDR is an effective treatment, it is so because it shares various factors common to all effective psychotherapies, such as interaction with a warm and supportive therapist or helper. The specific methods of EMDR--  eye movement and other forms of bilateral stimulation--  are probably irrelevant to the outcome of the treatment. Similarly, while it was comforting for the mother described earlier to think of a pleasant and safe memory, and while this was a positive experience which might help her stay calm and responsive to her children, “tapping it in” had nothing to do with the outcome.

Telling either the mother or the EI worker that bilateral tapping is magically helpful is not only untrue, but encourages them to think about mental processes in inaccurate ways and thus opens them to consideration of treatments that are potentially harmful in either direct or indirect ways. In addition, the stress on tapping distracts people from using evidence-based treatments that they may find more challenging than the simple ritual they are offered. A persuasive analogy to computer programming is employed when the EMDR language of “installation” is used.

Where does the tapping ritual come from? Parnell references the writings of Francine Shapiro, originator of EMDR, and her claim that when the body is bilaterally stimulated this experience hastens the “processing” of negative thoughts and events. Shapiro apparently based this claim on her experience when walking in the woods one day and moving her gaze back and forth while brooding on an unhappy memory. After her walk, she felt better--  which she attributed not to the passage of time or a pleasant walk, but to the fact that she had been moving her eyes back and forth. Because she naturally had been using both eyes in a coordinated fashion, she decided that it was the bilateral movement that did the trick.

Now, it’s nice that Shapiro felt better, but how could she not have been experiencing bilateral movement, during her walk or at almost any other time in her life? Except for people who have lost an eye or have paralyzed eye muscles on one side, all of us are coordinating our right and left gazes at all times, whether by changing the direction of the gaze to one side or the other or by converging or diverging the eyes as we look at nearer or more distant objects. Similarly, the act of walking involves bilateral coordination, as one foot takes up the body weight transferred from the foot that is taking a step. Simultaneously, the shoulders and torso counter-rotate in order to maintain the body’s balance as a foot is lifted; the counter-rotation in turn causes the arms to swing back and forth in opposition to the legs’ movements. We are all doing this all the time, so Shapiro’s  and Parnell’s claims that EMDR uses a specialized technique can hardly be supported.

The idea that bilateral activity is special and magical seems to have derived from the claims of the alternative practitioners Doman and Delcato in the 1960s. These people argued that the movement of crawling involved bilateral action as walking did not (but see above), and that this bilateral action provided sensory feedback that acted to “build” the brain. Those who had brain-related disorders such as autism or cerebral palsy must not have had enough bilateral movement, and they could be cured by being forced to crawl, or subjected to “patterning” in which helpers moved the patient’s head, legs, and arms in ways that imitated reflexive crawling movements of very young infants. It has been well known for many years that these methods are completely ineffective, but the appeal of bilateral stimulation persists and the naïve are still easily sold on this idea.

Another book by Parnell, A therapist’s guide to EMDR (W.W.Norton), provides another insight into the “tapping” approach. Parnell’s “tapping in” is clearly related to the various energy therapies such as Thought Field Therapy and Emotional Freedom Technique, where physically tapping at certain points on someone’s body and at certain rates of speed are expected to free the individual from emotional distress. This practice appears to be based on the idea that the human body has  “meridians”--  lines that enable the flow of psychic energy or qi and which if blocked will cause unpleasant psychological experiences. Tapping at a given rate of speed on a given meridian is claimed to release qi to flow appropriately. In spite of various efforts to test these claims, there is no evidence that energy therapies employ tapping to good effect, and of course the theories behind that use of tapping are implausible in terms of the accepted foundations of the scientific study of psychology.

Of course it is tempting to say that if the mother described earlier liked tapping, she should get to have it—until we question whether public funds should be expended on ineffective treatments.. The mother and her EI worker may well feel that if she feels better following her tapping experience, her improvement must have been caused by that experience, and the treatment should be not only allowed but encouraged. However, today’s standards for how we spend scarce public resources are much more stringent than that, and professionals on the whole turn to scientific evidence to help decide whether a method is actually effective. I hope that in the future Zero to Three’s reviewers will also take that approach.