One More on IACD: You Knew They Had to Talk About "Neuroscience"

   

  

 I hate to do one of these “research shows” numbers, but in fact there is a good deal of evidence that throwing irrelevant neuroscience references into an argument makes it harder for most people to detect logical errors (see, e.g., Weisberg et al., [2008]. The seductive allure of neuroscience explanations. Journal of Cognitive Neuroscience, 20, 470-477). This persuasive device has even been referred to as “neuroseduction”, and it is used freely by those who want to sell a practice or idea that is not really all it is claimed to be. Not surprising, then, that we see many such references at www.instituteforattachment.org.

Let me begin by talking about some of the logical problems that arise when people refer to mental illness as a brain disorder, as IACD does with reference to RAD. In this discussion, I am indebted to a recent article in American Psychologist (Schwartz, Lilienfeld, Meca, & Sauvigne’, [2016]. The role of neuroscience within psychology: A call for inclusiveness over exclusiveness. Vol. 71, 52-70).  These authors have produced a very clear and complete statement of the issues about neuroscience and mental health issues, and while I will summarize some of the high points, I would really recommend the article to anyone who has a serious interest in this area.

To begin with, of course mental or behavioral disorders are all associated with unusual brain functioning. To say this is simply to confirm that we don’t think a  disturbed noncorporeal mind or spirit is at work in mental illness. Thinking, feeling, and acting emerge from events in the brain and other parts of the nervous system and would not exist without an active brain. However, there is presently no information supporting the idea that a specific event in a specific area of the brain causes a predictable behavior, thought, or emotion. Given that most of our brain-behavior information comes from work on non-humans, a great deal of generalization is required even to think we have knowledge of general connections between brain areas’ activity and other observable events. Indeed, we may never have specific information about such connections, because behavior, thinking, and emotion are all events that occur in a historical and place context that may influence them as much as activities in the nervous system do.

In addition to the issue of context, we also have the fact that the rules that govern the functioning of parts of the brain may not apply in the same way when parts are working together with other parts. We may have an excellent understanding of the internal combustion engine, braking systems, and so on, but these do not help us prevent or disentangle traffic jams where many brakes and engines come close to each other, or contribute to the creation of codes of traffic laws. No matter how well we know about how brains function, we may never be able to jump from that knowledge to mastery of rules of human psychological functioning--- like traffic events, those rules may well have to be studied separately from the nervous system. They operate at a different level of analysis, just as engines and traffic do.

Why then do we have so many people, including governmental agencies, talking about “brain disease” and “brain disorder” rather than mental illness? My guess is that this began with advocacy groups like the National Alliance for the Mentally Ill (NAMI), who recognized the stigma attached to mental illness and the lingering belief that the mentally ill could be all right if they just exerted themselves a bit. “Diseases” and “disorders” can’t on the whole be blamed on their victims, whose brains have been “struck” by events beyond their control, so it’s very legitimate to fund programs to study and treat these problems, while such funding for mental illness might be seen as questionable. But when NAMI and other advocacy groups got this new locution in place, of course, they provided  powerful help for other organizations who were happy to throw “brain” into their mix and benefit from the resulting confusion.

Let’s look at some of the “brain” claims made by IACD. Here’s one: “Here at IACD we’ve learned that past experiences actually change  our brain patterns.” This is not a discovery that was made at IACD, nor is it actually a discovery at all--  instead, it is a viewpoint based on the current paradigm that rejects the idea of noncorporeal mental elements. Experiences are remembered and alter behavior, and the only way this can happen (without the existence of a nonmaterial mind) is by changes in the brain. In other words, this is not a discovery, but an assumption that most psychologists make nowadays. So what is the point of announcing that IACD agrees with the mainstream that memory results from changes in the brain? To use Benjamin Spock’s statement about alcohol rubs as an analogy, this statement “smells important”. In addition, it enables the author of these IACD remarks to continue and state without evidence that early adverse experiences cause the brain to be organized in a maladaptive way, and then to make a second logical leap and claim that the result of this organization is denial of painful feelings and avoidance of affection and nurturing interactions. This, of course, makes poor parent-child relationships all about poor brain organization, and not at all about parenting skills or parental empathy.

The view just described can also be used by IACD to state without evidence that attachment disorder “delays brain growth. … the kids in our program are ‘stuck’ developmentally and neurologically” (www.instituteforattachment.ong/explore-our-services/family-treatment-program/). Confusion and circularity reign here. If brain events cause attachment disorder, how can attachment disorder alter brain events? (Of course, this does not matter if the neuroscience references are simply for persuasive purposes.) However, the statement about being “stuck” is the important one, common as it is in attachment therapy circles. It suggests that both physical and mental development cease and remain in a holding pattern as a result of early adverse experiences. This is not the case. Where a problem exists, developmental change can be distorted, whether because there is no solution to a problem or because a “work-around” draws from usually-unrelated structures or functions, but development does not stop.

 Imagine, for example, physical damage to the brain that might result from an injury or from surgical treatment for cancer. If this occurs in the first months of life, other brain areas may be recruited to perform the function that would otherwise be lost. If it occurs during the preschool years, the child can be helped to find ways to compensate for the loss and come close to normal functioning. In neither case does the traumatized individual remain at the level of functioning present at the time of the injury, but development continues and turns toward the typical trajectory.

Is someone saying that emotional traumas are different? Sorry, you can’t do that if you’re going to define emotional problems as “brain disorders”. What then is the point of talking about this at all? Very simple--  it lays the IACD groundwork for the idea that treatment involves re-enacting the “attachment cycles” posited by attachment therapy, through a ritual dramatization of baby experiences, and thus, of course, rebuilding that brain. It also justifies another service offered by IACD, neurofeedback, which is claimed to alter frequencies of brain waves and “therefore” to improve daily life. Interestingly, the claims about neurofeedback, which actually does involve some aspects of brain functioning, are much less elaborate and vivid than other assertions about brain events on the IACD site--  but they do include an article by the egregious Sebern Fisher, well-known neuropseudoscientist.

Is all this fraudulent advertising as well as  a blow against critical thinking? It’s hard to say, because there are so few specifics given, except for the neurofeedback bit. It is not, however, the transparent reporting so much advised by all mental health and public health groups. And the “neuroseductive” aspects are more than plain.

 

   

  

Brand Loyalty: IACD Redefines Reactive Attachment Disorder for You

What if your child had an ingrown toenail and you took him to the pediatrician? What would you think if the doctor said, “All right, we’re going to call this chickenpox. And we’re going to treat it with a method that that’s not known to be effective and is possibly harmful for both ingrown toenails and chickenpox.” Would you, perhaps, seek a second opinion?

Sounds goofy, but in fact this is exactly parallel to what the Institute for Attachment and Child Development, and many related organizations, are doing with respect to Reactive Attachment Disorder.   The IACD website redefines Reactive Attachment Disorder as equivalent to, or another name for, the following list (www.instituteforattachment.ong/learn-about-attachment-disorder/common-questions/#1 ,and yes, it does say ong. I make plenty of typos but this isn’t one.) : Reactive attachment disorder or RAD, attachment disorder, oppositional defiant disorder, post-traumatic stress disorder, childhood trauma, PDD, and pervasive developmental disorder (sic--  does someone not know that PDD is the abbreviation for this term, which has been used to describe a form of autism?). Thus, it appears that in the IACD viewpoint, all of these childhood behavioral, mood, and cognitive problems are the same thing. Why DSM, ICD-10,  and the Zero to Three early childhood classification  system struggle so to distinguish among these categories--  well, one hardly knows; it would appear that they simply neglected to bring the IACD experts on board.

All right, so just as an ingrown toenail is chickenpox, it appears that PDD is Reactive Attachment Disorder. What are we told that the problem is, behaviorally speaking? It looks like the Randolph Attachment Disorder Questionnaire, so long debunked, is the focus of description, although I will concede that no one mentions Randolph’s claim that she could diagnose RAD when a child could not crawl backward on command (I not only did not make that up, I would not have had the imagination to do it). Here are the problems that identify Reactive Attachment Disorder, defined as including PDD etc. etc.: does not trust adults in authority (perhaps quite rationally?), has extreme need for control , is manipulative and hostile, has no empathy, remorse, or conscience, resists adult guidance and nurturing, lacks cause and effect thinking (but apparently this really means the child doesn’t anticipate being punished), provokes anger in others (the little beast!), lies, steals, and cheats, is destructive and cruel, argues excessively, is impulsive, and is superficially charming. Interestingly, at www.instituteforattachment.org/explore-our-services/family-treatment-program/#philosophy , the IACD site notes that the children “often treat dads better than the  mom”, and apparently being nice to your mother is the essential point of good mental health in this belief system (perhaps a throwback to Bowlby’s original assumption that only one attachment relationship could exist in early life). As I’ve pointed out before, none of these characteristics jibe with the symptoms of Reactive Attachment Disorder as described in any edition of DSM, although it’s possible that some of them could be associated with ODD or PTSD--  not superficial charm, though, which comes straight out of a decades-old effort to create a checklist for psychopathy.

So why classify this long list of symptoms and diagnoses all under the rubric of Reactive Attachment Disorder? Why not do some differential diagnosis and recognize that children with different problems may need different handling? Why declare that it’s all RAD and one size of treatment fits all? Well, folks, I would suggest that this is a matter of branding.

IACD and similar groups have spent many years developing their brand and attempting to spread their definition of Reactive Attachment Disorder through on line advertising and the work of unwary journalists (see http://childmyths.blogspot.com/2015/11/letter-to-abc-about-their-inaccurate.html). They are the RAD brand for the great majority of people who never heard of DSM or ICD-10  and accept that an expert is someone who says he is an expert. Operating outside the mainstream of mental health work, they are little constrained by the professional ethics that require statements to be based on evidence; certainly, none of the research that is so vaguely alluded to has ever been published. And who is going to complain about them, after all? The children can’t do it, at least not until they reach adulthood, and the parents are not likely to do it, because this was all their idea to begin with, and they are happy recipients of sympathy, support, and unlimited references to their “awesomeness”. Also, they don’t have to mind their children while they’re in the “respite home”.

As we can see, although the IACD group may lack remorse or empathy and do not trust adults in authority (e.g. the various DSM committees), they do seem to be very good at associating cause and effect. Beat the drum loud and long for your brand, and people will buy it without examining your statements too closely. It’s worked so far, it seems, so I don’t expect them to stop unless someone takes legal action about fraudulent claims (of which I’ve listed a bunch here and have more to talk about in my next post). Where county social services have bought into the brand, by the way, the False Claims Act would allow an award to a whistleblower. Are there any takers?

Caveat Emptor: Looking Further at Claims by the Institute for Attachment and Child Development (IACD)

In my last post, I examined some assertions put forward by supporters and members of the Institute for Attachment and Child Development, a Colorado organization with a long history of various versions of attachment therapy. Today I want to spend some time examining the claims made by IACD at www.instituteforattachment.org/join-our-mission/end-the-stigma/.  (N.B., the page actually says www.institutefor attachment.ong, but I don’t see how that will work.)

The IACD page expresses concern about the “stigma” associated with attachment therapy. This term, of course, has an emotional appeal, as we all know from Erving Goffman and others that stigmas are bad, unfair, and especially in the case of mental illness should be fought and contradicted by all right-thinking individuals. In the case of attachment therapy, however, it is hardly the case that there is a “stigma” attached to it. To reject something is not to stigmatize it. Most mental health professionals have never heard of attachment therapy, and those who have have made clear public statements rejecting it on logical and evidentiary grounds as well as in terms of its potential to harm children. The 2006 Chaffin et al task force report which advised strongly against the use of attachment therapy is a case in point. A negative task force report is not a stigma, any more than the current deep concerns of psychologists “stigmatize” torture during interrogations.

The IACD page references as a source of the claimed “stigma” the unintentional killing of a child by a Colorado therapist in the course of a “rebirthing” session in 2000. This, it is argued, somehow caused “respected therapists” to be blamed. The two therapists involved, of course, were Connell Watkins (AKA C.J. Cooill) and Julie Ponder, who were assisted by a number of helpers. The child was Candace Newmaker, who had been brought by her mother for a course of attachment therapy sessions, with the “rebirthing” just a frill that was added because an itinerant rebirther, Doug Gosney, had recently passed through the area offering training sessions.

As Michael Shermer cogently argued a few years later, Candace’s death was a “death by theory”. It would have been harmless, though silly, to play out the rebirthing drama with this child, as had been done with other children in episodes lasting only a few minutes. But Watkins and Ponder were deeply committed to the attachment therapy belief system promulgated by Foster Cline, and they believed that the child’s reported difficulties were simply resistance. For therapeutic success, they had, they thought, to force her to acknowledge the authority of adults by obeying their instructions to emerge from the flannel sheet that wrapped her.  It was this set of beliefs, long associated with the alternative developmental theories of attachment therapy, that caused them to ignore her 40 minutes of pleas for help, her vomiting, and finally 30 minutes of unresponsiveness during which Watkins and Ponder leaned on her wrapped body and discussed real estate (as clearly shown in the session videotapes). Watkins and Ponder killed Candace because of what they believed, not because of the specific techniques they chose. It is perfectly disingenuous to attribute this death to rebirthing, but of course this was the position taken by many who wished to weaken legislation that tried to prohibit potentially harmful treatments.

Let’s go on to look at a later part of this IACD page, the purported history of attachment therapy. First, let’s examine the statement that attachment disorders were discovered in 1972 by persons in Evergreen, Colorado. I am afraid this does not hold up under a strong light. John Bowlby in the 1930s was already looking at connections between disturbed early relationships and later delinquent behavior, and following World War II wrote extensively about the effects on young children of separation from parents associated with evacuation from British cities during bombing. Anna Freud did the same, and Rene’ Spitz focused on the depression and physical illness of babies grieving over separation. At a far less respectable level, Robert Zaslow, a California psychologist, began in the 1960s to use a form of holding therapy to create attachment, whose absence he considered the cause of autism and schizophrenia. After losing his license following a serious injury to an adult patient, Zaslow traveled the country giving demonstrations (one person who was present has reported to me that these included a 12-hour holding session with a young schizophrenic man). He encountered Foster Cline, a physician, in Colorado and recruited him to the attachment therapy doctrine. Cline later surrendered his Colorado medical license as part of a disciplinary proceeding after a child was injured. Cline preached that “all bonding is trauma bonding” and that physical restraint and authoritarian methods were the essence of child mental health treatment. (Zaslow went to Germany, where he published his new theory of the “Medusa complex” and the power of eye contact.)

Meanwhile, beginning in 1980, DSM had listed a syndrome called Reactive Attachment Disorder of Infancy and Early Childhood. This was a problem of babies and toddlers, and involved apathy and disengagement; it was seen as a feeding disorder, of concern because the children were not thriving physically. Later versions of DSM suggested that the real issue had to do with  inappropriate social engagement on the part of toddlers and preschool children. Cline and his group quickly picked up this term--  indeed, Zaslow had years before based his views on a mélange of Bowlby’s early, ethological attachment theory, and on the claims of Wilhelm Reich. By 2000, the checklist by which Cline’s followers diagnosed Reactive Attachment Disorder had been formalized by Elizabeth Randolph (N.B. license also revoked)  into the Randolph Attachment Disorder Questionnaire, whose manual plainly stated that the problem was not RAD, but something else that they were calling just “attachment disorder”. (This issue about what is RAD and what isn’t also comes up on the IACD website, but I will save that discussion for later.)

The IACD “history” proceeds to say that in the early 1990s, the organization ATTACh (Association for Treatment and Training of Attachment in Children) had already begun to be concerned about Cline’s “rage reduction” therapy. I do not believe this is true, although obviously I am not privy to all of the discussions that went on in ATTACh at this time, and I would be most interested in any substantiated correction. ATTACh materials up until about 2004 continued to list the names of therapists who certainly were using Cline-like treatments (in fact, it would appear that some of these are still listed). Only after Candace Newmaker’s 2000 death, and more importantly her therapists’ 2001 conviction and imprisonment, did ATTACh make public statements that rejected coercive treatment of children. This was in spite of the fact that the social worker Beverly James had already, in a 1994 book, expressed outrage and concern about the methods being used by this group.

One more rather interesting point about the IACD “history” (which seems to have been shaped to position Forrest Lien as the great leader of treatment for unhappy parents, and perhaps incidentally, their children): the page states that holding therapy “should consist of: essential components that include eye contact, appropriate touch, empathy, genuine expression of emotion, nuturance [sic], reciprocity, safety, and acceptance, While a variety of holding positions can be used, the physical safety of the client is the primary consideration” (italics removed). (Does it not boggle the mind, by the way, that any psychotherapist, far more one treating children, would have to state explicitly that he or she will avoid physically harming the patient? ) This statement appears to omit any consideration of either demonstrated effectiveness of the method (an outcome checklist seems to be in use, but no outcome research has been published), or, just as importantly, of emotional harm. Children who have experienced abuse or been engaged sexually by adults, or who are in treatment at the behest of adoptive parents, may experience being held as threatening and overwhelming, especially if they are past the preschool period when physical holding by parents is culturally acceptable.  The burden of proof is on IACD and its supporters to show that these techniques do not result in later emotional disturbance such as depression and suicidal thinking or actions. A discussion of the nature of informed consent for children, and the extent to which children who are under the control of adults are able to exercise this, would be most relevant here.

Curiously, the lengthy IACD statement about the nature of holding therapy is followed by the assertion that no form of holding is now used there, but no details of the actual treatment are provided, other than a reference to “revisiting the attachment cycles” by therapeutic foster parents. I’ve followed a number of links that purport to tell me more about the IACD treatment model, but they all end up with the same vague discussion.  

And there’s more: we’ll look on another day at IACD claims about what RAD is, and, most interestingly, about the idea that therapists are dealing with a :brain disorder”.    

True or False? "Ordinary Therapists Can't Treat RAD"

Once again I must thank Yulia Massino for pointing out a claim that needs refutation. In a tweet, Dawn Teo says “Traumatized kids don’t respond to traditional treatment. They need assistance from specialized clinicians.” This claim has been put forward by attachment therapists since the ‘90s, although initially they said not only that the children did not respond—they added that conventional treatment actually made the children’s conditions worse.

It’s hard to know where to begin to parse these statements. They provide not only an embarrassment of riches, but a good deal of embarrassment that people claiming to be mental health professionals would say such things. But we can begin with the simple fact that although attachment therapists have made these claims repeatedly, and have even provided lengthy rationales for why the claimed event might occur, they have never provided the slightest empirical evidence to support their statements. They have stated a hypothesis that is quite testable through systematic outcome research: that is, that when children with similar problems are assigned randomly to conventional treatment or to “specialized” attachment treatment, the latter group will have significantly better outcomes. They have not tested this hypothesis, but have simply asserted that the results of such a test are already known. This form of argument is common among alternative practitioners, who “already know” that their methods are effective and don’t feel the need to examine or allow for their own biases. For the rest of us, however, that approach is not adequate. The burden of proof for the statement is on the attachment therapists. (I would point out, by the way, that when parents pull their children out of conventional treatments because the therapist asks them to consider how they are contributing to a problem, this is not the same thing as the treatment “not working".)

What is “traditional treatment”, anyway? Does this mean a Freudian psychoanalytic approach, or Reichian character analysis? If so, no doubt it is true that these will not be very helpful for children (not that this means that attachment therapy is effective, of course).  There are excellent evidence-based treatments for children who are struggling with trauma, however. One of these, Child-Parent Psychotherapy, focuses on the needs and problems of preschool children who have endured traumatic experiences like seeing violent attacks on their mothers. Perhaps Dawn Teo and her colleagues do not regard evidence-based treatments as “traditional”? There would be a good deal of truth to that, historically speaking, of course, but her statement seems a bit different when we make it “traumatized kids don’t respond to evidence-based treatment”, so my guess is that this isn’t what she meant—but what she did mean, I am not sure.

Now, how about “traumatized kids”? There is a lot being said about trauma these days; in fact, trauma is the new fad word taking the place of attachment. This is not to deny the real importance of a trauma-informed view for those working with children’s disturbed moods and behaviors. But not everything is about trauma, any more than everything was ever about attachment. When children have actually experienced traumatic events, they need trauma-informed care—but undesirable behavior or moods do not necessarily show in and of themselves that they are caused by trauma. There are plenty of other factors that are possible causes of childhood disturbances, including genetic and prenatal problems, poor nutrition or exposure to toxic substances, delayed cognitive and language development, visual or hearing impairments, and physical illness. “Traumatized” is not a word to be used as shorthand for “adopted” or “Reactive Attachment Disorder” or “not behaving to parents’ standards”, nor does it mean the same thing as conduct disorder. If Dawn Teo was using the term in this shorthand fashion, her statement is not meaningful; if she really meant that there are no evidence-based treatments for traumatized children, she is simply wrong.

What about the “specialized clinicians” Teo references? Since she also alludes to an article from Forrest Lien’s Institute for Attachment and Child Development website, I can only assume that she means people like Lien and his staff, who were for many years involved with the alternative psychotherapy called attachment therapy by its practitioners (not the same thing as attachment-based therapies, by the way).  They have been committed for a long time to non-evidence-based treatments and have never published any reports on the outcome of their methods—in addition, as Rachel Stryker pointed out in her book The road to Evergreen, this group has defined long-term residential care as being a successful way for a family to “love at a distance”, so outcome measurements might have some unusual definitions.

Lien and similar practitioners have made much of their “specialization”, and this goes over well with the public. After all, if you have a Sears refrigerator, you call a Sears repairman; if you have gum disease, you go to a periodontist, so wouldn’t you seek a specialist for your child’s problems? The big difference is that although you can tell if your refrigerator isn’t working, and your regular dentist can tell you if your gums are in trouble, you, as the parent, are not likely to know which among many possible factors (some including your own behavior) are causing your child to be in difficulty. Indeed, you may not be able to ascertain on your own whether there actually is a problem or whether you are defining a normal child behavior as pathological simply because it is a nuisance. All this means that if you seek a “specialist”, you may be doing so on the basis of a misunderstanding of the child or family issues, and that “specialist” may define all problems as resulting from and treatable by aspects of his or her own “specialty”, like the little boy with the new hammer. In fact, contrary to Teo’s advice, parents who are concerned about child mental health need a person with broad general training in child development and clinical work with children, who will explore and consider all of the child and family factors that may contribute to a problem. That person may have been trained in an evidence-based treatment method, but he or she will never say that ALL other methods are ineffective, because there can be more than one effective method for a problem. (The person may, of course say that SOME methods are ineffective or even potentially harmful.)

What does this all add up to? Dawn Teo’s statement and those of all the others who have said the same thing over the years, are false.

Up next: a look at the IACD claims mentioned by Teo.      

Ordinary Child Abuse versus "Nancy Thomas Methods": What Investigators Should Know

However similar their results may be, two forms of child abuse are different in their motives, and to some extent in their methods. “Ordinary” child abuse can result from parental mental disturbances, from stress and frustration, from misunderstandings about discipline, or from a range of other factors like impulsiveness. Ideologically-motivated child abuse results from belief systems that claim that ill-treatment is beneficial for children and for their families, especially for adopted and foster children who have been neglected or abused in the past. In spite of some discussion in professional circles of coercive parenting based on an authoritarian belief system—often called “Nancy Thomas methods” after the former foster parent who has established an instructional empire claiming that coercive adoptive parenting creates child attachment—child welfare and criminal investigators may not realize that such ideological methods exist.

When questions are raised about a child’s care, investigators look for evidence of abusive or neglectful treatment, and because ideology-based coercive methods like limiting diet and threatening abandonment are correctly construed as abusive, they are likely to stop the investigation when they find those. But what happens next? Adoptive parents may present an appearance quite different from what investigators sometimes expect in abuse cases, and this may lead to questions about the need for, or the accuracy of, the investigation. Adoptive and foster parents have passed screenings for their health, education, solvency, and living conditions—otherwise they would not be permitted to adopt or foster (except in the shady circumstances of “rehoming”). They are likely to have extensive support systems in church and community groups as well as in adoption or foster care organizations, giving them plenty of character witnesses. If they are using coercive methods, they may have learned them from others in these organizations, and at least will feel supported by knowing that other people they like are doing the same things.

When the apparent respectability of the parents, their list of character witnesses, and their support systems are in place, and if no little or no direct harm  has been done to a child so far, an investigation may come to a halt prematurely. A strong potential for harm will still be in place, because the experiences of the child in “Nancy Thomas parenting” are equivalent to the adverse childhood experiences shown to cause both physical and emotional damage over the long term (see “Adverse Childhood Experiences Study”, www.acestudy.org). To protect children in these situations, investigators need to know what information is required to decide whether abusive coercive methods are being used by a family. That information will include not only what the parents do, but what instruction or encouragement makes them do it.

In cases of ordinary, non-ideological child abuse, investigation and evidence of abuse can lead to a range of outcomes, all presumably improvements of the child’s situation. At one extreme, children may be placed outside the family; at the other, stresses that have caused abuse may be ameliorated by improved housing or medical care and treatment by methods such as Child-Parent Psychotherapy. When abusive treatment occurs because of a shared belief system, and when abuse is assumed to have a beneficial effect on the child, it is much more difficult to think of ways the family can be helped--  and for that reason it is especially important for an investigation to reveal these factors in abuse. Abusive parents who believe they are doing the right thing are likely to continue their actions, but to become very careful about being detected by anyone outside their belief system. 

Several years ago, an adopted 10-year-old girl in Georgia ran away twice from her adoptive home. On the second occasion, the deputy sheriff who brought her back made an excuse to get inside the house, where he noticed that there was an alarm on the girl’s bedroom door. He knew enough to be aware of what this might mean, and an investigation of the situation was launched. Here was the complicated story: when a local couple (not the adoptive parents at the time of the runaway) had gone to Russia to adopt a boy from an orphanage, they had yielded to requests to take the boy’s sister as well.  But, it seems, they did not like her very much. They enlisted a couple of local practitioners of holding therapy to put her straight and periodically sent her to a “respite” foster home in the area. During one of the respite home visits, the first adoptive parents decided they did not want the girl any more, and they left it to the therapists and the foster parents to tell her this. The foster parents then said they would adopt her, and this was managed legally and bureaucratically--  not too hard, probably, because the people were already licensed as foster parents.

When the deputy reported what he saw in the house, a child abuse investigation followed. The adoptive parents’ fundamentalist church weighed in with many character references and statements that the couple could not possibly be abusive. In a lengthy hearing, both the character references and the facts of the girl’s treatment were considered--  but, it then transpired, the second adoptive parents had already sent her out of the state to the Seventh Day Adventist Miracle Meadows School in West Virginia, an organization frequently accused of abusive treatment of children (and recently closed down). This, of course, placed the case outside the Georgia jurisdiction.

What did the Georgia deputy know he should look for? What alerted him to the fact that this was not a simple runaway situation?

Here are some items that may give away the use of coercive parenting methods that reach abusive levels:

1 . Alarms and locks on bedroom doors

2. Minimal furniture in child’s bedroom

3. No lights in bedroom

4. Alarms and locks on refrigerators and food cupboards (unless there is medical evidence of an eating problem)

5. Evidence that a child’s diet has been limited; low weight for age; neighbors or teachers have seen child look in garbage for food

6. Evidence that a child has been put to tedious, unnecessary physical work, like moving stones from one side of the yard to the other and back again

7. Literature and videos by Nancy Thomas or similar authors in the home

8. Computer searches for organizations like radzebra.org, attach-china.org, attachment.org

9. Claims that the child suffers from Reactive Attachment Disorder, or simply “Attachment Disorder”

10. Claims that the child is dangerous but the parents want to keep him or her with them

11. Evidence of treatment by holding therapy

12. Evidence that a child past the toddler stage has still been fed with a baby bottle

13. Evidence that a child has not been enrolled in school or that homeschooling has been irregular

14. Family membership in a fundamentalist church that encourages adoption as part of the “Great Commission”

15. Multiple adoptions; evidence of use of “rehoming” for informal changes in child placement

Few of these facts or parent statements will be associated with non-ideological child abuse (although the two forms of abuse may overlap in their use of cages or similar restraint devices and of “hot-saucing” as a punishment). Even when there is evidence of abuse, the existence of a single one of these items does not demonstrate that investigators should pursue the case as one of ideologically-motivated mistreatment. When there are a number of these items noticed, however, it would be wise to understand that the parents in question may not be innocent simply because their character witnesses say so, nor may they be inclined to stop the abusive treatment of the current target child. Neither will they be unlikely to treat other children in the same way, because they believe it is the right thing to do.     

Block That Diagram! The "Attachment Cycle" and Persuasive Arguments

Over the years, I’ve commented a number of times on the claims of attachment therapists about what they call the “attachment cycle”. (I’ve also written about this on my other blog, http://thestudyofnonsense.blogspot.com.)  The “attachment cycles” – they actually claim two of these events—are the AT alternative theory about how a child’s attachment to adults develops. I call this an alternative theory because in fact it is in no way related to conventional attachment theory based on the work of John Bowlby. It's not actually an alternative for anyone who is well-educated about child development.

To state it very briefly, conventional attachment theory sees secure emotional attachment as based on social interactions between parent and child. During the first months of life, most of those social interactions occur in the context of caregiving, so sensitive and responsive parenting is a proxy measure for social interaction. Later in the first year, social interactions also include communication by voice, gesture, facial expression, and so on, and these events are often but not always associated with daily care routines. Unresponsive or depressed caregivers, or those who are concerned that their baby not be “in control” of them, are less likely at all times to interact socially with babies. Nevertheless, although the babies may develop insecure or ambivalent attachments that are within the normal range, they do develop attachment, because attachment is such a robust developmental phenomenon. In the second year, social interaction continues to strengthen attachment relationships (as shown by the children’s tendency to seek familiar people when distressed), but another factor comes into play: children who are beginning to walk and talk and generally be autonomous need to have boundaries set for them by their caregivers. This boundary-setting can be done kindly or unkindly, effectively or ineffectively, but caregivers who have been good at social interaction are probably better at being both kind and effective, so we would expect to see secure attachment emerging side by side with awareness of boundaries during the second year, even though the setting of boundaries is not directly related to attachment. As the child gets older, and the parent develops further as a parent, the two ideally create what Bowlby called a “goal-corrected partnership” in which each modulates wishes and behavior to help maintain the emotional connection between them. This partnership provides a developing pattern for partnerships outside the family, which after all is the eventual point of attachment.

The alternative theory of “attachment cycles” has different goals and posits different events. The goal assumed by this vernacular theory is that the child should obey, appreciate, love, and be grateful to the parent, not only in childhood, but in adolescence and even in adulthood. These outcomes are the measure of attachment, and a disobedient or noncompliant child is considered to have some form of disorder of attachment. Attachment, and therefore obedience, are considered to develop as a result of two sets of repeated experiences. The first one, in the first year after birth, involves the child needing something and the parent responding by satisfying that need, repeated many hundreds of times. Hunger and feeding are often given as examples of this “first-year cycle”, but there are many other discomforts with which a parent may help an infant. Parents who do not regularly satisfy the child’s needs are thought not to be fostering attachment, even when they are highly socially responsive but it is impossible for them effectively to help a sick or injured child. Such children are said to be at high risk of failure of attachment, with resulting noncompliant or even criminal behavior, as a result of their early experiences when the “cycle” could not occur.

The second set of experiences, the “second-year attachment cycle”, involves strict boundary- and limit-setting by parents. When a toddler does not seem to have learned boundaries, he or she is said to be lacking in attachment, because obedience is conflated with attachment in this alternative system. Noncompliant older children are also said to have disorders of attachment, although there is no evidence that attachment is necessarily a cause of disobedience, whether or not the two behaviors tend to develop in the same context.

How do attachment therapists persuade parents that these “attachment cycles” exist and function as claimed? One way is to present circular graphics of the “cycles” and trace them around and around to show how events get repeated. As it happens, of course, the series of events is in reality not a “cycle”, in which the same pattern would be represented repeatedly, with the same outcome each time. Instead, as both parent and child are changing through experience and maturation, their interaction does not stay the same, and it would be better represented by a waveform indicating each person’s constantly altered needs, communications, and responses. It’s hardly imaginable that the same process could persist through all the rapid changes in parent and baby during the first year.

But, be that all as it may, the AT proponents continue to present these circular patterns that are supposed to show how trust and attachment build with repeated need and gratification. Yulia Massino recently sent me material showing how this has been used in Russia by American evangelical groups who want to influence Russian adoption and fostering practices. It’s my thought that these people are aware of the persuasive power of mysterious diagrams. Just as juries have been shown in the past to be more easily persuaded when they are shown brain images as part of an argument, parent audiences may regard the presenter of the “cycle” diagram to be somehow more knowledgeable than his or her qualifications show. People really do not like to do the work of figuring out a diagram, especially one that is as abstract as the “cycles” are. Do they figure that anyone who understands that diagram must be pretty smart, so they, the audience members, should just accept what they have to say? Maybe that’s the way it works. If so, the best education about attachment may involve learning to interpret graphs and to move from the graph’s abstraction to the concrete reality it claims to represent. On the case of attachment, a circle does not do a good job of representing the actual interactions that culminate in attachment behavior.

Diagnosing Reactive Attachment Disorder: Don't Try This at Home

Rather regularly, I get blog comments, e-mails, and even phone calls from mothers who have read about RAD on the Internet and know that this is exactly what their children have. It doesn’t matter that much of the on-line information is not actually descriptive of Reactive Attachment Disorder; many of these parents are positive that they know what’s wrong, and all they need is to find someone who specializes in attachment disorders to treat the children and get rid of the disorders. Can I suggest a suitable person, they ask, because they are having trouble finding such a specialized therapist.

No, I can’t, and here’s why.

1.     1.  Unless you are looking at DSM-5, you will probably not find on the Internet much that actually describes Reactive Attachment Disorder. Most of the material that purports to do this focuses on disobedience, surliness, aggression, theft, and cruelty to others. These are all serious matters, and a family with a child or children presenting these  problems is certainly in need of good professional help. However, the behaviors are symptoms belonging to a range of other diagnoses, and not to RAD. Note: it’s possible that the children have attachment disorders in addition to these other problems, but the attachment disorders are not the cause of the very concerning behaviors, and “fixing” the attachment problems does not “fix” the antisocial behaviors.

2.    2.  Well-trained clinical psychologists may have most experience and interest in working with one problem area, but they are competent to deal with the full range of childhood mental health issues. Such a professional begins the process of diagnosis by considering all the difficulties that may be behind disturbed moods and behaviors. He or she will pay attention to the child’s cognitive and language development and to areas where the child is behind, up to, or beyond what would be expected at this age. The psychologist needs to be open to consideration of a full range of problems that may be present. To make best use of this professional help, parents need to bring in the best information they can about how the child seems to feel and to act in specific circumstances, and they too need to keep open minds about the causes of problems rather than trying to “cut to the chase” by insisting on one diagnosis or demanding that a therapist focus on a problem as the parent sees it.

3.      3. When children show disturbed relationships with others, and especially when there is antisocial behavior involved, parents need to realize that the child lives and acts within a network of family and other social connections. One possibility behind disturbed behavior is that events or actions of others in the family are making it difficult for the child to reach his best levels of thinking and behavior. These factors can range from marital tension and disagreement to sibling conflict and school pressures to inappropriate disciplinary methods. A therapist who addresses such problems is not assigning blame or pointing to anyone’s guilt, but is dealing with the fact that a child’s mental health problem is bound to be, in one way or the other, a problem of the whole family. Working with the child means working with the family, little as most stressed-out parents care for this idea. These facts also mean that the most accurate diagnosis of a child’s problems is only the beginning of the discussion.

4.      4. The assumption that many, even most, child problems are derived from attachment difficulties distracts parents from seeing the whole child, and unfortunately it can also distract some professionals in the same way.  A 2013 paper by the British psychologists Matt Woolgar and Steve Scott outlined a number of cases in which psychological staff focused on children’s attachment  issues to such an extent that they failed to notice  serious problems that were unrelated to attachment. When parents go out of their way to find professionals who state a specialty of working with attachment issues, and who also are willing to accept a parent’s statement that a child’s problem is Reactive Attachment Disorder, chances of  inappropriate exclusive concern with attachment are much increased.

When a child shows serious mood problems or frightening antisocial behavior, it’s a mistake to jump to the conclusion that Reactive Attachment Disorder is the problem. In fact, it’s a mistake to jump to any conclusions, or even to reach them without a thorough evaluation of the child and the family. Please don’t depend on a diagnosis you reached at home with the help of friends or the Internet, or search for a therapist who will concentrate on a narrow set of problems as instructed.  Look for a professional with thorough training in clinical work with children and adolescents and let that person make the complete assessment that is needed before a therapeutic plan can be created.

   

The Jackson Abuse Case: Religious Beliefs, Old-Fashioned Punishment, Nancy Thomas, or Mrs. Great Santini?

A former Army major, John Jackson, and his wife, Carolyn, were recently sentenced for child endangerment because of the injuries they caused to children in their care (whether these children were being fostered or had been adopted is not clear—media reports run about half and half). [CORRECTION: According to the indictment, available on line, one child had been adopted and the other two were in foster care.] In “disciplining” the then-toddler  or preschool-age children. who were already developmentally delayed, the Jacksons employed hot-saucing, feeding of hot pepper flakes, forced feeding of salt, and withholding of food and water for offenses like walking or eating too slowly or putting fingers into the mouth. There were broken bones, too, including a fractured spine. Further descriptions are at www.northjersey.com/news/prosecutor-army-major-wife-abused-adopted-kids.1.1111774  ; www.nydailynews.com/news/crime/ex-army-major-wife-convicted-abusing-3-n-foster-kids-article-1.2286026 ; www.nj.com/news/index.ssf/2015/former_army_major_wife_sentenced_for_torture_of_th.html .

John Jackson was given a sentence of probation and a fine, while Carolyn Jackson was sent to prison for two years. Rather ironically, it seems to me, it was argued that Major Jackson should not be taken away from his children! One of the couple’s biological children testified about the mistreatment of the foster/adoptive children, so one must wonder about the advantage to him of having his father left available to him.

Prosecutors had asked for a sentence of 15 to 19 years because of the intensity and duration of the abuse. The judge, Katharine Hayden, cited John Jackson’s military record as a reason for giving him probation only—a decision whose implications for punishment of other abusive military people are limited only by one’s imagination. Hayden did agree that Carolyn Jackson had endangered the children’s welfare, and indeed breaking someone’s spine or inducing hypernatremia can scarcely be argued to be in their best interests, even by defense lawyers.

According to the Philadelphia Inquirer, ”Defense attorneys argued during the trial that the Jacksons’ child-rearing methods might have been objectionable but they didn’t constitute crimes, and that the foster children had preexisting health problems.” Granted that desperate lawyers seek desperate arguments, this one nevertheless seems to be not just one but several pips. First, hot-saucing and forced feeding of salt certainly would be crimes if they were committed against adults. Second, let’s look at other forms of corporal punishment. Although spanking of children remains legal, the cut-off point for its legitimacy is usually considered to be the point where its intensity or duration leave physical evidence in the form of bruises or other injuries; when this occurs, this form of punishment becomes abuse. The parallel for other methods of physical discipline would reasonably be that a method that causes visible physical harm, like blistering from hot sauce or hypernatremia from forced salt ingestion, rises (or sinks) to the level of abuse and is far beyond being merely “objectionable”. I believe this argument is an adequate counter to the claim that the Jacksons’ actions did not constitute crimes.

Now, let’s look at the second part of the defense attorneys’ argument: the foster children had preexisting health problems. Now we are definitely in an upside-down moral universe! “The children were in poor health and developmentally delayed; therefore it was permissible—perhaps even advisable?—to brutalize them. This would teach them not to be so sick and motivate them to speed up their development.” Outrageous to state this baldly, of course, but is this not the implication of the defense argument? In fact, in reality, the children’s health and developmental problems made them especially vulnerable to the impact of abuse, and according to their present foster mother, they continue to bear the emotional scars of their time in the Jackson household.

Why did the Jacksons treat the children as they did? Evidently, they offered their biological children the explanation that it was necessary to discipline the foster children in these ways. The parents did not use the same methods with the biological children, although Carolyn Jackson apparently gave a thorough belting to her son when she discovered that he had told a family friend how the foster children were treated. Did the Jacksons believe that the methods they were using were actually a form of intervention, a “treatment” that would help the foster children get onto an improved developmental trajectory? It’s possible that they did think this; they may have been using a version of the Nancy Thomas treatment in which food and water are withheld to motivate children to comply with parental demands, or they may have believed that the children were possessed by demons and that the demons could be expelled by discomfort, allowing the children to return to normal health and development.

It’s also possible that what we see in the Jackson case is simply the perpetuation of the “good, old-fashioned” view of physical punishment as the cure for all childhood behavior problems, and the assumption that whatever punishments were familiar in one’s own early life are the best way to guide children today. This view is sometimes associated with the belief that following one’s parents’ child-rearing ways shows respect for the parents, and failing to do so shows disrespect. In families and subcultures where lack of respect for parents has a strong religious implication of disrespect for divine authority, this can be a powerful factor. There are many unanswered questions about the role of religious belief (including assumptions about demon possession) in this case, but religious positions have played such important roles in other child abuse cases that I think it is a mistake to ignore this as we try to understand what happened here.

Finally, with all due respect to the thousands of well-functioning military families, it would be absurd to ignore the part played here by authoritarian attitudes that punish deliberate and inadvertent disobedience equally. John Jackson has been administratively separated from the Army and I cannot find whether he is actually discharged, either honorably or otherwise. His military record has saved him from imprisonment in the civilian world, but there may be a limit to what even the military can tolerate, especially because this matter became public knowledge and makes the military look bad, which officers are not supposed to do—in church terms, it’s like causing scandal in the congregation.  

Many questions remain unanswered about the Jackson case. I hope further investigation will occur and be made public. The U.S attorney is apparently considering an appeal… and there remains a question about why the Jacksons were never charged with the death of one of the children. Another desirable investigation would look into the conduct of caseworkers responsible for monitoring the foster children.

How Babies Remember: A Tribute to Carolyn Rovee-Collier

Because babies can’t speak to tell us what they know, and because they don’t know how to encode whatever they have learned into language when they begin to talk, all kinds of peculiar claims have been made about their knowledge and memory of their experiences. these range from the idea that babies remember their prenatal lives right back to conception, to the belief that they remember being born and can articulate these memories later, to the assumption that they remember nothing at all even at age 2  years “because they’re too young to notice”.  It’s been pretty rare for people to figure out ways to investigate how babies learn and how their memories work.

One of the few people to create a method for looking at infant memory was Carolyn Rovee-Collier, whose death in 2014 was a great loss to the field of developmental psychology. Rovee-Collier’s work was an excellent example of something I’ve always thought to be true—that in order  to have real insights into ways to study babies, one has to have spent a whole lot of time with them. (No doubt what I am about to say will offend some readers, but I think this is a bit like what Daniel Lehrman and other comparative psychologists used to say about the study of animal behavior.) There’s a sort of total immersion that occurs when you are paying most of your attention to a baby for a long period of time. You begin to see things that were invisible to you before, just as an experienced dancer sees things in a dance performance that even the most enthusiastic non-dancer will miss.

Not all parents observe carefully, but Carolyn Rovee-Collier did while one of her children was an infant. She noticed that when her baby had discovered that by kicking his feet he could make a mobile swing, he kicked again when put back into the same setting, even though things had changed so he could not make the mobile move. At a few months of age, he had learned and remembered something he could do to make an interesting event happen.

Later on, Rovee-Collier systematically investigated the circumstances of learning and forgetting for infants of different ages. Her method—originally used to entertain her baby so Mom could get some work done!—was formalized under the name “mobile conjugate reinforcement paradigm”. The baby is put in a crib with a colorful print crib liner, a mobile is provided, and a ribbon is tied to the baby’s ankle and to the mobile so kicking will make the mobile move. (Do I need to say that babies are not left alone with the ribbon tied? This could be quite dangerous, so don’t try it at home unless you are staying nearby!) Whether the baby learns is measured by the increase in kicking; whether he or she forgets is measured by noting how long it takes for kicking to resume when the baby sees the print crib liner again. The baby learns not just that an action causes interesting results, but that the action works in certain circumstances and not in others, just like the “time, manner, place” learning that makes up so much of what we try to teach small children.

Just as you might expect if you didn’t think babies could remember their own births, younger babies learn more slowly and forget more quickly than older ones. Two-month-olds take 7 to 9 minutes to learn to make the mobile move, and forget  how it works in two days. Three-month-olds learn in 4 to 6 minutes and remember for 6 or 7 days. Six-month-olds learn the trick in 1 to 3 minutes and remember for 15 or 16 days, and after about 9 months the memory lasts for many weeks.

Now, here is the interesting thing that shows how the mobile conjugate reinforcement paradigm is relevant to ordinary real life learning. Babies remember longer when their memories are “reactivated” by letting them see (just see, not make the mobile move) either the mobile or the print crib liner at some time before they are tested. The timing of the reminder is critical, and it seems that some time must pass before the memory is affected by the repeated experience. For three-month-olds, at least 8 hours must pass before the memory is reactivated as shown by kicking in response to the crib and mobile, and it takes 3 days for the maximum effect of the reminder. A three-month-old who gets two memory reactivations (reminders) will remember what was learned for twice as long as the first learning lasted. By age 6 months, only an hour need pass before the reactivation effect is seen, and it takes only 4 hours to reach the peak effect.

The take-away message from Rovee-Collier’s work is that younger babies do learn, but they learn slowly and forget quickly unless they are reminded, not by having exactly the same experience as before, but by seeing the setting in which they learned. Even with a couple of reminders, three-month-olds remember the event for only two weeks. This suggests that a single experience in infancy is not likely to be remembered long, and that early learning that lasts will be likely to involve the many repetitions of familiar daily caregiving routines in familiar places. Only after about 9 months do we see quicker and longer-lasting learning. Another implication, and an important one, is that babies are motivated to learn not so much by gratification of physical or even emotional needs, but by the need to experience mastery over the environment and to make interesting things happen.  

It’s good to keep these things in mind when confronted by claims of prenatal and birth memories and their lifetime influences.

Worrying About Autism? Some Information

Two posts on this blog draw the most reads and comments week after week: these are http://childmyths.blogspot.com/2011/07/eye-contact-with-babies-what-when-why.html and http://childmyths.blogspot.com/2013/11/infants-autismand-eye-contact.html. Both of these posts have to do with infants’ eye contact with their caregivers, and by extension with symptoms of autism—readers who write comments and queries are almost always worried about autism, not about the visual impairment that might also underlie problems with eye contact. Recently, there have also been concerns about odd movements like hand-flapping that may be associated with autism, and some readers have been worried about whether some hand movements might indicate Rett syndrome.

For worried parents, one of the real problems is that they don’t actually know what “autistic movements” look like. Another is that infants are individuals who often don’t conform to averages of development that parents read in “the books” of norms for developmental milestones; they reach some milestones earlier than the average, then turn around and act a bit delayed on others. In addition, neither autistic or typically-developing children are “all autistic” or “all typical”, and their behaviors overlap quite a bit, especially during the toddler and early preschool periods. A fourth, and very real, problem is that it’s still not understood how autism can be predicted accurately for children who are still under a year old--  but this is exactly the age period when parents are most likely to start agonizing and watching for those “red flags”.

Here is a very fine video that shows behavioral differences between typically-developing toddlers and same-age children who are later diagnosed as autistic:

http://www.kennedykrieger.org/patient-care/patient-care-centers/center-autism-and-related-disorders/outreach-training/early-signs-of-autism-video-tutorial .

When you watch this, please notice that all the children are over 12 months of age. Don’t try to generalize from this information to younger infants. One of the features of autism is developmental delay, so an autistic child may act in some ways much like a younger child--  it’s important to realize that this cannot be reversed to mean that the younger child must also be autistic, or to assume that developmentally appropriate behaviors of the infant are signs of autism.

The first concept covered in the Kennedy Krieger video is the child’s ability to use play in ways that include other people, not necessarily as a formal “game”, but as part of a social interaction like pretending to eat or to feed another person. The typically-developing child in the video offers a “bite” to an observer and takes a “bite” himself. This ability develops after about a year of age, and its absence in a younger infant would be no reason for concern. He also follows what an adult does, imitating in a meaningful rather than a mechanical way. The same-age child who is showing signs of autism does none of those things, and he does not respond to his name, which is unusual at this age (though it would happen much more frequently with children some months younger). Although he acts as if he likes to be tickled by his mother, he doesn’t respond socially.

The second point is the making of social connections by typically-developing children, by looking at people and responding to gestures. The little boy in the video even makes an effort to turn and look at his mother, and he looks at an item pointed at by an adult, continuing the “conversation” by pointing at it again later. Another boy of the same age shows symptoms of autism by flapping his hands in excitement, but without looking at the adult; a typically-developing child may also flap his hands, but he looks at adults while he does so and seems to use the gesture as communication. The autistic child does not look at an object an adult points at, but instead looks at the adult’s finger (as a much younger infant might do).

The third important point in the Kennedy Krieger video is the typically-developing child’s capacity to carry out and enjoy social communication. The child in the video is fascinated by a moving toy, but frequently looks at adults and then back at the toy, while smiling. When the toy stops moving, she wordlessly communicates to the adult that she needs help to start it again. An autistic child of the same age watches the toy carefully, but does not smile at adults or look at them to create social communication. He does not respond to a gesture by which an adult asks to have the toy. His mouth and torso become tense and stiff as he handles the toy.

Watching this video may give you some hints about differences in behavior between typically-developing and less typical children, but remember, these differences do not apply to children under a year of age. There may be differences at earlier ages, but they are not yet well understood. In addition, remember that typically-developing preschool children sometimes do “autistic” things, and autistic children sometimes do “typical” things. It’s the general pattern of behavior that is of importance. Finally, keep in mind that even the children who are diagnosed as on the autistic spectrum as toddlers and preschoolers may well look much more typical as time goes on.

Social Workers Gallop Off in All Directions

I recently came across a document that stated that the National Association of Social Workers has endorsed “equine-assisted therapy” (EAT) for mental health problems. “Wha-a--?”, I said, and began to look up whether there had been such an endorsement. Now, this can be hard to do; I know NASW sometimes passes resolutions at their annual conference, and these can be hard to locate later for those of us who are out of the social work loop (e.g., the resolution against Holding Therapy some years ago). I didn’t find a resolution about EAT, but I did find that NASW had given continuing education credits for a class on this topic (naswct.org/wp-content/uploads/2015/04/NASW-Conference-2015-Brochure.pdf).

Horseback riding has been used therapeutically for many years for children with cerebral palsy and other neurological disorders that contract muscles and distort the structure and function of the limbs. Riding provides a warm and gentle stretch for leg muscles and is so enjoyable that children are distracted  from any discomfort. But, of course, this does not mean that people with other kinds of disabilities--  people who don’t need their muscles stretched—will also benefit from horseback riding. (Similarly, prescription eyeglasses that correct visual disabilities don’t help hearing impairments.)

For some time now, there has been a strong tendency to equate mental illnesses with “brain disorders”. Certainly it’s true that at some level every mental illness has a foundation in brain function and even structure, but this does not mean that it makes sense to force all mental illnesses and all results of brain injury or atypical development unto the same category. I understand the motivation to do this forced combination—everyone knows the results of an injury are not the victim’s fault, and some people still think that the mentally ill could stop being sick if they really tried, so presenting mental illness as equivalent to brain damage supports the important argument that the mentally ill should not be stigmatized.

The two things are not really exactly the same, though, and their treatments cannot be identical. Brain disorders like CP can have powerful effects on the body  and affect children’s behavior and development by damaging physical growth and abilities. Horseback riding helps corrects muscle and bone development and use; it does not cure the brain damage that caused the problems of physical development. It won’t cure any posited brain disorders that may lie behind mental illness, either.

Horseback riding, and learning to handle and care for horses, can be great fun for kids, and shared enjoyable activities are an important key to social skills, sharing, taking turns, and understanding other people. Sharing such activities with a social worker or other helping person can improve interactions and help establish a strong relationship.

But these points are a far cry from evidence that EAT in itself is an effective treatment for autism, ADHD, or other disturbances of children’s mental life. There is very little evidence to that effect.  In a recent review, Kendall et al (2014; Explore, 10(2), 81-87) described EAT as under-researched and largely anecdotal in its support. Even though there are randomized designs used in some studies of EAT, they generally fall down by having a treatment group who have elaborate social, interactive, and riding experiences, but are compared with another group who are given no new experiences at all. This failure to isolate the horseback-riding variable means that no one can know whether apparent benefits came from increased social experience, from interactions with social workers or other helpers, or from riding itself.  

In addition to the lack of empirical evidence supporting EAT as a therapy for children with developmental delays or other mental problems, there has been a strong tendency for advocates of EAT to make exaggerated, even ludicrous, arguments for the treatment. I discussed some of these  several years ago at http://childmyths.blogspot.com/2011/02/clever-hans-rides-again-equestrian.html. I was responding to claims that  horses know when a child is lying (they don’t care for this, it seems), and that a horse’s gait is “downloaded” into a child’s brain, thus apparently doing an end run around all the problems that have been blamed (wrongly) on a lack of crawling experience.  These both summon entertaining images--  a deeply disapproving horse shaking its head at a fibbing child (but why lie to a horse?), and the probable human gait that would be based on a “downloaded” horse pattern. (This last makes me think of playing horses as a little girl and being both horse and rider simultaneously.)

Perhaps NASW feels that interest in EAT by social workers can lead to some serious research about the treatment’s effectiveness, and that is possible, even though much about the treatment is implausible. Nevertheless, it would be wise to limit shows of approval like continuing education credits until better evidence is presented. It would also be a good idea to draw the line clearly between the “downloading” faction and the work of those who are interested in the actual possibilities of this proposed treatment modality.