Book to be released August 1!

Book to be released August 1!
Alternative Psychotherapies: Evaluating Unconventional Mental Health Treatments

Tuesday, September 16, 2014

Before the Fringe: Do Today's Unconventional Beliefs Have Common Ancestors?


A member of a Facebook discussion group recently speculated on whether there was a connection between the concerns of Christian groups in the ‘80s and ‘90s about abortion, and the “Satanic panic” of the ‘90s, which featured stories about how devil-worshippers conducted unholy rituals that killed babies. I don’t know the answer to this problem, but the question itself points up the possibility of connections between unorthodox beliefs and other religious or political principles and practices. These connections could involve ideas whose popularity was high long ago—a sort of  ”trailing edge” phenomenon--  or current beliefs which either affect each other directly or which are brought about by a shared predecessor.

I understand that historians don’t like this kind of search for connections, and I can see how it might be thought of as cherry-picking. Nevertheless, I think it may be useful to see whether the predecessors of today’s unconventional beliefs were also the “fringe” of their own times, and how they connect with other “fringes”..

Some aspects of current unconventional thought may be the “trailing edge” of Transcendentalism, a philosophy of the mid- 19th century that stressed the unity of physical and mental processes, the role of Nature in human life, and the importance of traditional Asian beliefs as guidance for Western thinkers.  Bronson Alcott (“Grandfather” of Little Women) was a Transcendentalist who tried to keep his family on a farm, “Fruitlands”, through a New England winter, living on oatmeal and apples and wearing only cotton and linen so as not to exploit animals; his wife finally persuaded him that the younger children needed milk as well, and after a while the family moved back to Concord.

This is simplifying a bit, but by the 1880s Transcendentalism had given rise to the New Thought, a system that emphasized the power of thought over physical events. The New Thought included approaches like Christian Science, a belief system that stressed physical health as it might be influenced by thought, and one which hangs on as a somewhat conventional, minimally evangelical religious group in the United States. The influence of the New Thought is still apparent in some current Internet and print  publications about Attachment Therapy, in which it is claimed that children can voluntarily vomit, defecate, or even die, out of their desire to disturb and humiliate their adult caregivers.

But although Transcendentalism and then the New Thought seem to be precursors of some alternative psychological beliefs, it’s difficult to bring those older beliefs into alignment with other “fringe” ideas--  especially those that have to do with physical facts and the history of the universe. In a 2012 book, The pseudoscience wars: Immanuel Velikovsky and the birth of the modern fringe, Michael Gordin discussed a number of beliefs that emerged between the 1940s and the 1970s and that seem to provide a foundation for more recent alternative beliefs. I want to summarize those and see if there is any evident connection between them and other unorthodox beliefs, whether about alternative psychotherapies or about Satanic ritual abuse.

Gordin concentrated on issues of pseudoscience and the demarcation problem of discriminating between science and pseudoscience. (This is a more difficult task in the physical sciences than in psychology or medicine, where the occurrence of injury as the result of an assumption provides a brighter demarcation line.) He organized this discussion around the 1950 publication of Worlds in Collision by Immanuel Velikovsky, a former psychoanalyst. Velikovsky’s book collated accounts of events in the Bible and other texts that could support the idea of planetary catastrophes having occurred within recorded history--  for example, the story of the sun having “stood still” for hours during an Old Testament battle. Using such examples, Velikovsky put forward the claim that changes in the planet and solar system have not been gradual and uniform as is assumed by geologists and astronomers. Instead, Velikovsky argued, a comet that later became the planet Venus brushed Earth with its tail, causing disasters but also creating the manna that fed the Jews in the desert (the explanation for this last bit was provided, but I really can’t get into it). The present form of the solar system was thus less than 5000 years old.

Worlds in Collision was published by Macmillan, the leading scientific textbook publisher of the time, after having been reviewed by someone who was only peripherally involved in astronomy. Its publication was followed by severe criticism of the publisher, not so much for having accepted the book at all, but for allowing it to be presented as if it were a scientific undertaking. (The author himself was at times quite willing to have it regarded as history.) Concerns about how the public might be deceived by Worlds were exacerbated by summaries and serializations of the book in the popular magazines Harper’s and Collier’s. Scientists who spoke critically of Worlds were, however, also concerned about the reality or appearance of censorship of scientific work; these worries were based on the current political witch-hunting of Senator Joseph McCarthy, and the recent history in the Soviet Union of suppression of modern genetic work in favor of the anti-Darwinian view of inheritance, Lysenkoism.

Velikovsky did not go away. He continued to write and developed a small but devoted following who by the 1970s became part of what Gordin called “counter-establishment science”. The counterculture, with its commitment to the Free Speech Movement of a few years before, helped establish several journals that gave serious consideration to Velikovsky’s proposals. As time went on, college courses examined his work as a breakthrough that went beyond the existing system of thought. Even quite recently, as Gordin pointed out, the whole 2012-Doomsday scenario included references to Worlds in Collision. Referencing Randolph Weldon, author of Doomsday 2012, Gordin noted: “Weldon supplements Velikovsky’s account with a mechanism that disturbed the solar system in antiquity, issuing the comet that became Venus… This hidden force was what the Mayas had calculated would return at the end of the Long Count, and a new force will soon terrorize and destroy Earth.” 

Where does this lead us with respect to alternative beliefs about psychology? Did such beliefs share ancestors with Velikovsky’s theory of the solar system? Except for the fact that Velikovsky had trained as a psychoanalyst, and psychoanalytic concepts of the unconscious and of repressed memory have been important parts of alternative psychologies and psychotherapies, it is difficult to see any direct connections—but there are commonalities between the psychological “fringe” and the physical science “fringe”. There are also unshared characteristics.

  1. Do the physical and the psychological “fringes” both appeal to nonmaterial forces as explanations?... Velikovsky’s arguments were supportive of a “young earth” approach and therefore of creationism with its strong spiritual emphasis, and he drew evidence from sacred writings of various kinds, treating them as historical evidence. Nevertheless, his explanations were as entirely material as one sees in conventional science. Lysenkoism used a material explanation too. In alternative psychologies and psychotherapies, however, it is common to see appeals to supernatural phenomena like telepathy or to the effects of unknown energies.
  2. Have physical and psychological “fringe” material been presented to the public in the same ways?... Velikovsky’s publication of Worlds in Collision with a well-known scientific publisher was something of a fluke. Most such material has been published by specialty presses and has not been widely advertised. The same has been true of psychological “fringe” material until the late 1990s and later, when there were publications of such material by the Child Welfare League of America, Academic Press, and Wiley. 
  3. Have physical scientists and psychologists responded in the same ways to ‘fringe” materials?... Gordin’s book discussed the confused response of physicists and astronomers to Worlds in Collision. Physical scientists wanted to argue against Velikovsky without falling into the censorship trap; some focused their criticisms on the publisher, whose approval of the book seemed to imply that it should be included in their respected natural science list. Others ignored Velikovsky’s arguments, or, like Albert Einstein, were friendly but would not give the support Velikovsky wanted. Psychologists have on the whole ignored issues about alternative psychologies and psychotherapies; the American Psychological Association has even in recent years given continuing education credits for study of alternative treatments. A possible explanation of this indifference comes from a comment by Martin Gardner on the work of Wilhelm Reich, a direct predecessor of today’s alternative psychotherapies: “The reader may wonder why a competent scientist does not publish a detailed refutation of Reich’s absurd biological speculations. The answer is that the informed scientist doesn’t care, and would, in fact, damage his reputation by taking the time to undertake such a thankless task” (quoted by Gordin).
  4. Have countercultures supported both physical and psychological “fringe” ideas over time?... The role of the ‘70s secular counterculture in popularizing and maintaining interest in Worlds in Collision--  even bringing it into college courses—is clear. The religious counterculture that supports creationism has also played a role. These countercultural phenomena were not just anti-science in a general way, but fought the authority of science by declaring their own sources of authority to be paramount. Aspects of the secular counterculture are also apparent as supports of some alternative psychologies and psychotherapies--  for instance, the countercultural appeal to “Asian tradition” as a source of knowledge shows up in the energy therapies of different kinds.  The idea of repressed memory is also fostered by the secular counterculture’s stress on emotion as a more trustworthy guide than thought. Religious countercultures like the charismatic movement have supported alternative approaches that focus on adoption issues or posited prenatal experiences of interaction with the mother; these concerns relate clearly to positions on abortion and extramarital sex.


It’s hard to come to any clear conclusion here. Alternative beliefs about the physical world and about psychological phenomena share some but not all concepts and histories. The one factor that seems to me to be most important in encouraging the “fringe” is the existence of countercultures that can increase their own power and prestige by advocating for a “fringe” belief. But perhaps an equally important point is the fact that as Martin Gardner said, “the informed scientist doesn’t care.”

Monday, September 15, 2014

The "Parental Rights Amendment"--Or, the Parental Interests Amendment

As www.parentalrights.org shows, a small group of senators and representatives are supporting what they call a “Parental Rights Amendment” to the U.S. Constitution. Here are the provisions of the proposed amendment:

  1. Parents have a fundamental right to direct their children’s upbringing, care, and education.
  2. Parents have the right to choose from public, private, and religious schools or to choose to school their children at home.
  3. Infringement on these rights is allowable only when the highest levels of government interest are involved.
  4. This does not extend to the right to make a decision or action that would end a child’s life.
  5. No treaty or international law may be construed to modify these provisions.

The basic concerns here seem to be in favor of parental choices of health and medical care (but not parental decisions to terminate pregnancy or to withhold treatment from a severely compromised newborn). Another concern--  apparently secondary, but possibly not so—is to continue to prevent the U.S. from ratifying the United Nations Convention on Children’s Rights and the United Nations Convention on the Rights of Persons with Disabilities. (Efforts to avoid ratification of the UNCCR have been successful for almost 30 years now, so chances are that www.parentalrights.org will continue to be happy about this.)

Arguments in favor of institutionalizing parental rights often focus on errors of child protective services staff who have “taken away” children inappropriately. There is no question that these problems occur with alarming frequency (see for example http://childmyths.blogspot.com/2013/08/when-attachment-therapists-dont.html).

However, it would be a great mistake to imagine that these errors are more frequent than erroneously failing to take custody of a child when the child is in real danger. The Barahona case in Florida was an egregious example of this, involving the common problem that caseworkers liked and thought well of parents and therefore did not even bother to contact the endangered children (http://childmyths.blogspot.com/2011/07/adoption-trust-compacency-and-barahona.html). A recent case was that of Timothy Jones of South Carolina, who is accused of killing his five children and driving with their bodies to Alabama (Blinder, New York Times, Sept 12, 2014; A18. According to the Times, Jones had been investigated in May and August 2014, following reports that one son had “extensive bruising”. The August investigation report spoke of Jones as “overwhelmed” by caring for the five children, ages 1 to 8 years, on his own following a divorce. Interviews with the children suggested that he depended on physical punishment as discipline, having the children do push-ups and beating them with a belt, and that he used rough horseplay. The May investigation concluded that there was not enough evidence for an arrest. (There had been earlier investigations of the conditions of the family home while Jones’ wife was still living there.)  

Advocates of a Parental Rights Amendment seem to be concerned only with errors of child protective services staff that lead to mistakenly taking the child into custody. The errors that leave children in the custody of parents who later injure or kill them are not mentioned. (To be fair, the website does state that prevention of abuse or neglect by governmental agencies would be continued under the amendment, because such prevention is a governmental interest of the highest order. However, it is unclear what parental actions would be included as neglectful or abusive under the amendment.)

For some decades now, U.S. courts have made decisions about child custody on the basis of the ill-defined term “the best interest of the child”. I refer to this term here for one reason only: its very existence indicates our awareness that the best interest of a child may not be the same as the best interest of a parent, and neither may be the same as the best interest of the state. All these interests may overlap to a greater or lesser extent, but they are not necessarily identical. This point is made even more  clear by the fact that the advocates of a Parental Rights Amendment have as a major concern the rejection of the Convention on the Rights of Children. They want priority given to the interests of parents which do not necessarily overlap with the interests of their children. (Because the concept of a “right”, fundamental or absolute, is difficult to define, I would suggest that we speak of parents’ and children’s interests, not their rights. This terminology may help us avoid the influence of the “natural law” system and focus on the outcome we desire.)

Modern democratic government is based on acceptance of the fact that different groups (and government itself) have different interests, and the principle that balancing the interests of different groups is the best way to assure survival of the entire community. Because interests of parents and children may not be identical, and because children are not competent to make use of civil rights and therefore possess them in a limited way only, the best interest of the government and community is in the protection of children from a range of dangers, including those that may unfortunately arise from their caregivers. To prioritize parental rights through a constitutional amendment would be to interfere with both children’s interests and those of the larger community as a whole.  Think about the amendment as a Parental Interests Amendment and I think you’ll see what I mean.

I don’t believe proponents of the Parental Rights (or Interests) Amendment are concerned about the outcome of balancing interests that I mentioned in the last paragraph. On the contrary, their motives are ideological rather than pragmatic. Exploration of the www.parentalrights.org site shows the influence of charismatic Christian leaders, for whom the establishment of correct lines of authority is an overriding goal. Legal arguments provided by parentalrights.org come from the law school of Regent University, a Christian school founded by the charismatic Pat Robertson. To put parents firmly in charge, and to avoid the “ungodly” influences of the United Nations (a concern of fundamentalists for many years now)--  these are goals that exist because of religious and political beliefs about authority, not because their outcomes are held to have value for the community.   








Thursday, September 11, 2014

More about Nasty Tastes and "Consequences" for "Choices"


Some time ago, I posted comments about the suggestion of a “nanny blog” that children should be disciplined by having unpleasant substances placed in their mouths (http://childmyths.blogspot.com/2012/03/putting-nasty-tastes-in-childs-mouth.html). I gave a number of reasons why this approach is inappropriate and potentially harmful to children.

A few days ago, a comment on that post was submitted by “Adam”. He said, “Since when is giving someone vinegar in any way hurting them. If you do your research you will see that vinegar has many healthy benefits to them. Giving it as a consequence is a deterrent. While I agree with spanking too, does this not hurt? The idea is not to hurt but to teach that for a bad choice comes a consequence. You may think that taking away a little tv time will do the trick but you have to consider the situation. Any kind of punishment is wrong if not done with love. If any of these are done out of anger they are wrong.”

It’s difficult to tell exactly what Adam’s argument is, of course. The original post had to do primarily with the recommendation of Tabasco sauce and pepper for disciplinary techniques, although vinegar and lemon juice were mentioned--  so it’s really irrelevant whether some people believe that vinegar is good for you (as are some of the other substances mentioned, including soap, when used for appropriate purposes).

The central point of Adam’s argument, I think, has to do with “consequences” and with punishment, and with the similarities and differences between the two. Like many other people, Adam seems to confuse these terms, and to follow a line of thinking in which a parent might say “I consequenced my daughter.”
I think the confusion shown by Adam and others can be traced to belief systems like that characterized by Foster Cline’s commercially-successful “Love & Logic” program. Perhaps finding that parents felt anxiety and guilt when they saw themselves as punitive, L & L introduced “consequence” as a transitive verb. The L & L group also created a false analogy between the impersonal painful effects of the physical environment on those who ignore its rules, and the personal administration of discomfort by adults who believe that painful experiences should alter a child’s unwanted behavior.

Ignoring the realities of the natural world does have its consequences, often uncomfortable and sometimes even fatal. Don’t wear your jacket when the temperature is dropping, and you might be miserably cold. Jump out a second-story window, and you could die or at least be seriously injured. It doesn’t matter who you are or whether some other person decides you’ve been bad or not--  these consequences are always the same, when conditions are the same.

Things parents do to children with the intention of discouraging unwanted behavior are punishments, not consequences. They do not just happen naturally, but occur when the adults make decisions about the behavior and how to respond to it. Unlike consequences, punishments don’t happen in exactly the same way every time. Sometimes parents decide that an unwanted act was accidental and don’t punish it. Sometimes they are too tired to follow through. Sometimes punishment is given so long after the unwanted behavior that it is completely ineffective. And sometimes there is no punishment because the parent does not find out about the act at all (and in that case, the child experiences all the reward value of whatever it was he wanted to do, without any associated punishment).

A strange but true point about the use of punishment is that both rewards and punishments are most effective when they are small. Intense, frightening punishments arouse so much emotion that children may not be able to understand their connection to the unwanted behavior. That would be likely to be the case when young children are “hot-sauced” as a punishment. Mild punishments like a raised parental voice or simply being physically stopped from an action, if they follow immediately or even better coincide with an unwanted act, are much more effective than intense punishment.

A recent webinar about working with FASD children, provided by the Canadian group CHNET-WORKS (www.chnet.works.ca) gave some useful hints about helping children comply with adult wishes. These were directed primarily at FASD problems, but also considered relevant to autistic children and others with problems of brain functioning. These children may be seen as noncompliant or oppositional rather than as unable to obey adult rules, although the latter point may be the real case.. Dan Dubovsky of SAMHSA gave some especially useful suggestions that are applicable to many children and adolescents.

One important point is that multiple rules or multiple directions may be confusing to some older children, just as they are to toddlers. When the adult says “take those clothes upstairs and put them away,” and the child does not follow through, the problem may well not be deliberate disobedience, but a state of confusion or even the inability to remember the second instruction after the first has been accomplished. Breaking a task into small, definite pieces may be necessary before poorly-functioning children can complete the entire task.
Dubovsky also suggested that only a reward system be used, rather than  including punishment or “consequences”. Children with cognitive difficulties respond well to small rewards (including praise), but can be upset or confused by punishment--  and this would be especially true of punishments that are delayed, as I mentioned earlier.

Another way of smoothing life with a poorly-functioning child is to give help in handling transitions--  getting up, going to bed, leaving for school, having company come. The child may need repeated warnings of what is going to happen in order to tolerate the change, even though these transitions occur every single day and adults imagine that the child will be comfortable with them.

As a final point, I want to refer back to one of Adam’s statements and point out how this way of thinking can cause poor handling of some children. Adam said that  “for a bad choice comes a consequence.” This “good choice, bad choice” talk is very common nowadays, and I think is harmless with well-functioning children, although it’s really just the modern way to say “good girl” or “bad girl”.

However, the idea of a “bad choice” contains within it the assumption that a child is making a choice, and that the ensuing action is voluntary. In other words, the reasons for all behaviors are thought to be within the child. This assumption is called the “fundamental attribution error”, and it is a matter of ignoring or minimizing the impact of external factors on behavior. To avoid the fundamental attribution error, it is important to realize that the child’s actions may be shaped by external factors, as much or more than they are by his or her decision about what to do. A crowded, over-stimulating room may cause disorganized, “hyperactive”, distractible behavior. An angry adult who appears threatening may cause stonewalling or lying. A set of overly-complicated instructions may be followed by failure to comply. These external factors can be altered by adults in ways that can change child behavior--  but this will not happen until the adults drop the idea that children’s behavior is necessarily a matter of “choice”.

Following some of the suggestions in this post will work much better than putting unpleasant substances in children’s mouths.

.






Wednesday, September 10, 2014

Help for Sick Mother of Autistic Boy in Czech Republic

About a year ago, I posted an account of my visit to a conference held by APLA, the Czech autism group (http://childmyths.blogspot.com/2013/10/holding-therapy-from-westminster-to.html). While I was in Prague I met many friendly and concerned researchers, therapists, and parents of autistic children. One was Marcela, the mother of an autistic boy, who may be seen in healthier days at www.youtube.com/watch?v=8Z9x-wwh-UGs.

Very sadly, Marcela had an illness that has now become much worse and that will probably have no good outcome. Her greatest wish is to be able to have her autistic son cared for in their home during the rest of her life, and afterward, rather than having to have him placed in an unfamiliar care setting that would be difficult for him to cope with. Social services in the Czech Republic cannot help with this.

The APLA group (www.apla.cz) has set up a fund for people who would like to respond to Marcela’s very understandable wish. I made a contribution by wire transfer this morning. If you would like to do so also, here is the information you will need:

IBAN CZ864000000000511144082   (that’s 9 zeroes in a row)  SWIFT/BIC SOLACZPP
Recipient name: APLA
Recipient address: Brunnerova 1011/3, Prague 17, Czech Republic   
Bank name: LBBW Bank CZ A.S.

My correspondent, Alena Bilkova of APLA, also included the information: text “Erik”, but my bank did not use this.

If you would like more information, you can contact Alena at a.bilkova@volny.cz. Alena does not speak much English, but her daughter can translate for her.


Monday, September 8, 2014

More Mistakes About RAD: Time to Mow the Hay at Miracle Meadows


The Miracle Meadows School in Salem, West Virginia, has made the local news a good deal recently. The commitment of the school to an unconventional view of Reactive Attachment Disorder and its treatment--  a view that has been associated with child injury and even death—means that this situation should receive much broader attention from parents and child maltreatment experts.

On Aug. 19, 2014, Miracle Meadows had its school exemption status revoked (www.wboy.com/story/26349774/miracle-meadows-school-employees-to-face-additional-charges). The exemption in question is one that frees religious schools from many of the requirements for public and independent schools (Miracle Meadows is a Seventh Day Adventist School).  One of the reasons for revocation was that a staff member apparently used a chokehold until a child lost consciousness. This event was followed by the arrest of a major figure in the school for child neglect and abuse (www.wvmetronews.com/2014/08/22/founder-of-miracle-meadows-school-arrested-on-charges-involving-child-neglect-and-abuse/). The school responded with denial and a press release stating plans for a lawsuit against the state agency (www.wdtv.com/content/files/Press%20Release%2082514.pdf).

What is the real story here?

I first came across Miracle Meadows in 2010 when I was asked to testify in a case involving an adopted Russian girl living in a southern state. “Marjorie”, as I’ll call her, had been adopted along with a sibling from a Russian orphanage. The adoptive parents had wanted only the sibling, but under pressure agreed to take “Marjorie” as well. However, on getting home, it appeared that they did not like “Marjorie” very much, whereas they were very pleased with the sibling. They put “Marjorie” into holding therapy with a pair of local licensed professional counselors who had been trained by the state some years previously to do this alternative therapy. Feeling no more pleased with “Marjorie” than they had before the treatment, the adoptive parents sent her several times for “respite care” with licensed foster parents. This did not do the trick either, so the adoptive parents decided they did not want her any more. The foster parents agreed that they would take her, and the counselors broke the news to “Marjorie”, who apparently did not even have a farewell meeting with the people who had brought her from Russia. How the legal steps that should have been part of this “re-homing” occurred seems to be unclear.

The foster parents were also committed to the alternative view of Reactive Attachment Disorder, as advocated by Nancy Thomas and Foster Cline, but not by any conventionally-trained practitioner using evidence-based methods. After some time with the foster parents, “Marjorie” ran away, but was found and brought back by a sheriff’s deputy. When she ran away a second time, the deputy made an excuse to come into the house, where he saw evidence of unusual treatment like an alarm on the bedroom door and little furniture in the room (I don’t know whether the deputy actually knew this, but these items would be congruent with Nancy Thomas’s advice.) An investigation followed, and in the midst of it, the foster parents sent “Marjorie” out of state to Miracle Meadows School.

Let’s have a look at this school and its history. In 2000, the West Virginia Department of Health and Human Resources brought a suit against William and Gayle Clarke and Miracle Meadows School, asking that the Clarkes turn over medical an school records of students enrolled at Miracle Meadows, in connection with an ongoing investigation of allegations of abuse and neglect, and that students and staff be made available for interviews in connection with the investigation. The investigation had begun with two girls running away, complaining of sexual abuse, and later recanting after having been returned to the school, then stating that they were afraid to remain at the school. Further investigation led to statements by DHHR that one boy had been forced to spend the night in a 5 X 5 secured room with a space heater, and that another had been beaten with a board.

The circuit court denied the DHHR suit on the grounds that requiring the Clarkes to hand over records would violate their constitutional rights against self-incrimination. The appeals court affirmed this (www.courtswv.gov/supreme-court/docs/fall2000/27915.htm).

It appears, however, that the school administration in its own statements has incriminated itself, not necessarily of beating children with boards, but of its commitment to non-evidence-based, alternative beliefs about Reactive Attachment Disorder and methods of treating behavior problems in children and adolescents.

For example, the school web site lists the same notional symptoms of Reactive Attachment Disorder , like fascination with blood and gore and lack of eye contact “on parents’ terms”, as are stated by Nancy Thomas and other proponents of holding therapy (www.miraclemeadows.org/#!untitled/c1hax). This list of symptoms is in no way congruent with the criteria for diagnosis of Reactive Attachment Disorder given in DSM-5 or any earlier DSM edition. The school application form provides a similar checklist (www.media.wix.com/ugd/b07d53_d482b005fd8ca609991e8c059aed0fad.pdf ).

The school has also presented a statement (www.media.wix.com/ugd/b07d53_599f36a47eb64f74ac6b09fbd4d6424a.pdf ) giving inaccurate material about RAD, claiming the usefulness of the alternative psychotherapy qEEG, and referencing training on RAD done in the state where “Marjorie” lived. The statement is signed by two licensed professional counselors who were certainly working outside their appropriate scope of practice if they claimed to be able to diagnose and treat this disorder . One of the signers had been involved in the case of “Marjorie”.

The school had posted a statement about Reactive Attachment Disorder by its division CARE, the Center for Attachment Resources and Enrichment (www.miraclemeadows.org/#!CARE-Releases-Statement-About-RAD/c4sd/F1882D98_74AA-4AE6-BEB9-E39ED2F32CB3 ), but although the link to this statement worked several days ago, it does not work for me today.

In addition, several Internet sites address the involvement of Miracle Meadows with alternative views of Reactive Attachment Disorder. www.gofundme.com/8xs8fg says Miracle Meadows specializes in RAD, but this parent apparently found the financial and other demands of the school excessive. www.3abn.com/Series/CLR/CLR000099A.html  provides a transcript of radio program referring to the made-for-TV Nancy Thomas movie “Child of Rage”, which has done so much to spread misinformation about attachment disorders. Finally, of particular interest is www.archives.adventistreview.org/article/6088/archives/issue-2013-1506/alternative-adventist-education , which states that Miracle Meadows staff were undergoing “training in RAD” in 2013 but fails to give the identity or the qualifications of the trainers.

The application form for Miracle Meadows (www.media.wix.com/ugd/b07d53_d482b005fd8ca609991e8c059aed0fad.pdf ) asks parents to agree that they understand the “activities” associated with the school and to authorize these activities, stating that “I am aware of the risks involved in such activities”. Parents must also agree with other rules, for example that “… parents are never to discuss leaving MMS with their students without prior permission from MMS administration. Doing so is grounds for immediate dismissal of the student.”  “…students are dismissed if parents do not pay tuition and/or are involved in unresolvable loss of trust with the school which impacts the students.”  This highly authoritarian position is congruent with the authoritarian ideology of Cline and Thomas, as exemplified with Cline’s statement years ago that “all bonding is trauma bonding.”

Practitioners of dangerous alternative therapies are rarely or never accused of criminal activity until children are injured or killed. The law prohibits child neglect and abuse, but only in a few cases has it named specific treatments as forbidden. Some states have now passed laws against “conversion therapy” as a way to change sexual orientation, and it would be a real step forward if that legislation could be expanded to include other potentially harmful treatments that are abusive of children. New laws should focus particularly on residential treatment centers and boarding schools where children may essentially be prisoners, without protection of any kind against ill-advised or overtly sadistic staff members.  

The Miracle Meadows lawsuit against West Virginia DHHR should be met with vigorous investigation of practices in the school, and would be an ideal foundation for legislation that would prohibit holding therapy and related methods. It’s very disturbing to me that as a society we fret about spanking with the open hand, while we have not yet come to terms with the existence of barbaric practices like those that seem to have prevailed at Miracle Meadows.















Sunday, September 7, 2014

DSM-5 and Autism

I had the good fortune yesterday to attend a lecture about the DSM-5 approach to diagnosing autism, given by Judith Miller of the Center for Autism Research at Children’s Hospital of Philadelphia. Dr. Miller provided a good deal of interesting information, and I want to summarize some of this.

Insurance companies adopted DSM-5 on January 1, 2014, and that fact caused much concern among parents of autistic children (previously diagnosed with Pervasive Developmental Disorders),  who were afraid of losing services that their children needed and had been receiving. This worry was triggered by the awareness that DSM-5 had dropped Asperger’s disorder as a diagnostic category and had removed Rett’s syndrome from the new Autism Spectrum Disorder diagnosis. However, children who had received the autism/PDD diagnosis in the past are “grandfathered”  into the new category and do not lose services. (This applies primarily to children diagnosed previously with Asperger’s syndrome. Rett’s syndrome is no longer a psychiatric diagnosis, but a medical one, as a genetic cause for it has been discovered.)

DSM-5 requires a narrative description of a child’s atypical behavior. This narrative includes reference to eight categories of problems, and assessment of the severity of each. It’s notable that delayed language, long considered a criterion for autism, is no longer included; assessing language problems is important, but these difficulties are not unique to autism, and children for whom language is the major issue should be evaluated for social (pragmatic) communication disorder.

Here are the eight categories to be considered in diagnosing Autism Spectrum Disorder. All need to be considered with respect to typical behavior for the child’s age, rather than in absolute terms.

1.      Nonverbal communication. This includes age-appropriate use of eye contact, gesture, and body language as means of communication.
2.      Difficulty with relationships. This applies to relationships in general, not just to peer relationships, and it includes delays in pretend play.
3.      Social-emotional reciprocity. Depending on the child’s age, this can include delays in playing peek-a-boo or other social games, difficulty in picking up social cues like facial expression, lack of social sharing through telling interesting things or attending to others’ interests, and impaired conversations in which the child is unable to start a conversation, to end one, or to take turns in speaking. People may be “used as tools” (for example, child places mother’s hand on a doorknob to get it opened) rather than approached with communication.
4.      Circumscribed interests. The child’s interests are intense and very specific, are often not interesting to others, but sometimes, as in the case of sports or music, may be the foundation of social interactions.
5.      Routines and resistance to change. The child may not be able to process what is happening outside the routine, and disturbance of the routine may be followed by a tantrum. The behavior may resemble anxious behavior or obsessive and compulsive patterns. (Typically-developing toddlers also show this tendency to some degree.)
6.      Stereotyped movements, speech, object use. Flapping, pacing, and bouncing movements, and repetitive or echolalic speech are included, as is the intense need to hold onto specific toys. (Again, toddlers’ typical development may have these features.) These behaviors are rhythmic and volitional rather than random fidgeting or involuntary tics, and the child seems “zoned out” while doing them.
7.      Unusual sensory reactivity or interest.  Some, but by no means all, children with ASD are overwhelmed by lights or sounds or textures, and some are “obsessed” by spinning objects, flashing lights, or smells. (Although these behaviors are sometimes attributed to sensory integration disorder, there is little evidence that such a disorder exists.)
8.      Onset in early developmental period. The previous criteria for diagnosis of autism had specifically stated that the disorder began before 30 months, but this criterion is now less stringent.

Several of these criteria must be met in order for a child to receive the new ASD diagnosis, but few children will show all of them. As Dr. Miller’s presentation pointed out, autism is a heterogeneous disorder, and in addition to that fact, there may well be co-occurring problems to be diagnosed. It’s important to avoid the “diagnostic overshadowing” that was shown decades ago in assumptions about Down syndrome--  that is, that if a child had Down syndrome, all difficulties were explained by that diagnosis. Any child may have ASD and also have medical problems and/or additional psychiatric or developmental diagnoses.

Readers of this blog regularly send in queries about very young infants and the possibility of identifying autism on the basis of their current behavior. Looking at the list of criteria above shows that infants under 6 months do not have the abilities to do any of these things other than using eye contact as a social signal, and typically-developing infants under 3 months do very little even of that. Until a child reaches an age where typically-developing children are able to behave in ways relevant to the rest of these criteria, the child’s atypical behavior cannot be used to assess for ASD. Because we are all concerned nowadays about the need for early identification and intervention with problems, young parents are afraid of missing some very early cues and passing some “window” during which their child could be helped. Nevertheless, although there is some work going on to try to identify ASD problems earlier, this cannot yet be done. And, in all candor, it would not be clear how to intervene with young infants even if early diagnosis were possible. The only advice that can be given is that good development is supported by sensitive and responsive parenting, and this presumably applies to children with ASD as well; such parenting may not prevent or cure ASD, but it will help to provide the best developmental outcome for a child’s particular issues.

An audience member at Dr. Miller’s presentation spoke of her experiences with parents who are willing to accept the ASD diagnosis before there has been a complete diagnostic work-up--  even, at times, when they see that their child shares some characteristics with another child who has been diagnosed. This may again have to do with the belief in the importance of early identification and intervention, or with the understanding that services are available for a child with the ASD diagnosis when they may not be there for a child with somewhat similar problems but no diagnosis. However, everyone should understand that ASD is not necessarily easily diagnosed, and that excellent training and experience are needed to put this diagnostic skill within a professional’s appropriate scope of practice. Remember, too, that there are specific genetic and other medical problems that may resemble aspects of ASD, but their treatment needs to be rather different than what ASD would require.


Sunday, August 31, 2014

Does Reactive Attachment Disorder Have Anything to Do With Cause and Effect Thinking?

A reader’s recent comment referred to the tendency shown by believers in the “Attachment Therapy” system to attribute children’s behavioral difficulties to a lack of  cause-and-effect thinking. At www.fromsurvivaltoserenity.com/2014/08/educating-about-rad.html, a graphic is presented showing dozens of “symptoms” of Reactive Attachment Disorder, few or none of them to be seen in the DSM-5 list of criteria for the disorder. Among them, problems with cause and effect thinking are noted. A document for teachers at www.attachmentnewengland.com/documents/educators/pdf also refers to such problems, and claims that children with Reactive Attachment Disorder cannot learn from behavior modification methods that use reinforcement for desirable behavior. (The latter document warns parents against using sarcasm, while providing a list of obviously sarcastic responses to children--  a point that raises questions about the sincerity of the writer—and states that attachment begins prenatally, raising further questions about the writer’s knowledge of the field.)

Strangely, however, these documents also stress the belief that children with behavioral difficulties can manipulate, exploit, and fool intelligent, well-trained, and experienced adults. How do they manage this, one must ask, if they cannot associate cause (their own behavior or speech) with effect (the beliefs and behavior produced in the apparently hapless adult)? For that matter, without some mastery of cause and effect associations, how can they do anything at all in the way of self-care, schoolwork, household chores, or play?

It does seem that just as these documents are not really talking about Reactive Attachment Disorder when they use that term, neither are they really talking about understanding cause and effect. Let’s have a look at the development of cause and effect thinking first, then maybe I can hazard some guesses about the real issues referred to by that name.

Learning about cause and effect is a gradual process, but one which begins quite early and is slowed only by cognitive impairment. Jean Piaget, the famous theorist of cognitive development, first described some steps in understanding cause and effect almost a hundred years ago. He suggested that between about 4 and 8 months of age babies begin to notice the effect of things they do, like kicking their feet or making sounds. They discover that sometimes their activities seem to make interesting events (like an adult smiling at them) continue--  but this little insight into cause and effect is only a beginning, because if the interesting event stops, the baby gives up and does not try to make it start again. From about 8 to 12 months, babies begin to put together single activities so that they can look, reach, and grab, and use that combination to keep interesting things going on. But, in Piaget’s theory (and many observations), a much more important step waits until about 12 to 18 months, when babies catch on to the fact that they can actually start interesting events by themselves--  and they do this over and over, by dropping and throwing objects and watching carefully to see what happens (cereal splashes, cheese doesn’t, and they all get eaten by the dog). This understanding of cause and effect is needed for a wide range of learned skills, from pulling a stool to the table in order to reach something, to drinking through a straw, to all forms of communication with other people and all planning of actions.

It’s common for people to assume that Piaget was taking a behaviorist position--  that infants develop cognitively only because they are repeatedly gratified by what happens when they exercise a new skill. That assumption is reflected in the idea of the “bonding cycle” of alternate needs and gratifications, as claimed by Attachment Therapy advocates. However, that is not at all what Piaget said.  His theory (and recent work on cognitive growth)  is based on the idea that cognitive development is driven from within and requires only ordinary experiences that the baby himself produces. When the attachmentnewengland document says “this [bonding] cycle promotes the development of cause and effect thinking which is the basis of all problem solving”,  it reveals a misunderstanding of how cognitive development proceeds. Naturally, reasonable physical care is needed for survival and healthy brain development, and social interaction is needed for attachment and language learning, but experiences of care are not privileged factors in the development of cause and effect thinking. To assume that they are is simply a rationale for the use of non-evidence-based methods.    

Of course, the understanding of cause and effect is not complete at age 18 months. The more steps intervene Rube-Goldberg-like between cause and effect, the harder the connection is to make. When someone doesn’t understand how something works, their comprehension of specific causes and effects will be limited. In the natural world, it is common for more than one cause to produce an effect, for one cause to produce more than one effect, and so on, and these situations make real understanding more difficult. In addition, even adults are prone to fallacious reasoning about causes. They may accept superstitious beliefs about spilling salt or having a black cat walk in front of them--  a matter of confusing cause and effect relationships. They may be swayed by fallacies about the order of events and how that reveals cause and effect, so that they assume that when B followed A, it must have been caused by A. They readily jump to the conclusion that if two things are correlated, one must have caused the other. In the Attachment Therapy- Nancy Thomas-Foster Cline belief system, they assume that when adopted children have mood and behavior problems, the events surrounding adoption must have caused the later problems.

Unless children have severe cognitive impairments, we can expect them at school age to be somewhere between toddlers and adults in their understanding of cause and effect. They know that they can make things happen, but they are still likely to display fallacious reasoning about complicated causes or those that are separated in time from their effects. Certainly they are able to know when their actions bring about immediate approval or disapproval from adults. As for responsiveness to behavior modification techniques, there is no reason why they should not respond as well to a properly-designed and implemented program as do all other living creatures right down to flatworms.

What’s the problem, then, if there’s no actual difficulty with understanding cause and effect? Might it not be that advocates of Attachment Therapy beliefs are convinced that when they use poor behavior management methods, those methods fail to be effective only because the children are so bad?  Using behavior modification or similar management methods requires careful planning and depends strongly on timely intervention. Research in this area showed many years ago that rewards work best when they come very quickly after an desired behavior, and reprimands or “consequences” for undesired behaviors work best if they occur in the middle of the act, or even better, just as the child prepares to do it. There is no reason to think that these rules would apply differently to children said to have Reactive Attachment Disorder than to other beings.

It’s my guess that much of the issue of unwanted behavior in “these children” (those considered to have attachment disorders by Attachment Therapists) actually has to do with the idea that the children must never “win” or “be in control”. The attachmentnewengland document recommends, per Nancy Thomas, that an adult “establish eye contact with the child and ensure that the child always looks up at the adult. The child with Reactive Attachment Disorder dislikes eye contact and will try to avoid it except when he/she is lying or trying to manipulate others. Avoid bending down to establish eye gaze with the student…”. In other words, mutual gaze is required because the child does not like it, and he or she must be made to submit, ideally through an uncomfortable posture that reminds the child of the adult’s size and power.

The document also insists that no explanations may be given to a child who is “consequenced”. “When giving a consequence, educators must stop themselves from telling the child why a consequence is given. When a child doesn’t have cause and effect thinking, he/she will never connect their inappropriate action with the consequence no matter how many times the connection is explained. … The child really doesn’t want to know why and just wants to argue… After the consequence has been given, it is important for educators to let go of caring about whether or not the consequence changes the child’s behavior, or has any impact upon the child, or his/her actions…”. 

It appears, then, that teachers are to abandon any hope of establishing cause and effect thinking in their pupils; if a child cannot make the connection with an explanation, surely he or she will not make it without one.  In addition, teachers are apparently being advised to abandon their own capacity for cause and effect thinking, and to ignore the outcome of their methods rather than to pay attention to what works for them with a given child. Rather than modeling the thinking behavior they should want, they are to adhere rigidly to what they are told, and to fall into their places in this authoritarian system just as the children are to do.

This is not about cause and effect thinking, any more than it’s about attachment or even Reactive Attachment Disorder as the evidence shows it to be. It’s all about obedience and punishment. Cotton Mather would recognize it easily.