CHILDMYTHS

If It Isn't Spanking That's a Problem, What Else Could It Be?

2012-01-27T13:12:00.000-05:00

Recently I’ve spent quite a bit of time indiscussion with Jeff of punishmentmadeobsoletebypsychology.blogspot.com. Jeffmaintains that even mild physical punishment is a risk factor for childdevelopment and is the cause of later violent behavior. I point out that thereis no evidence that, other things being equal, mild physical punishmentdistorts personality development, although there is good evidence for anassociation between experience of physical abuse (as defined in law and forresearch purposes) and later antisocial behavior.

In all candor, of course, I have to acknowledge thatthe evidence we need would be very hard to establish, no matter what theoutcome. Parenting practices don’t exist independent of other family characteristics.Education, family income, marital status, and certainly ethnicity are allstrongly associated with the parenting methods someone uses. In the real world,all those characteristics of a family are confounded/confused with each other,so it becomes impossible to tell what causes what-- especially if the effects of each factor onthe children are small ones. In addition, logic tells us that it is notpossible to prove that an effect does NOT exist under any circumstances; evenif it’s never been seen or reported, it might very infrequently be there.

What I’ve just said-- that a cause for an outcome may be very hardor impossible to demonstrate-- naturallygoes for all kinds of parenting, not just for spanking. You have to have amajor effect, like that shown for genuine abuse, before it shows up strongly.Nevertheless, it’s of interest to consider some parenting events other thanphysical punishment that may be risk factors for personality and behavioral development.

I’m going to talk about a few of those in a minute,but first let me point out that not everything I’m going to mention happens inearly childhood. It’s an important tenet of psychoanalytic thought that eventsin infancy and early childhood have special formative power, which later eventslack, and this view has been accepted in popular thought…. but, no, it ain’t necessarily so. If we’regoing to think about factors that may cause antisocial behavior or otherproblems, we need to look at all of development. This is not to say thatinfancy and toddlerhood are not important periods-- maybe even the most important periods-- but it is to say that they are not the onlyimportant periods.

So, what are some aspects of experience, withparents or other people, which may mark children with undesirable personalityand behavioral traits? The first one I want to mention is maternal depression. Perinatal mood disorders interfere with theordinary sensitivity and responsiveness to a baby’s signals that are displayedby the majority of adult caregivers. That interference means that a baby with adepressed caregiver experiences constant frustration of its efforts at activecommunication of its needs, and also fails to experience the joyful communication“just for fun” that characterizes a healthy adult-child relationship. The babyalso begins to act depressed and apathetic; a vicious circle of cause and effect makes the child less appealing toadults, who become even less likely to be attentive to communications or to “woo”the baby into a satisfying relationship. An obvious early outcome of theseexperiences is a delay in speech and in other earlier communicative techniqueslike facial expression and hand gestures. (Incidentally, the irritability thatoften accompanies adult depression may mean that the child also receives morephysical punishment than usual.)

Let’s look at emotionalabuse-- not as obvious to the outsideobserver as physical abuse, but possibly as influential. The psychologist JamesGarbarino has described clusters of emotionally abusive behaviors, some ofwhich may begin in very early life, others of which are likely only later inchildhood. To list Garbarino’s suggestions briefly: Rejecting is denyingthe child’s value and the importance of his or her needs; this can begin ininfancy with failure to smile back at the child’s smiles or answer herbabbling, and it can continue into childhood as constant verbal abuse andcriticism or “scapegoating” in which one child in the family is treated badlyand others are not. Terrorizing is creating an atmosphere of fear byconstant threats and intimidation, including deliberate teasing and scaring,often followed by punishing the child for being a “sissy” or a “poor sport”. (Ioften think of this when I hear the line, “I brought you into this world, I cantake you out of it.”) Ignoring includes failing to respond to the child’sspeech, but it also can involve failing to engage in the child’s schooling needsand failing to provide necessary supervision and care. Isolating is theprocess by which parents gradually prevent children from making friends orassociating with outsiders, speaking to neighbors, joining groups for play, orhaving any experiences that would provide either a variety of role models orpossible help for an abused child. (Homeschooling parents need to be carefulthat they consider the possible results of their decision in terms of the child’sisolation.) Finally, Garbarino suggests that a form of emotional abuse is corrupting.Corrupting parents intentionally teach antisocial behavior, involve the childin criminal activities, or act toward the child in ways like introducing him todrug use “because somebody else is going to do it”. Corrupting may begin intoddlerhood through deliberately antagonizing the child and encouraging him tofight, but criminal behavior is obviously more likely as the child gets older.

My last candidate for a parenting practice thatcould cause personality and behavioral disorders is intrusive parenting (see B.K.Barber [2002]. Intrusive parenting: How psychological control affects children andadolescents. Washington, DC: American Psychological Association). This termrefers to controlling and manipulative parental actions that demand not onlybehavioral compliance to parental desires, but psychological commitment toparents’ beliefs and wishes. Intrusive parenting attempts to counter the naturaldevelopment of autonomy that is usually considered to be an aspect of healthy personalitygrowth. Parents who are highly controlling psychologically may be moresensitive to hurt and less tolerant of negative emotion than others. In anycase, children who experience much psychological control are likely to haveincreases in both internalizing and externalizing problems, as well as loweracademic achievement.

Here we have several parenting factors that appear tohave a negative impact on development and behavior, but none of themnecessarily involve physical punishment, either mild or severe. I point thisout simply to show that the single factor of physical punishment is not likelyto be the whole cause of undesirable adult behavior. In fact, I’d suggest that eventhe negative outcomes of experiencing abusive treatment may well result fromother, accompanying factors like terrorizing and ignoring. To speculatefurther, the psychological ill effects of physical abuse may have nothing to dowith its physical side, but with other experiences that are present or absentin abusive families.

Once again, it’s not rocket science. It’s morecomplicated than that.

The Regression Myth versus Developmentally Appropriate Practice

2012-01-26T16:15:00.001-05:00

A disturbing report about a family in Snohomish, WA(www.heraldnet.com/article/20120121/NEWS01/701219927)states that a college-age adopted daughter has confronted her father with accusationsof sexual assault, and that investigation has shown that a “therapist” concernedwith attachment issues recommended years ago that the family share a bed. Theintention behind this advice was to correct the daughter’s posited problemsresulting from abandonment and lack of emotional attachment.

The details of the sexual relationship were outlinedin the news report, but they are not the real point of this post. My guesswould be that an adoptive father who was strongly tempted to be sexual with ayoung girl under his care would probably find some way to do this, shared bedor no shared bed. However wrong-headedthe therapist’s approach, her advice probably had little to do with the sexualmisconduct, other than possibly offering an increased level of temptation.

Sorry as I am that the girl had repeated experiencesof unwanted sexual approaches from one who should have protected her, whatconcerns me in a broader way is the belief system that made the practitioner(and note that I am not calling her a psychologist-- I doubt that she was one) think her advicewas appropriate. That belief system must have included the idea that through regression a person can rework earlierexperiences and resolve problems resulting from her early history, such asproblems about emotional attachment to caregivers. The system is likely also tohave involved the belief that regression can be brought about by behaving likea young child, or being treated like a young child. This view, which is commonamong advocates of rebirthing, patterning, primal therapy, and similarunconventional treatments, suggests that the cure for any problems that maydate from early life is to re-enact early life events-- but, this time, make sure the experiences areright.

How does this link up with having the family share abed? There is a popular set of beliefs (not usually necessarily associated withthe idea of regression), advocated by William Sears and his family, and oftencalled “attachment parenting”. Attachment parenting focuses on the idea thatinfants need intensive and extensive social and physical contact with theircaregivers in order for attachment to develop. “Kangaroo care”, skin-to-skincontact, breastfeeding, and the “family bed” are all part of this approach. Asa general comment, I’d say these activities are harmless but unnecessary; thedevelopment of attachment is a robust phenomenon that will occur if it’s givenhalf a chance and does not need this kind of artificial cultivation. (By theway, if you wonder how people maintain a sex life while doing the family bedroutine: some friends of mine used to give their 5-year-old a quarter to keep hislittle sister downstairs while Mom and Dad got it on-- necessity as the mother of invention!)

But surely the Searses do not say 15-year-oldadoptees should be in the family bed? No, indeed they don’t. And this is whereour so-called therapist fell prey to the regression myth. She knew thatco-sleeping was supposed to encourage attachment; she knew the girl had ahistory of separation and loss, as well as a new relationship with adoptiveparents whom she didn’t know well. If the girl would have developed anattachment to parents in her early childhood, given a chance--- and if co-sleeping was a way to develop anattachment--- and if regression through re-enactment of experiences typical ofearly childhood was a way to rework early personality development—voila! Putthe girl in bed with the parents, she will regress to early childhood becauseof this experience, because she is co-sleeping she will become attached to theparents , and that attachment will dissolve any personality problems she hasdeveloped because of her lack of attachment. It’s all so simple, really.

Except…. Except that these things aren’t true.People can’t regress to earlier stages of life, although of course they canbehave in immature ways and may do so particularly under emotional stress.Treating people as if they are infants or young children is a pointless “magic”ritual that cannot actually cause them to return to early development (and ifit did, would you expect them to return to maturity immediately, or would theyhave to repeat years of normal development?). Co-sleeping is not necessary orsufficient for the development of attachment. And, an individual who is already15 years old has a vastly different perspective on emotional attachment than aninfant is capable of having; she doesn’t form attachments as an infant does,and she doesn’t show them through an infant’s attachment behavior when she doesform them.

The therapist and the parents fell for some commonmyths about personality development. In addition, they forgot an importanttheme of childhood interventions for emotional, physical, or cognitiveproblems: treatments need to be developmentallyappropriate if they’re to be effective. We feed a tiny infant milk, anolder baby strained food, a five-year-old most of what adults eat. Giving thefive-year-old an all-milk diet will cause malnutrition, and so will feeding thethree-month-old barbecue. Treating an infant or toddler who is grieving overseparation and loss may well require staying with her a lot of the time, buttreating a teenager who has experienced many separations requires a much morecomplex treatment approach.

We can’t expect most parents to be aware ofdevelopmentally appropriate practice, but we surely should expect, even demand,that therapists working with children and families will know this concept. Regrettably,training and licensing in many related fields (like marriage and familytherapy) may completely ignore this and other important ideas. We seem to havea long way to go before we can be sure that all psychological treatments areeither effective or safe, let alone both. The therapist in this case made mistake after mistake because shemisunderstood some basic concepts, although her mistakes may not have been thecause of the sexual mistreatment that will probably be the focus of anydiscussion.

What About Alice Miller?

2012-01-16T09:56:00.002-05:00

Reader Neil Samuels has queried my unwillingness to accept Alice Miller’s views on physical punishment as necessarily correct, and has asked what I mean by the “Alice Miller belief system.” Before I go on to talk about these matters, let me state once more my position that mild physical punishment (open hand, one or two smacks on buttocks or upper legs) for preschool children may be effective and harmless when used very occasionally to enforce important rules. I have argued in an earlier post that there is no support for the claim that this parental behavior models a general tendency to violence. I have also argued for many years against genuinely abusive practices like those recommended by the Pearls and the “Babywise” books.

So, why do I not accept Alice Miller’s statements as unarguably correct? My reasoning is that those statements are based on a series of abstractions that lack empirical support, rather than on systematically-collected information about parenting practices and child development outcomes.

Alice Miller was a European lay-analyst and shared the attitudes and views of many such people, who have tended to reason from what they regard as first principles rather than to consider the necessity of working with reliable information. Much of Miller’s work resembles closely that of Marguerite Sechehaye and of Frieda Fromm-Reichmann. Like those authors, Miller emphasized the psychoanalytic principles of repression and regression, and by doing so placed the essential events in personality formation early in childhood and outside of consciousness. In addition, her view completely ignored the concept of transactional processes by which changing interactions between a specific child and a specific adult have developmental outcomes that would be different if either individual were different.

The psychoanalytic concept of repression claims that memories of disturbing experiences can be removed from conscious awareness and inaccessible to the individual except through psychoanalytic treatment, but can continue to influence mood, behavior, and motivation in ways that feel foreign to the personality. Although this idea has become almost universally accepted in Western popular culture, there is in fact no empirical support for such a mechanism. As Susan Clancy and Richard McNally have pointed out, ordinary mechanisms of memory and forgetting are perfectly adequate explanations of events that have been categorized as repression (for example, Clancy, McNally, Schachter, Lenzenweger, Pitman. [2002]. Memory distortion in people reporting abduction by aliens. Journal of Abnormal Psychology, 111, 455-461).

The psychoanalytic concept of regression claims that earlier versions of personality and experience can be re-accessed through psychoanalytic techniques, and that such re-accessing allows the individual to change a developmental trajectory that went wrong at a given time. In fact, as I have shown in my own work (Mercer [2011]. The concept of psychological regression: Metaphors, mapping, Queen Square, and Tavistock Square. History of Psychology, 14, 174-196), the idea of personality regression is a metaphor drawn from 19th century work on the results of physical damage to the nervous system. Although psychoanalytically-oriented practitioners over the years encouraged the acting-out of apparent regression (and this was especially true of proponents of “wild psychoanalysis” like Ferenczi), there is no empirical support for the existence of such a mechanism.

Thus, there is no evidence for the existence of Miller’s two major personality mechanisms repression and regression, and I believe this is a strong argument against the general accuracy of her claims. However, there are additional problems in her thinking. As is well known, Miller spent some years of involvement with and commitment to primal therapy, a form of treatment suggesting that psychological treatment must depend on regression to very early stages and intense acting-out of pain and distress posited to have been part of those stages ( an idea associated with Otto Rank’s and later with Wilhelm Reich’s views of development). Primal-related thinkers such as the “psychohistorian” Lloyd DeMause; David Chamberlain,who claims that all babies remember their births; and William Emerson, who massages babies until they cry as a way of working through the notional birth trauma, are all enthusiasts of Miller’s beliefs.

I see two major problems in this association. The first is that the concepts of early development espoused by primal therapists are based on adult experiences under LSD or hyperventilation rather than any systematic and replicable evidence about infancy and early childhood. When there are conflicts between LSD-based ideas and those derived from systematic study (for example, our understanding of infants’ memory and forgetting), I would hold that the latter source is more trustworthy, and I don’t believe it’s necessary to spell out why I take that position.

A second problem has to do with the assumption of the primal group, shared by Miller, that mechanisms characteristic of the individual (and speculative mechanisms at that) are sufficient to explain behavior of a group-- for example, that repressed anger and fear, were they in existence in members of a group, would be the reason for abusing children, going to war, etc. This belief ignores decades of work on, for example, economic factors in racial conflict, and fails to note that there must be some way in which such notional individual mechanisms would be translated into coordinated behavior of a group. Like the primal therapists, Miller chooses to ignore the complexities of social behavior in favor of discussion of the poorly-documented personal backgrounds of a few historical figures. Although this makes for entertaining reading, it is a very weak basis for a world-view.

These are the reasons that I do not accept Miller’s broad prohibition on all forms of physical punishment as necessarily correct. Her position is not in any way empirically based. Her thinking in general has the Platonic form so appealing to those who would prefer not to engage deeply with a topic, but instead are attracted to statements of what “must be”. I would suggest that people who are genuinely interested in how disciplinary methods influence children’s development should seek out the work of Grace Kochanska, who has shown how child personality differences interact with parental behavior to produce predictable outcomes.

Comments I Can't Respond To

2012-01-15T11:35:00.002-05:00

There have been several comments in the last couple of days that I'd like to answer, but blogspot doesn't seem to let me. This has happened before and I hope it will be fixed soon-- otherwise I'll just make a post that responds to each.

Physical Punishment Tales from the Memory Vault

2012-01-09T19:15:00.001-05:00

All this discussion of physical punishment has brought back memories from the long ago, and I want to recount one just to show how complicated these things really are.
Years and years and years ago, my older son was about three years old. I decided that it would be nice for him to have a blackboard in his room, because he always liked to write on the board if he came to class with me. I got some blackboard paint and painted a section of wall, got colored chalk, even fixed up a little chalk tray with a piece of quarter-round, and painted the rest of the wall a nice clean white. [Parents who are more experienced than I was at the time will see what’s coming.] I did all that, then left the room for half an hour-- and when I came back my firstborn had climbed up on some shelves, studiously avoiding the blackboard, and chalked all over the nice white wall. I was infuriated, which was really quite unreasonable because I hadn’t thought to tell him not to do this. I told him off thoroughly and delivered a couple of swats on the bottom.

A few hours later, this conversation took place.

CHILD: (firmly) Mom! I don’t like all that screaming and spanking.

ME: Well… what do you think I should do when you’re naughty?

CHILD: (thinks a minute) Tell me quietly, and clean it up.

ME: Oh. Well, if I did that, would you stop doing it?

CHILD: No.

It just goes to show-- as the saying goes, the camel driver he has his opinion; the camel he has his. But the family caravan still needs to keep lumbering along and usually manages to do so to the best of everyone’s imperfect ability.

More Mulling on Physical Punishment

2012-01-08T17:29:00.003-05:00

Boy, I never thought I’d be arguing against people who argue against physical punishment for children. However, I think and have always thought that blanket prohibitions or admonitions either require some evidence or, as an alternative, need to be stated on moral grounds. If anyone wants to say they simply think it’s wrong to use physical punishment, I can’t argue with their belief. But when a belief is disguised as a statement of evidence-- I can’t go along with that without a response.

There are three issues about physical punishment that I want to noodle about for a bit. One is the fact that if punishment is to be used, mild physical punishment has certain advantages. Another is an alternative way of thinking about the idea that parents who spank are acting as inappropriate role models and teach their children to use violence. The last involves the belief that it’s all right for parents to use physical punishment, but not for schools or day care centers to do so.

1. When I refer to mild physical punishment, I’m referring to one or two smacks with an open hand on the clothed buttocks or backs of the legs of a preschool child. If punishment is needed to bring about behavior change favorable to the health and safety of all concerned, mild physical punishment has some real advantages. It’s well established that punishment works when it is given concurrently with an unwanted behavior; it actually works best when it occurs just as the child prepares for the behavior; the longer after the behavior the punishment comes, the less effective it is. Punishment is quite ineffective when it’s delayed “until Daddy gets home”, or when it involves deprivation of some future treat like dessert tonight or a birthday party on Saturday. Mild physical punishment can be performed more or less on the instant. Note, though, that if it isn’t done right away, you might as well not do it at all, as it will not later be connected with the unwanted behavior, but instead will be associated with whatever has gone on just before. (Any thoughts about our correctional system, by the way?)

2. Now, this role model thing: everybody and their brother states with certainty that a parent who uses physical punishment is acting as a role model to encourage violent behavior. But is that actually true? Not everything parents do serves as a role model for their child’s general behavior. For example, single mothers regularly teach their toddler and preschool sons to pee standing up, even though the little boys, in their frequent invasions of the bathroom, always see Mom sitting down on the toilet. Mothers can wear high heels; little children don’t except for playing “dress-up”. Fathers and mothers too are heard to say selected words which children aren’t supposed to say.

In addition, much of our instruction and modeling of behavior for children is a matter of teaching time, manner, and place. We don’t, in fact, usually teach children that violence is never acceptable. We accept and even approve of it in sports, in defense of a person under attack, in self-defense, and so on. A football player who is highly aggressive on the field is admired, but if he beats up his girlfriend later there will be some people (not enough, though) who will disapprove deeply. Children are socialized by their experiences with their parents into an understanding of the times, manners, and places in which violent behavior is permitted (or even required). Learning that it is acceptable for an adult to spank a child for repeated dangerous behavior does not involve the same time, manner, or place rules as learning that it is acceptable to mug old ladies or participate in gang warfare. To think so is to over-generalize--- what Jerome Kagan has called the “seductive idea” of abstractionism.

3. Our society’s great confusion about physical punishment is exemplified in the idea that parents may spank or smack, but day care centers and preschools may not. (I omit discussion of physical punishment in elementary and high schools, which when permitted has often gone far beyond the “mild” level, and which should not be necessary at those ages for children who are less impulsive and better self-regulated than younger children.)

We seem to have two conflicting ideas about spanking. One is that it’s a bad thing to do, and that’s why teachers aren’t allowed to do it. The other is that parents have a right to do things to their children as they choose, and if they don’t spank their children the children will run wild (and be annoying to the rest of us, I suppose is the real concern). Logically, of course, if it’s a bad thing, nobody should be doing it, although we can probably stop teachers a lot more easily than we can parents; if it’s an acceptable thing for parents, why shouldn’t teachers do it too?

I think it’s possible that this conflict is based on the assumption that because parents love their children and know them well, they will not let physical punishment get out of hand, and they will comfort a child who is upset--- but that teachers do not love the child and are likely to turn the Kiddie Academy into Dotheboys Hall if given any opportunity. In reality, the opposite might well be true, as teachers are less likely to experience the fatigue and frustration of daily and nightly child care, or conflict with a co-parent who focuses on relationship problems in connection with childrearing.

A [temporary] final thought on these matters: as for myself, as long as parents are hot-saucing children, keeping them in cages, limiting their food, making them sleep outdoor without blankets in winter, or whipping them with plumbing supply line, I am not going to worry too much about a limited and possibly appropriate use of mild physical punishment. My energies are going to be directed toward stopping treatment that is, frankly, torture. Admirers of Alice Miller’s position can either join me or continue to enjoy their ideological purity. I hope it will be the former, because there is a lot of thinking and a lot of work to be done.

Alice Miller, Physical Punishment, Ideology, and Reasoned Approaches to Parenting

2012-01-08T14:38:00.004-05:00

On a number of recent occasions, I’ve come up against statements and ideas ascribed to Alice Miller, the late Swiss psychoanalyst. As Neil Samuels noted in a comment on one of my posts about physical punishment, Miller attributed war and other distressing actions and propensities of adults to their childhood experiences of punishment. I haven’t read all of Miller’s work, most of which is popularized and non-empirical in nature, but my impression from what I have read is that she argues strongly against all forms of physical punishment and categorizes together everything from a smack with the open hand onward, considering all of these behaviors to be deleterious. (If I’m wrong about this, no doubt I will receive speedy correction.)

I think there are many reasons to keep physical punishment to a minimum. An obvious one is that an incensed parent with an angry child may lose control and do physical harm. A less obvious one is that physical punishment may simply escalate everyone’s anger and make it more difficult to get the situation under control. Physical punishment may also substitute ineffectively for explanations and advice about how to behave. (There are a dozen more good reasons, but that’s not my topic just now.)

My concern in this post is to focus on the outcomes for parent and child of choosing one or another among the range of disciplinary methods, including both rewards and punishments of various kinds. (Negative reinforcement is not the same as punishment and does not lend itself well to use in everyday situations.) I think it is possible to consider what methods work best in specific circumstances and to use a reasoned approach to choice.

Miller, on the other hand, is primarily an ideologue. Her claims are based on a belief system that lacks empirical support, as are the claims of her companion-in-ideology, Lloyd DeMause, one of the founders of the “psychohistory” school that claims profound, although undemonstrated, effects of prenatal events. DeMause, Miller, and others have concluded that cause-and-effect relationships are plausible, not in the light of empirical work about families, but on the basis of statements by people like Frank Lake and Stanislav Grof, whose understanding of early development is founded on experiences with LSD. (These people were also strong though perhaps indirect influences on Nancy Verrier.)

I argue that an empirical, pragmatic approach is a more desirable way to think how people should act toward children, than an ideological one is. My reasoning is that there are multiple factors that help determine the outcome of any adult actions toward children, so it is unlikely that we can name a single factor and a single mechanism that have the same outcome for all children in all circumstances. An ideological approach argues that the truth is the same for all.

Here are some factors that seem to make a difference to children’s reactions to physical punishment:

1. Cultural differences: A smack on the bottom has a different meaning and therefore effect on children who have often seen other children get smacked than it does for those who have never seen such a thing and/or have heard it mentioned in discreet, horrified tones. There are great differences between cultural groups in the use of and attitudes toward physical punishment. Some groups would never dream of striking a child or using any other physical approach. Others, like many African-Americans, believe it is the obligation of parents, grandparents, and close family friends to employ physical punishment regularly. When a social group approves of the use of physical punishment, the children of that group do not respond as negatively to their experiences of mild punishment as do children whose group strongly disapproves.

2. Age: As a general rule, Europeans and North Americans believe that physical punishment is inappropriate for infants under a year of age and for older children and adolescents, but that well-thought-out physical punishments may be effective and suitable for many children from about age 2 to age 5. The reasoning about infants is that these children are too young to understand rules or to be expected to control their own behavior much, and that punishment may teach them to avoid adults at a time in development when their socialization depends on a lot of contact. The thinking about older children and adolescents is that physical punishment offers them challenges to physical fighting such that the child may win, or the combat become so serious that someone is hurt or the child runs away from home; in addition, many laws about child abuse would classify physical punishment of adolescents as abusive in itself.

Preschoolers, on the other hand, are capable of learning rules and regulating their behavior within reason, but are impulsive, over-confident, and able to hurt themselves and others unless carefully trained. Careful supervision and cue-ing of behavior can do a great deal, but many preschoolers show undesirable behaviors (like running into the street, or hitting each other, pets, baby brothers or sisters, or their parents) that are quite difficult to correct without the use of physical punishment. Balancing the possible consequences of those present behaviors against the long-term effect of punishment suggests that for everyone’s health and safety, brief, mild physical punishment may be an excellent choice. Many parents today attempt to use “time-out” methods but are unable to keep the child in the “time-out” chair or room; physical punishment as a back-up on a few occasions is likely to make it possible to transition to “time-out” alone.

3. Temperament: Children’s constitutionally-determined personalities may have strong influences on their responses to physical punishment. Some children have relatively little response to pain or other strong stimuli, and in my opinion should NOT be physically punished because of the temptation the adult may feel to escalate the punishment until the child seems to notice it. Others are extremely sensitive, and in fact are so overwhelmed by almost any kind of punishment that they forget what they are being punished for. However, some are attentive to physical sensations, but at the same time can notice and understand the adult’s admonitions and learn effectively what to do or not to do.

I believe these differences in children’ s responses to physical punishment, when coupled with the complete lack of anything but proof by assertion that physical punishment experiences are responsible for war and other social evils, lead us to only one sensible conclusion. That conclusion is that no single rule about punishment of children is applicable across the board. Parents need to consider carefully the characteristics of a child, the family’s social group and attitudes, and the goals they are trying to achieve through punishment or any other action. (This consideration, of course, has to happen during a calm time, not as the child pulls away from the parent and heads into traffic again.) The sense of righteousness one receives from ideology is much stronger than a reasoned approach can give, but I would suggest that a pragmatic, reasoned parenting mode is far more likely to produce happy children, families, and societies.

Those Empathic Rats: Take Two

2011-12-20T15:55:00.001-05:00

I jumped the gun the other day by trying to comment on a research report as it was described on an NPR interview and in the Science Times. As a result, I missed an important factor (although I stand by my remarks about the role of empathy and altruism in rats’ daily lives). Now my copy of Science has come and I can comment more constructively on the article by Bartal, Decety, and Mason, “ Empathy and pro-social behavior in rats”, Science, 9 December 2011, pp 1427-1430.

The basic study involved observing laboratory rats (the usual little Sprague-Dawley guys with the white fur and beady red eyes) to see whether they would work to open a door and release a familiar cagemate from a container. To be able to claim that rats were motivated to release a trapped rat, the authors also needed to show that the door releasing a trapped rat was opened more often than the door to an empty container or the door to a container with a toy rat in it. The rats were tested daily over several weeks, and on the average managed to open the door and let the trapped rat out after about a week. Twenty-three of 30 rats eventually opened the door for a trapped rat, and 5 out of 40 opened the door when there was no trapped rat. All 6 of the female rats who saw a trapped rat opened the door, but only 17 of 24 males did so. The authors concluded that the rats showed motivation by empathy when they released the trapped cage mate.

In an additional study, where the free rats could choose between opening a container that held chocolate chips and releasing a trapped cage mate, they did the two things about equally. In addition, they ate fewer of the chocolate chips when they had released another rat than they did when they were alone with the chips (these animals had free access to food and water and were not especially hungry). The authors referred to this as “sharing” with the other rat.

The general conclusion of the article was that the free rats were “not simply empathically sensitive to another rat’s distress but acted intentionally to liberate a trapped conspecific”. I believe this conclusion raises many questions, as does the use of the term “share” with respect to eating fewer chocolate chips. I don’t reject the idea that empathy might be part of rat psychology, but I consider the study to suggest as many questions as it answers.

One of my questions comes from watching the video of one of the rats at work, to be seen at www.sciencemag.org/cgi/content/full/334/6061/1427/DC1. As the free rat succeeds in opening the door to the container, it does not step aside and let the trapped rat out. Instead, it squeezes past the trapped rat into the container so they are both briefly inside; when the trapped rat emerges, the free rat explores the container for a moment, then finally comes out and follows the formerly-trapped rat closely, sometimes appearing to mount it briefly (not an unusual thing for a rat to do). My question is, what was the exploration of the container about? Did rats other than the one selected for the video also show this activity? To what extent would it be appropriate to say that a more parsimonious explanation--- that the container and the other rat are interesting-- may be more appropriate than the “empathy” conclusion?

A second set of questions has to do with the role of the trapped rat in triggering its “rescue”. The authors refer to the possibility that high-pitched distress cries were annoying to the free rat, who might have released the cagemate in order to stop all that crying. However, they used a bat-cry detector to record the calls, and reported that such calls were infrequent. This assumes that the pitch of the cries was the disturbing part, whereas human infants’ cries differ in many ways other than pitch during different emotional states, and the same may be true of rats. Although the report alluded in a note to the role of smell in rat emotional contagion, and although the container and “arena” were carefully washed between observations, there seems to have been no attention paid to the role of airborne pheromones in possible distress of the free rat. Finally, although the researchers reported the sexes of the free rats, they did not specifically state this about the trapped rats. Because the trapped rats were said to be cagemates of the free rats, and because normal procedure would be to cage males and females separately, it seems likely that male free rats were with male trapped rats, and females with females. This raises the question whether the “unhelpful” 7 out of 24 males would have been helpful to trapped females, and conversely whether the helpful females would not have helped trapped males. Again, it may be more parsimonious to consider environmental factors that led to the door-opening rather than assuming that some form of empathy was in operation.

A curious thing about empathy is that it may be just as important in negotiating hostility as it is in causing prosocial, helping behavior. Empathic responses are a matter of identifying and even experiencing another individual’s emotions, and are easy to recognize when we are sorry for a sad person and want to help him or her. But what about situations where someone may be angry at us, or frightened and ready for self-defense? To recognize those feelings before the other acts on them allows us to escape, to placate the other, or even to attack first--- all possibly related to survival of the individual and of the group, but not prosocial in the usual sense. And a mixed picture is surely possible. What if the rats had been confronted with a human hand restraining their cagemate? Would biting the hand be prosocial or hostile behavior? Like oxytocin, which can be involved in both maternal care and fighting, empathy has a complex function. We may reach some wrong conclusions when we assume that behavior must be empathically motivated.

Those Empathic Rats: Motivation and a Missing Measure

2011-12-13T15:59:00.004-05:00

N.B.-- 12/14: I may have been wrong in my remarks here. Read the comments that follow, too.

On NPR, in blogs, in Science, in the New York Times' Science Times, everybody’s talking about a study reported by Peggy Mason of the University of Chicago and her co-authors. To people’s surprise, these researchers reported that rats would make a lot of effort to open a door that would release a confined fellow-rat, and they would do this even if the other rat was beyond a barrier and they could not play together. The free rats opened the door to release the confined one as much as they opened it to get chocolate chips.

Quite a few people have interpreted the free rat’s “jailbreak” behavior as due to empathy with the confined one-- that the free rat feels unhappy when he or she perceives the displeasure of the rat in the container, and feels better when the other rat is happier, just as many human beings feel relieved when they can help a suffering human. Others have asked whether there might be an alternative explanation. Could it be that the confined rat squeals in distress, at frequencies higher than humans can hear, and that the free rat works to get rid of that awful squeaking? No, it seems that most of the confined rats did not squeal, so that explanation cannot replace empathy as a reason for the behavior.

Several bloggers have been extremely interested in the implications of the idea that rats, like humans, might be motivated by empathy. Some have argued that this is a blow for human exceptionalism and suggests that humans are not qualitatively different from other species.

Before we go to town on the implications of the study, though, it might be a good idea to consider whether avoidance of painful squeals is the only explanatory alternative to rat empathy. (I have no objection to the idea that rats could have empathic responses, but I don’t like conclusion-jumping.) As far as I can see, the study did not include an important comparison measure that might offer a better explanation for the behavior: it did not test what the rats did if given the chance to open a container with nothing in it. As a result, it confounded opening containers in and of itself, with opening containers and getting an outcome that might be gratifying.

Why would a rat open a container “for nothing”? Why, for that matter, do toddlers carry large objects from place to place? Why does my cat meow outside every closed door until it is opened, then walk away without going in? Why do I shut a drawer left open by a 16th of an inch? All of these actions can be considered in terms of mastery motivation, a tendency found across species and across ages to behave in ways that control the environment, even when there is no evident advantage to exerting that kind of control.

Jerome Kagan, in his book Three seductive ideas, criticized what he called the “pleasure principle”, the idea that all behavior comes down to a search for gratification of needs. Of course much of what any organism does is associated with needs and satisfactions, but this does not mean that everything is motivated in exactly the same way. Like humans, rats may do things simply in order to do them, and this is probably especially true of lab rats in cages. They ordinarily exist in a boring environment that offers them none of the usual activities of their species’ normal habitats. They don’t get to tunnel, gnaw different kinds of things (they do gnaw at the cage’s wire mesh), catch and eat bugs or other small animals, court, or mate. Occasionally some clumsy student reaches in to pick them up the wrong way and they get to bite that person, but that’s about the sum of the drama in their lives. Now, in the study we’re discussing, they get an opportunity to deal with exciting new technology. It’s time to be motivated by the need for mastery of the environment... maybe. I’m not saying that mastery motivation explains it all-- just that there is at least one alternative to interpreting the free rat’s behavior as empathic in nature.

The NPR “Science Friday” discussion of the study alluded to maternal care as the foundation of empathy, and so it may be, but anyone who has observed a breeding colony of lab rats is not likely to think of these animals as displaying much empathy. When babies get out of the nest, get cold, and squeal, the mother retrieves them and brings them back in, but that’s about it. They can find nipples and latch on by themselves (and they are so tiny, pink and hairless that you can actually see the bubble of milk in each stomach). The mother doesn’t do much more except lick them clean. And let one be sick, or injured, or die-- well, Mom tidies up the nest by eating the pup. If a male rat gets into the area, he’ll often tidy up further by eating the live pups too.

Could be that assisting in the jailbreak has some cause other than empathy.

Invisible England is Back and Talking About Holding Therapy

2011-12-11T10:43:00.002-05:00

I want to make sure everyone knows that Invisible England, a blog commenting on semi- officially-sanctioned Holding Therapy in the United Kingdom, is back after a short hiatus, at http://invisibleengland2.wordpress.com. The blog includes a personal statement and description of Holding Therapy by a young man who was subjected to the treatment. Another unique post on this blog is a videotaped interview with Dr. Edzard Ernst, the well-known critic of complementary and alternative medicine, who comments on Holding Therapy as an example of CAM psychotherapy. The blog also has a link for advance access to my paper in British Social Work Journal, responding to recent efforts to rehabilitate Holding Therapy; these efforts ignore the treatment's rejection by a task force of the American Professional Society on the Abuse of Children in 2006.

Faith-Based Child Abuse

2011-12-09T13:45:00.004-05:00

I want to call attention to two interesting comments on my post from several days ago, http://childmyths.blogspot.com/2011/12/prevention-v-cure-in-adoption-service.html. One contributor brought up the death of Kairissa Mark of Mt. Juliet, TN, within 90 days after her adoption from China by a pediatrician, Deborah Mark, and her husband, Steven, with the help of Bethany Christian Services. The contributor noted that Steven Mark had called Kairissa a “demon child” and had not made arrangements for family counseling as he might have. The child was beaten to death.

A second anonymous contributor reported that she (I think) knows the Marks and that they are not evil people. She believed that they must have been praying for a “miraculous cure” (she did not state what needed to be cured), but should have called in an exorcist or deliverer. I am assuming, based on this contributor’s remarks, that the Marks believed the child to be possessed by a demon and beat her as part of their efforts to end the possession. There was presumably some behavior or mood unsatisfactory to the adoptive parents which they believed indicated the presence of a demon.

When people come across the idea that religious beliefs can be associated with abusive treatment of children, they often think in terms of sexual abuse by Roman Catholic and other clergy. Disturbing as those events are, I suggest that in fact there are two other religious factors that create greater dangers for children. One of these involves a high degree of authoritarianism and the belief that absolute obedience to parents is a forerunner of absolute obedience to God, and that such absolute obedience is necessary for the salvation of the soul following the death of the body. A second risk factor is present when parents and religious groups believe that child behavior is caused by demons.

I have written about the authoritarian approach in several places, including a paper in the Scientific Review of Mental Health Practice (“Destructive trend in alternative infant mental health approaches”, Vol. 5, 2007, pp. 44-58). One relevant issue is the use of the Ezzo and Bucknam book On becoming babywise, discussed at http://www.gfi.org/. This book, and others in the “Babywise” program, date from the 1990s and emphasize the needs of adults. The program offers methods described as training the child to obedience and facilitating the parents’ relationship by preventing the child from making demands on the mother. The original version of the Babywise program advised moving the infant quickly to a reduced feeding schedule, with 6-month-olds receiving three meals a day and one liquid feeding at bedtime. (Writing for the American Academy of Pediatrics in 1998, M.T. Arney pointed out problems of dehydration and malnutrition that had been caused by the Babywise plan.) The goal of this program appeared to be to place the marital relationship (and perhaps above all the gratification of the father) as a priority, and to justify this in terms of the importance of learning obedience and humility.

A similar goal has more recently been set in the book To train up a child, by Michael and Debi Pearl, which has been widely discussed in various blogs including this one. The Pearls’ authoritarian approach involves physical punishment that is potentially severe and has even been fatal.

Question and answer material presented by Michael Pearl’s church includes belief in demonic possession, but I have not found any references to children’s behavior as caused by demons. However, the belief that a child can be demonically-possessed, and sometimes that painful treatment may be required to end the possession, is rather common among Christian fundamentalist groups. Doris Wagner’s book How to cast out demons (2000; Ventura, CA: Renew Books) states that demon possession is increasingly likely for children who are adopted, have had difficult births, or who fail to be “bonded at birth” (not defined by the author). [Incidentally, this book includes an informed consent document to be used by exorcists!] Other sources suggest that a child who has been sexually molested is more easily possessed by demons.

“Conventional exorcists”, if I may use that term, appear to address demonic possession by prayer. Fasting is also mentioned, although it is not clear whether the exorcist or deliverer is to fast, or the possessed person, or both (see http://www.stmichael.pair.com/laitydeliverance.html); it would be interesting if fasting as a form of purification ritual were related to the limitation of food used in some unconventional child psychotherapies. Nevertheless, there may be rituals that use physically-painful and injurious methods, or there may simply be frequent misunderstandings among adults who seek to change their child’s behavior by exorcism, because deaths as a result of exorcism rituals are frequently reported (http://www.tylerpaper.com/apps/pbcs.dll/article?AID=/20081203/NEWS01/812030289/0/FRONTPAGE; http://www.tldm.org/news8/possession2.htm; http://www.journalgazette.net/article/20110528/LOCAL03/305289976).

Adoption agencies, including Bethany Christian Services, make a point of screening adoptive parents for health, education, financial security, and so on. Isn’t it time that we screened for faith-based risk factors like beliefs in absolute obedience to parents, and in demonic possession as a cause of behavior problems? My anonymous correspondent was quite right when she said there are a lot of whackos out there. Screening for these beliefs would be a way of keeping adopted children out of their hands.

When Superstition Claims to Be Science: The Conscious Conception and Peace Lark

2011-12-06T13:26:00.003-05:00

A reader recently called my attention to the forthcoming publication “Parenting for Peace” by Marcy Axness. This book, and Axness’s website www.quantumparenting.com/ , claim to integrate science (“quantum”, right?) with spiritual insight, and stress neurobiology as a major source of information. In reality, though, much of the material Axness promulgates is nothing more nor less than superstition. If she wants to present her views as a matter of faith, well and good-- but to state that they are based on science is incorrect.

Here is one example from the quantumparenting site:

In discussing fertility issues, Axness quotes Laura Uplinger’s description of her beliefs about becoming pregnant. “My husband and I sent out a call to the universe—as if posting an ad on a galactic website—stating who we were and what we could offer to a soul who wished to join us. We carried on our daily activities in a mood of solemn expectation and profound surrender; was a soul going to be drawn to us?” In commenting on this and similar ideas, Axness refers to the idea of thought as an organizing principle that can influence even conception and development.

Are these views correct? Do souls wait in some nonmaterial world until they join bodies at the time of conception? Do our thoughts shape our physical structure and function? Those who believe these things don’t want or need systematic evidence to support their beliefs, and I don’t want to argue with their universe of discourse. However, I can say that those beliefs aren’t science. Science as a modern human endeavor is based on certain assumptions that are contrary to the ideas Axness promulgates. Science is mechanistic, assuming that even the most complex human functions are based on the same physical and chemical events that occur in the non-human, non-living world. Axness’s views are vitalistic-- she assumes that living organisms contain some factor that is absent from non-living substances, a factor that may be thought of as a spirit or soul. She also appears to assume that the soul is not just an animating principle, but is instead a personality with intention and power to make decisions, and one that can at all times be influenced by thought (cf. the “primal wound”). These assumptions are by definition not scientific, and ideas based on them are not scientific, no matter how many tidbits of neurobiology they are bolstered with.

Axness has a strong tendency to try to shape material from scientific study so it matches her vitalistic and transcendentalist view, with its characteristic tone of the 19th century’s New Thought. For example, in a statement on http://icpa4kids.org/ (website of a chiropractic organization), she says this: “A child who is securely attached to his parents is deeply motivated to behave in harmony with them.” Now, certainly it is true that conduct disorders, extreme risk-taking, and age-inappropriate oppositionalism can all be associated with a poor attachment history or with other evidence of insecure relationships. But this does not mean that secure attachment is characterized by “easy” relationships in which little discipline is required-- which is what seems to be implied by “deeply motivated to behave in harmony” and by other comments Axness has made about children who are brought up according to her principles. Axness assumes, and presumably believes, that easy and desirable outcomes can be produced by thinking in the right ways. (Is this part of that “idealization of motherhood” that can be so problematic?)

Here again we have statements that do not follow a basic rule of science, the rule that all information must be considered unless there is a very good reason for omitting it. What Axness omits is the fact that failing to “behave in harmony” with parents may be an essential step in a child’s development. Bowlby’s attachment theory describes a set of events that do not stop with parent-child affection and commitment. Attachment is about learning to deal with other people, knowing whom to trust, knowing what to expect, and these lessons must eventually be applied to persons outside the family. A big portion of that learning has to do with the practice of negotiation and compromise, a major emphasis of development in the preschool years and again in early adolescence. When parents are helping children learn to negotiate, negative feelings can run high on both sides; Indeed, this may be a desirable situation, as it helps the child learn that people can be very mad at each other but still work out a satisfactory compromise. The child is deeply motivated to move along its own developmental pathway-- which includes autonomy--- but this really cannot be seen as behaving “in harmony”.

The First Amendment permits Axness to make what statements she prefers about early development, but the fact is that there is no science involved in her views. Neither, by the way, is she a leading figure in child development circles, as some websites say. Axness has a Ph.D degree from the Union Institute in Ohio, an intermittently-accredited organization that as far as I know allows students to choose the academic field where they feel a dissertation belongs and to have the degree granted in that field. (Other alums are Lark Eshleman, a therapist involved in the Nathaniel Craver case; Gregory Keck, a Ohio attachment therapist whose degree is said to be in criminology, and Bill Goble, who diagnosed Candace Newmaker over the telephone before recommending that she be taken to the Colorado therapists at whose hands she died.) Although her website suggests that she does some form of therapeutic work, I do not see a California license verification for Axness as either a psychologist or any kind of counselor; she refers to her work as “psychoeducational”, so perhaps she doesn’t need a license.

Whatever Axness is, she isn’t a scientist. Whatever her beliefs are, and however often she mentions brains, her principles aren’t based on science. Is it even pseudoscientific to claim that thought shapes the physical world? Frankly, I’d call it superstition.

Addendum, 12/10/11: The statements about the Union doctorate in the following are presumably also true about Axness's degree claims: www.signorile.com/2011/07/what-kind-of-doctor-is-marcus-bachmann.html.

Prevention v. Cure in Adoption Services

2011-12-01T19:25:00.002-05:00

In a recent publication, the Evan B. Donaldson Adoption Institute commented on the need for post-adoption services, and cited the comments of parents and professionals in two focus groups (http://adoptioninstitute.org/publications/ParentFocusGroup2.pdf and http://adoptioninstitute.org/publications/ProfessionalFocusGroup.pdf). These focus group summaries make interesting reading and make it clear that in spite of hybrid parent-professional organizations like ATTACh, the goals and attitudes of parents and professionals overlap only partially.

One parent is quoted as saying, “It’s very difficult because there’s a lot of biases built into how the professionals see our children. One of the things I’ve often seen is that the first thing that is asked when the child has a problem is ‘What’s going on in your home?’ There’s no thought given to this child’s history, the child’s background. There’s got to be something wrong with you in your home, and it’s a frustrating situation to be in when you’re trying to get assistance for the children.” It’s not surprising that parents resent feeling “blamed” for children’s problems, and they appear to find it very hard to see the situation from the professional’s perspective. What if the caseworker immediately focused on the child’s history, and neglected to ask whether there had been a change in the family-- to find out later that it was the family’s alteration that had triggered the child’s problem behavior? Finding out first what is happening right now is common sense, especially because the present events may be open to change, as the past cannot be. A well-known case in the infant mental health field involved a child’s inexplicable behavior that turned out to result from a conflict between a grandfather and grandmother, and the resulting changes in the family system.

One of the real – possibly insoluble-- problems with adoption services is that parents and professionals do have different goals and viewpoints. The parent focuses on personal experience and wants to settle into life with a family as he or she expects it to be (and these expectations may or may not be realistic, as Rachel Stryker and others have pointed out). The professional has many other families to consider, and wants to minimize both adoption disruptions and abuse of any kind, even though there may be a paradoxical relationship between these two events. In addition to these differences in perspective, parents and professionals are different in the power they are perceived to have and actually do have. The adoption professional has the power to disrupt an adoption under certain circumstances and to require parents to follow directives in order to avoid disruption or to get the services the parents ask for; the parents have no similar powers, but if they do not do well as a group, the caseworker does not look good either. The relationship between the parent and the professional thus has the makings of a sort of mini-Stockholm syndrome, or alternatively various levels of conflict and resentment.

It’s possible that adoption services will not be genuinely effective until the ambivalence and conflict between parents and professionals is settled. I would speculate-- without any real evidence-- that this may not occur as long as parent support groups are encouraged. These groups, like all that have spun off various 12-step programs, are much loved by their members, but may serve primarily to establish a perception of the parent group as supportive and knowledgeable in comparison with professionals, thus worsening the existing conflict.

The unfortunate conclusion to be drawn here is that until such time as parents and professionals can work out their differences, the chances are that post-adoption services may not be very effective. This leaves us with two possible ways to improve the experiences of adopted children and adoptive families. Both are preventative approaches rather than “cures”: pre-adoption services like parent education, and improved screening of adoption applicants.

A good deal is known about the process of adoption and the important characteristics of both parents and children. But both the Evan B. Donaldson focus groups express pessimism about the possibility of training adoptive parents before the child comes into the family. One professional said, “Although we give parents a lot of information in preparation, obviously they don’t hear it because they’re thinking about their goal of having a child.” People in the parent focus group agreed with this: “Yes, I went through training, but it wasn’t the right training, and I don’t think it was really the right time, because when you’re [becoming] an adoptive parent, you’re excited, you have these children…” “Let’s face it. When you’re just coming into being a foster or adoptive parent, you don’t know anything, so you’re all excited and you only remember a quarter of what’s being said in that training. It’s too much information all crammed into one, and you’re just thinking about getting that cute little child.”

We seem to be left with improved screening of adoptive parents as a possible preventative of some problematic adoption situations. This approach, of course, will be abhorrent to many adoptive parents-- in particular those who might be excluded by screening. Increased screening may not be welcomed by some adoption professionals, either, as they are often much concerned with getting children placed in homes. However, as it happens, there is a good deal of relevant information that might help a screening process.

Some of this information contradicts common assumptions about the kind of person who would make a good adoptive parent. For instance, the developmental psychologist Mary Dozier’s work has demonstrated that people who have fostered many children are less capable of forming an attachment relationship with a child than those with fewer of these experiences. Other work (like the suggestions by St-Andre and Keren [Infant Mental Health Journal, 2011, pp. 694-706] that I mentioned a few days ago) emphasizes not only problems of the individual like a history of depression, but also the social environment-- depression or bipolar disorder in the adoptive parent’s family, and a lack of social support existing even before the adoption. (As the Evan B. Donaldson parent focus group indicates, social support is often lost after the adoption has occurred and difficulties are manifested.) St-Andre and Keren also note the force of the interaction between existing parent characteristics and problems associated with the child, such as multiple simultaneous adoptions. Screening to prevent parents with certain histories from adopting more than one child at a time (or perhaps even successively) might be a service of great help to a child’s developmental outcome.

St-Andre and Keren made another suggestion that is of great interest, but not necessarily supportable. They referred to the use of the Adult Attachment Interview as a way of predicting the capacity of applicants to function well as adoptive parents. The AAI is a structured interview that classifies adults as secure or troubled in their own attachment concepts. St-Andre and Keren described a woman applicant as appearing “pleasant and motivated for the adoption”, but as giving contradictory statements about her childhood and becoming “derailed” when talking about the early loss of a child. As a result of these responses on the AAI, she was excluded as a candidate for adoptive parenthood. However (and this is my comment, not St-Andre’s), the AAI, like many tests of its kind, was designed for research purposes and for guidance of treatment, not as a way to predict an individual’s personal life.

Adoption Risk Factors and "Strong Idealization of Motherhood"

2011-11-29T13:49:00.001-05:00

A recent publication discusses the emotional difficulties associated with adoption and takes a much more complex view than the Primal Wound approach advocated by Nancy Verrier. The paper (St.-Andre, M., & Keren, M. [2011]. Clinical challenges of adoption: Views from Montreal and Tel Aviv. Infant Mental Health Journal, 32, 694-706) examines a variety of risk factors and recognizes that no single problem determines a good or bad developmental outcome for the adopted child.

Among other issues, St.-Andre and Keren consider the effect of post-adoption depression (PAD), a problem that has received little study but that probably occurs at least as often as post-natal or post-partum depression (PND or PPD-- also called perinatal mood disorder, PMD). They point out a number of reasons why PAD may have received so little attention, including the view of adoption as a happy ending to a sad story of infertility, the fact that there are no obstetrical problems to deal with, and the apparent absence of the abrupt hormonal changes that follow childbirth. There may also be an assumption that an adopted older child will be less “trouble” to take care of than a newborn, and that the adoptive family can thus just go on with its life without missing a step. Whatever the actual causes of depression following birth or adoption, there is no question that maternal depression contributes to developmental problems.

St. Andre and Keren suggest that, just as birth mothers should be screened for PND, adoptive mothers should also be screened for factors that make PAD likely-- and that the factors contributing to the two forms of depression are quite similar. They list among the risk factors a past history of depression or anxiety, a family history of depression or bipolar disorder, low social support, and early relationship difficulties. To these, they add a risk factor that I find very interesting: “strong idealization of motherhood”.

To the best of my knowledge, there has been no systematic investigation of the role of “idealization of motherhood” in postpartum depression or in problems of adoptive families. It’s not even clear how such an attitude would be measured or detected. From a purely speculative viewpoint, though, I must say it rings a bell.

Idealization of motherhood has been mentioned in two popular books (Estela Welldon’s 1992 Mother, Madonna, whore: The idealization and denigration of motherhood, and Susan Douglas and Meredith Michaels’ 2003 The mommy myth: The idealization of motherhood and how it has undermined all women). As well as discussing other feminist issues, these two volumes touch on the idealization of motherhood in the sense that I think St-Andre and Keren intend-- the belief that being a mother is woman’s highest calling, the crowning achievement of life, and a state of nobility and virtue. This kind of idealization is also much to be met with on web sites that specialize in what we might call “motherhood porn”, sentimental descriptions of mothers’ love and sacrifice in the face of their children’s indifference or even hostility. These approaches are nothing new, going back to Victorian times and before; when seriously annoyed with me, my own mother once sent me a verse that described how a mother was the only person who refused to believe that her child had committed murder (and he actually had!).

Why would idealization of motherhood be a factor in the development of post-adoption depression? Motherhood (and fatherhood too) in reality involve a tangled skein of joys, pains, boredom, overexcitement, social isolation, financial terrors, and exhaustion. The adoptive family additionally experiences both praise and criticism from outsiders, fears about the nature of the “stranger child”, and the impact of being observed by agency staff. They have had a roller-coaster ride of timing, sometimes having to “hurry up and wait” for long periods and sometimes being told that the baby is here right now. To represent this life stage as a crowning achievement is about the same as suggesting that having your appendix out is a transcendental experience. (It’s much better than not having it out when you need the operation, of course.)

I don’t mean to downplay the wonderful things about having children. But parenthood is real, not ideal. It has all the gritty, dirty, discouraging aspects of any part of real life, and however well we manage it we cannot realistically consider later on that we did everything right. As a Massachusetts DMV worker once told me, “we’re doin’ the best we can”. If we’ve idealized what it means to be a mother, and can’t accept that all we can do is “the best we can”, the meeting with reality may trigger depression in people who are vulnerable to that emotional problem-- whether it’s labeled PND or PAD. On the other hand, if nobody idealized motherhood at all, how many people would adopt?

Of course we can’t completely prevent depression by reminding people of the realities of parenthood and arguing against idealization of motherhood. And there is more to the picture than parents’ mood disorders, wherever they come from. In thinking about the potential problems of adoption, St-Andre and Keren emphasize the importance of taking a transactional view-- looking not only at multiple factors, but considering how parents and children influence each other, and how those influences change over time. Although a mother’s vulnerability to depression is of great importance, characteristics of the adopted child also contribute to the risk of problems. For instance, difficulties are more likely if the child has experienced extreme deprivation of care in the first two years or when adoptions are later in the child’s life. Multiple simultaneous adoptions are problematic (and unfortunately appear to be encouraged by Russian orphanages).

The Nathaniel Craver Case: Many Dissatisfactions With Decisions

2011-11-25T13:42:00.003-05:00

If you have been following the trial of the adoptive parents of Nathaniel Craver in York, PA, you know some of the details of the case. Nathaniel (Ivan Skorobogatov) was adopted from Russia in 2003 and died as the result of multiple injuries and malnutrition in 2009. The parents, Michael and Nanette Craver, were recently convicted of involuntary manslaughter and given a sentence which allowed them to be released for time served. Their defense had argued that Nathaniel’s injuries were self-inflicted.

Russian representatives have stated strong objections to this mild sentence, as has been reported by the New York Times (http://www.nytimes.com/2011/11/20/world/europe/russia-angry-at-penalty-against-dead-adopted-boys-parents.html) and also by the English-language version of Pravda (http://english.pravda.ru/russia/politics/22-11-2011/119704-cravers_russian_boy-0/). Pravda reported a statement addressed to Secretary of State Hillary Clinton and Attorney General Eric Holder by the Russian Ombudsman for Children’s Rights Pavel Astakhov. Astakhov remonstrated about the inappropriateness of the sentence and asked for an appeal to be filed. In addition, Vladimir Markin, spokesman of the Investigation Committee of the Russian Federation, stated that documents about the case have been forwarded to the National Central Bureau of Interpol, a step that according to Markin placed the Cravers’ names on an international wanted list with the goal of arresting them and bringing them to Russia for prosecution.

I too am dissatisfied with the results of this trial, but I acknowledge that without far more evidence a death penalty decision would have been profoundly questionable. My concern is directed to the failure of the state of Pennsylvania to discipline persons who were either active or passive accessories to the child’s death. This situation was a regrettable example of similar failures that have occurred in case after case of deaths and injuries of children in the last 15 years. Individuals who were mandatory reporters of child abuse (required by law as members of their professions to bring abusive situations to the attention of child protective services agencies) did not report and were apparently inattentive to indications of trouble. Others who were not mandatory reporters but observed problems failed to take the responsibility they should have taken.

Again and again, therapists and counselors have come forward to testify that children who have been harmed are themselves guilty of their injuries. The two-year-old Russian adoptee David Polreis, who died of injuries in 1996, was said to have beaten himself to death with a wooden spoon. An older Russian boy (State v. Salvetti, North Carolina Court of Appeals 2010) who was poorly nourished and had been kept in isolation was said by a therapist to have refused food offered by his adoptive parents. Staff of the Institute for Children and Families, who were involved with treatment of Nathaniel Craver, stated that Nathaniel knew how to push his mother to the breaking point. One staff member, a school psychologist with a degree from a sometimes-accredited institution, testified that the child’s condition might have been worsened by a period in foster care, apparently implying that his condition was the factor that led to his death.

Where were these people when the harm was being done? If they believed that the children self-injured or precipitated injury by other people, why did they not monitor what was happening more closely? Why not help the parents engage in training programs to help them deal with risk-taking or self-injuring children? If the parents were seen as potential threats to provocative children, why not guide them into counseling that would help them control their own impulses? If a child is refusing to eat or is known to have feeding difficulties, why not enlist the family physician and keep growth records to make sure that growth stays within normal limits? Although legal restraints come into the picture only after harm is done, good practice for mental health professionals includes anticipating problems and helping to prevent them by supplying appropriate interventions.

The First Amendment permits therapists and parent educators to state their opinions to parents, even when those opinions are not supported by systematic evidence. Making mistakes in their practice, advice, even testimony, does not make these professionals liable to prosecution. However, the state of Pennsylvania, like other states, has the option of disciplining mental health and other practitioners through state licensing boards. These boards can investigate professionals for ethical and practice errors and can discipline them in a variety of ways, including license revocation. But a look at the on-line records of state boards shows that investigation and discipline are rare except where there was an injury caused directly by the practitioner, or where there was sexual misconduct, or where drugs and alcohol were involved. Failure to follow up injury or malnutrition is rarely a disciplinary matter-- even when the practitioner later testifies that the child’s own behavior (the practitioner’s presumable focus) caused the problems. State licensing boards justify their disengagement by pointing to their low budgets-- but cases that culminate in physical injury or death of children surely deserve priorities even higher than cases of sexual contact with an adult patient.

It has become abundantly clear in recent years that Russian adoptees are especially likely to be injured, killed, or abandoned. Whether this is due to the problems the children have to start with, to the nature of the adoptive parents, or to both, is unclear. Anecdotes about Russian institutions suggest that there may be pressure for adoptive parents to “take” more children than they had planned for, and this may also be a risk factor. But whatever the causes or mechanism, everyone with an interest in adoption has already heard about the tragic outcomes for some of these arrangements. Doesn’t this suggest that therapists, counselors, caseworkers, teachers, and pediatricians should all be especially alert to signs of trouble in adoptions from Russia? Lark Eshleman, one of the Cravers’ therapists, notes on her website the many years in which she has worked with foreign adoptions; did it not occur to her that a Russian adoptee with unexplained or self-inflicted injuries should receive extra attention, and that his parents needed more careful guidance than most adoptive families? Did not the fact of a previous abuse investigation alert anyone to the need for an appropriate care plan that would not punish the parents but would guide them to safe and effective child-rearing approaches?

If professionals working with foreign adoptions can’t keep these issues in mind, and state licensing boards are indifferent-- well, perhaps the Russians are right in turning to Interpol, but they need to add some names other than the parents’.

Disrespect or Disobedience? A Matter of Perspective

2011-11-23T12:41:00.001-05:00

This morning I received an e-mail from someone who writes about nannying. She very nicely sent along some of her work, and hoped I might mention it on this blog. I am going to talk about it, but I won’t cite my source, because I can’t agree with most of what she said.

The material I was sent discussed problematic child behavior that nannies might have to deal with and listed a number of issues like disobedience, tantrum-throwing, and lying. I certainly agree that these can be problems if they occur frequently (but breathes there a child who has never done any of these things?). My concern is not that my correspondent pointed out these problems, but that she classed them as matters of disrespect to the nanny.

From early life, children behave toward others with what would be appalling disrespect if it were done by an adult. (I don’t know about you, but if one of my friends stuck a finger up my nose, I would definitely take umbrage.) One of the jobs of adult caregivers is to guide children toward empathic responses that will lead them to be respectful of others’ feelings.

This is a job that is better done by adults who see it as the job it is, rather than focusing on whether they have personally been disrespected. One of my real concerns with the nanny material I was sent is that by using the term disrespect to categorize disobedience and other problematic behaviors, it encourages child care providers to perceive child behaviors as personally significant, rather than as goals in the task of child guidance. When we see ourselves as being disrespected, we are likely to be angry and resentful; when we are angry and resentful, we don’t think clearly; when we don’t think clearly, we can’t bring all our knowledge and ability to bear on what we want to accomplish.

Don’t misunderstand me. Although I know that disobedience and so on are common foibles of childhood, I would not for a moment say they are unimportant or suggest that they may all be ignored. On the contrary, it’s because I think child guidance is so important that I don’t want it to be confused with separate issues like a nanny’s sense that she gets the respect she deserves.

Disobedience and other problem behaviors are significant issues in several ways. One is that they are strongly related to health and safety concerns. Children who frequently disobey home rules (“don’t jump on the bed”) can’t be trusted to stop at the corner before crossing a street, or to keep their hands away from sharp knives in the kitchen. We owe it to children to train them in reasonable obedience to reasonable rules, for their safety as well as for our adult convenience (our needs do count in this equation sometimes, too). However, a sensible approach to obedience recognizes that young children may forget or misunderstand directions, and some older children may act on impulse or take risks when they need attention. Their disobedience, although it needs to be worked on, should be understood in terms of their developmental stage or individual characteristics, not in terms of their wish to annoy a particular adult, or their lack of esteem for that adult.

My correspondent included lying and tantrum-throwing among “disrespectful” behaviors, and of course if our adult friends do these things to us we rightly interpret their attitudes toward us as less than respectful. With reference to children’s lying, let me suggest several interpretations that may be more fruitful than assuming they are disrespectful. Depending on the child’s age and situation, here are some possibilities: the child may be frightened of some consequences of his own or other people’s actions; the child may have misunderstood events or information; the child may be telling a story about imagined events; the child may not remember events or understand the question. If the child has reasons to be frightened, those reasons need to be explored for the child’s own sake. If none of these possibilities seems to apply, but the child is persistently untruthful, it’s important to investigate whether the behavior is an aspect of emotional disturbance.

Interpreting tantrum behavior also needs to be done in the context of the child’s developmental age. Toddlers who do not yet talk well are likely to have tantrums as a result of frustration about unsuccessful communication. Punishing them for this behavior simply increases the frustration level and decreases their ability to handle problems in a more mature way (which will not be very mature in the best of circumstances). Older children may have learned to have tantrums to “get their own way” when adults have rushed to placate them when they make a scene-- but they may also behave in this way when overwhelmed by frustration. When older children have tantrums, it might be useful to explore whether marital problems are leading the parents to be less responsive or positive than usual; whether the child is overscheduled with school, lessons, and sports; whether divorced parents are scheduling visits that are too long or too unpredictable for the child’s comfort; whether the relationship with the nanny feels tenuous to the child (e.g., parent threatens to fire nanny, nanny mutters about quitting). In none of these cases is the tantrum an expression of personal disrespect for the nanny.

In high-quality child care settings, staff are provided with what is called “reflective supervision” to help them focus on problematic interactions with children as tasks to be done, rather than personal wars to be won. Ideally, nannies too would be provided with that kind of help, but very few of them, if any, are supported in this way. We certainly don’t need for nannies to be told that childhood problems are personal disrespect—potentially making matters worse rather than better.

If It's Not RAD-- What Is It?

2011-11-20T10:29:00.001-05:00

Again and again, parents and semi-professional therapists turn up on the Internet and in print, stating their claims that aggressive and difficult children have Reactive Attachment Disorder. They go on to say that the undesirable behavior can be cured only by correcting problems of attachment and causing the children to become emotionally attached to their parents. The same group used to press these ideas with respect to autistic children, too, until research showed that those children were normally attached to their parents and caregivers.

Also again and again, various authors (including me) have rejoined that the criteria for diagnosis with Reactive Attachment Disorder do not include aggression, firesetting, or any of the other frightening behavioral symptoms so often claimed for that disorder. At the same time, though, no one commenting on this issue has denied that there are children who display a range of disturbing behaviors. What, then, should be the diagnosis for those children, if it is not Reactive Attachment Disorder?

One possible diagnosis for children who display severe behavior problems early in life is early-onset schizophrenia. This has been said to be the difficulty of Malcolm Shabazz, the grandson of Malcolm X, who started the fire that killed his grandmother, Betty Shabazz. Malcolm Shabazz was reported to have fought with his mother (also apparently mentally ill) until they were both bloody, when he was only three years old. Now in his late teens or early twenties, he has continued to display violent, irrational behavior. Although it is certainly true that Malcolm Shabazz has poor relationships with others, there is evidently far more going on here than problems with attachment.

Early-onset schizophrenia is not frequent. A more likely, and far more common (between 2% and 6% of the population), diagnosis for children with extremely difficult and aggressive behavior is Conduct Disorder. An article by the eminent psychologist Alan E. Kazdin has recently discussed Conduct Disorder-related behavior and appropriate treatments (Evidence-based treatment research: Advances, limitations, and next steps. [2011]. American Psychologist, 66, 685-698). I am going to be quoting his comments directly and indirectly in this post, as well as adding my own remarks.

Here are some characteristic behaviors of the children Kazdin discusses: fighting, destroying property, lying, using a weapon, physical cruelty to people or animals, stealing, forcing someone into sexual activity, firesetting, truancy, and running away. According to Kazdin, “a typical outpatient case would be a 10-year-old boy who is constantly fighting at school and having frequent explosive tantrums at home. Siblings may have been harmed or may be in jeopardy of being harmed. He may be playing with matches in his bedroom at night, not coming home from school, occasionally not going to school even though the parents believe he is there, and making threats to harm others (peers, teachers).” (This child, by the way, might well be labeled a “psychopath” by those who use that term rather freely.)

Kazdin notes that Conduct Disorder is frequently followed by adult psychiatric disorders, and that it has harmful consequences for parents, siblings, and teachers, as well as the child himself or herself. Without commenting on the complex possibilities of cause-and-effect relationships, Kazdin goes on to say that “many children with [Conduct Disorder] are subject to moderate-to-heavy corporal punishment or live in very stressful environments”.

How can Conduct Disorder be treated? The interventions suggested by Kazdin are far removed from the various “attachment therapies” preferred by those who attribute difficult and aggressive behavior to Reactive Attachment Disorder. Kazdin focuses on parent management training (PMT), an intervention that examines parent-child interactions in the home and guides parents in altering interactions that make the child’s behavior more deviant. Randomized controlled trials have shown this method to be an effective one. When there is no parent involvement, for example because of substance abuse or simple refusal to participate, Kazdin recommends a cognitive approach, problem-solving skills training (PSST), which again has been shown to be effective and to significantly reduce undesirable behavior. In contrast to the “attachment therapy” approach, Kazdin’s program thus emphasizes altering parent behavior if possible, and follows up by using well-understood principles of learning rather than efforts at changing basic but poorly-understood attitudes and emotions.

A frequent comment of “attachment therapy” advocates is that conventional treatments make children’s disorders worse, that children must be capable of trust in order to benefit from psychotherapy; in addition, they state that parents who have “tried everything” will be happy with interventions approved by ATTACh and its admirers. Kazdin’s treatment program is of demonstrated effectiveness and does not require that children trust--- on the contrary, trust might be expected to result from behavior changes beneficial to both child and parent. I would hazard the guess that those who have “tried everything” have not tried serious interventions like PMT, but instead have spent a few hours with popular local counselors who have little more than their personal experiences to guide their work.

From the point of view of ATTACh and its members, PMT has one characteristic they would very much wish to avoid. This is the fact that parents are asked to examine their own behavior in detail and work to change it. “Attachment therapy”, although it may include some version of parent education, is attractive to parents because it does not ask them to change in any difficult way. Parents may be asked to make intense demands on their children, to watch them constantly, and to refuse to let them “get away with” anything, but all these are matters of investing time and energy-- not the more difficult matter of considering whether what one just did was part of the problem and not part of the solution. To admit that you are not an “awesome parent” is frightening, especially for families where the authority and rightness of the parents is a matter of religious belief. But it may be the most important step in helping children whose actual problem is Conduct Disorder.

For [Heaven's Sake] Never Amber [Necklaces]

2011-11-15T13:51:00.001-05:00

Has anyone else stumbled across the recommendation to put necklaces of amber beads on teething babies, to act as a “natural analgesic”? I just came across this idea, on the Internet of course, but I’m not going to provide a link, because why encourage this stuff? If you want to see what they say, you can Google “amber” and “teething” and you’ll see plenty... including one or two expert debunkers at work.

When I first read about these necklaces, I was reminded of the “teething coral” necklaces of Victorian times-- but the amber necklaces are not meant to be chewed on and are not just to relieve the irritation of itchy gums. The basic claim appears to be that amber contains a substance called succinic acid, and this substance is absorbed by the skin, resulting in reduction of discomfort and increases in immunity, nervous function, etc. But there appears to be no evidence whatever that succinic acid has such an effect, or even that the small amounts contained in amber, if absorbed, would be sufficient to have any effect at all. One necklace website, by the way, claims that amber will help asthma and other disorders as well--- again, an unsupported claim.

The obvious concern is that an infant wearing a necklace could either catch it on something and strangle, or could break the necklace and choke on the beads. Websites advertising the necklaces advise against keeping the necklace on at night. Some necklaces are described as hand-knotted, with knots between each pair of beads, just like real pearls, so a break means that only one bead will come off the string. Others are said to have magnetic clasps that will break away under pressure.

So, what we have here is a situation where the sellers of the necklaces themselves recognize the potential danger of strangulation, resulting in death or (almost worse) near-death and severe, incurable brain damage. The necklaces are potentially harmful, and only anecdotes suggest that they are in any way helpful. Yes, the amber contains succinic acid as well as many other components, but there is no reason to think that succinic acid could possibly have the desired effects.

Why would anyone choose such a method, then? One reason seems to be the everlasting conviction that anything that is “natural” must also be beneficial. This belief perseveres in the face of the facts that illness, injury, and death are all natural events, and in spite of the clear evidence that naturally-occurring substances may have evolved ways of protecting themselves by harming creatures that consume them. What about a healthy, natural meal of oleander leaf salad, death cap mushrooms on toast, polar bear liver (get your Vitamin A, folks) and a pokeberry crumble (mmm, those scrumptious-looking, juicy purple berries)? The survivors, if any, might then enjoy a soothing massage with natural oils from poison sumac and poison ivy.

A second reason for the amber necklace idea is the lingering commitment to folk beliefs--- what you might call the trailing edge of medicine. Amber itself was an ingredient in pre-scientific medicine and could be consumed as a powder or used in other ways. But stones of all kinds were believed to have specific powers and connections with body parts and functions. These ideas were part of sympathetic magic and the belief that when two things resemble each other or “go together” in some way, they have some sort of cause-and-effect relationship. In modern life, we still see some of this focus on stones in the custom of “birthstones” and the characteristics associated with them; astrologers and alchemists associated not only the birth month, the stone, and the characteristics, but features of the heavens, body parts, and geographical areas. The attention paid to amber is only one facet of this (sorry, talking about gems made me think of that word!).

Be their reasons what they may, devotees of amber teething necklaces seem to have forgotten the caution common sense would advise for treatments that are potentially harmful AND that lack evidence of usefulness. And, regrettably, merchants of snake oil are also happy to supply amber necklaces to the naïve. They won’t be standing by to help a choking baby, though.

Spanking Is Not Whipping (and Why It Matters)

2011-11-13T16:12:00.003-05:00

Tempting though it is to take a simplified view, I don’t want to be the one to claim that once you’ve defined your terms you’ve found a way to understand any disagreement. However, I am quite willing to propose that clear definitions will help make constructive discussions of arguments about corporal punishment of children. Here is an effort to start the process:

Spanking is not whipping. Spanking is not paddling or beating. Spanking may or may not be the same as a smack. Spanking may or may not be equivalent to a whup, a whoop, or a tap. Spanking is not caning, belting, or flogging, or even slippering.

Spanking has been defined again and again, in the course of discussions about differences between corporal punishment of children and physical abuse of children. Spanking involves a small number of blows given with an adult’s open hand, usually to a child’s buttocks, legs, or hands. It does not include blows to the face or head or “boxing” the ears. Spanking does not employ kicking, giving blows with the closed fist, or using an object like a whip, switch, wooden spoon, belt, or razor strop to strike. Spanking does not cause bruising, bleeding, or welts, although it may leave a reddened mark for some minutes on pale skin.

This definition appears clear enough, and it is quite familiar to anyone who has read a little of the literature about child abuse and physical methods of punishment. Yet few people seem able to make the distinction. The Nov.7 Times article on children whose deaths were associated with the recommendations for corporal punishment of Michael and Debi Pearls (now at http://www.nytimes.com/2011/11/07/us/deaths-put-focus-on-pastors-advocacy-of-spanking.html?scp=1&sq=1&sq=Michael%20Pearls&st=cse) bore the following headline: “Preaching Virtue of Spanking, Even as Deaths Fuel Debate”. Yet the Pearls’ recommendation was not for spanking; it was for whipping with a narrow object like a willow switch or plastic plumbing supply line. Advocating for the opposite viewpoint, Project NoSpank (www.nospank.net) uses the word “spank” in its name, yet focuses primarily on corporal punishment involving blows with objects.

Why is it important to clarify whether corporal punishment involves actual spanking, as defined, or some other form of blows? To begin with, when we’re talking about important things, it’s wise to be sure exactly what’s under discussion. And, second, it really does not do to dismiss the differences on the grounds that “corporal punishment is corporal punishment” and that details like its intensity are irrelevant. Nobody would say that scolding is always the same thing, when it can range from a quiet request that a child think twice, to terrifying yelling and screaming coupled with threats of mayhem. We have every reason to think that, in corporal punishment as well as in other treatments, there is a dose-response relationship, and that more of a treatment should be expected to have a greater effect than a small amount does. We are not likely to be able to understand the influence of corporal punishment unless we are sure how intense and how lengthy the punishment is.

It’s obvious how a clear definition of spanking is necessary for understanding of ordinary claims about physical punishment. Is it also important for the understanding of research on outcomes of corporal punishment, or can we expect researchers and discussants to insist on definitions of terms? As it turns out, published research reports are not always cautious about definitions. For example, two papers by Elizabeth Gershoff conclude that corporal punishment may have short-term benefits, but may also cause long-term harm by increasing aggression and aggravating mental health problems (Gershoff, E.T. [2002]. Corporal punishment by parents and associated child behaviors and experiences: A meta-analytic and theoretical review. Psychological Bulletin, 128, 539-579; Gersgoff, E.T. [2010]. More harm than good: A summary of scientific research on the intended and unintended effects of corporal punishment on children. Law & Contemprary Problems, 73, 31-56). Criticizing these papers, however, other authors pointed out that Gershoff’s work had combined studies of spanking with studies of other forms of corporal punishment (Larzelere, R.E., & Baumrind, D. [2010]. Are spanking injunctions scientifically supported? Law & Contemporary Problems, 73, 57-87). Examining research on spanking alone, as defined above, did not show an association with long-term problems.

By the way, there’s a distinct possibility that neither spanking nor other forms of corporal punishment have long-term influences of their own. Instead, it might well be that the kinds of parents who choose to spank, and the other kinds who choose other corporal punishment, have other ways of influencing their children, through the behavior they model and through the specific instructions or messages they communicate. In addition, the kinds of children who do things that their parents believe require physical punishment (like taking dangerous risks or harming other people) may be different in personality to begin with, and retain their differences as they grow older-- rather than being “shaped” by their parents’ child-rearing methods.

If people want to claim that God wants children to be punished physically, it’s pointless to argue with their belief system, nor does it matter much whether they advocate spanking or blows with objects. Those people don’t need or want specific definitions. However, if the argument is about the outcome-- whether children who are spanked develop well or poorly, and whether the effects of other physical punishments are the same or different-- we need to avoid the Times' headline-writer’s blurring of distinctions and be sure we all know what we’re talking about.

RAD Foolishness at Huffington Post

2011-11-11T11:35:00.002-05:00

The Huffington Post columnist Lisa Belkin deplores the deadly results of child abuse, and well she may. But in her remarks at www.huffingtonpost.com/lisa-belkin/adoption-spanking-childabuse_b_1081617.html , she falls heavily for an idea associated with an eccentric view of child mental health--- the belief that emotional disturbance can cause an inability to feel pain. Belkin says that Reactive Attachment Disorder is “essentially the inability not only to bond, but to feel… these children can have elevated levels of the hormone cortisol, which increases their tolerance for pain… Some speculate that … spanking can spiral out of control” because the children do not respond to normal levels of painful stimulation.

Let’s parse this remarkable statement.

Do “some” speculate on this idea and claim that children with Reactive Attachment Disorder (or adopted children-- the two are sometimes spoken of in the same breath) are not very responsive to pain? Yes, “some” certainly do. Here are a couple of examples. At www.attachmentdisorder.net?Letter_to_Teacher.htm, we are told that “RAD kids can walk around in significant physical pain from real injuries”. At www.adopting.org/DrArt/diagnosisrad.html, the social worker Arthur Becker-Weidman, the soi-disant “Dr. Art”, provides one of those do-it-yourself RAD checklists, including the item “My child ‘shakes off’ pain when hurt, refusing to let anyone provide comfort”.

These statements confuse the actual response to pain with the seeking of comfort from the “right” people, and ignore the possibility that the child does not find particular adults (or adults in general) to be very comforting people. Belkin, however, accepts the idea that children diagnosed with Reactive Attachment Disorder may have an increased tolerance for pain-- by which I assume she means a raised threshold, requiring a higher level of painful stimulation before the child experiences pain.

Is it possible for this to happen? Yes, as Belkin states, changes in stress hormone levels can make a difference to pain tolerance. Physical stimulation can result in changes in pain threshold called stimulus-induced analgesia. People with diseases of the peripheral or central nervous systems such as leprosy can lose skin sensitivity of all kinds in some parts of the body. Studies of soldiers during World War II showed that wounds treated at front-line dressing stations required much less morphine than similar injuries due to surgery. A very few people are congenitally insensitive to pain and are frequently injured as a result (for example, being unaware that a hand is on a hot stove until they smell charred flesh). A few others, afflicted by harmful genetic factors, mutilate themselves by chewing their lips and tongues and do not seem to find this painful-- but can learn not to do it when subjected to painful electric shocks.

Is there any documentation of the claim that children who have been given the RAD diagnosis are in fact less responsive to pain than other children? This could be ascertained through standard laboratory tests of pain thresholds, or by systematic observation of toleration of dental work or medical procedures like immunization. No one has done this, so in fact the idea of higher pain thresholds (better pain tolerance) remains entirely hypothetical. The DSM description of Reactive Attachment Disorder certainly mentions no such symptom.

Let’s look at Belkin’s suggestion in another way. Does ordinary child guidance depend on experiences of pain? If a child felt little or no pain, would he or she then be untrainable? Although many parents do use spanking (a few blows with the open hand, no weapon) as a disciplinary method for preschool children, it is also common and effective to use timeout, isolation in the child’s room, scolding, or deprivation of treats-- all useful methods without physical pain. An ordinary spanking itself, when applied through a layer or two of clothing, involves intimidation much more than pain. In fact, it is not necessary for punishment to be painful in order to be effective . (The use of aversive treatments like electric shock-- certainly a painful experience-- is ethically limited to situations when a child will put himself in danger of real harm if he does not comply with instructions. ) If indeed children with Reactive Attachment Disorder had high tolerance for pain, there is no reason to think that this would affect their response to ordinary discipline one iota.

This line of discussion leads to another claim, one not made by Belkin but common among the people whose work she seems to have been reading. This is the idea that children with Reactive Attachment Disorder are unable to learn cause and effect connections, as stated by the “Evergreen Consultants in Human Behavior” at http://attachmenttherapy.com/ad.htm and many others. This bizarre belief appears to have come from someone being frightened by Piaget at an early age. In fact, learning to associate cause and effect begins in the first months of life, and is shown in thousands of daily behaviors such as becoming toilet-trained and using a spoon to eat with. The belief that Reactive Attachment Disorder necessitates severe parenting methods and high levels of child discomfort appears to be based on this entirely hypothetical inability to associate cause and effect. Children who attend school, dress and feed themselves, and do household chores all are demonstrating evidence of cause and effect learning, but they may for quite other reasons fail to learn to display affection or gratitude to their caregivers, or to make the caregivers feel that they have achieved the family relations they wanted.

Belkin associates Reactive Attachment Disorder with an “inability to feel”-- perhaps deriving this idea from the claimed lack of responsiveness to pain. Yet even the attachment therapists from whom she seems to have adopted ideas would point to the children’s rage and grief about separation from their original caregivers, even in cases where there was not enough time for an attachment to have occurred. The real issue appears to be that the children do not feel what their adoptive families want them to feel, or if they do, they do not display their feelings as is expected of them.

Belkin’s suggestion that children are abused because they are insensitive to pain and do not “feel” emotions is simply not tenable. This is not a matter of parents who must escalate physical punishment because without pain the children will not learn; it’s clear that children, adopted or not, do learn without pain. There was something else going on in the child deaths associated with “To Train Up a Child”. What was it? There were undoubtedly different factors and combinations of factors in the three known cases, but here’s a short list of possibilities:

The belief that the child’s eternal damnation or salvation rests on present obedience.

The belief that physical punishment is traditional, Christian, or in some way linked to a set of “family” values.

The belief that it’s a child’s job to make a family happy.

The belief that isolation of the family from the surrounding community is desirable.

The belief that adopted children are different from others in essential ways (a belief, by the way, fostered by Belkin’s comments on this subject).

The belief that there is an undefined process called “bonding” that may be undertaken by children and which is different in its nature from emotional attachment.

These factors could all be part of the lives of fairly ordinary adoptive parents. When we add in the possibility of serious mental illness in parents or in children (sorry, RAD doesn’t count), we multiply enormously the possibility of child abuse, injury, even death. The hypothesis that adopted children have a high tolerance for pain is not only unsupported, but an unnecessary addition to the discussion. Stressing that hypothetical factor is just another way to say, “the child made me do it.”

Pearls or Swine? Another Death Possibly Related to "To Train Up a Child"

2011-11-07T11:13:00.003-05:00

The New York Times this morning reported on the front page a third child death among apparent followers of the evangelical ministers Michael and Debi Pearl (http://www.nytimes.com/2011/11/07/us/deaths_put_focus_on_pastors_advocacy_of_spanking.html). Mr. and Mrs. Pearl are the authors of “To Train Up a Child” (posted in its entirety at www.achristianhome.org/to_train_up_a_child.htm), a document that advocates not what most of us would call spanking, but practices like whipping of 6-month-olds with plastic plumbing supply line. I have written about the Pearls in the past (Mercer, J. [2007]. Destructive trends in alternative infant mental health practices. Scientific Review of Mental Health Practice, 5(2), 44-58), but this third death report makes me feel that there is plenty more to say.

The Pearls are evangelicals living in Tennessee and associated with an organization called the Church at Cane Creek. According to the Times, there are 670,000 copies of their self-published book in circulation (an interesting fact when the book is readily available on line). The Pearls share an intensely Calvinistic belief system in which obedience to God is the essential correlate of salvation. Human beings are naturally “froward” or disobedient and rebellious, and those sins are the deeply serious ones that caused Lucifer to be hurled from heaven. Parents are responsible for their children’s salvation, and the first step they must take is to “break the spirit” and stamp out all rebelliousness expressed against the parents themselves. Without this step, children will not be meek and obedient before God, and therefore will be damned eternally. (There appears to be no room in this system for mercy or grace-- and Unitarians or Quakers need not apply!) The experience of pain is the natural tool for breaking a rebellious tendency, and although it may be uncomfortable for parents to cause this, it is their job to do so and rescue the child from an eternity in the torments of Hell.

In one anecdote in “To Train Up a Child”, the Pearls tell of a visit from a toddler who had never seen Mrs. Pearl before but was left with her for some hours. As he appeared unhappy, she offered him some roller skate wheels to play with-- but he “rebelliously” refused. Smiling at him, she whipped his leg with her plumbing supply line. This event was repeated ten times, at the end of which, according to the Pearls, the child played happily (I’m just reporting the news here, you know). Whipping was advised for a wide variety of early offenses like turning the head away when offered a spoonful of food or rolling off a blanket when placed there. The Pearls also approve of occasional withholding of food and of using a garden hose on a child who has had a toilet accident.

However appalling these practices may seem to many of us, it is unlikely though possible that they would ordinarily cause death or even serious injury. It is difficult to know whether the three child deaths-- all of adopted children, by the way-- can legitimately be attributed to the Pearls’ advice, although the parents in these cases are known to have been admirers of the Pearls’ practices. In each case, the parents’ behavior went far beyond the Pearls’ recommendations. To summarize from the Times article: The first death, that of Sean Paddock of Johnson County,NC, in 2006, involved suffocation of the 4-year-old child in a tight blanket wrap. The second, early in 2010, was that of Lydia Schatz, age 7, in California. She was whipped for hours, with pauses for prayer, and died from severe tissue damage, cut to ribbons by the lashing. The most recent death, last May, was that of 11-year-old Hana Williams in Washington State; according to the Times report, she “was found face down, naked and emaciated in the backyard; her death was caused by hypothermia and malnutrition… [she was] deprived of food for days at a time and [made to] sleep in a cold barn or a closet and shower outside with a garden hose.” The day she died, she was beaten with a link of plastic tubing as recommended by the Pearls.

Some questions come to mind, not so much about these pitiful children, who suffered unimaginably, but about the role of parenting advice and of religious belief in the United States . The First Amendment guarantees freedom of speech, but that freedom has its limits-- for example, it does not extend to yelling “fire!” in a crowded theater when there is no fire. Should there be limitations on advice that might be misused by parents whose mental health or intelligence limitations distort their understanding of appropriate parenting behavior? What should be the constraints placed on adoption caseworkers or other publicly-paid functionaries, whose instruction to parents may be out of line and lead to injury? Do parents’ religious beliefs allow authorities to waive the usual requirements about adherence to child abuse statutes? How do we, as a multicultural society, decide what laws to enforce for all families?

Simple and suitable though it may seem to just make the Pearls shut up and withdraw their book, and deplorable though the apparent results of their teachings may be, legislation may not be the answer here. However, the continuing silence of professional societies is of no help in this complex situation. The American Professional Society on Abuse of Children spoke out against attachment therapy in 2006. When will we see a task force addressing the intertwining of serious child abuse with religious and cultural beliefs? And when, particularly, will adoption organizations notice that it is dangerous to place older, foreign-adopted children with large families who concern themselves with “spirit-breaking”?

Lark Eshleman's "Becoming A Family": Approach With Caution

2011-11-06T13:31:00.001-05:00

A Pennsylvania school psychologist, Lark Eshleman, published in 2003 a book called “Becoming a Family: Promoting Healthy Attachments With Your Adopted Child”. Although Ms. Eshleman is eager to be helpful and has written an enthusiastic volume, looking through the book unfortunately reveals misunderstandings that could easily lead to inappropriate treatment of adopted children.

Ms . Eshleman quickly focuses on the idea that adopted children are likely to suffer from Reactive Attachment Disorder and presents two definitions of “what RAD looks like”. She does not appear to notice that these “clinical definitions” (as she puts it) have little to do with each other.

Looking at discussion of Reactive Attachment Disorder in the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association, Eshleman quotes the following description:

“Reactive Attachment Disorder (RAD) is a complex psychiatric condition that affects a small number of children. It is characterized by problems with the formation of emotional attachments to others that are present before age five. A parent or physician may first notice problems in attachment with the caregiver that ordinarily forms in the latter part of the first year of the child’s life. The child with RAD may appear detached, unresponsive, inhibited or reluctant to engage in age-appropriate social interactions. Alternatively, some children with RAD may be overly or inappropriately social or familiar, even with strangers. The social and emotional problems associated with RAD may persist, as the child grows older.” [I haven’t checked for the accuracy of this quotation. It seems a bit clumsy, but nobody ever said psychiatrists had to be engaging writers.]

Next, apparently with the intention of reinforcing the comments above, Eshleman proceeds to quote the Association for Treatment and Training of Attachment in Children (ATTACh, a hybrid parent-professional group that has in recent years offered credentialing to those trained in their perspective on attachment issues):

“ Attachment disorder is a treatable condition in which there is a significant dysfunction in an individual’s ability to trust or engage in reciprocal, loving, lasting relationships. An attachment disorder occurs due to traumatic disruption or other interferences with the caregiver-child bond during the first years of life. It can distort future stages of development and impact a person’s cognitive, neurological, social and emotional functioning. It may also increase the risk of other serious emotional and behavioral problems.”

Let’s examine these two statements point by point and see to what extent they are in agreement with each other.
The APA statement refers to a specific diagnosis, Reactive Attachment Disorder, which has been listed in DSM for a couple of decades and which originally referred to a type of feeding problem of infants. The ATTACh statement speaks instead of “attachment disorder”, a general term that could be applied to less-than-ideal attachment styles that are nevertheless well within the normal range.
The APA statement makes no comment about treatability of RAD, while ATTACh introduces the idea of treatment before even describing the problem.
The APA statement describes observable behaviors that are part of the disorder and which presumably could be noted by parents and teachers as well as by psychiatrists, psychologists, or social workers. The ATTACh statement refers to vaguely-described problems such as the “ability to trust” or to “engage in reciprocal, loving, lasting relationships” which are not observable, but can only be inferred from behavior that is not described.
The APA statement refers to problems that can be observed beginning in the latter part of the first year of life. The ATTACh statement points to causation by events that occur in the first years (not otherwise specified), but does not cite behavior that occurs early.
The APA description notes that the social and emotional problems of concern, such as detachment and reluctance for social interaction, may persist rather than be “outgrown” as the child gets older. ATTACh warns that attachment disorder can “distort future stages of development”, a different and more serious matter than persistence of early problematic behavior. In addition, ATTACH speaks of impacts on “cognitive, neurological, social and emotional functioning”. The APA description is entirely focused on the social and emotional eccentricities that are the basis for a diagnosis of Reactive Attachment Disorder and never refers to either cognitive or neurological effects.

Following her quotations from APA and ATTACh, Eshleman goes on to add a description of a girl who is said to have some type of attachment disorder. This girl, in her early teens, is described as aggressive, destructive, jealous, and controlling, and steal from the family as well as shoplifting. At this point in her narrative, Eshleman introduces the idea that the girl shows “many of the typical features of RAD”, and cites these as lying, inability to trust, oppositional, acting-out behavior, engaging in dangerous behavior, apparent desire to keep others at a distance, and hypervigilance. None of these, please note, were mentioned as characteristic of Reactive Attachment Disorder in the APA description.

Eshleman appears to disagree on almost every point with the APA concept of Reactive Attachment Disorder. Between her quotation from ATTACh and the conclusions drawn from her case description, Eshleman has provided a view of Reactive Attachment Disorder that thoroughly contradicts that of the APA description.

Why, then, did she include the APA description to begin with? I can only attribute this to a sort of “showing the flag” by citing a conventional professional organization’s views. Or perhaps we might call it “sweetening the well” as the opposite of the persuasive technique of “poisoning the well”. By quoting the American Psychiatric Association, Eshleman claims for herself a modicum of orthodox authority and thus prepares the reader to accept her later statements. As Eshleman and similar authors well know, naïve or careless readers are not likely to say, “Wait… what? That’s not what you said before”, but are likely to read straight on and conflate the two contradictory statements with each other.

When a book displays so many contradictions in a few pages, readers need to be cautious about accepting the content. Even though some material is correct, it would be silly to assume that all of it can be trusted.

Moral Panics and Reactive Attachment Disorder

2011-11-01T17:17:00.002-04:00

Some sociologists have a useful term for a kind of change in public attitude: moral panic. Moral panics are periods of agitation and concern about an issue that is not realistically of much importance (and by the way, the term has nothing to do with sexual morality, but is an old-fashioned way of saying that the panic exists for psychological reasons). Discussing these periods in a 1994 article (Goode & Ben-Yehuda, Moral panics: Culture, politics, and social construction. Annual Review of Sociology, 20,149-171), two sociologists defined moral panics as “explosions of fear and concern … about a specific perceived threat. In each case, a specific agent was felt to be responsible for the threat; in each case, a sober assessment of the evidence… forces the observer to the conclusion that the fear and concern were, in all likelihood, exaggerated or misplaced.” During moral panics, much attention is focused on the agent that is thought to cause the feared events, which incidentally need not be common and may even be nonexistent. Actions taken against the perceived agent can in themselves be far more dangerous than the feared events.

Moral panics have been common enough throughout history. The pervasive fear of witches in Europe and in the Massachusetts Bay Colony, the “Red Scares” of the last century, and the more recent preoccupation with “Satanic ritual abuse” are examples. Such panics may run their courses relatively quickly, but often leave traces in folk beliefs or even in institutions like laws that were originally established to deal with them. It can be argued that moral panic is responsible for some prevailing but unrealistic concerns of modern life and for some unnecessary and potentially dangerous steps taken in the hope of escaping a perceived threat.

I would suggest that for some episodes of moral panic over the last 60 years’ the perceived threat has been the same, although the agents thought to cause the threat have been different. The perceived threat is this: our children will hurt us.

In the 1950s, the psychiatrist Frederic Wertham invoked a moral panic by claiming that comic books depicting violence caused young people to behave violently. His beliefs remain institutionalized in comic book publishers’ “codes”. Both jazz and rock-and-roll music were subjects of moral panic in episodes when these forms of music were declared to loosen inhibitions and weaken morality, including resistance to violent impulses. Presently, moral panic is visible in intense concerns about violent screen games and the impulses to aggression they are said to foster ( a connection that is not supported by research on violent behavior and screen game-playing). While moral panics focus on factors that are considered agents of the threat, in these cases the threat remains the same: our children will hurt us.

Although I am far from claiming that moral panic is the sole reason for confusion, I would like to suggest that the continual misinterpretation of the symptoms of Reactive Attachment Disorder by the media and by a small number of professional and quasi-professional authors is also facilitated by the fear that our children will hurt us. Those experiencing moral panic about this issue look for agents that they believe contribute to the perceived threat. They do not imagine that their children will hurt them because they have hurt their children, or because they have modeled aggressive behavior for their children, or because they have failed to provide their children with non-violent strategies for dealing with others. Instead, encouraged by the work of a few authors and lecturers, people look to aspects of modern life which they think are the agents that can cause their children to hurt them--- abuse by other caregivers, their mothers’ thoughts about terminating the pregnancy, experiences in the NICU, difficulties with attachment, and of course adoption. To control these “agents” is their goal, because these factors are seen as the causes of the threat that creates moral panic.

Misunderstandings and false claims about the nature of Reactive Attachment Disorder focus on the violent nature and dangerous behavior posited for affected children-- in other words, in the probability that such children will hurt someone, and the likelihood that it will be a foster or adopted parent who is hurt. This focus links Reactive Attachment Disorder with the subject of moral panic, the fear that our children will hurt us. From that moral panic and pervasive references to the fear, misinterpretation of Reactive Attachment Disorder draws the energy that maintains it in the face of all evidence and arguments to the contrary. Institutionalization of Reactive Attachment Disorder as a focus of moral panic has occurred in the form of publication of misstatements by major publishers like Wiley and Academic Press and in payment for training of social services workers in related beliefs by some states (for example, Georgia).

Why do I say fears about being hurt by our children are a matter of moral panic-- a completely disproportionate reaction to the actual occurrence of any such events? The reason is that in fact youth violence has decreased rather than increased over the years when the supposed agents encouraging aggression have stayed constant or increased. Like any form of panic, moral panic makes it difficult for us to think clearly or make reasoned decisions. Under the impetus of moral panic, we may choose actions that are in fact harmful, like accepting and promulgating mistaken views of Reactive Attachment Disorder, or using treatment methods that are assumed to be harmful by child abuse researchers. Difficult though it may be, all of us-- and the media above all—need to breathe deeply and count to 100 before we allow moral panic to work through us and cause us to do harm while trying to escape an unlikely threat. Let’s not hurt our children out of our unrealistic fear that our children will hurt us.

Fallacies: Some Problems of Thinking About Infants and Children

2011-10-31T11:24:00.002-04:00

It can be quite hard to think straight about child development, and even harder to think about practical child-related issues like parenting and teaching. One problem is that each of us individually (even teachers) can know only a limited number of children in our lifetimes--- yet we want to use that small number of children to generalize and come to conclusions about millions of children. Another problem is that even when we read about empirical research, or when we do it ourselves, so we have a lot of information, it still doesn’t work to make a prediction about an individual child on the basis of data summarized statistically. These problems make it awfully tempting to jump to conclusions from the information we have. Our jumps don’t always land us on solid ground.

I’m going to describe some fallacies, or errors in reasoning, that are all too easy to make when wrestling with complicated material about child development. Keep in mind that these have nothing to do with whether the basic facts are straight, although getting the facts wrong is obviously a problem too. Fallacies are mistakes we make in drawing conclusions even from correct information.

The ecological fallacy involves assuming that information about a large number of children can give us an accurate prediction about a single other individual. For example, in a recent series of articles, several psychologists have suggested that research work on the Strange Situation as a measure of attachment can justify using the Strange Situation to make a decision in a child custody conflict. Although no one would be justified in dismissing research evidence as a way to think about the family situation, it is fallacious to claim that what was found statistically in a study of a number of children will also be true of a single individual. The statistical findings were calculated from a set of measurements which were different from each other, and no single one of them may have been exactly equal to the calculated statistics. (But this does not mean that it is useless to compare an individual child to characteristics of a group, as is done in calculating the height or weight of a child relative to growth norms.)

The post hoc fallacy is the assumption that if one thing happened after another, the first thing to happen must have caused the second event. (In some cases, of course, the first did cause the second; the error is to think that it must have done so.) This is a common error of reasoning about child development. In its broadest form, it leads to the belief that because childhood happens first and everything else happens later, events in childhood must be the cause of all adult events such as happy or unhappy marriages, success or failure in school, and abusive or nonabusive treatment of one’s own children. By this reasoning, infancy and early childhood are of necessity more important periods than later childhood, as suggested by Bruce Perry and many others. A specific recent example of the post hoc fallacy is the belief that if adolescents who behave violently have been engaged in violent video games, the games are necessarily the cause of the violent behavior. (This idea was in fact shown in the syndicated comic strip “Funky Winkerbean” this morning, which suggests that it’s now something “everybody knows”.)

The misleading vividness fallacy involves the assumption that an event that is experienced, remembered, or imagined with many vivid details and strong emotional implications is more likely to cause an important outcome than events that are remembered or imagined vaguely or without much associated emotion. One special issue for child development discussions is that adults who would experience a strong reaction to an event right now are likely to attribute that same strong reaction to an infant who experienced a similar event. For example, an adult who can experience or imagine vividly a powerful reaction to abandonment or separation from a loved one may incorrectly attribute the same kind of reaction to a newborn baby; this attribution may lead the adult to assume that an experience of separation for a newborn was not only emotionally vivid but must of necessity be the cause of important life outcomes.

The genetic fallacy (nothing to do with heredity!) reasons that the origin of an idea provides the proof of its correctness. A common form of this fallacy looks at beliefs as proposed by one’s grandmother, a member of the clergy, or an experienced foster parent, and takes the sterling qualities of the sources to be evidence that what they say must always be correct. For example, when I was asked to discuss a problem with a young foster mother some years ago, I found she was far from interested in my attempts to re-frame a foster child’s bad behavior; she responded, “My grandmother says something different, and she goes to church every Sunday, so I think she’s right.” The genetic fallacy also applies to situations where people take a position because “I was always taught…” or “in my family they say…”. As in other fallacious reasoning, of course, the claim about child development may be correct, but it is not correct because of its origins--- other evidence must exist to show that it is correct.

If you are in an argument with somebody about a child development issue, don’t expect to be able to win by demonstrating a list of fallacies your opponent has committed! That strategy will just make them madder and more intransigent. The usefulness of looking for fallacious reasoning is really in our individual examinations of our own beliefs. It’s hard for most of us, including me, to ignore vivid experiences, for example, and there’s so much post hoc reasoning around that we can easily be sucked into it. But if we all examined our own beliefs more carefully--- well, we might be able to improve our thinking, and the world along with it.

What Is Child Abuse? Not Such an Easy Question

2011-10-30T15:26:00.001-04:00

Most parents and teachers feel that, although they can’t necessarily define child abuse, they know it when they see it. Given anecdotes about several children’s experiences, they can readily identify each one as having been “abuse” or “not abuse”. Nevertheless, the term “child abuse” can be confusing. At times it’s used simply to mean that the speaker doesn’t like something, as in Richard Dawkins’ famous statement that religious instruction is child abuse. In addition, what is or is not abusive changes historically. I’ve been reminded of that recently by a communication from a distant relative of about my own age, to the effect that the person’s father used to punish his children by imprisoning them in a rabbit hutch. People now past middle age may remember that kind of punishment, or having their mouths washed out with laundry soap, or being sent to bed without supper-- not methods practiced by every family, but frequent enough to be known and recognized, and not widely perceived as abusive.

Even psychotherapists and other professionals may be unsure about whether a parent’s action constitute abuse or neglect, and they want to be sure because they are required to report to child protective services when they have knowledge of such actions. The other day, I was present at a discussion in which a therapist who works with parents was expressing her concern over a patient who had moved away. but had called to tell some things about her toddler’s life that had caught the therapist’s attention. Nothing had really happened, but the therapist was worried not only about the child but about her own obligations and the effect on her licensure if she made a mistake.

If we want a nice clear definition, can’t we just consider child abuse to be a matter of breaking laws about how children should or should not be treated? No, unfortunately that does not work very well. Statutes prohibiting abusive treatment are written as generally as possible for fear of omitting some unusual but undesirable action. There may be no very bright line between a permitted punishment and one that is regarded as abusive. If a child may legally be sent to her room as a punishment, does it matter how small the room is? Is being confined to a bathroom, or to a closet with a light in it, equivalent to being sent to her room? When does a structure become a large cage rather than a small room?

In day-to-day legal decisions, these matters are treated on a case-by-case basis, and considered within the context of factors like past history, the child’s age, and so on. But it would be impossible to do reliable research on child abuse if two cases that were counted in the same way actually had very different characteristics. Over a number of years, the four National Incidence Studies of Child Abuse and Neglect have worked out categories and definitions of child abuse events that are used for the purpose of describing samples of cases and extrapolating the frequencies of events in the United States. The most recent of these studies, NIS-4, is described at https://www.nis4.org/DOCS/ProjectSummary.pdf. The description discusses “sentinel agencies” which are asked to report to NIS-4, and notes that “the kinds of abusive and neglectful situations included in the NIS do not necessarily correspond to those covered by their state’s child abuse and neglect reporting statutes. The study guidelines should not be interpreted as indicating whether an official report is required or appropriate” (important points for professionals who are mandatory reporters of abusive treatment).

Other documents, such as http://www.nis4.org/NIS_History.pdf show the development over time of categories of child abuse. For example, failing to seek necessary medical care is one category of abuse and neglect, but the category was fine-tuned to exclude failure to provide even legally-mandated immunizations, unless the parent had received specific advice that this ought to be done. This decision is obviously arguable, but it involves recognition that failure to immunize, out of ignorance or because of religious objections, is a different matter from failing to have a child professionally treated for a broken leg. The History document shows steps in the development of current definitions, from the original telephone and in-person interviews with parents to more recent interviews with child protective services supervisors.

Does child abuse consist of actions that cause harm to a child? Generally speaking, behavior is likely to come to the attention of authorities only if some demonstrable harm has resulted. However, by NIS standards, there are actions that are so egregious that they are considered to be abusive even if no harm to the child can be demonstrated. These are shown in Table 6.2 of the History document and are described as having “assumed” harm. They include sexual penetration, abandonment, and failure to permit a runaway to return home. Also included are tying or binding of a child, but not confinement to close quarters (for which harm must be demonstrated).

The NIS definitions do not specifically mention (except as “other”) some forms of maltreatment that have been discussed on this blog. “Hot-saucing” (by putting stinging condiments on the child’s tongue) and restraining the child physically in the prone position are not discussed, possibly because they are quite rare or because they were little known at the time the NIS definitions were being developed.

Neither do the NIS definitions address the problem of the therapeutic use of actions that would ordinarily be defined as abusive or neglectful. If there were evidence that methods like prone restraint or food withholding are effective treatments for emotional disturbance, their use under appropriate circumstances could not be defined as abusive-- but of course there is no such evidence. And although there is evidence that aversive treatment like electric shock can be an effective way to stop severely disturbed children from mutilating themselves, there is no evidence that broad-scale, noncontingent use of such methods (as in the Judge Rotenberg Center cases) is a generally-effective disciplinary approach. Quasi-professionals or misguided professionals may advise parents to use such methods and may persuade child protective services or the courts that they are not abusive in spite of all evidence to the contrary. It would be wise if NIS efforts to come followed the thinking of reports like that of the American Professional Society on the Abuse of Children (APSAC; http://depts.washington.edu/hcsats/PDF/Attachment TaskForceAPSAC.pdf) and gave serious consideration to the problem of abuse in the guise of intervention.

Steve Jobs and That Primal Wound

2011-10-27T10:16:00.002-04:00

Once a myth gets into circulation, it’s awfully hard to get it out again. What “everybody knows” comes to be regarded as just common sense, even though it’s actually common nonsense. A case in point: the recent discussion of Steve Jobs’ difficult personality and its attribution to his having been adopted.

Maureen Dowd’s op-ed column in the New York Times on October 26, entitled “Limits of Magical Thinking”, did not claim that Jobs’ conduct was caused by his adoption history, but did quote two other people who thought so. The mother of his more-or-less-abandoned oldest child stated that being adopted had left Jobs “full of broken glass”. His friend Andy Hertzfeld said that Jobs’ cruel behavior toward others “goes back to being abandoned at birth”. Although they did not use those words, both these people seem to be believers in the Primal Wound idea-- that separation from the birth mother, even in the early days of life, causes long-term misery, rage, and grief.

Given the Primal Wound concept, it’s easy to focus on a single possible factor and neglect to consider the thousands of other events that shape a personality. It’s particularly easy to confine oneself to looking at early childhood and to forget that the circumstances of adulthood also contribute to mood and behavior. It’s easy, too, to neglect to consider the Zeitgeist—the spirit of the times-- and the extent to which reprehensible behavior was excused or even admired.

Let’s have a look at the interpersonal behavior of some non-adopted people in the ‘70s, ‘80s, and even more recent times:

1. The famous Newt Gingrich hospital visit to tell his very sick wife he was divorcing her

2. The Roman Polanski drug ‘em and leave ‘em approach to a girl in her early teens

3. Woody Allen-- need I say more?

4. John Edwards and his out of-wedlock child

5. Jesse Jackson and his ditto

Without naming names, I can also mention personal acquaintances from the time when Jobs did his child-abandoning-- non-adopted, non-celebrity people who were enraged at the idea of child support, who insisted that a handicapped adopted child be “given back” as “too much trouble”, or who proposed that a handicapped 18-month-old alternate 6 months with the father and with a mentally-ill mother in another state.

There are a couple of important issues here. One is that there are plenty of non-adopted people who—whether or not they are “full of broken glass” (or any other substance)-- excel at making the world full of broken glass for those who are dependent on them. If Jobs’ sins are to be blamed on his adoption, what do we blame those people’s bad behavior on? Do both adoption and non-adoption create the same outcomes? If so, it’s hardly worth discussing the matter.

A second point is that fame and fortune provide opportunities for bad behavior that may not be available to those who are just soldiering on in ordinary life. Those who sport entourages can count on those entourages to cover their tracks. Those who live outside the rules of employment and family life can leave for distant spots and make sure their paths do not cross with those boring and annoying “exes” and children.

And a third point: there have been periods of time when “going with the flow” and “following your bliss” were widely-accepted goals. The ‘70s and ‘80s were periods when irresponsible behavior of men toward women and children was to some extent admired in the United States. Having shifted toward a greater emphasis on fathers’ responsibilities (for example, couples who say, with social if not biological accuracy, “we’re pregnant”), we find it shocking to look back at a not-so-distant period when that was not the situation. In considering Steve Jobs’ life, it’s easy to forget that he would have been influenced by the prevailing attitudes of the time, in addition to multiple other factors, not omitting his life with his adoptive family. The attitudes that prevailed during his youth may have helped shape his personality development in ways that conflict with today’s popular value system.

Children adopted in the early weeks or months of life have been shown to have no more and no fewer emotional problems than non-adopted children, by extensive research on large populations of children. It would be foolish to expect that no adopted child would behave badly, exhibit mood disturbances, or even have serious psychopathology. Non-adopted children have these problems too, and in about the same proportions as those adopted early in their lives. The two groups share these characteristics, so it makes no sense to say that in one group the problems are caused by adoption and in the other they are not. (Such an argument would require us to claim that the group of adopted children is genetically superior to the group of non-adopted children, and the adoptive parents are better parents than the non-adoptive parents, so that the only remaining cause of problems is the adoption itself. )

No doubt proponents of the Primal Wound myth will add Steve Jobs’ story to their repertoire of evidence that adoption is in itself harmful. Those who think through the facts of early development and of research on adopted children will reject that viewpoint, and will realize that Jobs’ behavior was comparable to that of many other famous, but non-adopted, people, as well as to actions of the less famous.

Incidentally, Nancy Verrier, the author who has drawn attention to the Primal Wound concept, has never answered the questions in my open letter of some time ago.

More About Reactive Attachment Disorder: "The Boarder" Movie

2011-10-20T07:05:00.001-04:00

I’ve mentioned misconceptions about Reactive Attachment Disorder many times before on this blog. But it would seem that it’s possible to promulgate myths and misunderstandings on this topic a lot faster than I or anyone else can correct them.

A new example of the spread of misconceptions about Reactive Attachment Disorder is the movie “The Boarder”, created by Jane Ryan and based on her book “Broken Spirits, Lost Souls: Loving Children with Attachment and Bonding Difficulties” (iUniverse Star, 2004). (Incidentally, iUniverse is a “professional self-publishing” company rather than a traditional publisher that sends manuscripts for expert review before accepting them.) “Broken Spirits, Lost Souls” includes a foreword by Foster Cline, the well-known advocate of holding therapy and proponent of the belief that “all bonding is trauma bonding”; following the surrender of his medical license, Cline became a self-proclaimed expert on child psychopathology and effective parenting. “Broken Spirits” begins with unsubstantiated claims about the increasing incidence of Reactive Attachment Disorder and describes cases of teenagers planning Columbine-like massacres as if this behavior is caused by Reactive Attachment Disorder. It goes on to quote with approval the ideas of advocates of holding therapy like Martha Welch.

www.theboardermovie.com/what_is_rad.html provides a page that purports to offer definitions and descriptions of Reactive Attachment Disorder. In fact, its answers to the question “what is RAD?” are a mélange of accurate and inaccurate statements. Curiously, there is a link to http://en.wikipedia.org/wiki/Reactive_attachment_disorder, a Wikipedia featured article which in fact I wrote much of myself. But much of what is argued on the “Boarder” page is highly questionable. One inaccurate statement is that Reactive Attachment Disorder was once rare but is no longer so, as the number of children affected by neglect or abuse is rising “exponentially”; neither of these claims is supportable by evidence, nor is there necessarily a connection between them.

The author of the “what is RAD?” page-- presumably Ryan or a colleague—states that one possible cause of Reactive Attachment Disorder is separation from primary caregivers in the first 33 months of life, “including while in utero”. This is far from accurate, and is of special concern because of its implications about the developmental effects of adoption. While unpredictable and unresponsive care are factors in the development of Reactive Attachment Disorder and other problems like language delays, separation in the first six months does not appear to be problematic. Abrupt long-term separation after 6-8 months, when attachment emotions and behavior emerge, is associated with intense grief and other emotional reactions for a period of some months, but care by normally responsive and consistent caregivers facilitates recovery and the outcome does not involve Reactive Attachment Disorder.

Ryan (or her colleague) goes on to say that the “criteria for a diagnosis of Reactive Attachment Disorder are more severe and pronounced than the criteria used in the assessment or categorization of other Attachment Disorder styles such as insecure or disorganized attachment”. This statement shows a complete misunderstanding of the nature of Reactive Attachment Disorder and the concept of attachment styles (not Attachment Disorder styles). In “Broken Spirits”, Ryan makes it clear that she believes Reactive Attachment Disorder is shown through the checklist so often presented by proponents of holding therapy/Attachment Therapy-- the fascination with blood and gore, the “crazy lying”, fire-setting, animal torture, sexual molestation of other children, etc., etc.

These “symptoms” are completely non-overlapping with the description of Reactive Attachment Disorder given on the “what is RAD?” page, with any description in DSM or ICD, and certainly, as I can attest, with the linked Wikipedia article. Such child behaviors do occur, sad to say, but they are not aspects of Reactive Attachment Disorder. To claim them as signs of Reactive Attachment Disorder is like saying that because some (unimmunized) children do get an illness that involves swelling of glands in the neck, that kind of swelling should be called chickenpox. Understanding and treatment of mumps would be much lessened in effectiveness if the disease was assumed to be the same as chickenpox, and in the same way understanding and treatment of disorders like early-onset schizophrenia would be lessened by assuming that its symptoms were indications of Reactive Attachment Disorder.

Some readers may find it unimportant whether Ryan speaks of “Attachment Disorder styles” or “attachment styles”. In fact, the difference is an important one. To say “Attachment Disorder styles” implies incorrectly that a wide variety of psychopathologies are based on attachment problems, and that the standard Reactive Attachment Disorder is only one among them. Describing insecure attachment as an “attachment style” communicates corrrectly that this type of attachment behavior is in the normal range of development. Some have even argued that there may be social and family situations where insecure attachment is healthier and more appropriate than secure attachment. Disorganized attachment may be a normal response of toddlers to temporary family dysfunctions like divorce and custody disagreements, and a return to more stable relationships may enable the disorganized child to return to a better attachment style. (However, some methods of assessing attachment do not even use the “disorganized” concept, and it is not a basic part of Bowlby’s attachment theory.)

Will “The Boarder” ever be released? The web site indicates that contributions of money are needed to make this possible, and I have little doubt that it will occur. There are quite a number of quasi-professional therapists who benefit greatly from the spread of the inaccurate beliefs presented in Ryan’s book. Regrettably, there are also many parents-- especially those who have adopted-- who will rush to have their expectations confirmed by Ryan’s book and movie.

Meanwhile, those of us who know something about early development had better do our best to argue against these false and potentially harmful beliefs.

Babies and TV: Why Not Have Them Watch?

2011-10-19T11:53:00.002-04:00

The American Academy of Pediatrics has again spoken against screen entertainment for children under two. They made their first policy statement about this in 1999, and they haven’t changed their minds. You can see a discussion of their position and thinking at http://www.nytimes.com/2011/10/19/health/19babies.html. When TV first became available, the cautionary joke was that if you watched too much your eyes would become square; the AAP today is seriously cautioning that young children’s mental development can be slowed by exposure to this kind of stimulation.

Is there clear evidence that television, videos, and computer displays do interfere with cognitive development in the first years of life? No, as a matter of fact, the evidence is not very clear, because it’s very difficult to establish. Because the first principle of research on human beings is to do no harm, and because that principle is especially important for the study of the very young, no one is going to do a randomized controlled trial (experimental) study of the effect of screen-watching on intelligence and academic ability. We’re left with nonrandomized studies, in which babies who ordinarily watch screens a great deal are compared with those who watch little or no screen entertainment. But although such evidence should certainly be given some weight, it’s important to remember that it involves confounded variables-- a confusion between the effects of screen-watching itself and other characteristics of families who do or do not expose their young children to screen-watching experiences.

It seems unlikely that chance alone determines the amount of screen exposure young children get, because on the whole they depend on their caregivers to set up a program, turn a device on, etc. Parents do or don’t do these things because of their own beliefs, motives, needs, and understanding of their children’s needs, and those beliefs and so on will also impact other aspects of their caregiving. For instance, parents who are exhausted or overwhelmed by problems may be more likely to want their children to be distracted and to leave the adults alone, but they may also talk to and look at the children less or be more irritable and difficult to communicate with. Parents whose poverty keeps them cooped up in a small apartment with their children, and whose dangerous neighborhood discourages them from going outside, may find screen-watching a lifesaver, but their children’s development may also be influenced by living in a poor and frightening place. When these children with a history of extensive screen-watching do poorly in school, we can’t know which of these factors really caused the problem-- or indeed whether it was caused by all the factors working together.

Nevertheless, all the major thinking of the last century about early mental development has emphasized the idea that children under the age of two are active rather than passive learners. They can learn some things by watching other people, but on the whole their understanding of the world develops through activity and interaction with the environment. They learn, for instance, that an object still exists when it’s hidden from view, and they learn this by crawling, reaching, grabbing, and mouthing objects, not just by observation (and certainly not by instruction).

Jean Piaget, the great Swiss theorist of cognitive development from birth into adulthood, referred to the period from birth to two years as the “sensorimotor” stage. He used this term to describe what he believed was the essential nature of early learning-- that it was based on a combination of information from the senses and from movement. He considered that toward the end of this stage toddlers became capable of symbolic thought and no longer were forced to learn solely through sensorimotor means, but that human beings continue throughout life to have a capacity for sensorimotor learning. Piaget’s theory of early development was based on a small number of direct observations of young children, and more recent work suggests that infants can learn some things by observation much earlier than Piaget believed. Nevertheless, it is a generally accepted idea among developmentalists that combined sensory and motor experience plays the major role in the early learning which forms a foundation for later school success. This view strongly suggests that much exposure to screen-watching will take away time from the needed sensorimotor experience from which young children learn most. The problem is not what screen-watching causes to happen, but what necessary experiences it interferes with.

A more recent thinker, the late Stanley Greenspan, the outstanding child psychiatrist and developmental theorist who founded Floortime/DIR as a treatment for autism and other problems, added an important concept to Piaget’s view of sensorimotor learning. Greenspan saw the senses and movement as essential to early learning, but in addition he emphasized that the most effective learning involved multisensory stimulation. In order to learn efficiently and to be interested, babies need to have a variety of senses stimulated at the same time-- not just vision, but hearing, touch, taste and smell, and movement senses of various kinds. What is most likely to provide excellent multisensory stimulation? It’s interaction with an interested, affectionate, engaged adult. That adult is not planning to give some planned form of instruction or purposely “teach” the baby, but because he or she is attentive and involved, whatever happens next helps the baby learn.

The affectionate caregiver provides the baby with two essential conditions for good learning. One is a combination of sensory experiences-- the warmth of touch, the rhythms of movement, the visual interest of facial expressions and eye positions, and speech or other sounds like humming and tongue-clicking. These are combined with each other into patterns that are more than the sum of their parts, as voice sounds follow the same rhythm as facial expressions and touch changes together with the movement of the adult body. These patterns offer powerful forms of sensory stimulation which draw the intense interest of the baby. In addition, the adult’s movements, speech, and gaze can all be instantly modulated in response to what the baby responds to-- what Greenspan, in talking about slightly older children, called “following the child’s lead”. The interested, caring adult provides multisensory stimulation that engages the baby’s interest and maintains it in ways impossible for any screen that offers entertainment to the passive baby. When babies spend much of their time in screen-watching, the opportunities for multisensory stimulation are limited.

There are other issues about screen entertainment or similar stimulation. One is that infants and toddlers have not yet achieved good control over attention (most of us are never perfect on this point). Where there is a great deal of noise or activity, young children find it difficult to focus mentally on everyday things they would otherwise learn about the world. The National Association for the Education of Young Children makes a point of this in their standards for early childhood education, in which they suggest that early childhood classrooms need to have low noise levels most of the time so that children can pay attention to speech or other sounds. Young children have trouble ignoring loud or distracting stimulation, which may draw them away from important sensory experiences. I recall visiting a foster home where a two-year-old boy was completely distracted by a television set and some music playing simultaneously. He stood between the two sounds and rocked back and forth from one foot to the other, and didn’t respond to his name being spoken. He was totally engaged with a sensory experience that was not meaningful in terms of the learning he needed to be doing--- in strong contrast to what he might have experienced if sitting on someone’s lap looking at a picture book.

The American Academy of Pediatrics and other interested groups are not concerned about what screen-watching does to children, but about what it prevents them from accomplishing. Because of the special nature of early childhood learning, watching passively does not give infants and toddlers the learning experiences that older human beings can achieve through observation. This is true no matter how carefully programming is claimed to have been designed for the very young.

How Does Maternal Depression Affect Young Babies?

2011-10-13T15:19:00.001-04:00

When I’ve mentioned maternal depression on this blog, I’ve sometimes been quite surprised to have readers respond as if the condition was a moral failure rather than a mental illness. That attitude was especially common when the reference was to depression in adoptive mothers-- some seemed to think that such women were simply spoiled brats who changed their minds about what they wanted after they discovered that baby care was a challenge. I don’t think there’s much point to arguing about that belief. Depression is more common in women than in men, and is especially common during the child-bearing years. Although some women who are depressed while caring for young babies have been depressed earlier in their lives, it is also true that life-changing events-- even much-wanted ones-- can trigger depressive reactions, however counter-intuitive that may be.

Mood disorders in young mothers can exist for a variety of reasons. But it doesn’t really matter whether they occur because of moral turpitude or because of a genetically-determined emotional disturbance. In all cases, effective treatment is desirable, because a depressed caregiver cannot provide the foundation for a baby’s good cognitive and emotional development.

Why is this? How can a very young baby even know what a caregiver’s mood is? And as long as it’s fed, warm, and clean, why would the baby care?

To answer these questions, it’s important to look very closely at communications between caregivers and young babies-- communications that are quite subtle and occur very quickly, so a casual observer can notice only a few, if any, of them. Understanding such communications requires a microanalysis of videotaped movements and facial expressions. These can be examined in the order in which they occurred, so it’s possible to see how each member of the pair responded to changes in the other. (As an example of this, I’m going to summarize an article by Reck, Noe, Stefenelli, Fuchs, and others, “Interactive coordination of currently depressed inpatient mothers and their infants during the postpartum period”, Infant Mental Health Journal, 2011, Vol. 32, pp. 542-562.)

Ideally, we’d expect the baby and the caregiver to be coordinated in their behavior and mood, and to respond to each other by matching a communicated mood (what Edward Tronick calls mutual regulation). But we’d also expect that the two will occasionally make mistakes or “mismatches” and respond with a smile to a frown, or vice-versa. Normally, baby and caregiver fairly quickly notice their mistakes and “repair” the communication by moving to match the other’s mood more closely. Those repair events seem to be even more important than frequent accurate matches, because they teach the baby that moods can be changed and regulated, and that mistaken communications can be corrected with effort.

Reck and her co-authors looked at a group of mothers who were hospitalized together with their babies for treatment of serious depression, and compared them to a group of healthy mothers and their infants. They observed the frequency of positive matches (when both partners showed positive emotion) and negative matches (when both showed negative emotion such as crying, withdrawal, hostility, or intrusiveness). Because it has been reported that maternal depression interferes with the development of joint attention (looking at an object and then back at each other), shared looking at objects was also studied. There was particular interest in the pairs’ abilities to repair mismatches and come to similar positive states. The babies ranged from 1 to 8 months in age.

In order to encourage mothers and babies to show their social interactions, the researchers used the “face-to-face still-face” method. In this, mother and baby were seated opposite each other, with one video camera recording each face’s expressions and a single microphone between them. The mothers were instructed to begin just with a normal interaction, to get the babies’ attention and play with them without using toys or a pacifier. After two minutes of this play, the mothers were to do two minutes of an unresponsive “still face”, in which they simply stare into space toward the baby without responding to the baby’s bids for communication. For the final two minutes (the “reunion” phase), the mothers were to return to normal responsiveness and engage with the baby again.

Depressed mothers and their babies did behave somewhat differently from healthy mothers with their babies. When the mother was depressed, repair of mismatches took longer. Healthy mothers were quicker to repair mismatches in the reunion phase than in the initial play phase, as if they were “trying harder” after the difficult period of the still-face episode, but when mothers were depressed the difference was the opposite. There were also differences in the time it took the mother-baby pairs to come to a match. For the healthy mother-baby pairs, half of them got to a positive match in 3 seconds after they began, whereas in half of the cases with depressed mothers they needed 12 seconds to get to a positive match in the play episode and 18 seconds in the reunion episode.

The babies of depressed mothers thus had quite different experiences of social interactions than did those of healthy mothers-- and experiences of this kind would be repeated many thousands of times in the early months of life in ordinary caregiving. Slower development of communication skills would certainly be expectable for babies of depressed mothers. This would be only one of several reasons why treatment of maternal depression is important with respect to infant development. Babies don’t have to know their mothers’ moods, or to care about them-- they are affected by depression in their caregivers in ways that do not support the best development.

"Your Brain on Childhood": An Entertaining Book for Serious Parents

2011-10-12T12:27:00.003-04:00

A good new book recently came across my desk-- Your Brain on Childhood: The Unexpected Side Effects of Classrooms, Ballparks, Family Rooms, and the Minivan, by Gabrielle Principe (Prometheus, 2011). I recommend this book to parents who are able and willing to confront the complicated realities of early development and to avoid the over-simplified strategies of Mozart and Baby Einstein. Your Brain on Childhood is clever and accessible-- but let’s face it, not everybody wants to do the hard work of understanding developmental change, and I don’t think this book is for anyone who wants a simple high-tech fix. (Unfortunately, the publisher has not provided an index or even a proper bibliography, so what might have been an excellent undergraduate course supplement is not very usable in that way.)

As some readers may know, Prometheus Books is associated with a skeptical and science-oriented publication policy (although I’d love to know why they continue to publish Arthur Janov the primal therapy man!). In line with that policy, Your Brain on Childhood questions a number of commercial ventures like the Your Baby Can Read system, and points out the power of placebo effects and the presentation of testimonials boasting that a given child can do things that are in fact in the normal range for his age. Advertising of this type is successful because many parents are unaware of confounding factors that operate together with supposedly “scientific” treatments, and may be very unclear about developmental milestones expectable at particular ages. Principe points out the commercially-manipulated confusion that tempts parents to pay high prices for products that in fact are not helpful to development.

Addressing the concerns of so many modern parents about their children’s brain development, Principe acknowledges that experience helps to drive brain growth and complexity. But she points out that not all environmental factors are relevant to brain functions. There really isn’t any evidence that Mozart-- or Beethoven, Sibelius, Elgar, or reggae-- has a predictable impact on the developing brain. In fact, it would be a pretty fatuous arrangement that would have organized normal human development so it required a kind of experience that was not present at the beginning of human evolution, in the environment of early adaptation. Could our remote ancestors have had a desperate need to hear stringed instruments in order to develop the normal intelligence and sharp senses that enabled them to survive a most challenging environment? Presumably not, because there were no stringed instruments, and they did survive, otherwise we would not be here.

As Principe points out, what we modern humans need to facilitate our development is similar to what our ancestors needed and must usually have gotten. A critical part of our brain plasticity (the capacity of the brain to be shaped by experience as well as by heredity) is what is called “experience-expectant plasticity”. This capacity involves an association between specific aspects of brain development and events that are very likely to occur during the first year or two after birth. Experience-expectant plasticity is generally a matter of fine-tuning abilities that are only generally governed by genetic factors. For example, good depth perception requires that information from the two eyes be put together appropriately by the brain, which has to taken into account the distance between the eyes. But that distance changes as the head grows during the first year, so the “formula” used by the brain cannot be the same at birth and at age 1. In addition, almost everyone has a slight difference between the distance from the right eye to the midline and from the left eye to the midline. The baby’s preferred head position molds the soft bones of the head so the face is a trifle asymmetrical, and the brain has to deal with this individual difference which is not genetically controlled.

Just as our ancestors 250,000 years ago responded to expectable experiences of this kind, we modern humans do too. And although it’s conceivable that by chance some experiences that were never present in that early environment could have an impact on modern babies’ development, it’s much more likely that present brain development is organized to be facilitated by the same kinds of experiences that made our ancestors’ babies develop normally. To think otherwise is like proposing that the diet our ancestors needed for good health has in some way been altered so that we now need to eat a substance that they did not need.

So, Principe asks, what did those ancestor babies need? What could they get? And what does this tell us about the experiences modern babies need for optimal development? Obviously, early human babies did not need battery-operated toys, DVDs, or flash cards in order to develop normal intelligence and abilities, or they would all have been starved because they couldn’t find food, or eaten because they were not bright enough to know they WERE food. What they needed, and what they had, was play-- play with things, and play with other people. Principe proposes that opportunities for play are exactly what drive the development of certain brain structures and their cognitive functions. When we prevent or interfere with play, we may also slow that development. Babies don’t need to be “entertained” or “stimulated” artificially; they do need the opportunities for play that are part of our evolutionary heritage.

A major reason that babies need to play is that playful manipulation of things and ideas remains an essential part of human life through childhood and adolescence, right on up through vibrant and successful adulthood. One important characteristic of humans is that, like the pet animals we love, we show neoteny-- the tendency to maintain certain child-like behaviors throughout life. (By the way, I haven’t found a page where Principe mentions this, but it may be there; oh for an index!) Play and exploration, not obviously connected with food or safety, are the foundations of our learning and are an important factor that determines our ongoing learning and the fact that it’s not all over at age 3. Play and exploration are also the foundations of science, invention, the arts, and all the other things that are positive achievements of human beings.

YourBrain on Childhood is full of really good stuff about things to do as well as things not to do. In many an aside, it punctures unverified assumptions like “learning styles”. I wish I had written it (but I would have fought for an index). Highly recommended for parents, and even more so for teachers!

Bring On the Taties, Bring on the Bread: Feeding, Eye Contact, and All That

2011-10-06T15:16:00.002-04:00

“Bring on the taties, bring on the bread-- Won’t somebody get this baby fed!” Feeding hungry babies is a universal task of childrearing. Before they reach the toddler period, babies get frantically hungry and seem to think that only desperate crying will bring them anything to eat. Parents and other caregivers sometimes feel that they spend most of their time in feeding, and sympathize with mother and father birds confronted with wide-open beaks every time they return to the nest.

Obviously, feeding enough of the right things, in the right amounts and at the right times, is essentially to babies’ very survival, as well as to normal physical growth and development. The physical effects of feeding are so important and so obvious that it’s easy to forget that much happens during feeding other than transferring food from the outside of the baby to the inside. Studies of preterm infants have shown a number of factors that affect feeding and digestion even in very tiny babies who cannot suck and must be tube-fed-- these include the experience of smelling the mother’s milk, the experience of sucking a pacifier while being tube-fed, and the experience of being fed during a period of activity rather than when deeply asleep (all of these increase growth rate).

Even the youngest babies are actively engaged in the experience of feeding and are paying attention to events that they connect with being fed. This is a simple but powerful type of learning-- the kind Pavlov called classical conditioning-- in which the babies learn to expect one event to follow another one. More and more complicated learning builds on these early feeding experiences, until the hungry one-month-old who quieted when Mother began to undo her blouse becomes the one-year-old who tries to unbutton those buttons herself.

All those moments of learning are closely connected with social and emotional development. Except for the unlucky baby who has to make do with a propped bottle or pureed food in a bottle with a big hole in the nipple, infants almost always experience feeding as an interaction with another person. It’s an interactive experience of communication with a caregiver who does a lot of the physical work of providing food-- but who ideally does this in response to the baby’s communications of wanting to eat or wanting to stop. Both parent and baby use their best communicative skills to do this job. They both use their eyes to gaze at or look away from the other person or the food being offered, as well as putting out their hands to control a spoon or a bottle and their voices to show approval or protest. The baby wants food but may like some foods better than others, and prefers certain feeding rhythms; as he or she experiences a more satisfied appetite, there may be changes toward slower consumption or stronger preferences or avoidances.

These facts mean that ideally babies and caregivers have many sessions of practicing communicating with each other about a topic that is of great interest to both of them. It’s fun to eat when you’re hungry, and it’s fun to see your healthy baby consuming the food you’ve offered, so both of them are likely to find feeding time pleasurable and to associate that pleasure with their communication and social interaction. However, if a baby is sick or developmentally delayed, and if the caregiver is worried, depressed, afraid of wasting food, frightened, or exhausted, neither of them will have much fun in the feeding situation, and they will miss a major chance to learn to enjoy their interactions. They may not advance well in their abilities to communicate with each other, either about feeding or about other important things.

When parents and babies are not doing well together, they need support that pays attention to both adult and child needs and abilities, but they do not always get this even when intentions are good. A few years ago, I observed a program for adolescent mothers and their babies. There had been some concerns about neglect in the case of each participant, and the babies were receiving intervention in the form of supportive day care, while the mothers attended classes and discussion groups. The highlight of the day was supposed to be lunch, with each mother feeding her baby. The babies had high chairs and plenty of food provided. BUT--- nobody had remembered that it was important for the mothers and babies to be able to look at each other’s faces in order to communicate. There were no chairs for the mothers! Each young woman stood in front of her baby and bent over awkwardly to spoon the food into the baby’s mouth. The babies had to look up and away from the spoon to see their mothers’ faces, and even then saw only a tense-looking expression on a face held at an odd angle. What appeared to be a tiny detail actually caused a major impediment to the social and emotional interaction that’s a critical part of feeding.

It’s popular nowadays to emphasize early interactions, “skin-to-skin” experience, and so on, and I don’t dismiss those. But if we want to see how relationships, communication, and understanding of other people develop, I suggest we look at the thousands of feeding experiences that occur in the first year or so of a baby’s life. If someone invented feeding as a brand-new intervention, parents would rush to take workshops and learn how to do it. It doesn’t need to be invented, but parents need to understand its importance, and so do those who “coach” or support parents in other ways.

Authority versus Evidence: Arguing About Adoption and Psychological Interventions

2011-09-30T10:56:00.001-04:00

Off and on for a couple of years, but especially in the last few months, I’ve found myself upholding the idea that there must be an evidence basis for treatment, against others who believe that statements by people who claim authority are the most powerful of all arguments. I’ve referred to this conflict as a “culture war”, and I am convinced that it is an argument between ideological, a priori assumptions about the world, on the one hand, and positions based on systematic observations and evidence, on the other-- same old Plato versus Aristotle, if you like.

Von and other adoption bloggers argue strongly for a Primal Wound, on the basis of their own experience and on the authority of Nancy Verrier (who, incidentally, has not yet answered the questions I asked a month or so ago). They reject the systematic research evidence provided by Michael Rutter and the English-Romanian Adoptees Project or by other investigators, showing that most adopted children, even those adopted late and after intense social deprivation, do quite well in the long run. For Von and friends, the vividness of personal experience and the statement of an authority establish a set of assumptions that do not need to be tested against other evidence. For Rutter and other researchers, evidence is to be explored carefully as a test of existing assumptions.

Valle Oberg, a proponent of Ronald Federici’s methods of dealing with post-institutionalized children, also appeals to authority as the foundation of her argument. She states (in comments on this blog) that Federici has worked with thousands of children (although the arithmetic on this does not seem to work out very well) and has “saved” them, and that her own children were among those. Therefore, she argues, what she says, and what Federici has said, must be correct. In addition, she proposes that peer-reviewed publication of outcome research is not evidence that methods are effective. Oberg dismisses the view that Federici needs to report his evidence to the public before his methods are said to be effective.

While mulling over these disagreements, I came across a letter to the editor published in Science in 2004 (a silent testimony to the number of papers on my desk). That LTE was in response to discussion at that time about hormone replacement therapy and the way it failed to provide the benefits to heart health that had been expected of it. The authors, Philip Guzelian and Christopher Guzelian, pointed out that it was not surprising or anomalous that the predicted results did not occur. They commented that the outcome was a “dramatic example of the difference between authority-based conclusions (arising from opinion, experience, intuition, judgment, and scientific inference)… and evidence-based conclusions (derived from an objective, unbiased, and systematic analysis of scientific knowledge)… The lesson is quite generalizable. Uncritical acceptance of authority-based opinions as conclusive evidence is pervasive, even though top authorities unsuccessfully predict what scientific knowledge will be preserved as ‘fact’ “. Guzelian and Guzelian noted that there are times when decisions need to be made without adequate scientific evidence, but warn against confusing them with evidence-based conclusions and propose that “the obvious solution is to explicitly acknowledge when shortcomings in the amounts or quality of evidence necessitate a reversion to authority”.

An important point in the contribution of Guzelian and Guzelian is the acknowledgment that evidence-based conclusions are not always available. Those authors were not talking about psychological interventions, but that acknowledgement is an important one in discussion of psychological treatment, where design and implementation of research can be extraordinarily challenging. Although Guzelian and Guzelian did not mention levels of evidence (the idea that some forms of research offer stronger arguments than others), they did imply the need to balance evidence and authority differently in different situations. When evidence is strong, it should be weighed far more heavily than authority; when evidence is weak or non-existent, authority and personal experience are better to rely on than flipping a coin or casting the I Ching.

Perhaps the most important message in the Guzelians’ letter is the need for explicit statement that in the absence of systematic evidence, one is appealing to authority for support of a claim. This is only appropriate, of course, if there is no evidence or if the existing evidence is weak or open to interpretation, and if the maker of the claim can show that this is the case. It is not sufficient to do as Von, Valle Oberg, and many others have done-- to ignore the existing evidence and put forward instead a contradictory claim based on authority, and not only authority, but the authority whose views are welcome.

But, of course, if your way of thinking is to appeal to authority, this will make sense to you only if stated by an authority of your choice.

You Can Pick Your Friends, But You Can't Pick Your Monkeys: Origins of Attachment Theory

2011-09-25T11:14:00.002-04:00

One of the greatest temptations in the field of psychology is the urge to leap from research on animal behavior to a conclusion about human beings. Unfortunately, unless research about human beings substantiates the conclusion, the landing may be a bumpy and unreliable one. This danger does not always stop leapers; Alan Schore’s “modern attachment theory” is based on a number of such leaps, and as I have pointed out elsewhere, Schore does not make much of an effort to insure that readers realize which animals were the actual subjects of the research he cites.

The history of attachment theory, right back to John Bowlby’s time, has been characterized by generalization from animal behavior to human beings’ child care and early development. Bowlby originally compared human emotional attachment to the “imprinting” of ducks on the first moving objects they saw, and their later following of the imprinted object (usually the mother) and eventual courtship and mating with another member of their own species. Imprinting had an enormous impact on the duck’s life, determining that it might spend its early life following a toy train, or in adulthood “fall in love” with a human caretaker and ignore available mates of its own species. Considering the facts of duck behavior, Bowlby at first thought that human attachment would have similar mechanisms and effects, including “monotropy” (an inability to make an attachment to more than one human being). But further observation showed that attachment did not occur in the first days of life as imprinting did, that human beings had the ability to develop more than one attachment, and that a child who lost the first attachment relationship was capable, under the right circumstances, of developing a strong emotional attachment to a new caregiver.

Bowlby realized that the leap had gone too far and had landed on the wrong spot. Although human attachment was in some ways analogous to imprinting, it was not the same thing, and it was not possible to draw safe conclusions about human development simply from observations of duck behavior.

Bowlby and his colleagues then moved on to consider another type of animal behavior-- this time, an animal much more like human beings than ducks are. As is well known, Bowlby was much interested in the work of the comparative psychologist Harry Harlow on rhesus monkeys. Harlow demonstrated that rhesus babies, when separated from their mothers, sought out soft fabric model “mothers” and clung to them even though those “mothers” offered no nourishment. They would leave the soft mother to drink from a wire-framed “mother” that contained a bottle of milk, then scurry back to the soft model. Both Bowlby and Harlow were taken with the fact that the rhesus babies did not seem “attached” to the models that supplied milk; this result was in contradiction to Freud’s belief that the experience of feeding created emotional attachment, and it supported Bowlby’s argument that there was something in the social experience with the caregiver that triggered the development of attachment. Bowlby and Harlow were also interested in the later difficulties of the rhesus babies as adults, when they were reluctant to mate and did a very poor job of caring for their own infants if they had them. This outcome seemed to suggest that attachment experiences determined a great deal about personality development, an idea that was later built into Bowlby’s attachment theory and that has informed much of the later research on attachment.

Here’s an important question, though: What if Harlow had chosen some other kind of monkey? This was an issue which in fact received much attention from psychologists and zoologists in the couple of decades following Harlow’s reports and Bowlby’s adoption of the Harlow studies as evidence for attachment theory. The discussion at the time-- largely forgotten now that everyone has seen films of sad-looking rhesus babies on wire “mothers”-- focused on the fact that monkeys exhibit species differences in maternal-infant behavior. A monkey is not “just a monkey”, but a particular kind of monkey. (Much less work on these differences is done today because of the great expense of field studies and current concerns about the ethical treatment of lab animals.)

Harlow worked with rhesus monkeys, Macaca mulatta, a monkey that has frequently been employed in various types of research and which gave its common name to the Rh factor well-known to influence human reproductive success. But other researchers pointed out that the results of behavioral work with rhesus monkeys might not be the same as similar work with other types of monkeys. In one review article (Seay & Gottfried [1975]. A phylogenetic perspective for social behavior in primates. Journal of General Psychology, 75, 5-17), the authors described typical maternal-infant behavior and responses to separation in several monkey species in addition to Macaca mulatta.

Seay and Gottfried noted that in spite of the developmental difficulties of the “surrogate”-reared rhesus infants, rhesus monkeys who had somewhat less deprivation all eventually did well, whether they were reared in small groups of infants, reared alone but had a play period with other infants daily, were reared by brutal or abusive mothers, or had normal rearing by their mothers. They concluded that only an extremely unfavorable environment would alter these animals’ play, aggression, or sexual behavior. In addition, they stated that “even the organism maturing in an environment inadequate to support species-typical behavior will not develop unique techniques for coping with that environment. Rather, his behavioral repertoire will consist of fragments of the behavior patterns which ensure individual and species survival for most of his species-mates” (p. 10).

Comparing the rhesus monkey to other species, these authors noted that their own work on a different monkey, Macaca fascicularis, showed results rather similar to that on Macaca mulatta. However, the African red monkey (patas) showed a different pattern of social behavior. If rhesus monkeys were housed in cages such that the infants could go out to a central playground, when one came out, one or more others would join him. When an infant patas monkey came out, though, other patas infants did not join him—or, if one did, the first baby went back to his mother. As patas monkeys got older, they played chasing games, but unlike rhesus monkeys did not contact each other much.

Rhesus mothers object to physical disturbance from their infants, and will bite or hit an annoying baby. However, they will allow “strange” babies to come into the cage, as long as they “behave”. Patas mothers allow their babies to explore or play-attack them, and either do not respond or respond playfully-- but they will not allow a strange baby to come in. When nursing, rhesus babies are belly-to-belly with their mothers; patas babies do not have much of the body surface touching the mother. All monkey babies are disturbed by separation from the mother, but patas babies recover more quickly than rhesus babies do.

Who are we humans like? Should we accept a theory of personality development based on rhesus monkeys, or are we more like patas monkeys? The best guess is that we are like ourselves. Like other species, we have our own patterns of social interaction and of response to environmental changes. We may resemble other species, and their behavior may seem familiar and appealing to us. But when we come down to it, the behavior and development of other species can only provide a hint about what human beings might be like. We need to be cautious about our leaps from animal evidence to theories about humans--- however, cute, sad, and sympathetic those baby monkeys look to us.

What is Reactive Attachment Disorder? Further Discussion

2011-09-17T15:27:00.001-04:00

I’ve made a number of statements to the effect that violent or aggressive behavior, lying, stealing, and so on, were not diagnostic of Reactive Attachment Disorder. Some readers disagree strongly with this perspective. Reader Valle Oberg, for example, has been arguing against my position for several days at http://childmyths.blogspot.com/2010/12/federici-v-mercer-story-behind-lawsuit.html.

I’d like to call people’s attention to a paper by Charles H. Zeanah and Anna Smyke from Tulane University, arguably the leading U.S authorities on Reactive Attachment Disorder (Zeanah, C.H., & Smyke, A.T. [2008]. Attachment disorders in family and social context. Infant Mental Health Journal, 29, 219-233). This paper discusses criteria for attachment disorders and compares the DSM and ICD-10 versions, as well as referring to categories suggested by Zeanah in previous work.

In none of this material is there any reference to violent or aggressive behavior, self-injury, lying, cheating , stealing, refusing eye contact, or any of these issues so much stressed by therapists and parent groups outside the mainstream of psychological and psychiatric thought. Zeanah and Smyke come no nearer to these issues than referring briefly to the possibility of risk-taking as one aspect of a RAD-like category.

Zeanah and Smyke discuss measures of inappropriate behavior suggesting a disorder of attachment. They point out three ways in which such measurement has been approached. One method looked at whether children wandered away from caregivers without becoming distressed, whether they approached strangers, whether they were never shy with new adults, whether they were friendly with new adults, and whether they would go off with strangers. A second approach considered whether children failed to differentiate among adults (that is, treated all adults the same way and did not have a preferred caregiver), readily went with a stranger, and failed to check back with a caregiver (i.e., by looking back to them or calling to them as distance between them increased or separation became likely). The third method looked at not having a preferred caregiver, lack of reticence with a stranger, failure to check back, and willingness to go with a stranger. (Once again, none of these methods looks at aggressive behavior, lying, self-injury, etc., etc.)

Zeanah and his colleagues several years ago wanted to develop a technique of assessing preschool children’s attachment to caregivers without depending on parent or teacher reports. They developed what they called the “Stranger at the Door” procedure. One of the researchers knocked at the door of the child’s home, and the caregiver and the child answered the door together. The stranger looked at the child and said, “My name is ____. What is your name? Let’s go for a walk.” Observers coded the child’s behavior in response (if the child was willing to go, they walked a few feet, then came back into the house). Children’s willingness to go with the stranger was greatest in the group who had been institutionalized, but there was also atypical willingness in a comparison group of children who had been in foster care.

The Zeanah and Smyke paper noted that in a group of children adopted from institutions, there were no cases of the inhibited form of RAD, but a “substantial minority” showed the disinhibited type, with less avoidance of strangers and less preference for familiar caregivers than is typical among family-reared children.

In discussing “self-endangering” behavior as an aspect of RAD (the nearest thing mentioned to the claims of aggression and self-injury made by some advocates of an unorthodox view of attachment disorders), Zeanah and Smyke emphasize the possibility that risk-taking is part of a “two person” disorder which is difficult to describe in present language. They raise the issue of possible relational attachment disorders (different from RAD as now defined) that are evident only in the context of the association between the child and a specific caregiver. I would add that this is a very interesting idea with respect to the claims made by members of ATTACh and similar groups that children with RAD behave angelically outside their homes, but are difficult or even dangerous in interaction with their mothers.

What Is Attachment?

2011-09-12T11:37:00.000-04:00

What IS attachment, anyway? This word is used constantly by parents and teachers, attorneys and judges, as well as psychologists and social workers. What do they mean? Is attachment one of those things like obscenity, that we can’t define, but “we know it when we see it”?

Actually, one of the problems with understanding attachment is that many people don’t know it when they see it. As a discussion of attachment and child custody decisions pointed out a couple of years ago, “few custody evaluators recognized the distinction between a highly dependent or demonstratively affectionate relationship between a parent and a child and a secure attachment” (Calloway & Erard [2009]. Introduction to the special issue on attachment and child custody. Journal of Child Custody, 6, 1-7). Some quasi-professionals who emphasize attachment believe that the attachment of a child to a caregiver is indicated by physical demonstrations of affection, eye contact “on the parent’s terms”, obedience, and gratitude.

Many textbooks define attachment as an “emotional bond” or “tie” between two people, especially a parent and a child. The organization ATTACh (Association for the Treatment and Training of Attachment in Children) gives the following lengthier definition of attachment:
“Attachment is a reciprocal process by which an emotional connection develops between an infant and his/her primary caregiver. It influences the child’s physical, neurological, cognitive, and psychological development. It becomes the basis for development of basic trust or mistrust, and shapes how the child will relate to the world, learn, and form relationships throughout life.” (www.attach.org)

But let’s parse these definitions. Is it of any help to say that something is an “emotional bond”, without saying what an emotional bond is? Actual bonds involve close physical proximity, enforced by physical methods like ropes or handcuffs. Attachment, then, is being said to be like a bond in that it maintains proximity, but the way it does this is through emotional factors rather than with ropes. This is an analogy rather than a definition, and it is inadequate for two reasons. One is that although attachment does maintain a young child’s physical proximity to a caregiver, continuing development alters the way in which attachment is expressed. In any case, the seeking of proximity is not the same at all times, but occurs when the child feels threatened or uncomfortable. The other problem is that this description of attachment leaves it unclear whether both members of the pair behave in the same way or have the same emotions or motivations relative to maintaining proximity. In fact, in the course of development, parent and child trade several times the position of being the one that wants more proximity; the child who has a toddler clung to the parent who was leaving for work grows to the teenager whose parent is anxious to know where he is going and when he will be back

Now let’s look at the ATTACh version. It’s longer and more complicated, but is it any better? It begins by saying that “attachment is a … process”. No doubt there are processes leading to attachment, but if attachment is a process, it’s difficult to see how we can determine whether attachment is secure or even present. Surely attachment is some sort of end state, and not simply an ongoing process. Perhaps the “emotional connection” which is said to result from the attachment process is the actual attachment, but it too remains undefined.

ATTACh also says that attachment is not just a process, but a “reciprocal process”. I interpret this as meaning that attachment develops in the course of interactions with other people and could not exist in a social vacuum, and this is certainly correct. ATTACh may also intend to say that attachment (emotional connection?) in a child develops in tandem with some emotional change in the adult caregiver, which may be true, but seems to be irrelevant to the later emphasis placed on the child’s own development.

ATTACh speaks of connections between an infant and the primary caregiver and appears to be limiting attachment to this relationship. Here we encounter some problems, because all the evidence is that young children can have many attachment relationships, some more obvious than others, and that these relationships may or may not share qualities like security. On the other hand, caregivers tend to be monotropic and have one or two preferred infants, even if they work with a group of children of similar ages; perhaps the ATTACh authors were thinking of the adult’s connection with a “primary” baby when they wrote this.

ATTACh goes on to cite the various aspects of development that are influenced by attachment (although whether as a process or as a loosely-defined emotional connection is not clear). It is not stated how attachment affects the child’s physical development, or how psychological development is different from cognitive development, but even if these points are set aside, these remarks do not contribute to the definition of attachment, but simply say more about things that are related to the undefined process or end state. Similarly, in the last sentence, references to basic trust and to shaping relationships do nothing more than to say that something called attachment is involved here. (As to the statement about learning, it is far from clear what the authors meant.)

It would seem that neither the textbook definition nor the ATTACh effort is of much use in clarifying what attachment actually means. I’d like to offer an alternative definition that I believe cuts through some of the difficulties we’ve seen here.

I would suggest that attachment is best thought of as an attitude, or a readiness to behave in particular ways toward the object of the attitude. It is an attitude toward human beings that involves the readiness to behave differently toward familiar and unfamiliar people, but to do so in different ways when there is perceived threat than when there is not. Like other attitudes, attachment changes with development, and although young children show their attachment by seeking proximity to familiar people when uncomfortable, they gradually move toward other related behaviors. Also, like other attitudes, attachment involves characteristic emotional responses that may occur together with or instead of observable behavior, and these too change with development. Attachment attitudes vary with experience as well as with age and culminate in an internal working model of human relationships in general as well as the specific reaction to threat which is their foundation.

This may not be the perfect definition, but at least it actually is a definition. Comments and editing are invited.

Infant and Toddler Overnights: A Focus of Divorce Disagreements

2011-09-11T17:17:00.003-04:00

When couples have children of infant and toddler age, the breakdown of marriage is often followed by intense and bitter argument over allowing the child to have an overnight visit and sleep away from the familiar home. In most cases, the mother is the custodial parent and continues to live in the marital home, while the father is more likely to be the one who moves out, lives elsewhere, and does the “visiting”.

Mothers are very likely to resist overnight visits for young children. They are concerned that the father is unaware of the child’s bedtime rituals or needs, that the child may be distressed by the experience, or even that a father who has behaved violently in the past may lose his temper if the child cries or fusses in the unfamiliar night-time setting. Fathers, on the other hand, may be concerned that the child spends less time with them than with the mothers and may therefore be less attached to the fathers. They may also believe that if the child does not form a strong attachment to the father in the first couple of years, no real relationship will ever be possible.

However the estranged couple work things out, this problem will pass (and of course will be replaced by different issues). The child will get older and reasons to resist overnight visits will gradually disappear. At the beginning, though, the overnight issue seems to be of overwhelming importance. In a recent special issue of the journal Family Court Review (2011, Vol. 49), the issue editor noted that when she surveyed readers to ask what they wanted to know about attachment and child custody, 60% of them asked what to do about overnights.

Several well-known psychiatrists and psychologists who contributed to the issue made a point of commenting on the overnight question. And all of them said about the same thing: overnight visits are problematic for about the first two years of the child’s life. Depending on the child, it may be best to wait as late as age 4 before beginning overnights (George, Solomon & McIntosh [2011]. Divorce in the nursery: On infants and overnight care. Family Court Review, 49, 521-528). The reasoning behind this advice is that children have real individual differences in temperament (for instance, the ease with which they accept a new situation) and in language development (which allows them to understand what they are told about the length of a visit). Children who are easily distressed, who have little concept of time, and who are still immature in their understanding of language may interpret an overnight visit as permanent abandonment by the custodial parent and may not be able to communicate their fears to the other parent-- who may have no wish to hear of the child’s longing for the divorced spouse. When children have handicapping conditions that affect communication and cognition, their level of development may be much more important than their chronological age.

But what if there are no overnights? Does this mean that the child’s relationship to the noncustodial parent is negated from the beginning? Charles Zeanah, the well-known attachment researcher, commented about this: “it’s not necessary for both parents to have attachment relationships with the child in the early years. That can happen later, when the child has more sophisticated abilities to sustain attachment relationships over time and place. Where it is possible, it does make sense for the child to keep contact at the level of comfort and familiarity until they are ready for more” (Lieberman, Zeanah, & McIntosh [2011]. Attachment perspectives on domestic violence and the law. Family Court Review,49, 529-538). Alan Sroufe, another leading attachment researcher, said, “I think that if parents, judges, lawyers, and so on took the view that attachment is a gradual building process, and that each relationship is built on its own terms, there would be less paranoia about this… even if they had no overnights for the first 2 years” (Sroufe & McIntosh [2011]. Divorce and attachment relationships: The longitudinal journey. Family Court Review, 49, 464-473).

These commentators are stressing the best interests of the child, a vague standard indeed, but one which we can clearly distinguish from an emphasis on parents’ rights. They seem to agree that it’s in the child’s best interest to have as calm an infancy and toddlerhood as possible and not to be asked to adjust to unnecessary changes and transitions. They also agree that two caring parents-- even if separated-- are better than one, but that there is no natural process that demands that both sets of relationships must develop simultaneously and early on. The fact that no “window of attachment” closes at age 2 means that it’s possible both to preserve family connections and to support a child’s early needs for a peaceful life.

Separated parents with very young children would do well to take these cautions to heart, but at the same time they may want to consider whether they want to try out visits with an eye to overnights. A gradual approach, including nap-time at the noncustodial residence, may give them an idea whether a child is ready to take the step to an overnight stay. If the child copes well with one overnight visit, it is wise to wait a while for the next one rather than rushing to a new schedule of frequent changes and risking overwhelming him or her. But none of this will work well unless the parents are able to concentrate on the child’s needs and reactions rather than hurrying to blame each other for any distress the child shows.

When overnight visits begin, one point that can be difficult for separated parents to deal with is co-sleeping. Plenty of parents let infants and toddlers sleep with them part or all of the time (and I am far from criticizing this practice). In addition, if a father leaves the household, the mother is likely to respond to the child’s distress and her own by letting the child sleep in her bed. What happens, then, if the child stays overnight with the father? Can the co-sleeping mother deal with having the child share a bed with the father, or will this trigger concerns about sexual behavior? How does the father comfort the child who is accustomed to sharing a bed, except by co-sleeping? This highly emotional situation is one in which straightforward discussion with neutral parties is essential in order to avoid distress, fears, and accusations that are in the great majority of cases completely unrealistic.

P.S. The comments of Alan Sroufe about attachment as a gradual building process are also highly relevant to adoption issues.

P.P. S. The issue of Family Court Review I'm referring to is available for free on line. Google the journal name and you'll see how to get to the articles.

An Open Letter to Nancy Verrier

2011-08-31T10:13:00.001-04:00

Dear Nancy:

As you probably know, some of your strong supporters are very mad at me for contradicting the idea that adoptees suffer from a lasting emotional trauma that you have called the Primal Wound. I’m told by people who know you that you are a sensible and friendly person and a supportive, helpful therapist. I wonder whether you might be willing to answer some questions for me. They are more challenging questions than I suppose you often get, but I am asking them in a genuine spirit of inquiry after reading some of your work. I am curious about unconventional theories and have been working on a book that examines some of the ideas shared by such theories and the therapies that are associated with them, and that work is the source of some of my questions. In addition, I believe that better understanding of these issues could facilitate mutual understanding between the “pro-PW” and “anti” groups.

1. Why do you accept and use the idea of cellular consciousness or memory? I’m sure you know that conventional views attribute consciousness and memory to the functioning of cells of the nervous system and not to other types of cells. Are there aspects of memory that you feel are better explained by cellular memory than by the conventional perspective?

2. Do you think personality development can be explained in terms of natural, material events, or would you say that some non-material/spiritual factors are needed for an explanation?

3. It seems that different adoptees have different feelings about their adoptions. What do you think are the factors that lead them to have one opinion or another?

4. What are some examples of what you call biological mirroring, ways people look or behave that you say have special meaning for biologically-related children? What are your reasons for thinking they have special meaning?

5. You have been involved for some time with the organization APPPAH, which in turn has connections with primal therapy and other “primal” ideas. I assume that this connection
is why you chose the term Primal Wound. Do you share beliefs with Arthur Janov and earlier contributors like Frank Lake and Francis Mott? Do you consider their LSD and “breathwork” experiences to give an accurate depiction of the experiences of an unborn baby?

6. Do you recommend that adoptees use any of the “primal” or “rebirthing”therapies to help with distress that they consider a result of adoption? Would you say there are other treatments that are helpful?

I think the answers to some of these questions might help explain the very intense commitment of some adoptees to the Primal Wound concept. It’s possible that the attractiveness of this idea to its proponents may have to do with a broader set of beliefs, not just with the single idea-- that discussions of this issue are culture wars in miniature. If that’s the case, discussing the “real problem” might be the beginning of a way for well-intentioned people concerned about adoption to come together for good purposes rather than attacking and blaming each other.

I hope you will take the time to answer at least some of my questions, not necessarily all at once. I would be grateful for your help on this, and I believe readers of this blog would also appreciate it.

Yours sincerely.
Jean Mercer

[9/1/2011 Nancy Verrier has kindly responded that she will be answering these questions in the near future. ]

Examining Unconventional Theories: More on the "Primal Wound"

2011-08-29T13:59:00.001-04:00

Like many other unorthodox belief systems, Nancy Verrier’s “Primal Wound” theory just keeps on keeping on in spite of clear evidence that it can’t be correct. For those who are just coming in, the Primal Wound idea is the entirely speculative notion that babies adopted in the first days or weeks of life are deeply troubled by separation from the birth mother, and that this disturbance causes psychological difficulties that continue to be experienced right into adulthood.

An interview with Verrier at http://blog.adoptionmosaic.org/interview-with-nancy-verrier/ shows a continuing emphasis on some easily refutable points.

The first of these is the assumption that infants are psychologically more vulnerable in the period soon after birth than they are later. This belief depends on a logical fallacy; it’s based on the idea that if childhood is a vulnerable period, and people in later life are less psychologically vulnerable, then earlier and earlier developmental periods are times of greater and greater vulnerability. In fact, though, both physical and psychological vulnerability have schedules in which a somewhat later period is more sensitive than the earliest time. As an example, the probability of birth defects from exposure to rubella is much less right after conception than it is 6 weeks later.

Critical periods in development, when normal events are more easily disturbed by trauma or disease, are different for different aspects of developmental change. Emotional attachment to a caregiver has not developed at birth and is not apparent until 6 months or so later. Think about this a bit-- what has there been for the baby to attach to, before birth? In the interview with Verrier, she says the baby knows nothing but that mother. In fact, though, the baby knows nothing but the inside of that mother, not the outside.

Are we to assume that newborn babies are grieving for the taste of the amniotic fluid and for the sound of the mother’s stomach rumbling, not to mention other less socially-acceptable noises? If not, what are we to think they miss? Is it the “psychological connection” mentioned by Verrier, which she says is not severed with the umbilical cord? What was that connection? Are we actually talking about a telepathic communication between mother and baby, as posited by the ‘50s psychoanalyst Nandor Fodor? If so, why doesn’t such a connection continue after birth-- is it somehow dependent on physical transmission through the cord? There seems to be quite a confusion of material and non-material events here.

Verrier argues that babies remember not only birth but prenatal events back to conception because of cellular consciousness. This idea, that experiences are imprinted on cells and need not be represented in the nervous system, has been popular among Scientologists for many decades (see Janet Reitman’s recent history of Scientology). It has also much been much favored among advocates of Janov’s primal therapy, including the Australian physician Graham Farrant, who believed that there were memories from the egg and sperm stages too (see http://primals./org/articles/farrant3.html). There is certainly no evidence that this type of memory exists or that either subjective experience or recall can occur without the functioning of high levels of the nervous system; this also applies, by the way, to the “body memory” idea much discussed by Bessell van der Kolk. Once again, this belief seems to involve a confusion between functions of cells and some posited non-material component of the personality.

Now let’s consider Verrier’s idea of “biological mirroring”, which seems to be the experience of observing others who share some of one’s genetically-determined behavior traits. I wonder whether Verrier is aware that human infants don’t even recognize themselves in the mirror until 15-18 months of age? How are they then to compare their own more subtle behavior characteristics with those of others until a much more advanced age? And when they do notice differences, what does this mean--- would we see psychological problems caused by being the only girl in a large family of boys, or the blue-eyed child of heterozygous brown-eyed parents? As for genetically-determined behavior traits, I would be at a loss to name even one that is obvious and is inherited according to a dominant-recessive pattern (we can’t expect tongue-rolling or tasting certain chemicals to be easily observed). Instead, behavior traits like temperament are determined by combinations of genes and environment. The big similarities in behavior of some separated twins, so much emphasized by the media, need to be considered in the context of other separated pairs who have little in common. Before arguing for the positive impact of “biological mirroring”, Verrier needs to present evidence that children in families where there are strong resemblances are somehow psychologically healthier than those in families where the roll of the genetic dice has produced varying temperaments and appearances.

The Sunday New York Times (Aug. 28, 2011) this week carried an obituary whose details reminded me strongly of Verrier’s claims. This was the obituary of Budd Hopkins, an abstract expressionist painter-- and, more to the point, the instigator of the “alien-abduction movement”. According to the Times, “Many who shared their stories with Mr. Hopkins had no conscious memory of their abductions at first. But they had lived for years, he said, with the nagging feeling that somewhere, something in their lives had gone horribly wrong….. by his reckoning, 1 in 50 Americans has been abducted by an alien and simply does not know it.” Here is a theory of emotional discomfort that is as much supported by evidence as the theory of the Primal Wound. Is there the slightest reason why anyone should accept either of these ideas?

A Russian Adoptee, Child Abuse, RAD, and MAD

2011-08-23T16:28:00.004-04:00

In an all too common scenario, the Alaskan adoptive mother of a Russian child is on trial for child abuse, and her defense argues that the child is so awful that it was suitable to punish him by putting hot sauce in his mouth and by forcing him into a cold shower. (See http://articles.ktuu.com/2011-08-19/hot-sauce_29907825 and http://www.ktuu.com/news/ktuu-jessica-beagley-child-abuse-trial-closing-statements-082211,0,2078692.story for information about this.) Jessica Beagley’s actions toward her adopted son might never have been detected, or if detected might not have “made news”, except for the fact that she wrote to “Dr. Phil” and made a tape for the show, describing her anger and frustration and the use of worrisome disciplinary methods.

During Beagley’s child abuse trial, her attorney argued that she had done nothing wrong. Her family therapist, Chantal Cohen, and others stated that the 7-year-old was difficult because he suffered from Reactive Attachment Disorder as a result of his early life in a Russian orphanage. Cohen stated that such children can be “sweethearts at school and monsters at home.” Other testimony said that children with Reactive Attachment Disorder “are uncontrollable and don’t show empathy”. Cohen also testified that the children “intuitively find the one button that’s intolerable to you and then they smack it really hard.”

This all seems pretty inconsistent; how can a person without empathy, the capacity to know what others feel, also have a capacity to figure out what someone else’s concerns are? But, be that inconsistency as it may, there’s a much bigger issue to consider about these statements regarding Reactive Attachment Disorder. My question is, what did Chantal Cohen and others think they were talking about when they referred to Reactive Attachment Disorder? The characteristics they referred to and attributed to Beagley’s adopted 7-year-old form no part of Reactive Attachment Disorder as it is defined by the official source, the Diagnostic and Statistical Manual of the American Psychiatric Association (often called just DSM).

Here is how DSM describes the characteristics of Reactive Attachment Disorder (code 313.89):

Markedly disturbed and developmentally inappropriate social relatedness in most contexts [not just at home-- J.M.], as evidenced by either (1) or (2):

Persistent failure to initiate or respond in a developmentally appropriate fashion to most social interactions [again, not just at home-- J.M.], as manifest by excessively inhibited, hypervigilant, or highly ambivalent and contradictory responses…
Diffuse attachments as manifest by indiscriminate sociability with marked inability to exhibit appropriate selective attachments (e.g., excessive familiarity with relative strangers…).
[The DSM description goes on to cite other points that are irrelevant here but can easily be found by interested readers. ]

There is nothing in this description about being a “monster at home”, about lacking empathy, or about intuitively finding and pushing a parent’s most sensitive button. What, then, is Chantal Cohen talking about? Chances are that she misunderstands Reactive Attachment Disorder because she has been “trained” in an alternative view, put about by quasi-professional family therapists and life coaches, that describes either Reactive Attachment Disorder or something called just “Attachment Disorder” in a way completely different from the DSM description. They sometimes call it RAD, sometimes AD; I’d like to call it MAD for Misunderstood Attachment Disorder (and because it makes me mad to see this deception practiced).

Here are the characteristics of this MAD/RAD as stated at http://www.attachment.org/pages_what_is_rad.php:

Superficially engaging and charming.
Lack of eye contact on parent’s terms [this does not seem to preclude the existence of normal eye contact most of the time-- J.M.]
Indiscriminately affectionate with strangers.
Not affectionate on parent’s terms (not cuddly).
Destructive to self, others, and material things (accident prone).
Cruelty to animals.
Lying about the obvious (crazy lying).
Stealing.
No impulse controls (frequently acts hyperactive).
Learning lags.
Lack of cause and effect thinking.
Lack of conscience.
Abnormal eating patterns.
Poor peer relationships.
Preoccupation with fire.
Preoccupation with blood and gore.
Persistent nonsense questions and chatter.
Inappropriately demanding and clingy.
Abnormal speech patterns.
Triangulation of adults [might be difficult to do without empathy-- J.M.].
False allegations of abuse.
Presumptive entitlement issues.
Parents appear hostile and angry.

This list is on a web site belonging to Nancy Thomas, a foster parent and advocate of Holding Therapy, as well as in print and Internet publications by similar authors. In no case is evidence provided that such a group of characteristics is in any way associated with emotional attachment of children to caregivers, or that these characteristics tend to be shared in the form of an identifiable syndrome. Only two of these characteristics (“indiscriminately affectionate with strangers” and “inappropriately demanding and clinging”) overlap conceptually with the description of Reactive Attachment Disorder in DSM.

It appears that Jessica Beagley’s defense is arguing that she has been abusive in the course of her well-intentioned efforts to deal with a child with Reactive Attachment Disorder. However, nothing reported about the testimony suggests that the child has been professionally diagnosed with Reactive Attachment Disorder as it is properly defined. On the contrary, the testimony suggests that the witnesses wish to use the established term Reactive Attachment Disorder as a way of normalizing their unconventional diagnosis, the MAD/RAD concept. Assigning a child to the MAD/RAD category, with the characteristics listed above, enables the defense to argue that the child is lying and making false allegations of abuse, that the mother’s hostility toward him is in response to his personality disorder, and that the mother’s escalation of unacceptable punishments was entirely an effort to control the uncontrollable.

The RAD defense is regrettably becoming more common as a way to extricate abusive, even homicidal, parents from legal difficulties. In the Salvetti case which I discussed some months ago on this blog, the defense argued that another Russian adoptee had refused to eat until his weight dropped noticeably, rather than having his food limited by his parents as a disciplinary measure. The Salvetti defense stressed the idea that as a RAD sufferer, the boy was a persistent liar.

Prosecutors and judges need to be aware of the real and the false Reactive Attachment Disorder descriptions so they can respond appropriately when the RAD defense is mounted during child abuse trials. It’s time to stop the repetition of this scenario, with its tendency not only to do injustice, but to spread disinformation and encourage mistreatment of adopted children.

P.S. Aug.24-- Jessica Beagley has been found guilty, and SLATE, in commenting on this, has invented something called Radical Attachment Disorder!

When Will My Baby Understand....?

2011-08-22T14:48:00.003-04:00

Concerned parents (and what other kind is there, really?) pore over lists of developmental milestones, checking out the average age for the first independent step, first word, and so on. Even more important-- but much harder to establish-- would be developmental milestones for ways of understanding and communicating with other people.

As it happens, an American developmental psychologist who has contributed much to our understanding of infant understanding, Michael Tomasello, has just received the 2011 Wiley-Blackwell/British Academy prize for contributions to psychology. I’ve been going through some of his research articles (kindly posted for free by Wiley-Blackwell), and I put together some “milestones” that I think will be of interest to parents. Some of these developmental achievements may seem pretty ordinary at a casual glance, but if you think it over you’ll see that they’re very significant steps in understanding other people.

12-month-olds:

How do 12-month-olds understand pointing? Do they just look where you point, as they look where you look, or do they understand that a pointing person means to communicate some information? When an adult pointed at a hidden toy, 12-month-olds could usually find the toy. Those who had understood the pointing could also point correctly themselves when an adult asked them where a toy was. This suggests that 12-month-olds know that a gesture like pointing means that another person knows something and wants them to know it too.
[Behne, T., Liszkowski, U., Carpenter, M., & Tomasello, M. (2011). Twelve-month-olds’ comprehension and production of pointin. British Journal of Developmental Psychology, 29, 1-17.]

Do 12-month-olds point just because they are interested in a toy or an entertaining sight? No, they point for various reasons. One is to call a person’s attention to something she does not know about or isn’t looking at; one is to share a positive or negative attitude about things they are both looking at; and one is in reference to things that are mentioned but are not there--- for example, a puppet that is no longer in a window the baby can see. These different purposes seem to be related to the 12-month-old’s developing understanding of other people’s mental states.
[Liszowski, U., Carpenter, M., & Tomasello, M. (2007). Pointing out new news, old news, and absent referents at 12 months of age. Developmental Science, 10, F1-F7.]

14-month-olds:

Do 14-month-olds just remember things like toys, or do they pay attention to the toy experiences they have shared with other people? In this study an adult and a baby played with three toys. The adult acted excited and encouraged the baby to be excited about one toy but was bland about the others. Later, the baby was shown all three toys on a tray, and the adult excitedly said “give it to me!” (leaving it unclear which toy was meant). 14-month-olds most often chose the toy they had been excited about--- but they did not make the same choice if they had only watched the adult acting excited without being involved. The babies could use the past history of playing together to figure out which toy the adult meant.
[Moll, H., Richter, N., Carpenter, M., & Tomasello,M. (2008). Fourteen-month-olds know what “we” have shared in a special way. Infancy, 13, 90-101.)

Do 14-month-olds understand when someone else is having trouble, and do they want to help? In one study, an adult pretended not to be able to reach a dropped clothespin. 14-month-olds spontaneously tried to help. When the adult was struggling with a more complicated task like opening a box, though, 14-month-olds did not always try to help. The toddlers could understand that the adult had a problem, and wanted to help, but they could apparently also figure out whether they could do the task or not.
[Warneken, F., & Tomasello, M. (2009). The roots of human altruism. British Journal of Psychology, 100, 455-471.]

18-month-olds:

Will 18-month-olds work hard to give help when they see it’s needed? When older toddlers saw an adult “struggling” to reach a dropped object, 18-month-olds would walk around obstacles to help, and they did this without being rewarded. They not only understood what another person might want, but they were eager to help and would do something difficult for them to manage while they were still amateur walkers.
[Warneken & Tomasello, above]

Do 18-month-olds understand that different people can know and mean different things, even if they say or do the same things? In one study, when 18-month-olds played with a toy one way with the first adult and another way with a second adult, they started the first activity when the first adult pointed at the toy, and the second activity when the second adult pointed at the toy.
[Liebal, K., Behne, T., Carpenter, M., & Tomasello,M. (2009). Infants use shared experience to interpret pointing gestures. Developmental Science, 12, 264-271.]

20-month-0lds:

Will 20-month-olds put helping someone above their immediate play interests? In one study, 20-month-olds would stop playing and leave an attractive group of toys to help someone who seemed to be having trouble. They would not only do this without reward-- if they were rewarded they became less likely to help on another occasion! Their understanding of the need for help and their motivation to help were both apparently very high.
[Warneken & Tomasello, above.]

Can 20-month-olds use other information to figure out the meaning of words they don’t know? In one study, 20-22-month-olds were shown pictures of puppets doing odd things that were described with nonsense words like “tamming”. If they were shown a picture and just told “this is tamming”, they did not seem to learn the meaning of the word. But if they were helped to practice by seeing pictures and hearing about one thing doing something to another thing, they were later able to use that kind of information to choose the right meaning for a word. If they saw a picture of a frog “tamming” a monkey, and heard it described with a complete transitive sentence, they would later look toward the correct picture -- for example, they would look at a frog doing something to a monkey, not at a picture of a monkey doing something to a frog. They used the relationship between the two animals to help decide what the unknown word probably meant; they did not need to be “taught” every word.
[Dittmar, M., Abbot-Smith, K., Lieven, E., & Tomasello, M. (2008). Young German children's early syntactic competence: A preferential looking study. Developmental Science, 11, 575-582.]

24-month-olds:

Children of 24 months know that if someone leaves the room before an event occurs, that person does not know about the event. But in one study, when an adult stayed in the room but could not see a new object because of a barrier that was above her eye level, 24-month-olds did not act as if the adult knew more about the hidden object than about two other objects she had seen. Just being together when the child saw the object was a factor that confused the children about what the adult might know—suggesting that for all the social and cognitive skills described here, there was still a lot of development ahead.

[Moll, H., Carpenter, M., & Tomasello, M. (2011). Social engagement leads 2-year-olds to overestimate others’ knowledge. Infancy, 16, 248-265.]

36-month-olds:

Do three-year-olds understand enough about what others can see or hear to be able to be “sneaky” in disobedience? Even though this might be something we don’t want them to do, we have to give credit for understanding to anyone who is able to manage this task. In one study, 3-year-olds were told not to peek in a box that had a very nice toy in it, and told they could play with it when the adult said it was all right. They were more likely to peek when they could tell that the adult could not see what they were doing. Given a box with two doors, one decorated with bells and one that would not make noise, they chose the silent door to peek through. To manage this “sneakiness”, they had to be able to think about what the adult could see or hear and whether they could do what they wanted to without being “caught”. (This is one of many cases in child development where being “bad” is evidence of good development.)

[Melis, A.P., Call, J., & Tomasello, M. (2010). 36-month-olds conceal visual and auditory information from others. Developmental Science, 13, 479-489.]

Can 3-year-olds really pretend, by playing that an object is one thing at one time, another thing at another time? In one study, they were able to switch back and forth from one pretend identity of an object to another and could talk about whether a wooden block “was a car” or “was an apple” at different times. This advance in pretend play may be associated with the earlier understanding that different people may mean the same thing by different gestures.
[Wyman, E., Rakoczy, H., & Tomasello, M. (2009). Young children understand multiple pretend identities in their object play. British Journal of Developmental Psychology, 27, 385-404.]

Do 3-year-olds mind if bad things are done to other people? Does their earlier “helping” tendency extend to social problems? In one study, each child and each of two hand puppets made a picture or a paper sculpture. One hand puppet “left”. For half of the children, the remaining hand puppet then destroyed the other one’s work; for the other half, the puppet destroyed some extra materials that had not been used. The children seeing the departed puppet’s work destroyed were more likely to protest, tell the puppet not to do that, and tattle on the destructive puppet; they also comforted or helped the second puppet on its return. The children’s concern extended to situations where another person was hurt, even though the child had no problems of his or her own. “Tattling” in this situation seemed to be a natural part of the child’s attempt to help.
[Vaish, A., Missana, M., & Tomasello, M. (2011). Three-year-old children intervene in third-party moral transgressions. British Journal of Developmental Psychology, 29, 124-130.]

Tomasello’s work shows that young children already know a lot about how to learn from other people and how to communicate with and act toward them. But what if your child can’t do all these things at the “right age”? Should you be worried? Parents usually ARE worried, but there are a lot of reasons not to panic here. One is that even in these studies there were some children of a given age who did not manage to do the task. They may have been having a bad day, or maybe the successful children were having good days. (Some of the children didn’t complete the tasks at all.) Also, the researchers did not just march up to each child and try to get him or her to do a task. They spent a long time with “warm-up” tasks and with getting the child ready. In addition, they were in a specially-designed lab, without a lot of familiar objects and people to distract the child from the job at hand. You may try this at home-- but results will vary!

Holding Therapy in the UK

2011-08-20T13:58:00.005-04:00

For an audio account of his experiences by a young man who when in his early teens was given holding therapy in a well-known UK residential treatment center, go to http://anyachaika.wordpress.com/2011/07/29/first-audio-account-of-holding-therapy.

Those who think this method is "nurturing" may have their minds changed by listening to this disturbing account.

Back to School, Maybe for the First Time

2011-08-19T14:03:00.002-04:00

I recently participated in a very pleasant interview/discussion with a representative of the organization care.com. We talked about issues belonging to this time of year (August), especially “back to school” events. Because my interviewer has a four-month-old, we also discussed entry into day care. You can see a version of the discussion at http://www.care.com/child-care-back-to-school-troubles-p1017-98420002.html, but here are some other thoughts about these issues..

Not all children are concerned about staring back to school. Older kids may be bored with summer and ready for a change, especially if they are returning to a familiar school with familiar classmates. But younger ones may have some anxiety about the whole thing--- after three months of vacation they may not remember all the details they once knew well-- and are especially likely to feel worried if they are going to a new school, with a new teacher and new classmates.

Whether or not children express concern about starting school, it’s probably a good idea to make sure that their last week or two out of school is a calm, undemanding period. Unless there’s absolutely no choice, this is not the time to take an elaborate and fatiguing family vacation. Traveling with children is hard on the whole family, as we can see when everyone gets home and younger children demand even more attention than usual of their exhausted parents. Although a vacation trip may end with wonderful memories and a sense of family solidarity, it’s also a time of stress when new experiences demand extra consideration of each other’s needs if “meltdowns” (of parent or child!) are to be avoided.

Don’t forget that even a trip of a week in length really takes two weeks when you count planning, packing, unpacking, and catching up afterward, and those are two weeks when young children experience unpredictable events that are inconsistent with their usual lives. Yes, those are valuable experiences, and we want children to learn that things aren’t just the same all the time; however, it’s probably better for children not to have those experiences just when they are about to enter a new situation that will not become completely familiar to them for a couple of weeks.

Most children of school age are only a little anxious about school and adapt readily and quickly. Entry of younger children, toddlers, and infants into out-of-home child care is not such a simple matter, and how complicated it is depends on the child’s age and temperament. This matter is confusing to parents because it contradicts the usual rule that children get better at doing things as they get older. In the case of starting and attending child care happily, we see instead that babies under about 6 months of age are generally comfortable with non-parent care (always assuming that it is of good quality, of course), but that starting at some point in the second half of the first year, the great majority of babies will express distress at out-of-home care and will take some time to adapt to it. Preschoolers of 3 or more will probably show some reluctance to go into a new situation, but their developing language skills help them understand that a familiar caregiver will be back to get them, and that this will occur at a predictable time (“after juice” or “after circle time”, for instance).

This relationship between age and adaptability to child care does complicate life. Many parents are reluctant to use out-of-home care in the early months because of a realistic concern about infectious disease, or about the amount of attention a young baby needs, or about continuing to breastfeed. The parents may at that point also have access to continuing maternity leave that gives them the option of caring for their baby at home. Although the baby at this point may be able to adapt very easily to out-of-home care, there are many reasons not to use child care at that point.

A few months later, in the second half of the first year, parents may have weaned the baby from the breast, may feel he or she needs less individual attention, and perhaps have become more accustomed to common childhood illnesses. Maternity or paternity leave has probably run out in the U.S. (if indeed they had such a luxury). There are growing reasons for out-of-home care. But, whoops! The baby has developed to the point of feeling quite anxious about strange people and places. Adapting to care outside the home is a lot more difficult than it used to be.

What to do at this point? Are there ways the parents can ease their baby’s transition and make the family arrangements they need without excessive stress on anyone? Yes, most babies can be guided into greater comfort with a strange care situation, and the key word here is “gradualness.” Perhaps a few people have learned to swim by being thrown into water over their heads, but more have been frightened badly-- and the same thing is true of babies having new experiences. A gentle introduction fine-tuned by observation of the baby’s reactions is the best way to achieve a happy acceptance of any new situation.

Ideally, a baby should be introduced to a new care arrangement by short visits with a parent, leading after a few days to a short period there without the parent, and gradually increasing to the desired amount of care time. (A child care center that will not cooperate in this or that does not want the parent to stay is not a place you want to leave your child, by the way.) Ideally, also, the baby will have an assigned caregiver, and at least at the beginning will be cared for by that person most or all of the time, rather than having to deal with “floating” staff who work with any baby who seems to need attention. In addition, the ideal arrangement will involve careful attention to transitions, having a staff member greet the child and engage with her when she enters, and say goodbye as child and parent leave. Child care centers that are accredited by the National Association for the Education of Young Children are well aware of these points.

Real life is not ideal, of course. What if things just don’t, or can’t, work out this way? Let me give just one hint about what a parent can do: Don’t Sneak Out. Don’t ever sneak out. Tiptoeing away is easier on parents than hearing babies cry, but it’s very important for a baby to learn that a parent will not go away without making it clear that this is about to happen. Otherwise, anxiety may be constant that at any moment Mom or Dad could be gone, and when the baby feels this, it’s much harder to play and learn, or even to get used to day care.

More on the Russia-US Adoption Treaty

2011-08-14T09:23:00.003-04:00

When I commented a few weeks ago on the need for the conditions of foreign-adopted children to receive independent monitoring, rather than monitoring by the placing agency, a number of readers stated their agreement. I want to point out to you a way to bring your opinion on this to the attention of the State Department.

I've received a response from Sarah Shaffer of the Office of Children's Issues (ShafferSF@state.gov). She said that the treaty itself has been signed, but she can receive comments as the agreement moves toward ratification and implementation. More information on the treaty itself is available at http://adoption.state.gov/content/pdf/FAQs_re_agreement_07_13_2011_FINAL2.pdf
and at http://www.uscis.gov/adoption
and http://adoption.state.gov.

Changes will be posted on those sites, and you can request e-mail or feed notification.

I hope readers will join me in passing on opinions to Ms. Shaffer.

Adoption, Trust, Complacency, and the Barahona Case

2011-07-27T15:42:00.003-04:00

While most of the nation was intensely involved with the trial of Casey Anthony in Florida, another case in the same state got much less attention in spite of its seriously disturbing nature. In that case, a grand jury investigated the death of Nubia Barahona and the serious injury of her twin, Victor, apparently at the hands of their adoptive parents, Carmen and Jorge Barahona. The death and injury followed a series of reports of child abuse, including complaints from Nubia’s teachers that she seemed to be very hungry and that she was nervous and afraid to go home. Other complaints stated that the twins were bound with duct tape, locked in the bathroom, left to sleep in the bathtub, and fed on bread and milk once a day. The Barahonas took the children out of school and said they were homeschooling them. Following the pattern of the all-too-familiar-story, caseworkers had not succeeded in seeing the children, but had accepted Carmen Barahona’s statement that they were fine. Then, on Feb. 14, 2011, Nubia was discovered dead and rolled up in a carpet in Mr. Barahona’s truck; her brother was there too, badly hurt.

The Miami-Dade County grand jury that indicted Carmen and Jorge Barahona filed a final report that is of great interest (http://media.miamiherald.com/smedia/2011/07/25/14/27/1aTHrq.So.56.pdf). In this report, while acknowledging all the many problems of caseworkers, including poor training and heavy caseloads, the jury members emphasized a problem that is prevalent but rarely mentioned. They referred to it as a bias of trust and complacency.

The bias of trust stressed by the grand jury report is the assumption on the part of the social work profession that adoptive parents are by definition good people, and that they cannot be the source of harm to the children in their care. Without wishing to accuse an entire professional group, I must agree strongly that this belief characterizes many adoption caseworkers and the staffs of adoption agencies. All adoptive homes are described as loving and nurturing, as if adoption were synonymous with excellent child-rearing. Adoption-oriented web sites describe adoptive parents as “awesome moms”. When adoptive families are functioning poorly, there is haste to say that someone, somewhere, did not tell the truth about the children, who are considered the causes of any trouble. These common beliefs may be the basis for the caseworkers’ bias of trust in adoptive parents which the grand jury report points to so explicitly.

Come, let us reason together about this. Why should adoptive parents be uniformly “awesome”, wholly loving and nurturing, and worthy of the unquestioning trust of society, when birth parents as a group do not meet these standards? Some would assume that adoptive parents must be excellent because they must have wanted the children; these people attribute child abuse to being saddled with unwanted offspring and resenting them. But, in fact, birth parents too may abuse children whom they wanted and even planned. (Shockingly, the grand jury report suggested that the investigation of the Barahona case would have been more careful if the children had been with their birth parents.)

Others who think adoptive parents are always good rely on screening and evaluation of adoptive parents to mean that only those who can do a good job are allowed to adopt. It’s true that screening makes it much less likely that people who are physically ill will be allowed to adopt, or that those living in poverty or substandard housing will become adoptive parents. Those with florid mental illnesses are also likely to be screened out. But in actuality there is no screening that will allow us to know exactly how a person will behave toward a particular child, and that is why post-adoption monitoring by an independent observer should be an essential part of the adoption process.

It would be a grave mistake to attribute cruelty and abuse to all adoptive parents, most of whom manage their families’ relationships in such a way that their children grow up as healthy, competent, successful contributors to society. It is an equally grave mistake, however, to assume that adoptive parents must not be the cause of evident problems in their children-- problems as serious as constant hunger, bruising, and fearfulness of going home. Adoptive parents are human beings; human beings can do wrong. If we are to do right by vulnerable children, we cannot let this be forgotten.

Is it too difficult for caseworkers who have known adoptive and foster parents for years, who may have been involved in the placement of children with them, to approach these families without bias? Is it too important to some caseworkers to be the friends of adoptive parents and to feel their approval? We can hardly blame the caseworkers if these things are true. Human beings trust people they have known for a long time, and human beings don’t enjoy being disliked by the people they work with. So, can we trust caseworkers to avoid that “bias of trust” when they have been involved with screening parents or placing children? It may well be that we cannot, and that the solution is to change the system so that strangers do the monitoring.

The Miami-Dade County grand jury report is a remarkable document. I congratulate the grand jury members for their ability to cut through the bureaucracy and to suppress temporarily the distress they must have experienced at the details of the Barahona story. By homing in on the trust issue, they have pointed out an essential flaw in our efforts to prevent abuse of adopted children in the United States. I would hope that this report will become required reading for all social work students and social services staff.

Behind the Norwegian Terrorist: The Grande Dame of Conspiracy Theory

2011-07-25T11:57:00.004-04:00

I really don’t believe in “synchronicity”, but I made a find that startled me yesterday. I turned on my laptop and saw headlines about the Norwegian domestic terrorist Anders Breivik. Then, sighing and shaking my head, I turned to EBSCOhost to continue the work I had been doing, which involved reading articles about some unconventional belief systems.

The first thing I saw was a small number of articles discussing the life and work of one Nesta Helen Webster (1876-1960), an Englishwoman whose writings were a powerful influence on the John Birch Society, the Patriot movement, Pat Robertson-- and now, believe it or not, even radical Islamist groups. Her 1924 book “Secret Societies and Subversive Movements” told of organizations “gathering strength for an onslaught not only on Christianity, but on all social and moral orders”. It’s very likely that Nesta Webster’s views helped form the framework for Breivik’s fears and actions.

Mrs. Webster believed that subversive groups, initially in the form of the Illuminati, had conspired to bring about the French Revolution in an effort to destroy the aristocracy and break down class barriers so they could rule the world. In her own time, she thought, this work was being done by Communists, Freemasons(!), and “international finance” (read: secular Jews). She had a general admiration for the Nazis, but felt that they were not Christian enough and was concerned about their treaties with Russia.

According to some commentators (Ruotsila, M. [2004]. Mrs. Webster’s religion: Conspiricist extremism on the Christian far right. Patterns of Prejudice, 38, 109-126), Mrs. Webster’s beliefs about international and multicultural conspiracies were based on her own upbringing as a member of the Plymouth Brethren, a dissenting group whose “existential gloom” was matched only by a few members of the Church of England. Like some fundamentalist Christian groups in the modern United States, the Plymouth Brethren were premillenialists, believing that the “end times” would soon arrive and would involve a battle for souls between the forces of good (basically, themselves) and those of evil (everybody else). Premillenialism usually includes a concept of an Antichrist as the incarnation of evil, although the specific identity of the Antichrist is left unclear, enabling groups to fill in the blank with the name of their most concerning enemy. Of course, non-Christian groups can readily adapt the story to their own needs by using some term other than Antichrist but keeping the rest of the narrative.

Mrs. Webster’s conspiracy theory seems to have done little but insert the names of her particular feared people into the Antichrist blank. The rest of her concerns (and those of modern complex conspiracy theorists) mirror the premillenialist narrative. The basic story is as follows: there is a battle that has been going on for a long time; many enemies conspire against us; they want to destroy our cherished ways and replace them with an immoral and disgusting society; they operate secretly and unfairly; the end of the battle is near, and we must counterattack if we are to survive; no compromise is possible; they hate us, and we are right to hate them.

It was just as simple for Anders Breivik and many others to make use of this narrative as it was for Mrs. Webster. Breivik easily inserted Islam and multiculturalism into the Antichrist blank-- just as radical Islamists can insert the names of European and North American people and institutions into the same opening. It’s a terrific story, very exciting and engaging, and even contains some partial truths. How difficult, then, for many people to question or resist it!

Whether Anders Breivik is “crazy” is already being debated, as happens every time there is violence committed by one of these true believers in conspiracy. Even Mrs. Webster had some personal beliefs and assumptions that are likely to raise some eyebrows-- she thought she might be the reincarnation of an aristocrat who died in the French Revolution, she believed in ESP , “ancestral memory”, and the influence of “spirit presences” (see Lee, M.F. [2005]. Nesta Webster: The voice of conspiracy.Journal of Women's History, 17, 81-104). Yet having unusual beliefs is not clear evidence of “craziness”, and neither is killing a lot of people, an action for which we reward soldiers with high praise.

In fact, it may not be particularly relevant whether Breivik is “crazy” or not. Focusing on this issue may be important for the making of legal decisions about him, but it can also have the effect of distracting us from the much larger problem shown by Internet sites like “Gates of Vienna”. In fact, to declare Breivik “crazy” may have the unfortunate effect of hiding the power of the basic Antichrist story which motivates modern conspiracy theories of the kind Breivik acted out. Christians, Muslims, and other religionists, can you recognize this dangerous narrative, this self-fulfilling prophesy, and speak out against it before it creates more mini-Armageddons?

[Incidentally, I fully expect a number of attachment therapists to declare that Breivik was suffering from Reactive Attachment Disorder. Let me point out that there is no reason whatever to think that this was the case, or that if it had been, that this would have offered an explanation for his actions.]

What About the Fathers? The Anthony Case and Danieal Kelly

2011-07-18T11:23:00.001-04:00

I confess that I winced away from watching the Casey Anthony trial and only inadvertently picked up information from people who wanted to tell me about it. Now that the trial is over, though, I find myself thinking about an aspect that rated some sidebars: what about the father?

The Internet remains full of discussion of who the child’s father might have been, whether he’s alive, why he hasn’t come forward. A woman in New England has even declared that her son is the father, carrying family solidarity and maternal pride (?) to unheard-of levels. The comments on this issue are a melange of different types of disapproval, ranging from the idea that the father might have saved the little girl’s life if he had been paying attention, to the concern that anyone putting himself forward at this juncture is merely acting in hopes of cashing in on the selling of the Anthony story.

Not many people have mentioned the possibility that an identified biological father may have some legal responsibility in the child’s death and the mother’s subsequent ill-judged actions. I don’t know what the Florida law is, or what prosecutorial intentions might be, but a somewhat parallel case in Philadelphia shows that a father may be found guilty of various offenses in connection with the death of a child with whom he has no contact.

A lengthy legal process has tried several people for their culpability in the 2006 death of Danieal Kelly (see http://articles.philly.com/2011-07-12/news/2976489_1_danieal-kelly-mickal-kamuvaka-kelly-household). Danieal, who was physically very much impaired by cerebral palsy, died at age 14, weighing 42 pounds and covered with bedsores. She essentially starved to death. Her mother, Andrea Kelly, is already serving a prison term, but a few days ago, after trial, the social workers who had failed to respond to the child’s condition, and Daniel Kelly, Sr., Danieal’s father, were convicted of charges in this case. Daniel Kelly, who had at one time had custody of his children, returned them to their mother, who, he claimed, denied him access to Danieal. He did not report the matter to authorities or make any effort to be sure that Danieal’s special needs were met. He has been convicted of child endangerment and may be sentenced to as much as 7 years in prison.

Would Daniel Kelly have been convicted if he had never seen Danieal, or if he did not know he was her biological father? It’s possible-- even likely-- that he would not even have been tried under those circumstances. As it was, having spent some time living with Danieal, he was well aware of her physical incapacity and her special needs for physical care and for educational services. He must have had some idea of the degree of danger involved in leaving her to the sole care of her mother, although he also may have legitimately assumed that the social work service would oversee what was happening to Danieal. Nevertheless, some will object to his conviction for events that occurred when he wasn’t fully aware of the situation, and might well argue that if he had never known there was a baby, he would not have been at all responsible for Danieal’s death.

Daniel Kelly’s conviction is a message to some disengaged fathers of their minimal responsibility toward their children; even if they never provide a meal or pay child support, they must be sure that their children are receiving the basic care they need. But what is the message to those who never saw the baby, or even paid enough attention to know there was a pregnancy? What are the legal implications for those men of coming forward at a later time? Generally, unknown fathers are thought to lie low in order to avoid paying child support, but where a child has been harmed or killed, such men might also have possible concerns about charges of child endangerment.

This situation is fraught with ethical and practical dilemmas. On the one hand, it seems completely unfair to bring serious charges against someone who didn’t know what was going on-- but is Daniel Kelly’s “failure to know” any more or less culpable than the failure of a man to know that he impregnated a woman? And what would happen if unknown (but later identified) fathers of abused children were charged with endangerment? Would this encourage such men to take responsibility for their children’s well-being-- or would it encourage them to withhold their identities from partners and avoid serious relationships?

Perhaps the various candidates for Casey Anthony’s impregnator should think over their positions before they rush to declare themselves and sell their stories.

Eye Contact With Babies: What, When, Why, and How

2011-07-17T12:55:00.003-04:00

When I look at the statistics Blogspot gives me, I see that day after day, large numbers of people end up at this blog when they Google questions about babies and eye contact. Parents are obviously worried about this issue, and that fact is confirmed by the existence of quite a few websites that give instructions about how to get your child to make eye contact more often. But what are the facts about all this? Can you get your child to increase eye contact? Do you need to? Why are we concerned about this matter at all?

What is eye contact? The term “eye contact” might be better replaced by “mutual gaze”, because of course there is no real “contact” about this common human action. In mutual gaze, two people’s faces and eyes are aligned so that each set of eyes is gazing at the other set. This is often very brief, although it can also be maintained for seconds at a time. Mutual gaze may also be performed in a sequence of episodes, for example as two friends approach each other, joining and breaking gaze along the way, stop and briefly engage in mutual gaze, and finally avert their gazes slightly while talking. Prolonged mutual gaze may indicate deep emotional involvement-- but it can be either a loving look or a hostile or frightened stare, depending on the context and the rest of the facial expression. Mutual gaze has a terrific communicative power for human beings, but it can have more than one meaning.

When does eye contact happen? From birth, babies are interested in looking at faces and especially eyes, and do this so carefully that they can and do accurately imitate facial expressions in the early days of life. Nevertheless, most new parents find that it is quite difficult to get a sense of mutual gaze until some weeks have passed. At about 4 to 6 weeks, as babies begin to do what used to be called “taking notice”, they start to look more responsively at people who are looking at them-- especially if the adult does something attention-getting like opening eyes and mouth wide and “looming” closer to the baby’s face. Soon, the baby smiles in response to a smile, and maintains a mutual gaze with a friendly adult (familiar or unfamiliar). If the adult looks blank or “stares through” the baby, though, the latter will avert the gaze, appear uncomfortable, and begin to cry. The baby expects the adult to “manage” his or her gaze in a way that coordinates with the baby’s gaze.

By about 6 months, babies begin to look toward an adult’s face and eyes for “social referencing” purposes, not for eye contact in and of itself, but to get information from the facial expression and the direction of the adult’s gaze. This information guides the baby in understanding the environment and knowing whether unfamiliar things are worrisome, neutral, or pleasant. The baby continues to pay attention to the direction of people’s gazes and between 9 and 12 months begins to show “joint attention”-- using the gaze as a “pointer” to show someone else where to look, and following another person’s gaze to see an interesting sight. These are not examples of mutual gaze, but they are other forms of communication that may emerge from mutual gaze.

It can be hard for an inexperienced parent to know whether a baby makes eye contact soon enough, long enough, or often enough. Anyone who expects prolonged mutual gaze many times a day from the time of birth is bound to be disappointed and frightened. The earliest eye contact events are fleeting, and even at 2 months the baby may not pay much attention without a good deal of adult effort. Mutual gaze during breastfeeding is not likely until the child is old enough to pause in sucking and look around, or let go the nipple temporarily and move the head-- perhaps 5 or 6 months of age.

Why is eye contact important? Mutual gaze is an important form of communication that conveys information both to the baby (“hey, people are quite interesting and pleasing”) and to the adult caregiver (“oh, my baby’s looking at me-- this feels so good-- he thinks I’m important and interesting”). It may be the foundation of other uses of gaze and other gestures for communication.

Looking at whether young children engage in mutual gaze can be a helpful way of understanding whether their development is typical or whether they have certain special needs. One of the best-known aspects of autism is the infrequency of eye contact. Individuals with Asperger’s syndrome, a disorder related to autism, may say that they dislike being looked at and find mutual gaze very uncomfortable. Persons with Fragile X syndrome are also known for their poor use of the gaze in social communication.

When people avoid looking at other’s eyes, or when they are simply inattentive to gaze information, they can miss much other information too. If an adult uses a word a child does not know, for instance, the child can often make a good guess by watching the adult’s gaze, to see what he or she is looking at. When a child also has poor language development, as is common in autism, the combination of underdeveloped language and of lack of gaze communication can make for serious difficulties, the appearance of deliberate noncompliance, and frustration for both child and adult. These facts all suggest that if a child is really not using mutual gaze or other gaze information, helping him or her gain those skills would be a valuable achievement.

However, it’s important to realize that increasing mutual gaze is not a way of increasing the child’s emotional attachment. Toddlers are more likely to engage in mutual gaze with people they are attached to, but increasing gaze episodes does not make them attached. Blind children become strongly attached to their familiar caregivers just as sighted children do; attachment is a very robust developmental phenomenon that involves hearing and touch as much as, or instead of, sight. Mutual gaze may have its strongest effect on adults, who are much influenced by the child’s gaze and feel a sense of emotional contact when exchanging gazes, so it’s possible that increasing mutual gaze can have an indirect effect on children through its influence on their caregivers. However, of course, blind parents also have strong emotional involvements with their children; they too can use other sources of communication to develop these intense relationships.

How to increase mutual gaze? I notice on several websites a variety of instructions for improving eye contact with children. These include wearing funny glasses (something like this was suggested by Nikolaas Tinbergen 40 years ago), playing games based on prolonging eye contact, and giving the child sweets while maintaining mutual gaze.

Whether these methods are a good idea depends in part on whether the child really does show too little eye contact for his age and situation. This is a point on which most parents need professional guidance. If the parent’s motivation comes from the belief that more eye contact would cause better attachment, and especially if the parent believes the child is poorly attached because he or she is disobedient, there is certainly little point in doing any of these things.

However, if the child is being treated for a developmental problem that is characterized by poor mutual gaze, the parent may already have received some training in rewarding eye contact or may at least be aware of how the behavior therapist works with this. An article that describes one method is to be found at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2649838/ (Hall, S.S., Maynes, N.P., & Reiss, A.L. [2009]. Using percentile schedules to increase eye contact in children with Fragile X syndrome. Journal of Applied Behavior Analysis, 42, 171-176). Similar work can be done at home, but it needs to be carefully thought out beforehand.

The Russian-U.S. Adoption Treaty: The Psychological Evaluation Issue

2011-07-14T15:44:00.002-04:00

After a considerable period of discord, and a history of disasters for children adopted to the United States from Russian institutions, Russia and the U.S. have signed a treaty intended to address problems that have caused harm to adopted children (M. Schwirtz, “Pact on adoptions ends a U.S. Russian dispute”, NY Times, July 14, 2011, p. A12). In addition to improving the mechanisms for monitoring families after adoption, this treaty requires improved screening of potential adoptive parents and better information about the children’s medical and psychological histories.

How are people evaluated before they are accepted as adoptive parents? Psychological evaluations, often done through private sources or as recommended by the adoption agency, generally involve an open-ended interview less than an hour long, and may include a paper-and-pencil psychological test, usually the Minnesota Multiphasic Personality Inventory (MMPI). The MMPI provides an assessment of the individual on a number of scales (including whether they are so inconsistent that they are probably lying) as well as on some combinations of scales.

The MMPI does a good job of identifying individuals who are seriously mentally ill-- schizophrenics, for example. But most adoptive parents who harm or reject their children are not actually mentally ill. Instead, they have other personality characteristics, beliefs, habits, or social circumstances that culminate in child abuse or neglect, or even in the child’s death.

Can the MMPI identify those concerning personality characteristics and help to prevent adoptions that may lead to harm? Regrettably (considering how much people rely on this test), the answer is probably that it cannot. Of the thousands of studies done on the MMPI, very few have focused on the success or failure of adoptive parents, nor have most considered whether the responses of potential adoptive parents to the MMPI should be interpreted in any special way.

Almost 20 years ago, one researcher, J.E. Dalton, looked at a group of prospective adoptive parents and analyzed their scores on MMPI scales and on other personality tests (“MMPI-168 and Marlowe-Crowne profiles of adoption applicants.” Journal of Clinical Psychology, Vol. 50, 863-866). Dalton noted that there was a serious lack of normative data that would allow adoption applicants to be compared to other adoption applicants rather than to people who were free of the stresses peculiar to the adoption situation. He noted that the typical MMPI profile for the applicants he tested was “characterized by a high degree of defensiveness, particularly among females… the [average] female profile on the validity scale would be interpreted as follows: “This is a valid profile. Persons who obtain similar scores are often seen as naively defensive individuals who have a strong need to present an image of virtuousness or perhaps strong moral character. They tend to have little insight or awareness of their own stimulus value… “(p. 865). Dalton then went on to say-- and this is the significant part--- “Although it is possible that defensive people are more likely to apply to adopt children a more likely interpretation is that the [preadoption] screening process creates a defensive attitude” (p. 865). Dalton strongly advises comparing the MMPI scores of potential adoptive parents to those of other such people rather than interpreting them in terms of the larger population, in comparison to which the adoption applicants may appear to have some undesirable personality traits.

It is doubtful that preadoption psychological evaluations often do follow Dalton’s suggestion. Even if they did, however, there is little or no information to show us whether successful adoptive parents have different MMPI profiles than those involved in serious failures. Few evaluators who specialize in preadoption screening are research-oriented, and few potential adoptive parents would give permission to include their data in research reports. As a result of this lack of information, we may have a situation in which psychological evaluation can screen out seriously mentally-ill applicants, but fails to determine characteristics that may or may not fit a potential adoptive parent to do a successful job with a child.

I suggest that preadoption evaluators may do better to focus on certain personality and social characteristics that are not assessed by the MMPI but may be highly relevant to adoptive parenting. One of these is authoritarianism, a personality characteristic focusing on the issue of obedience to authority. Authoritarian persons are concerned with the obedience children owe to their parents and are simultaneously concerned with the obedience they, the parents, owe to persons in authority over them. Authoritarianism values obedience in and of itself, not simply as a means to an end; a nonauthoritarian parent may work to instill obedience in children so they will come out of the street or away from a hot stove when told, but the authoritarian parent sees child obedience as a goal in itself, independent of child safety or health outcomes. Some authoritarian parents consider child obedience to have special value in a religious context and consider obedience to a parent to be the foundation of obedience to God, while others want obedience as part of a secular value system.

A high degree of authoritarianism motivates a parent to require obedience of children even if they cannot do what is required of them or do not understand what is being ordered. When there are cultural differences which the parent does not understand or accept and which the child cannot articulate, there may be apparent intentional disobedience that an authoritarian parent finds unbearable. An example here might be the conflicts over pet animals so often noted in adoption blogs; poor or post-institutionalized children or those from the Third World may have had no contact with pets and may regard them as predators or vermin that should be killed, whereas an authoritarian adoptive parent may demand what he or she sees as appropriate affectionate behavior toward animals. More and more severe punishment may follow the child’s failure to comply.

Authoritarianism may also make adoptive parents especially susceptible to adoption counselors or therapists who focus on child obedience and parental control as the sole route to family success. Such semi-professional or professional advisors may advise physical restraint and control over food intake as appropriate means to achieve the obedience they have claimed as the key to positive development. These methods, or similar techniques like exposing the child to heat or cold or forced drinking or eating, all have very real potential for causing injury and even death.

Psychological evaluators, do your assessments consider authoritarian personalities as matters of concern for preadoption psychological evaluations? Do your interviews explore adoption applicants’ connections with advisors who may suggest potentially harmful paths to inappropriate goals? The U.S.- Russian adoption treaty will not tell you to do these things, but you may find them more genuinely useful in preventing adoption disasters than the MMPI’s standard textbook interpretation. The same goes for the post-adoption monitors required by the treaty.

RAD on Youtube; or, Caveat Spectator

2011-07-13T10:54:00.007-04:00

“Open source” mental health information on Wikipedia is problematic enough, as I’ve written elsewhere, but at least it tends to be watched and corrected (or perhaps just edited) by interested editors and Wiki admins, and citation of sources is supposed to be required. Youtube productions can present a more serious problem, because no one can make corrections by editing within a video; the best they can do is to make their own video and strive to correct any misconceptions that may have been caused by the original presentation. In addition, it’s up to the contributor to decide whether any source of information should be cited-- and often none is given

I’ve been looking at Youtube material that purports to discuss Reactive Attachment Disorder, and a depressing job it’s been. I can’t possibly talk about everything I’ve seen that’s wrong, especially that old TV melodrama “Child of Rage”! However, I do want to comment on two of these gems, http://www.youtube.com/watch?v=dCgb4iu-k8o, whose authorship is not clear, and http://www.youtube.comwatch?v=WV6d1nAgBNI, created by the Association for Treatment and Training of Attachment in Children (ATTACh). Each of these is full of inaccuracies, inconsistencies, and downright errors (it’s a trivial point, but the creator of the anonymous video apparently believes that Mary Salter Ainsworth was a man).

The anonymous video (uploaded by one vsulley) commits the very worrisome error of conflating Reactive Attachment Disorder (RAD) as described in the Diagnostic and Statistical Manual of the American Psychiatric Association with the notional problem sometimes called just “Attachment Disorder” (AD for short). Reactive Attachment Disorder is characterized by age-inappropriate social behavior, especially with respect to familiar caregivers. Children may be unusually aloof, independent, and willing to interact with strangers for their age, or unusually clingy and demanding of adult attention for their age. The RAD diagnosis can be given in either of these cases, but only if the behavior began before age 5 years and if there is a history of poor care. AD has nothing to do with symptoms of RAD, and the manual for the Randolph Attachment Disorder Questionnaire, a test intended to detect AD and cited in this video, actually states that it is not intended to diagnose RAD. Speculative discussion of AD, whose existence is not supported by systematic evidence, claims that symptoms of the disorder include a fascination with blood and gore, cruelty to animals and younger children, refusal to make eye contact on adult terms, “crazy lying”, and so on. These are obviously very different symptoms than those associated with RAD (not to mention the lack of evidence that such a disorder exists or is related to attachment in any way). But the anonymous video treats RAD and AD as equivalent and cites a very weak 2003 Journal of Psychology article by Hall and Geher as a major source. On the positive side, this video does not support the use of holding therapy and notes the lack of evidence that HT is effective, neglecting, however, to state its potential harmfulness.

The ATTACh video, posted by the parent-professional organization that has for many years promulgated the idea that adopted children are likely to suffer from mental health problems associated with attachment, takes a different approach. It rejects the DSM description of Reactive Attachment Disorder as an insufficient diagnosis for the posited problems of adopted children, but rather than referring to AD (once a major tenet of ATTACh’s belief system), the video emphasizes the Developmental Trauma Disorder proposed by Bessell van der Kolk but not included as a diagnostic category in the work on the upcoming DSM-V edition. The ATTACh video fails to state that a lack of systematic evidence for the disorder suggested by van der Kolk is the reason why DTD will not be included in the new revision.

The ATTACh video re-emphasizes a position long taken by the organization-- that Reactive Attachment Disorder in childhood develops into serious personality disorders, antisocial personality, depression, anxiety, and suicidal thinking. The video completely omits any discussion of longitudinal research by Michael Rutter and his colleagues, showing how few children adopted from Romania had later mental health problems. I’ve discussed this research at www.childmyths.blogspot.com/2011/01/urban-legend-about-Russian-orphans.html and included the comment of the developmental scientist Megan Gunnar that so-called attachment problems may not be associated with attachment at all.

There are two other interesting points about the ATTACh video, and both of them require some explanation for those who cannot “read between the lines”. One is a startling acknowledgement of the influence of Foster Cline on the organization and the continuing importance of his views of attachment and related disorders. Foster Cline is an M.D. who was strongly influenced by Robert Zaslow, a psychologist who developed an intense and intrusive form of holding therapy in the 1970s. Cline learned Zaslow’s methods and applied them during the ‘80s and ‘90s, during which time he compared holding therapy to chemotherapy as a painful and frightening but necessary treatment that should not be avoided in spite of its dangers (it was eventually associated with a number of child deaths). Cline stated that “all bonding is trauma bonding”. Both Zaslow and Cline surrendered their professional licenses after disciplinary actions following injuries to patients. It is quite remarkable to me that ATTACh continues to state its Cline connection in contradiction to its efforts to become a kinder, gentler organization following the 2000 death of Candace Newmaker during a therapy session.

A second point, and one surprising to me, is the appearance in this video of the psychologist Michael Trout. Trout, at one time a highly-respected clinician, has in the last 15 years become greatly involved with the Association for Pre- and Perinatal Psychology and Health (APPPAH), a group committed to the idea that babies remember their gestations (perhaps even conceptions) and births and will sometimes spontaneously report on these. APPPAH attributes much emotional disturbance to prenatal and birth trauma and supports massage of neonates by individuals like William Emerson, who claims to release birth trauma by pressure on infants’ heads and necks. In the video, Trout specifically refers to the mantra “baby can remember” on which much APPPAH thinking is based.

Rather than providing reliable facts about childhood mental health issues, the ATTACh video gives some revealing information about the direction ATTACh seems to be going. A connection with APPPAH is a remarkable step away from the “mainstream” status once aspired to by this group. The ATTACh video is thus remarkably informative about ATTACh-- but not so much about Reactive Attachment Disorder.

Monkeys or Mamas? It's a Toss-Up for Newborns

2011-07-07T19:06:00.002-04:00

There’s been a lot of discussion about whether newborn humans recognize their mothers’ voices, or anything else about them, The voice issue has received a great deal of emphasis because babies can hear speech sounds before birth. Even though the sounds are somewhat muffled by the mother’s skin, muscles, viscera, and amniotic fluid, they can be heard and are apparently recognized, as babies after birth have been shown to prefer familiar speech sounds to unfamiliar ones.

In addition to preferring the familiar, newborns prefer voices over other kinds of sounds from inanimate sources. They show this when they have learned that by sucking frequently on a pacifier-like object they can control whether they get to listen to voices or other sounds, or to familiar or unfamiliar voices.

Most researchers working on this topic have not thought about the effect of sounds that are not only unfamiliar, but not likely to be heard at all by most infants in the industrialized world. However, one group looked at whether babies were attentive to hearing rhesus monkey vocalizations (Vouloumanos, A., Hauser, M.D., Werker, J.F., & Martin, A. [2010]. The tuning of human neonates’ preference for speech. Child Development,81, 517-527). They were interested in learning whether newborns were really especially attentive to speech, or whether they preferred all sounds with characteristics they share with human speech-- like the sounds of monkey vocalization. These researchers let newborn babies hear nonsense speech and also recorded vocalizations of rhesus monkeys. The neonates were equally likely to choose (by sucking at the right time) to hear human nonsense speech or to hear monkey sounds. They chose both of these over synthetic sounds.

It seems that the newborn humans could not, or at least did not, tell the difference between humans speaking and monkeys vocalizing. But adults and even older children can readily make that discrimination. How and when do they manage this? Vouloumanos and her colleagues tested 3-month-old babies, using a different technique than the one they had used with the newborns. The 3-month-olds could keep a sound playing by looking at a black-and-white checked screen for a long time; if they looked away, the sound stopped; when they looked back again, one or another sound occurred at random. Unlike the newborns, the 3-month-olds spent more time looking in a way that would allow them to hear human speech sounds. They not only could, but did, tell the difference between human and monkey sounds.

How does this work compare with the research (by DeCasper, for instance) suggesting that newborns can make very careful discriminations, not only recognizing their mothers’ voices but even telling the difference between stories that were read? How could they tell these rather subtle differences, but not discriminate human and monkey vocalizations? Is a puzzlement, yes?

Vouloumanos and her colleagues suggested that this peculiar difference might result from the fact that the nonsense speech they used was quite brief and was not the connected speech of ordinary use. It may be that spoken sentences make available to babies a good deal more of the distinctively human speech characteristics that differ from those of monkey vocalization. Connected speech contains a variety of information in the form of syllable length, intonation and emphasis, rhythm, and so on. This rich, variable material may be much more effective in catching infants’ attention than brief nonsense words. In other words, the researchers speculated that the newborns actually could tell the difference between human and monkey sounds, but did not pay much attention to what they did not find very interesting.

Whether or not newborn babies can tell monkeys’ voices from mamas’ voices-- and a definitive answer is not yet available-- it’s clear that they do discriminate between voice sounds and synthetic sounds, and spend more time listening to voices when they get the chance. They are born with a positive bias, an interest in the sounds voices make. Is this because of prenatal experience with voices, because of a built-in “tuning” of the auditory system for those important sounds, or because of a combination of the two? That isn’t clear yet, but it is clear that newborns are still very much in the process of development, and adults should not jump to any conclusions about resemblances between the very young and the older human being.

Just a little addendum: when Vouloumanos and her colleagues did one of these experiments, they tested 30 babies. Another 44 babies were available but were excluded from the study because they fussed or fell asleep or because they did not suck often enough. If you ever wonder why research on young infants is not done more often and with larger numbers of babies,do remember this: just as you can’t make a turtle come out, you can’t make a baby participate if it doesn’t feel like it.

That Lawsuit Again: Ronald S. Federici vs. A Crowd of Critics

2011-06-30T10:12:00.002-04:00

Some readers may remember a lawsuit for defamation filed against me and a number of other people, part of which I attempted to describe at http://childmyths.blogspot.com/2010/12/federici-v-mercer-story-behind-lawsuit.html. I have to acknowledge now that my guess about Ronald Federici’s complaint about me was quite incorrect. I assumed he was going to complain about my comments on his involvement in the Salvetti case, in which adoptive parents went to prison for withholding food from their son and keeping him locked in a room for months. When I appeared in Fairfax County, VA, Small Claims Court to answer his original suit, that was what I thought the issue was, and I never found out otherwise because the judge rather quickly found for me.

However, when, after several other legal moves, Federici brought suit again against me and others, I discovered that my comments about the Salvetti case were not even a point of concern--- and I presume that this was because the factual parts of my remarks were drawn from documents of the North Carolina Court of Appeals. (I would not have made the statements I did without that kind of evidence to back me up.) Instead, Federici had a number of complaints about things that had been said about him on the Internet, and as it happened not one of them had been said by me.

Now that sufficient time has passed from the dismissal of Federici’s suit in Virgina Eastern District Court (incidentally, the same court that dismissed a defamation suit against Paul Offit about a year ago), all the relevant documents are now posted at http://www.citmedialaw.org/threats/federici-v-pignotti-et-al. You can see in “Federici’s complaint” his attorney’s description of what was said about him, and you can look at the many copies of Internet material to see what actually was said. As I mentioned, there was nothing about the Salvetti case; presumably, it would have been too hard to argue that my remarks were inaccurate. By the way, if you look at the “update” on this case, please note that the recent granting of Federici’s motion was in response to his attorney’s request for a formal statement that the suit against the “John Does” was dismissed, as well as the suit against the named defendants. For anyone interested in this situation, a look at the Memorandum requesting that dismissal will be rewarding, as it reveals the attorney’s reasons for wanting to stop representing Federici.

The Dismissal Hearing Transcript posted at citmedialaw has some points that I found of particular interest. Federici’s lawyer made the following statement: “… they have even called and made complaints that Dr. Federici assisted in the--- in the killing of a child. And they have actually not only put this online, they have actually reached out to the Virginia Board [of Psychology] to actually make the same false complaints.”

I have several comments about this statement. The first is that nowhere in material quoted in the Complaint is any such claim made, by any of the defendants. One thing that is actually said is that some of the methods advocated by Federici are potentially dangerous and have been associated with deaths in a considerable number of well-documented cases. A second point made in that material is that Federici’s methods resemble those of a group of so-called Attachment Therapists some of whose members have been involved in child deaths.

No one among the defendants in this case has accused Federici of killing a child directly or of in any way assisting in such a killing. If any of us thought there was evidence of such a thing, we would not bother to tell his professional licensing board, but would go as quickly as possible to bring our evidence to the police. My own complaints to Federici’s licensing board, which I made some years ago, have to do with inaccurate representation of his professional credentials, which, interestingly, I see repeated by his attorney in the Dismissal Hearing Transcript.

The statement made by the attorney at the dismissal hearing seems to be based on faulty logic. If someone says I’m a clumsy parallel parker, is that the same as saying I’ve damaged other people’s cars and had my insurance rates put up? No, of course not, and to say that someone’s methods are dangerous is not the same as saying that he has directly or indirectly caused a death. Naturally I’m very pleased that the suit was dismissed, but there’s something in me that would have liked to see how an opposing attorney would have handled the claim that anyone had accused Federici of killing.

One question people have asked is who the John Does were. Of the ones I know anything about, most are people who commented online and used pseudonyms. Strangely, though, two were Mr. and Mrs. Salvetti, Federici’s clients who went to prison after their adopted son was found to have been denied a normal diet. Did someone think these people had commented on Federici’s methods? As far as I know, they have been completely silent about the advice they received from him. And, again as far as I know, they were not served with this complaint, any more than the Internet commentators were.

The fact is that this lawsuit was what is called a SLAPP suit: a strategic lawsuit against public participation. Its intention was to have a chilling effect on public discussion of the methods Federici advocates. Federici was asking for compensation of $300,000, plus treble damages under a Virginia law, plus various other odds and ends. I am sure that these amounts were not expected to materialize; the goal was, instead, to encourage mediation, and to demand, in exchange for dropping the suit, a promise not to mention Federici again. Some states have legislation that allows defendants to fight these SLAPP suits, but Virginia is unfortunately not among them.

I mentioned above that the documents are posted on http://www.citmedialaw.org/. Let me take a moment here to praise the Citizen Media Law Project. I’d put their badge up here if I could figure out how to do it! This group, which is hosted by Harvard’s Berkman Center for Internet and Society, provides services to people who run into difficulties when posting legitimate material on the Internet. I e-mailed them on a Sunday and first thing Monday morning had an answer. Within a day, I participated in a conference call with the group and told them what I most wanted, which was a contact with a Virginia lawyer knowledgeable about defamation and Internet issues. They quickly provided me with the name of Josh Heslinga of Richmond, with whom I arranged for an hour’s consultation at his regular fee-- and the work he actually did must have taken about 5 hours and was enormously helpful. Because Josh was at some distance from the court in question, he suggested several other attorneys, and I found excellent representation at Cochran & Owen of Vienna, VA. All of this went smoothly because of the input of the Citizen Media Law Project-- without them, I have no idea how I would have found an attorney I trusted in a state at some distance from my home.

Adoptive Parents Feeding Survey

2011-06-22T19:42:00.002-04:00

The SPOON Foundation has asked me to invite any readers who are adoptive parents to take a quick survey about foods you used to help the transition from your child's past experience to your ordinary family diet. It's at http://www.surveymonkey.com/s/LZYBK9C.

Do give them a hand, and if you want to talk about it further I'd like to hear your comments.

Creepy Crawlies: Response to Jessica's Comment

2011-06-20T19:58:00.001-04:00

On the comments for “Jean Talks!” post from several days ago, Jessica has asked an important question-- which I would answer right there if I could, but some glitch in this site seems to prevent me from doing that recently. (Help, blogspotters!). In brief, Jess is thinking about crawling because her baby is at about the age when it happens, and she wants to know what the story is, about advice that tells you you have to make your baby crawl-- even that you should move the furniture farther apart if a baby who hasn’t crawled yet wants to “cruise”.

As it happens, I was just looking up some material about this today. The first point I want to make about this is that nowadays most of the people who give this advice are chiropractors. See, for instance, http://unitedfamilychiropractic.com/pediatric-chiropractic/chiropractic-and-the-importance-of-crawling/. This chiropractor warns you that if your baby doesn’t crawl, he or she may not learn to read either.

This is pretty scary, but fortunately not true. If you doubt that, ask yourself if you’ve ever met a person with severe cerebral palsy who couldn’t have crawled, but who reads very well. Q.E.D.

The idea of the essential role of crawling in development seems to have been initiated by one Glenn Doman (not Dorman as the unitedfamily site says), a physical therapist who got his degree in 1940 and who in 1955 started the Institute for the Achievement of Human Potential, which still exists in the Philadelphia area. Doman opined, and he convinced many parents and teachers, that failure to crawl was problematic, and that many developmental disorders, from cerebral palsy to autism and severe brain injury, could be cured by a treatment he called “psychomotor patterning”. Patterning was a procedure in which five adults grasped a child’s head and limbs and moved them repeatedly in a pattern that imitated a reflexive movement of early infancy. (This procedure has twice been rejected as useless in position statements of the American Academy of Pediatrics.)

Why did Doman and his present-day chiropractic followers think this would work? As a first reason, they cite neuroplasticity-- the fact that the nervous system can continue to grow and develop long past infancy. Such a characteristic of the brain certainly exists, but it does not mean that any and all damage can be overcome, nor, certainly, does it mean that crawling movements would cause such recovery.

As a second reason, Doman and the gang repeated the mantra of the late 19th century, “Ontogeny recapitulates phylogeny”, or, the development of the individual repeats the development of the species. To a certain extent, this is true-- but it’s also irrelevant. What they really are saying is that they think ontogeny can recapitulate ontogeny, that a person whose development was interrupted or damaged can be made to go through the same developmental stages a second time and emerge healthy. That’s a lot different from anything about species development, and once again, what does it have to do with crawling?

The “cross-crawl” is an especially silly idea, because what true crawl would not be a cross-crawl, with right arm and left leg moving together and so on? It’s true that some animals “pace” by moving the two legs on the right together, and the two on the left together (I think tigers do this, and horses can be trained to do it). But imagine an infant doing a pace-crawl without falling over. As for some poorly-defined need to use the two sides of the body in “cross” fashion, we do this when we’re walking! One leg bears the weight while the other moves forward, and simultaneously older children and adults counter-rotate their shoulders to keep their balance, causing the left arm to swing forward with the right leg and so on.

There are a number of other issues about motor development, in addition to the Doman/chiropractor stuff. One is what Jessica said: babies will crawl or do whatever when they and the circumstances are ready for the action. If you have a very slippery floor, or a rough splintery one, they may skip the crawling part. In any case, they may only crawl briefly, then get themselves up (maybe because your furniture is a good size and shape to pull on), or for whatever reason they may figure crawling gets them where they want to go and stick with it for months.

However, if a baby gets to be 18 months old and shows no sign of standing, or if he or she crawls asymmetrically, using one leg much more than the other , or if only one hand is ever used in crawling or in reaching, those are all possible signs of developmental problems and should be carefully checked out (and in my opinion, not by a chiropractor).

Jessica also queried advice to put the baby on its stomach on a hard surface when he or she is awake. This is an interesting issue. If you are putting your baby to sleep on its back (and I’m afraid there is no really good reason to do that, no matter what you’re told-- but save that for another time), the order of motor development in the first months will be different than what it would be if the baby slept and spent most of its time on the tummy. Pushing up when in the prone position exercises neck and arm muscles and takes strong muscles to do well. If a baby doesn’t push up well because it hasn’t worked at doing it, getting up on all fours is not going to work too well either, and without all fours, crawling doesn’t happen. All those things will happen eventually, but unless the baby gets lots of tummy time, they won’t happen as early as they did before “Back to Sleep” came along. But… by age two years, no one will be able to tell the difference, so unless you’re worried when the baby doesn’t meet the milestones that are based on babies 20 years ago, there’s no real problem here.

Book Review: "Selfish Reasons to Have More Kids"

2011-06-18T13:30:00.002-04:00

I’m bemused. I’ve just been reading the anti-Amy-Chua, Bryan Caplan, whose “Selfish Reasons to Have More Kids” declares that parenting should not be hard or anxiety-provoking, because what parents do doesn’t have much long-term impact anyway. I must say it’s not so easy to make Caplan’s claims and citations congruent with much that’s known about child development. I wouldn’t want to say he’d been cherry-picking, but he seems to have used a peculiar pie recipe, and some of the fruit is hard to identify.

Let me begin my discussion of “Selfish Reasons” by saying that Caplan starts and ends with a surprising and ill-supported premise: that it’s better to have more people, better for the whole world and for you, too, even if they aren’t your children. If we don’t have lots of people, he says, much of the world will be like living in Hays, Kansas (Caplan’s example, not mine, and what he means is that it would be boring to him). This statement suggests some interesting ideas, because what if there were suddenly many fewer people? This has happened at times, for instance in the time of the Black Death in Europe, and the social consequences were enormous. But you can’t necessarily reason from one event’s results to the possible consequences of its opposite. Having no money is bad, and we can reason from that to the idea that lots of money is good. On the other hand, what about Vitamin A? A deficiency is a bad thing and can result in blindness-- a lot is also bad, as we see from the effects on Arctic explorers of eating polar bear livers.

Have we forgotten that much population growth would mean one of two things: either an increased and destructive demand for food and energy, or a great many starving and distressed people? To assert that it’s better to have more people, without providing a rationale that addresses these possibilities, is certainly to slide by an essential question.

However, I can accept with enthusiasm the idea that having more children [than you thought you’d want] would have a number of selfish benefits for the individual or couple. Yes, kids are a lot of fun, and in the words of Holly Near’s old song, “they remind us how to play”. Having a little crowd of people you know very well is a great idea in this age of high mobility, where the old gang of old friends may not be easy to reach. It’s great to see the grandchildren and watch the whole process of parenting from an intimate but safe distance.

Okay, so far we have two assertions by Caplan—first, that it’s good for the world to have more people (which I challenge), and second, it would be nice for me and others like me, and probably for my children and grandchildren too, to have a big family (which I accept).

But how about the assertion that it doesn’t really matter in the long run what parents do? Ah, here’s the crux, because now we run into matters of definition and of choices of information. Everyone is going to die, no matter what their parents did, so looking at occurrence of death would support the idea that parenting makes no difference, but naturally that’s not what Caplan or Judith Rich Harris mean when they make their claims.

I’m going to make a suggestion about what Caplan really does mean. I think he means that the small differences in childhood experiences for the families he knows don’t over-ride the effects of biological differences. Speaking about a highly restricted range of experiences, Caplan is saying that within that range experiences don’t have much long-term effect. Whether the child goes to a Montessori school or a Waldorf school doesn’t make much difference. Whether he’s given a time-out or a single smack on the behind doesn’t matter much in the long run. But Caplan knows that there are some things that do make a difference, because he points out (on p. 89 and elsewhere) that you ought to be kind to your children. He thinks, probably correctly, that unkindness is not inside that restricted range of circumstances where variations have little effect.

In warning against unkindness, Caplan stumbles into the area of parental attitudes and beliefs that help determine both parent and child behavior. Unkindness is not necessarily defined in the same way by people inside and outside Caplan’s circle. In Michael Pearl’s book, “To Train Up a Child”, Pearl and his wife propose that four-month-old infants who cry or resist a parent should be whipped with a willow switch, or, if no switch is available, a length of plumbing supply line is excellent for the purpose. The Pearls believe this is a kind thing to do, because a child who does not learn early to obey his parents will also defy God and be condemned to Hell. Naturally, if you take this view, you’ll consider it far kinder to save your child from Hell, at the expense of a few minutes of pain, rather than to let him roast for Eternity, just as some of us might think the pain of an immunization is kinder to cause than allowing the risk of death by tetanus.

Caplan’s advice to “be nice”, although undoubtedly valid, is in its vagueness a clue to the lack of real information and thought that went into this book. I can’t expect anyone to read on forever, so let me just address one example of incompleteness here: the discussion of behavior genetics. Caplan provides a handsome equation on pp. 73-74, describing the fraction of developmental variance explained by heredity, the fraction explained by shared family environment, and the fraction explained by aspects of family environment that are not shared by the family’s offspring. Very nice, but what is missing, and quite important, is the variety of interactions between heredity and environment. An example of such an interaction would be the custom in some parts of the world of giving available food to males in a family, and restricting females to whatever food is left over. This is particularly relevant to protein sources. The genetic factor, maleness or femaleness, determines how much food is consumed when resources are limited; the genetic factor thus causes an environmental effect that has a direct influence on development of both body and mind. In this type of interaction, the genetic characteristic actually evokes a response from the environment because of social attitudes.

Very well, you say, but I don’t feed my son more than I feed my daughter. What does this have to do with my parenting? What it has to do with the parenting of people who are likely to read this review is that discipline techniques, to work well, need to be matched to children’s biologically-determined temperaments, such as tendencies to explore or to withdraw from new things, or to have a generally positive or generally negative mood. (By the way, I expected Caplan’s interest in biological factors to lead him to temperament, but apparently it didn’t.) An example of research in this area is Kochanska, G., Aksan, N. & Carlson, J.J. (2005). Temperament, relationships, and young children’s receptive cooperation with their parents. Developmental Psychology, 41, 648-660.

Another important point about interactions between heredity and environment has to do with age. It’s so easy to assume that whatever is true about “nature” and “nurture” in infancy will be true in childhood, adolescence, and so on. But this is not the case, and statements about heredity and environment need to consider events across the developmental trajectory. Take for example Williams syndrome, a genetic disorder that has obvious effects but is not very debilitating. Adult Williams syndrome individuals have wonderful language abilities and are extremely sociable, although because they have little social anxiety they may make things awkward for others. So what would you think they were like as babies? Friendly, early talkers? No, they are not at all the way you would expect them to be. They have horrible colic, which lasts longer than with most babies and makes them extremely irritable. When they begin to recover from the colic, rather than laughing and smiling, they stare at people as if longing for eye contact. They don’t even begin to talk until about age two, rather than the typical 12 months or so.

These are just a few examples of the failings of Caplan’s book, which may have started as a desirable antidote to Amy Chua’s drag-them-by-the-hair philosophy, but which has ended up omitting too many details to provide useful arguments. I notice that the Wall Street Journal review admires the book for its omission of abstruse psychological concepts; that’s okay with me, but I do want to see evidence and reasoning that are relevant to claims, not just evidence that “shows the flag” but does not actually speak to the premises of the book.

[Disclosure: This review was written at the instigation of my son. Now may I play with the grandchildren?]

Gotta Pass the Physical: Child Psychotherapy as a Contact Sport

2011-06-16T09:45:00.002-04:00

A friend recently passed on to me some interesting information about some Ohio practitioners who employ holding therapy (HT), a physically-intrusive procedure, as a method of purportedly establishing a child’s emotional attachment to his or her parents. Like many proponents of the Attachment Therapy approach, these particular people attribute a great many childhood problems to a lack of attachment, believe that establishing attachment will solve the problems, and also believe that their HT methods create attachment.

There are quite a few proponents of this unconventional form of treatment, in spite of the fact that HT, a type of physical restraint, has been associated with injuries and even deaths of children, and is remembered with terror by adults who were formerly subjected to it. (For more information on this point, see Attachment Therapy on Trial [Mercer, Sarner, & Rosa; Praeger, 2003]). What makes the subjects of today’s post a bit different is that they require a physical examination before accepting a child into their treatment program. Children aren’t treated unless there’s medical evidence that they can stand the treatment.

I will bet a large amount of money-- even the amount an unconventional practitioner recently sued me for unsuccessfully-- that nobody can find me a conventional psychotherapist who has this requirement for treating a child. (Asking for a general medical exam, to make sure there is no physical reason for mood or behavior problems, is not the same thing.)

The HT practitioners in question are at an Ohio counseling center (www.lake-cc.com). Here is what they say about the need for a preliminary physical examination: “… some attachment and bonding interventions evoke anger or anxiety responses similar to those found after exercise. … at times during the treatment process elevated emotional states are expected. If at any time a participant’s behavior creates a risk of physical harm to themselves or others, brief periods of physical holding (i.e., several minutes) to ensure safety may be indicated. In order to further ensure the safety and wellbeing of all participants in attachment therapy using holding interventions, we require participants to pass a physical exam from their medical provider (similar to those given for sports activities) prior to participation.” (Incidentally, these practitioners also state that they abide by the safety standards of ATTACh, the Association for Treatment and Training of Attachment in Children (www.attach.org), a group that has been stating that its members use only mild holding since shortly after the 2000 death of 10-year-old Candace Newmaker at the hands of holding therapists.)

Let’s examine the claims of the Ohio therapists under a strong light. “Anger or anxiety responses similar to those found after exercise.” What anger or anxiety responses are found after exercise and actually caused by exercise, as opposed to anger at getting a red card or anxiety that your ankle injury will sideline you for the season? As an every-other-day gym attender, and mother or grandmother of four sports enthusiasts, one whom lifts 500 pounds, I have never seen or heard of exercise-caused anger or exercise-caused anxiety. On the contrary, exercise is usually thought of as having a calming effect. Why would we contribute to the YMCA swim team if it made kids unnecessarily upset? Wouldn’t there be a nation-wide anti-youth-sports movement if there were any truth to this idea?

So what’s the point of making this claim, equating exercise and sports activities with the experience of being restrained? It would appear that the goal here is to “normalize” the use of physical restraint in child psychotherapy, to make it appear to be common and acceptable, just like Little League-- when in fact it is not only unconventional but has been established as a potentially harmful treatment as defined by the Emory University psychologist Scott Lilienfeld. By introducing the exercise concept early in their discussion of HT, these practitioners pave the way for their later statement requiring a physical examination, and they close the persuasive bracket by another reference to sports. The "logic" then becomes the following: childhood sports are normal and acceptable; childhood sports require a physical examination; HT requires a physical examination; therefore HT is, like childhood sports, normal and acceptable…. so don’t be alarmed at the idea that there might be some potential for harm in HT; there’s some risk in everything, even being on the swim team.

This is really quite a beautiful and expert use of persuasive techniques, and one almost has to admire the author of the document. Almost--- until it’s remembered that HT is a method whose effectiveness is unsupported by research evidence and which is potentially harmful. It doesn’t work, it can do harm; doesn’t this tell us something important? Of course, the document doesn’t address either of these concerns.

One query: what about the physicians who do these physical exams? What do they think if and when they’re told that the exam is in preparation for psychotherapy? Pediatricians, if you’ve received such a request, did you think of discussing it with child protective services?

P.S.
A few additional points of interest: the Ohio therapists state that they may have parents hold their children for diagnostic purposes. Now, any behavior sample can contribute to a diagnosis, but it’s deceptive to suggest that observations of holding are in any way standardized, or that any systematic research has connected holding behaviors to one diagnostic category or another. This claim is not surprising, though, in light of the therapists’ use of the Randolph Attachment Disorder Questionnaire (RADQ), a poorly-developed and unstandardized test whose creator, Elizabeth Randolph (California psychology license revoked some years ago) states that it diagnoses “Attachment Disorder”, a disorder never described or used in any conventional work.

Jean Talks! Podcast for Center for Inquiry

2011-06-14T16:04:00.004-04:00

If you want to hear a podcast discussing myths, mistakes, and misunderstandings of child development, go to

http://www.pointofinquiry.org/jean_mercer_child_development_myths_and_misunderstandings/

where you'll also see the adorable cover of my critical-thinking-oriented book Child development: Myths & Misunderstandings (Sage, 2009).

I had fun being interviewed by Karen Stollznow... now I have to buckle down and do the promised revised version of this book.

If anyone has a new myth to suggest, I'd be interested to hear about it....

Eye Contact and Sign Language: A Comment from "Messy Mommy"

2011-06-11T11:52:00.005-04:00

Blogger seems to be having difficulty in permitting me to respond to comments, so I'm going to use this method to call people's attention to a fascinating response I received to a recent post, http://childmyths.blogspot.com/2011/05/more-about-infants-and-eye-contact-gaze.html. "Messy Mommy" has written to describe issues that arose when her toddler was paying attention to gestures and not to faces.

Do read what she had to say if you're interested in this eye contact business.

If anyone has had other relevant experiences with their children, I would be very interested in hearing your stories.

When Child Therapists Promote Coercive Tactics: A Deadly Trickle-Down

2011-06-06T17:47:00.002-04:00

The front page of the New York Times today (June 6, 2011) carries a most disturbing story headlined “A Disabled Boy’s Death, and a Troubled System” (http://www.nytimes.com/2011/06/06/nyregion/boys-death-highlights-crisis-in-homes-for-disabled.html?_r=1&ref=dannyhakim). The article reports that “on a February afternoon in 2007, Jonathan, a skinny, autistic 13-year-old, was asphyxiated, slowly crushed to death in the back seat of a van by a state employee who had worked nearly 200 hours without a day off over 15 days. The employee, a ninth-grade dropout with a criminal conviction for selling marijuana, had been on duty during at least one previous episode of alleged abuse involving Jonathan. “I could be a good king or a bad king,” he told the dying boy beneath him, according to court documents. In the front seat of the van, the driver, another state worker…, watched through the rear-view mirror but said little.” The boy was in the face-down restraint position well-known to carry a risk of asphyxiation. When Jonathan stopped responding, the two staff members spent an hour driving around, talking and shopping, with his body in the back of the van.

The article goes on to describe how Jonathan had been losing weight at the state school where he was a resident, and a logbook about his treatment revealed that “the school was withholding food from Jonathan to punish him for taking off his shirt at inappropriate times”. Bruising and other injuries had been part of Jonathan’s school life as well as that of other residents.

Obviously, there was no single cause for this horrible event. Overwork , undertraining, and lack of supervision of staff are important reasons, as is the hiring of individuals with criminal records. But I believe there is another factor: methods proposed by a small number of child psychologists, therapists, and parent educators, which suggest that coercive and potentially dangerous techniques are acceptable ways of dealing with noncompliant children. Those methods are directed toward family use, but I question whether such recommendations do not “trickle down” to use in so-called special education facilities.

Some readers will recall that I have mentioned in earlier posts situations in which parents were advised to withhold food from children in order to force compliance. (I described one case in which the parents who withheld food and kept a child locked up both received prison sentences, but the therapist who advised them suffered no consequences.) Others as well as I have repeatedly discussed the continuing problem of recommendations for restraint of individuals in the prone (face-down) position, and the possibility of asphyxia when this advice is taken.

I would contend that these suggestions do more than put specific home-reared children and their families in danger. The existence of this advice, without response by comment or consequences from professional licensing boards or from national professional organizations, is a signal to those who care for the developmentally disabled. The signal says: withholding food and using dangerous types of restraint are good techniques for families to use; therefore, they are appropriate and acceptable for residential school staff too.

Recently, I spent 90 minutes listening to an audio presentation available at http://www.consequences.com/aggression/audio.html. This presentation was essentially a lengthy advertisement for a $900 weekend training in which parents would be taught methods of restraint declared to be safe by one of the presenters, a person who in his self-published work has recommended face-down restraint as a means of establishing compliance in children.

The weekend was described as providing contact with people to talk to, who would not turn the parents in to child protective services. It was also to include advice about establishing relationships with the police and with protective services staff so they would not take complaints of abuse seriously. Declaring that he didn’t understand “fancy psychotherapeutic stuff”, one of the presenters stated that he was “FBI trained” and that he would personally train and certify parents in restraint methods. The certification would give them credibility with authorities who might otherwise object to their treatment of children. The presenter suggested that single parents needed to recruit outsiders to help them with restraint, and that living in northern Virginia he arranges for Marines from Quantico to do this.

This presenter, and others with similar messages, break no laws when they give this type of advice and suggest ways to evade the attention of authorities who deal with child abuse. Even parents who follow the advice are unlikely to meet legal consequences unless, and until, a child is injured by their actions. As the Times article shows, when that kind of advice trickles down to the residential treatment center level, even harm to a child may receive only the mildest punishment. (In Jonathan’s case, the driver who watched the child being killed “had been fired from four different private providers of services to the developmentally disabled before the state hired him to care for the same vulnerable population”.)

I don’t propose legislation that would prohibit giving bad advice about parenting. There are too many possibilities for any law to cover. I do ask, however, why professional licensing boards and professional groups like the American Psychological Association appear to be indifferent to advice that can mislead parents and harm families, and that may encourage public attitudes that foster ill-treatment of the developmentally disabled. I understand and cherish the First Amendment, but I don’t believe that professional privileges include the right to mislead.

Incidentally, in the audio presentation mentioned above, one of the presenters says that in some states continuing professional education credits may be available for the advertised workshop. If anyone comes across CE units given for such a class, I would very much appreciate hearing from you about it.

Does Individualized Treatment Mean Systematic Research is Impossible?

2011-06-04T11:26:00.002-04:00

In a recent e-mail discussion, someone mentioned to me her belief that it was not really relevant that some psychotherapies for children are not supported by clear research evidence and thus can’t properly be called “evidence-based”. She reasoned that because psychological treatments have to be tailored to individual cases, it is impossible to control how the treatment is done, and real experimental research like that done in physical medicine cannot be managed. Therefore, she argued, we should not demand that psychotherapies be supported by evidence from randomized trials.

That correspondent was talking about a treatment called Dyadic Developmental Psychotherapy, which has not earned the “evidence-based” category, but she was certainly not the only person to make that argument, nor is DDP the only treatment that has been discussed in this way. Several weeks ago, when I was present at a workshop on Sensory Integration treatment, I took the opportunity to ask the presenter privately where she stood on the idea that Sensory Integration lacks the support of research evidence. She cheerfully agreed that it had very little support, and followed up her statement with the argument that individualization of treatments means that it will never be possible to evaluate SI and provide clear research evidence supporting its effectiveness--- so, we should choose to use SI or similar methods simply on the basis of therapists’ judgments about what seems to “work”.

These are not irrational arguments, but I think they are wrong. Obviously, research on any treatment of human beings is going to involve many more complicated factors than, say, studying which kind of fertilizer gives the best crop for a particular kind of bean. With more factors, it becomes increasingly harder to define and interpret outcomes. Nevertheless, by following rules of research design, it’s possible to work out ways of deciding whether a treatment is more effective than another choice (whether it’s a different treatment, no treatment at all, being on a waiting list for the desired treatment, or whatever it may be). Applying those rules gives a better assessment of the treatment than can be given by the judgment of a therapist who is very much involved in the therapy, or the judgment of parents who may have their own reasons for enthusiasm or hostility toward a particular psychotherapy for their children, or for that matter the judgment of the treated children themselves.

Here’s the thing: in most situations where either a child or and adult is going to receive psychological treatment, somebody is going to make a decision about what the treatment will be. That “somebody” may be a parent or a teacher or a judge or a psychologist or a social worker. Without research evidence, none of those people have anything but their own experience or other people’s opinions to go on, and even very experienced therapists can hardly have treated more than a few hundred of certain kinds of problems in their professional lifetimes. Their opinions may be better ways of making choices than flipping a coin, but they can’t be nearly as good decision guides as systematic research, and I’ll tell you why.

1. Individual teachers or therapists can only have a limited number of past observations to go on, but systematic research approaches can bring together information about hundreds of similar cases. The great advantage of having all those cases is that the individual differences between children and their situations are likely to average out and “disappear” arithmetically from measurements of the children’s conditions. In addition, when you work with small numbers of children, it’s much more likely that individual differences will affect the results, and even that the children you are looking at are by accident a different sort of people than the rest of the population. (This is like the old sock drawer problem: if you have a drawer full of socks, half of them white and half black, and you pull out only three, it could easily happen that all three are the same color. But when you pull out a dozen socks, chances are that you will get something closer to half black and half white, and with two dozen that’s even more likely. Similarly, if half of the children will get “better” with a treatment, and the other half will get ”worse”, it could easily happen that a small number of children could by accident all be of the “getting better” type.)

2. Individual therapists or parents may not be in a good position to compare children in treatment to children with similar problems who are not being treated. Without that kind of comparison, it’s impossible to know whether changes in the treated children are caused by the treatment, or whether they change just because they are getting older, or whether their problems are of a temporary kind to begin with. The rules of systematic research direct us to begin a study by establishing a comparison group of people who are similar in age, sex, socioeconomic status, etc., etc. to the people who will be treated, but who will receive a different treatment, or possibly no treatment at all. Simply comparing the children’s conditions before and after treatment is just not good enough, because it gives us no idea whatever why any improvement has occurred, and improvement can take place for a thousand reasons-- even the parents’ changed behavior because they have confidence in a therapist.

3. Individual therapists, parents, or teachers, however careful they may try to be, can find it impossible to be objective about the effects of a treatment. This is not an insult, or even a criticism, but just the statement that all of us human beings easily think or remember things the way that makes most sense to us or that suggests that we’re right about something. Well-designed research does not let this kind of subjectivity get in the way, because it makes sure that children are evaluated by people who do not know what kind of treatment they are getting, and that the data collected are also analyzed “blind” by people who don’t know the children.

4. Individuals may be very much tempted to make decisions about treatments on the basis of other individuals’ experiences-- testimonials, for example. But those individual experiences are very likely to be seriously biased in ways that systematic research is not. What testimonial ever said, “Oh, it was okay, I guess”, or for that matter, “It was ghastly-- what a waste of time and money”? Decisions based on individual experience are likely to pay close attention to positive statements and ignore neutral or negative experiences. On the contrary, the job of systematic research is to try hard to find negative information that will lead to the rejection of a treatment unless it is far more than balanced by positive findings.

All these are reasons why choices about treatment are better based on systematic research than on individual experiences. All choices are likely to be based on some information rather than by random decisions, so it only makes sense to choose treatments based on systematic research evidence when that is possible (and, by the way, it usually is possible, as there are well-supported psychotherapies for parents and children).

One other thought, however. I don’t mean to say that individual experiences are worthless, and in fact there is one situation where they may be enormously valuable in the assessment of a treatment. This is the case when a therapy is actually potentially harmful under some circumstances. We can assume that even potentially harmful therapies don’t hurt every client, because it would rapidly become obvious if they did. However, if they harmed only one person in a thousand, it would be important to know this. Chance factors might mean that no individual in a systematic study would be hurt. We would be likely to find out about problems only from family members or from a therapist who observed an adverse event. Let’s hope that if such discoveries are made, the observers will find some way to make their findings publicly known.

Comments

2011-05-26T10:43:00.001-04:00

I don't know what's going on with Blogspot today, but I seem to be able to publish people's comments but not respond to them. Sorry!

Jean

Reactive Attachment Disorder: Mistakes in a Master's Paper

2011-05-23T19:36:00.003-04:00

NOTE: No sooner had I posted this comment than a message forwarded to me stated that UW staff had intended to take the paper down and somehow the process had not worked. I am going to leave this post in place in case there is some mysterious archive or cache where the paper I discuss remains, but I want to give credit where it is due for a good decision.

MY ORIGINAL POST
Some months ago, I came across a master’s thesis from the University of Wisconsin, with the title “Effective Interventions for Children With Reactive Attachment Disorder”. I read the document, which was on the Internet, and felt very disturbed by the misconceptions that it passed on to the public. Most unpublished master’s theses never really see the light of day and quickly tumble into the academic abyss, but when things are available on the Internet it’s a different story. I was concerned that this paper would be read, believed, and repeated in the form of undergraduate psychology or education papers handed in to unwary instructors who didn’t use turnitin.com. This would mean that the misunderstandings contained in the paper would multiply and multiply further, following the psychological version of Gresham’s law-- “bad ideas drive out good.”

Because of these concerns, I contacted the department that awarded the master’s degree and stated my concerns. They were very polite and said they would take down the document and discuss the matter, and I suppose they did. They didn’t tell me, and I could hardly expect them to.

But guess what: here’s the paper on line again, at minds.wisconsin.edu/bitstream/handle/1793/42939/2008/wiersumc.pdf?sequence=1.

The author begins her paper by referring to a claim by Nancy Thomas to the effect that Ted Bundy, Saddam Hussein, and Adolf Hitler probably all had Reactive Attachment Disorder. Thomas is a former dog trainer who has achieved a considerable following among a group of foster and adoptive parents by stating, among other things, that the way you know whether people are good parents to foster or adopted children is that the children still have their arms, legs, and heads attached. She is completely without training in child development or clinical psychology and is a most inappropriate source for a master’s thesis to quote as an authority. As for the statement about the three frightening figures, little accurate information about their childhoods exists, particularly about the preschool period in which it might be possible to diagnose Reactive Attachment Disorder, a problem that is difficult to identify in any case (as the author herself later notes).

The master’s candidate goes on to discuss Reactive Attachment Disorder, citing a couple of published sources. She then lists without citation characteristics that she attributes to RAD, including tantrums, destructive behavior toward self or property, problems making eye contact, and being affectionate toward strangers while failing to show affection to parents. None of these are characteristics of Reactive Attachment Disorder as it is described in the Diagnostic and Statistical Manual of the American Psychiatric Association. They are, however, included in various checklists available on line and recommended by their promulgators for use by parents deciding whether their child needs therapy for attachment problems or for diagnosis of the entirely notional “Attachment Disorder” suggested by various unconventional therapists. Our author, incidentally, does not reference DSM-IV-Tr and presumably has not read it; her only citation to this important volume is in a secondary source edited by Dziegielewski (of which the first edition recommended Holding Therapy and failed to discuss criticisms of that method).

By p. 5, the master’s candidate states that children with RAD have been unable to complete the “attachment cycle”, a term she fails to define or cite a source for, and one that is completely unknown to John Bowlby’s attachment theory. Although she refers to Bowlby, she does not reference his work and it is fairly clear that she has only come across it in secondary sources.

The author eventually concludes that there is no evidence supporting any of the methods of treatment she outlines, nor, for that matter, is there any clear method of diagnosing RAD. While I would certainly agree with these conclusions, I must point out that she discusses none of the efforts that have been made at testing the methods she refers to, nor does she touch on the numerous critiques of that research and of diagnostic approaches that have been published in the last 10 or 12 years. Neither does she refer to the 2006 report of the APSAC Task Force on Attachment Disorders, published in Child Maltreatment; instead, she cites authors who were specifically mentioned in that report as using inappropriate treatments. In addition, she omits to mention evidence-based treatments like Parent-Child Interaction Therapy.

I am especially concerned about the flaws in this master’s thesis (of which I have mentioned only a small portion) because the degree is in school psychology, an area where it is all too easy for professionals’ misunderstandings to spread to teachers, parents, and children themselves. The fact that a school psychology professional means well is not a sufficient saving grace when harm can be done in this way. As authors writing about fads in special education have pointed out, meaning well can be dangerous; “politically correct treatments are… adopted… because they resonate in their purported nature and effects with ideological perspectives, or because their use contributes to the realization of other, perhaps tangible, socially progressive goals… The rationale… may be no more complex than ‘ to do the right thing’ “ (Jacobson, J.W., Foxx, R.M., & Mulick, J.A. (2005). Preface. In J.W. Jacobson, R.M. Foxx, & J.A. Mulick [Eds.], Controversial therapies for developmental disabilities [pp.xi-xvii]. Mahwha, NJ: Erlbaum, p. xv).

It’s hard to see what motive other than political correctness allowed this paper to be approved and a degree awarded, or indeed any reason why the paper should be on the Internet to confuse and mislead readers who are unlikely to know how to critique it. What those reasons may be, I leave to others to consider. My sole hope is that when students or parents Google and find the master’s thesis, they will also find my comments-- and perhaps be warned by them.
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What is Floor Time? Well, Folks, It Isn't Physical Restraint

2011-05-21T14:41:00.001-04:00

I’ve just been hearing some discussion at http://www.beyondconsequences.com/aggression/audio.html. In this audio presentation, preparatory to a weekend conference for adoptive parents concerned about aggressive children, Heather Forbes and Ronald Federici spoke of methods that involve physical restraint as a way to reduce child violence. It wasn’t clear exactly what methods were to be used, but presumably they resemble the ones talked about in Federici’s book.

Much has been said about physical restraint in a prone position and other aspects of Federici’s methods. I don’t plan to talk about those criticisms here. What I’m concerned about is terminology and what might be called “definition creep”. I’m especially concerned about the use of the term “Floor Time”.

In the audio presentation, Federici uses “Floor Time” to refer to physical restraint of a child lying on the floor. He also refers to Stanley Greenspan, the originator of the actual Floor Time approach. Whether Federici, who knows of Greenspan, also knows that the term Floor Time had been used for about 20 years to mean something quite different from physical restraint-- well, that I can’t tell. However, I hope this post will help readers differentiate between Floor Time as defined and practiced by the recently-deceased, much-admired child psychiatrist Stanley Greenspan, and the methods advocated by Federici. Incidentally, the term Floor Time is trademarked.

Floor Time (the TM kind developed by Greenspan) is an aspect of DIR-- Developmental, Individual Differences, Relationship-based therapy for autism and similar developmental disturbances. It’s not only a method, but a philosophy characterized by adult responsiveness to the child’s lead and the complete absence of coercion. Here is a description of the Floor Time method: http://www.icdl.com/dirFloortime/overview/documents/WhatFloortimeisandisnot.pdf.

Floor Time has been used for many years as a method for working with normal toddlers and preschoolers in child care and educational settings. It is an effective way to help anxious children communicate their fears and relax and play. Teachers trained in doing Floor Time learn to follow the child’s lead by accepting and encouraging whatever the child wants to deal with, rather than doing what is all too easy and trying to distract the child from themes that are “not nice” or too worrisome to the adult.

Parents can also do Floor Time by spending twenty minutes or half an hour not only “on the floor” (i.e.,at the child’s level) but carefully responding to the child’s ideas. This “following the child’s lead” does not mean getting bossed around by the child, and of course safety for people and property is a first rule. Instead, a parent who is following the child’s lead will accept a role to be played (“you be the fireman”) and will occasionally and cautiously make a suggestion that elaborates on the child’s thinking. Practice in Floor Time is enormously helpful to parents who don’t know how to play, or who get bored with the child, or who are concerned with their own dignity rather than with the developing relationship. Greenspan was known for his belief that emotional and intellectual abilities are deeply connected, and Floor Time is intended to support their intertwining development.

When you read about Floor Time or hear it mentioned, it might be a good idea to check whether the term is being used accurately or not. Not everything that happens on the floor is Floor Time! And I believe the idea that Floor Time is physical restraint would be shocking to Stanley Greenspan if he could know, to Gil Foley, and to other people involved with the Interdisciplinary Council on Developmental and Learning Disorders. I plan to pass my concern on to the latter.

Looking Backward: Sources of the "Primal Wound" Belief

2011-05-20T15:33:00.004-04:00

Very few ideas get created out of nothing, so it’s always interesting to look for the “ancestors” of beliefs that seem to appear suddenly and be spoken of by a small number of people. Ever since I first came across the “Primal Wound” (the belief that newborn babies who are relinquished for adoption thereby sustain a deep, lifelong psychological wound) , I’ve been wanting to find time to look for some historical background. I’ve found quite a bit-- all confirming the statement attributed to Gershon Scholem, that “Nonsense is always nonsense, but the history of nonsense is scholarship”.

In an earlier post, I pointed out the roles of the Czech psychiatrist Stanislav Grof and the British “clinical theologian” Frank Lake in arguing that unborn babies are aware, not just at 34 weeks, but all the way back to conception. Grof and Lake believed it was possible to know what unborn babies felt, by means of LSD experiences that they thought allowed them to recall their prenatal lives.

Just a little earlier than Grof’s and Lake’s work, a book called The search for the beloved (1949) was published by Nandor Fodor. Fodor had been a psychic researcher, “ghost-hunter”, and exorcist in England before training as a psychoanalyst. In an interview published in Psychoanalytic Review not long before his death in 1964, Fodor asserted that there was telepathic contact between a mother and her unborn child (Spraggett, A., “Nandor Fodor: Analyst of the unexplained”. Vol. 56, pp. 128-137). In a 1957 article (Fodor, N. “Prenatal foundations of psychotic development”. Samiksa Vol. 11, pp. 1-42), Fodor advised that all births should be by Caesarean section in order to avoid the shock of birth and possible resulting schizophrenia. In The search for the beloved, incidentally, Fodor advised that no psychotherapeutic treatment was complete until it reached memories at the fetal level. Emphasizing the influence of the mother on the unborn baby, he suggested that birthmarks are indeed caused by mothers’ experiences. He rejected the idea that most maternal shocks are not followed by birthmarks, saying “the cases in which the shock of the mother is not followed by a marking of the child’s body furnish no contrary argument. Negatives never prove anything “ (p. 330)-- an argument that has emerged a number of times in discussion of the “Primal Wound”.

A number of Fodor’s remarks in The search for the beloved foreshadow statements by Nancy Verrier and her followers. Here are some of them: “At first, the child is unable to realize that the mother’s breasts are not part of its own physical and psychic organism, that the mother is a being apart” (p. 174). “[F]oster parents and institutions cannot enter into the same psychic bond which the pre-natal community of life and immediate post-natal maternal care established “ (p. 165). “In the case of illegitimate birth the child’s reactions to life are bound to be completely abnormal” (p. 166).

Next question: where did Fodor get his belief system? Some answers to this question can be found by looking at the authors whom Fodor quotes in The search for the beloved. There are two major sources cited, one of whom in turn quotes the other. The first is the psychiatrist J.Sadger (I can find no first name for him, and assume that he is not the same person as Freud’s colleague I.I. Sadger). In 1927, at a psychoanalytic conference in Innsbruck, Sadger spoke of the need for analytic patients to go back to memories from infancy, birth, or earlier; if neurotic symptoms did not dissipate at that point, they need to focus on the embryonic period in earliest pregnancy, or even on their memories as sperm or the ovum. In a 1941 Psychoanalytic Review paper (“Preliminary study of the psychic life of the fetus and the primary germ”, Vol. 28, pp. 327-358), Sadger discussed whether the ovum consciously selects one or another sperm for fertilization purposes, and whether the zygote contains an inheritance of “the rejection or inclination of one [parent] toward the other at the time” (p. 330). He asserted that “I believe first of all that the embryo already feels plainly whether its mother loves it or not, whether she gives it much love, little love, or none at all, in many instances in fact in place of love sheer hate” (p. 336). Assuming that all events, physical and mental, are overdetermined by psychological factors, Sadger opined that “many a fall or other accident of a pregnant woman is nothing else than an attempt at abortion on the part of the unconscious” (p. 336).

Sadger in his turn seems to have owed some of his thinking to Georg Walther Groddeck, a second source frequently cited by Fodor. Groddeck was a physician whose ideas had some influence on Freud’s later work. In 1923, Groddeck published Das Buch vom Es (The Book of the It), a volume in the form of letters to a female friend signed by “Patrik Troll”. This volume was translated and re-published in 1947 as The Book of the It, with a preface by the British novelist Lawrence Durell. The “It” of this title had nothing to do with the Addams family, but was a vaguely-defined combination of a universal vital force and the learned anxieties and desires of an individual, working together through the unconscious mind to shape both physical and psychological characteristics of the person. Groddeck considered the primary motivations to be the desire of the child for the mother and the mother’s experience of sexuality while holding the child inside her body and while giving birth, an event that Groddeck seemed to perceive as a sort of reverse intercourse with the object being expelled rather than penetrating. Groddeck’s belief that all aspects of life can be influenced by the unconscious shows in his anecdote about telling a woman with a breech presentation that giving birth vaginally with a head presentation felt very good; he claimed that the fetus reversed positions within half an hour after this discussion. He attributed both infertility and impotence to unconscious rejection of relevant aspects of life-- and, by the way, claimed that a man could not penetrate a woman unless she “unconsciously” wanted this to happen.

Here we see some, though by no means all, of the precursors whose ideas are responsible for Nancy Verrier’s “Primal Wound” belief. Need I point out that none of them have any basis in systematic study of psychology, biology, or medicine? These claims date back to a time when few people asked for the evidence behind assertions like those of Fodor, Sadger, and Groddeck (but even Freud numbered Groddeck among the “wild psychoanalysts). We’d do well to think of these ideas, including the “Primal Wound”, in 2011 terms, not those of 1923.

Myths and Misunderstandings, Ages and Stages, and "Parenting Within Reason"

2011-05-20T10:37:00.003-04:00

A month or so ago I had the pleasure of being interviewed by Colin Thornton of Parenting Within Reason. He was interested in issues discussed in my book Child Development: Myths & Misunderstandings (Sage, 2009), and we got into some points from the book, some other points that have come up on this blog, and some brand-new things as well. You can hear the podcast at http://foundationbeyondbelief.org/fbbpodcast. (I warn you though-- it’s a whole hour long.)

Colin asked some excellent questions and made me glad I’ve spent a long time thinking about this stuff. Even so, there were some where I was tempted just to say “hommina hommina hommina.”

One question was an important one that I confess I would never have thought to talk about. Colin asked me about stages of development-- were there really stages, and is it essential to go through all of them? This is one of those questions where a simple Yes or No is not much help, so I tried to touch on a lot of issues (probably many more than Colin had in mind when he asked).

To begin with, “stage” is a metaphor. The use of metaphors for description in psychology is very common, because many of the events we need to talk about are not easy to observe directly. They may be mental events like attitudes, which we can only infer. Or they may be events that take a long time to unfold, as is usually the case in child development. “Stage” is a metaphor because it compares events in a child’s life to passages over spatial distance rather than focusing on them as changes over time. A stage is literally “a place to stand”, but that implies the possibility of standing in other places at other times. A stage coach was a vehicle that covered a set amount of distance and either dropped off passengers to catch another coach, or changed tired horses for fresh ones. Each stage or distance covered was thus not only farther away from the original one, but in other ways different from the ones before it.

Similarly, the metaphorical stages of development also have each their specific distance (time) from the starting point, and they have both quantitative and qualitative differences from the previous stages. “Quantitative” differences are obvious enough-- at later stages, many things (like walking or talking) may be done faster or more often than at earlier stages. “Qualitative” differences are not just more or less, but new and different ways of doing things. A baby who crawls moves in a different way than a toddler who walks, and the toddler’s stiff-legged, wide-based walk is in turn a different kind of movement than the 8-year-old’s free rope-jumping, dancing, or hopscotch-playing. Each stage of development is not only more advanced toward maturity than the stages before it, but is qualitatively different both from the previous and the succeeding stages.

So, Colin Thornton asked me, do people have to go through all the stages? What if a baby doesn’t show much evidence of a particular stage, but instead goes right on to the next one? Is that child going to miss something developmentally? How about crawling, particularly-- a stage that many parents have worried about over the years? No, the fact is that if a child has not developed to the point where the actions of the “next” stage are possible, he or she can’t do those things. Whatever the child does, that by definition shows his or her level of development. And children don’t all spend the same amount of time on each stage. It’s as if some have very fresh horses to pull their stage coach through one part of development, and tired ones for another stage. Some crawl for months and months before standing to walk holding on, others crawl for a day or two, and still others just sit around until they’re ready to stand, or scoot on their bottoms to get where they want to go. In the long run, it makes little or no difference to the child’s general development. (And there’s certainly no reason to try to insist that a child crawl; like trying to teach a pig to sing, it doesn’t work, and it annoys the pupil.)

There are a couple of other points I’d like to make with respect to stages of development, and these are things that Colin and I never got to. One is that although there’s no reason to be concerned about a “skipped” stage, there may be reason for concern if a child has been able to do some movement or task consistently and then “drops back" to an earlier stage. An example would be a child who has been walking holding on and now goes back to crawling exclusively (not just for convenience). It’s important to find out whether there’s a physical problem causing this apparent regression.

Second, one factor in whether a child seems to move beyond a particular stage has to do with what the Russian psychologist Lev Vygotsky many years ago called the Zone of Proximal Development. This term describes a phenomenon common throughout development: a child can perform an act when a parent or familiar caregiver is watching from nearby, but not when alone. The social and emotional support of a smiling, encouraging adult seems to help the child (or even a teenager) organize a new and difficult behavior which may not be possible when alone. We don’t “teach” a child to walk, but our encouragement may actually make it possible for actions to be accomplished at the beginning of a new stage. (Look away, or go and answer the phone, and the baby gets disorganized and falls down.)

There’s more about development on the podcast, and I promise you that although I sometimes thought “hommina” I never actually said it. I’m embarrassed to urge you to buy the book, but if you’re interested in what I say on this blog you might like it (see Amazon for a sample).

More About Infants and Eye Contact: Gaze, Words, Gestures

2011-05-18T14:40:00.001-04:00

How and why people make “eye contact” is a source of never-ending interest, especially to parents and caregivers of infants and toddlers. Experiencing a mutual gaze (which is probably a better term for eye contact) can be very gratifying to adults; it seems to tell us that some other person thinks we are really worth paying attention to. We don’t care for a stare-- when another person keeps his or her gaze ready to “catch” ours even though we pointedly look away-- but when we gaze at another, we are happy to find that that person gazes back at us. Because we find mutual gaze pleasing, parents are delighted when their infants return their gaze and carry on a prolonged shared look. When infants don’t do this after a few months of development after birth, their parents may also worry that there is something wrong. Perhaps the child’s vision is not normal, or perhaps there’s some burgeoning problem of early mental health. Autism is commonly feared by modern parents who have heard that lack of eye contact is characteristic of children with serious developmental problems of this type.

It’s true that in typical development, there is a growing use of the gaze in communication. It’s not just relevant to love and attachment, but to thinking about and understanding what other people want and do. Watching another person’s gaze gives more than emotional gratification—in combination with facial expression, it can tell you what he knows about, what he’s afraid of, what he wants you to do, and so on. All these are important things for a baby to figure out. Let’s not forget, though, that visually-impaired babies, children, and adults usually manage to learn these things about other people even though they do not have the capacity for mutual gaze or for monitoring the direction of another person’s gaze. The typical pattern of development for the normally-sighted baby is probably the easiest to manage, but it is not the only way human beings can learn to communicate with others and we should not give it so much importance that we think of it as a magical factor.

A recent study by Eugenio Parise et al. (“Influence of eye gaze on spoken word processing: An ERP study with infants”, Child Development , 2011,Vol. 82, pp. 842-853) examined whether a person’s gaze, seen before speaking began, made a difference to the way 5-month-old babies’ brains processed the speech they heard. The babies sometimes saw a face gazing directly at them and sometimes saw one with averted eyes; they sometimes hear a voice speaking normally (“forward”) and sometimes heard a voice speaking backward. They seemed to be especially interested in the direct gaze-- perhaps signaling “Hey, I’m talking to you, kiddo”-- combined with the unfamiliar backward-spoken words. The point about their responding differently is that the babies did not act as if what they saw and what they heard were unrelated. Instead, their listening was partly guided by what they saw, and especially by whether there was mutual gaze or not. What they saw seemed to have a role to play in their attention to and learning of the spoken language-- an exceedingly important step in child development.

One thing this tells us is that caregivers who look at infants infrequently are not giving them as many opportunities to learn as they may need. Caregivers who use their gaze, either in direct looking at the baby’s face, to “point” to an interesting object, or to avert when occasionally avoiding social contact, are providing much more information about language than dozens of flashcards pinned around the room. Caregivers who rarely use the gaze in ways babies can learn from may be depressed, sick, tired, or overwhelmed with work --- an example might be day care providers who have too many babies to care for.

Now, here’s what I want to know, and to the best of my knowledge no one has asked or answered this question: what about gesture language? It’s presently quite fashionable to use gesture language with infants and toddlers, to teach it and to encourage the children to use it, either at home or in group child care settings. Where does the adult’s gaze come into this? Can a direct gaze guide the child to be especially attentive to a gesture? If the child has to look at the hands to see the gesture, rather than listening while following the adult’s gaze to see an object referred to, how is language learning influenced? The great advantage of spoken language is that we can look at the thing talked about while listening to speech at one moment, and look at the speaker’s gaze while still listening to speech at the next moment. This seems to be a pattern that comes easily to sighted babies by about 5 months of age, but what if they don’t often get to do it, or do it only while simultaneously trying to look at a gesture?

I don’t want to suggest that gesture language in some way interferes with the typical process of learning. Babies with both visual and hearing impairments learn to communicate, but they follow their own patterns of growth and development. Is the same true for babies who are taught to use and understand gestures? It might be. There’s much still to learn, but it’s clear that eye contact can play a complicated role in both social and cognitive development.