Neglecting The Child's Role

"Gone are the days when parents could simply love and touch and enjoy their child for her own sake," (Frank Furedi)

In the video, a young mother is seen lovingly watching her two year old son play on the floor, while intermittently making encouraging comments. At the signal, she leaves him for a few minutes and goes into the other room to watch him on CC TV, expressing how sad but cute he now looks. The therapists instruct her to comfort her son when she returns to the room, so "their attachment is strongly reinforced". This is called "filling the cup", they tell her. When she returns to her son, she dutifully kisses him on his head as instructed, though he doesn't seem to notice it. The narrator points out that now her son's "energy level is back up", then asks; "but is his cup full"? With an air of suspense, the narrator then informs us she is about to "miss a cue" and challenges viewers to see if they "can spot it". While mum gives her toddler her full attention, he bangs a toy truck on the sofa. She instructs him: "No, on the floor. Got to go on the floor," and changing to a somewhat contrived affectionate tone, she adds; "Now you're just being rambunctious," and plants another kiss on his head. Minutes later, the psychologist and young mother watch the tape together.
"You're paying attention to the truck rather than "the cup,"" he points out to her.
Slightly defensive, the young mum replies; "Because otherwise he thinks he can do that at home!"
The psychologist dismisses her explanation; "I believe the underlying message he's giving here is not to challenge you or make life difficult for you. It's to say I'd like to have that cup completely full."
"Actually my instinct was to pick him up," the teen mom anxiously tries to reassure the psychologist.

The narrator sums it all up; "The messages our children give us can be so subtle, even the best parents miss them," and he provides a solution to this ominous dilemma: "the best way to make amends (for missing these subtle cues) is to show affection every chance we get."

The Circle of Security (COS) is a six month parenting course based on the assumption that learning occurs from within a 'secure base relationship', and that the quality of 'attachment' plays a significant role in the life trajectory of the child. During the course, the participants are given this handout;

At first glance this chart seems like a practical illustration for parents. Who could refute wanting to help a child feel secure? On the other hand, do the vast majority of ordinary parents really need to learn the obvious? Who needs to be taught something that is perfectly natural, and driven by the love parents feel for the child from birth? This desire to give to the child, to allay their fears, to enjoy the world through their eyes, is natural. Turning that which is already instinctual, into a parenting skill is fraught with problems.

With attachment "interventions" like this, mothers cannot just be human any more. They have to become hyper-vigilant, super-human "hoverers" - loving, smiling and encouraging their child all day long, ie "acting". This can only lead to contrived, mechanical and phoney responses to the child, and give the child the false idea that they are the centre of the universe and that adults are perfect. Devoid of joy and spontaneity, it role-models dishonesty. It also does not allow the child to access its own inner resilience and coping skills, which are inborn. A lot of attachment theory and psychotherapy is based on assumptions such as the Blank Slate and the Noble Savage which Steven Pinker argues are myths, have moral baggage, cultural prejudice and have done a lot of harm. Recent research has discovered that babies are able to make moral choices as young as six months, can spot mathematical errors and even have favorite colors.

Furthermore, children are highly sensitive insincerity detectors, and programs like COS make parents feel obliged to feign constant interest in their child's every action and word, and undermine the expression of genuine emotions or states of mind. "Loving a chid is a wonderful fulfilling experience," says Frank Furedi. "But loving on demand is an incitement to display an empty gesture. It introduces a dishonest ritual into the conduct of family life. Worse still the compulsion to love trivialises authentic expressions of this most desirable sentiment. .... Yet it is far from evident that loving and giving attention for their own sake provide any real benefits for children," writes Frank Furedi, in Paranoid Parenting. Furthermore, he says that "youngsters who are trained to believe that parental attention and love on demand is their birthright are likely to find it difficult to cope with circumstances where they are not the focal point of everyone's attention."

Diminishing The Role of the Child

Furedi points out that the flipside of assuming that children are innately vulnerable is that parenting has an overwhelming impact on a child's development; "The tendency to downgrade children's internal resources, coping skills, and resilience has been paralleled by the rise of parental determinism. Time and again, mothers and fathers are informed that their behaviour determines the experience of infancy that in turn determines their child's future. Omnipotent parenting is the other side of the coin of child vulnerability. Parental determinism not only diminishes the role of children, it also overlooks the influence of their peers and social circumstances in a child's development. By assuming that so much is at stake, it legitimises a highly interventionist adult role in childhood."

Thankfully this modern, western, anxiety-driven, child-obsessed fear of missing elusive and "subtle" child cues, is a myth. The idea that the child is both a blank slate and highly vulnerable is a powerful idea with which to frighten parents. "An exaggerated perception of an infant's emotional vulnerability has helped to reinforce the view that children are by definition at risk. In the realm of the emotions, certainties give way to doubt and confusion." .... "If children are indeed so weak and fragile that they cannot overcome negative experiences of their early years, then parents need to be permanently on guard. Fortunately, this powerful idea has little fountain in empirical evidence. Parents would do well to ignore these frequent appeals to what is in fact a display of cultural prejudice." (Frank Furedi Paranoid Parenting).

Ironically, by overcompensating, downgrading and ignoring the child's instincts, innate learning capacity and natural resilience, it could be argued that these therapies actually create a new form of hidden neglect.

Child Development vs COS

In fact studies have shown that children take an instinctual and active part in following their mothers around, "the children were observed to stay within a predictable distance of the mother without effort on her part". However, children with developmental or neurological conditions often lack this instinct. Instead, they may run in the opposite direction of the mother when afraid. Autistic children are typically tested for "tracking", "joint attention" and "referencing" - all of which are instinctual abilities in the typical child to keep track of others and respond to the ever-changing environment he finds himself in. In fact, developmental therapies like Relationship Development Intervention are based on recouping these instincts in children who have social impairments. There are many activities that challenge the child to cue the parent, rather than the other way around. In one of the objectives, the child has to learn to "track" the parent. To enable the child to learn this, the parent moves around the room to a different place every time the child looks away.

In the book Look Me In The Eye: My Life With Aspergers, author John Elder Robinson said that adults following his lead actually kept him from figuring out his role in conversations; "Adults - almost all family members or friends of my parents - would approach me and say something to start a conversations. If my response made no sense, they never told me. They just played along. So I never learned now to carry on a conversation from talking to grown-ups, because they just adapted to whatever I said." However, children are always more honest in their interactions; "Kids, on the other hand, got mad or frustrated." In Dr Stephen Gutstein's new book about autism "Relationship Development Intervention", he says that the mother and baby's miscues, ie their mistakes, were the key to the child's learning to relate. Not reinforcing the child's inefficient or partial cues partial cues, or communication signals, challenging him or her to take more of an active co-regulatory role is an essential and natural part of child development, and children with developmental disorders need an even more exaggerated lack of reinforcement.

But the COS founders seem to have missed these very important pieces of the puzzle. In fact, it could be argued here that treating children as though they have no instinct to play a reciprocal role in a relationship would be reinforcing a dulled "center of the universe", ie "autistic", state. With the already discussed possibility that conditions currently being classed as Attachment Disorders could be hidden "neurological" conditions, wouldn’t it be more beneficial if the child developed his ability to read and respond to the world? That if you take up the slack for the child, they will remain in their little worlds, just as autistics do? When the boy in the video banged his toy on the sofa, really wanting to be picked up and hugged, what would have happened if mum had ignored this bad communication signal - if that's what it was - and instead set limits on banging toys on furniture? What if adults were relaxed enough to trust in this boy’s innate ability to find a new way to communicate his need?

Noone is denying that there are extremely incompetent parents out there, but they are a tiny minority, despite the hype from the media. Developmental disorders are far more prevelent than "bad parents". These "attachment therapies" only serve to have a disorientate and disempower parents, while empowering therapists. Once reserved for children wasting away in extreme conditions, "attachment theory" has now mainstreamed. Fear mongering about child "outcomes" is a dubious manipulation of attachment theory and its already problematic legacy. "Happily, infant determinism is more of a cultural myth than a scientific truth," says Furedi.

Like the African American mother, blamed for her son's autism in the Refrigerator Mothers DVD, lamented ironically: "They were too focussed on the little things like: ... "you're not holding his hand", or "you didn't kiss him" ...!" we need to focus on the bigger picture.


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We Will Help You .... Whether You Like it, or Not

Therapeutic Education encourages children to see themselves and their feelings as the most important topics they can learn about, say the authors, Kathryn Ecclestone and Dennis Hayes, in The Dangerous Rise of Therapeutic Education. This intriguing new book exposes how "therapy" - has changed its meaning from a treatment of the mentally ill, and morphed into a positive value. With the institutionalisation of therapy, from Circle Time in the classroom and rhetoric about "relevancy" in curricula, teachers are less inclined to challenge children about the content of what they say, ie whether it is "logical" or "reasonable"; because all views are equal. This approach erodes subject disciplines and encourages a curriculum where topics can only be engaging if they relate to The Self. But the negative impact does not stop there. Children (and adults) internalise a vocabulary of "dysfunction" and psychological syndromes to explain their social and educational difficulties ... or just everyday struggles with life that we used to call "normal". Therapeutic Education has become the new
Social Justice.

'Emotional Waywards': the New Underclass

The authors trace this new coercive variety of therapy to the beginning of the end of the class wars in Britain in the 70s. Today, instead of "the poor" we have the "emotionally deficient". Supporters of therapeutic education claim that children should be encouraged to "share" their deeper feelings, enabling the excluded or disaffected child to feel included and that it normalises emotional problems. The authors wonder where this might lead, ie to the touting of the advantages of the emotional elite and the deterioration brought to our society by the emotional underclass? We are not far from that today: "Not only does therapeutic education lead schools to take on an extended and intrusive role in children's socialisation, but the emotional well-being industry peddles a strong, negative message of emotional determinism," say the authors.

Institutionalised therapy, in schools, universities and the workplace is not optional, and their methods are coercive. The authors tell how they have been confronted by supporters of therapeutic education suggesting their theories are a sign of their emotional repression, the female author being the main target. Fear of being labelled “emotionally inadequate” has the danger of rendering the masses subservient and paralysed in the face of this new Therapeutic Culture.

Imposing an orthodoxy of "appropriate" feelings and behaviour

Emotional correctness, scripted ways of speaking, conformity to "appropriate" ways of feeling and acting, formulaic, compulsory rituals through which people make sense of themselves, will be the inevitable result, the authors argue. But normalising emotional difficulties infantilises children, making them suggestible to fears, problems or 'uncomfortable feelings' that they may, or may not, face. They also normalise the bad experiences of a minority of children as universal difficulties we "all have". The majority of children and young people are not damaged, but the training will damage them. It is no accident that children reporting anxiety in unprecedented numbers have already experienced the “interventions” discussed in the book. Therapeutic education inserts vulnerability and anxiety, children express it ….. and then get more therapeutic interventions. The over-emphasis on emotional awareness can lead to paralysing introspection, self-centeredness and the dwelling in certain moods .... rather than problem-solution oriented thinking.

"Thank you for your sharing"

Since the ancient Greeks, both Eastern and Western philosophy has used dialectic as a form of reasoning based on the exchange of arguments and counter-arguments, in the search for a higher truth. The outcome a dialectical exchange might be the refutation of points of view, or a synthesis or combination of opposing ideas, or at least some form of transformation as a result of the dialogue. The aim of the dialectical method is resolution of the disagreement through rational discussion, and ultimately the search for truth.

But this cornerstone of civilisation is not possible in the face of Therapeutic Education where premises are simply equal "viewpoints" not needing counter-arguments. Its result will be paralysis in the face of crisis, change or when critical thinking is needed to solve problems, in favour of staid emotional correctness. There are many signs out there already. In the past staff meetings, appraisals, complaints or suggestions put forward to management in the workplace were a means to enact change and improvement. But "viewpoints" are unlikely to garner an action orientated response from management. Instead, scripted and phony expressions of empathy with “feelings”, and thanking the individual for "sharing" is becoming more commonplace, disempowering both management and workers.

Dissatisfaction and Unhappiness Crucial To Humanity

The authors argue that consciousness of human misery, personal discontent and unhappiness are more likely to motivate people to change the world. They conclude that: "The celebration of the emotional over the intellectual fundamentally alters the historical idea of what it is to be human. ..... an obsession with the self means that you will not change the world, and nor will you change yourself: it is active engagement with the world that leads to confidence, self esteem, fulfilment or, to use the latest piece of therapy speak: happiness and well-being …. the wish and the will to change the world characterises humanity: to turn humanity inwards is to diminish all our selves."

In the face of this new Orwellian Therapeutic Education, where "negative" emotions are pathologised and "remediated", and short-cut promotions to "happiness" are advocated, perhaps this little benediction attributed to St Francis needs to make a comeback;

May God bless us with discomfort
at easy answers, half-truths, and superficial relationships, so that we may live deep within our hearts.
May God bless us with anger
at injustice, oppression, and exploitation of people, so that we may work for justice, freedom and peace.
May God bless us with tears to shed
for those who suffer from pain, rejection, starvation and war so that we may reach out our hands to comfort them and turn their pain into joy.
And may God bless us with enough foolishness
to believe that we can make a difference in this world, so that we can do what others claim can not be done.
Amen

The Nurture Assumption: not a benign little myth after all

If parents discovered that they had little, if any, influence over their child's outcome, wouldn't that create an open door to abuse and neglect? That fear has been expressed by mothers online and to Judith Harris, author of the award winning book "The Nurture Assumption" which debunks the myth that parenting equals child outcome in life. The author responds to such an allegation rhetorically; asking if they would abuse or neglect their husband or friends simply because they knew they had no influence over their future. Do adults need fear of consequences to drive us to decent human behaviour towards others? Of course not. We treat our kids well because we love them and want to do the right thing simply because it is right, not out of fear of hell and damnation (ie "bad child outcome"). We don't have an ulterior motive. If there is an ulterior motive, then, paradoxically, there is no love but just a bunch of phony gestures.

The Nurture Assumption is not a benign little myth. A summary of Harris' reasons why:

1. It puts a paralysing burden of guilt on the parents unfortunate enough to have a child who does not meet a certain standard. Not only must they live with and deal with a difficult child on a daily basis, they must also bear the community's opprobrium.
2. It has turned children into objects of anxiety, not enjoyment.
3. It has introduced an element of phoniness into family life. It has made sincere expressions of love meaningless because they are drowned out by the obligatory, feigned expressions of love.
4. It has held back scientific progress and inquiry into what researchers should be really looking at.
5. It has exonerated people from their character flaws and mistakes in life by blaming their parents. Criminals even avoid jail by claiming they were abused as children.
6. A century of the Nurture Assumption (or half a century of a more intensive assumption) has not decreased child abuse, nor are there any signs that its offspring are any happier or in better mental health than they were two or three generations ago.

Attachment Model "useless": Harris

Judith Harris argues that the Attachment Model is useless for predicting how other people will behave in relationships outside of home. "John Bowlby, inventor of what is now called Attachment Theory, proposed that the mother-child relationship forms a sort of template for all later relationships. Fuelled by the nurture assumption, the idea took off. The baby, said Bowlby, develops an "internal working model" of its relationship with its mother, and then expects other relationships - with father, siblings, peers, babysitters, and so on - to follow the same pattern. An appealing theory but, not to put too fine a point on it, wrong. There may well be a working model of Mommy-baby relationship in baby's mind, but if so, it is trotted out only when Mommy is around."

Harris believes this is part of the reason that programs that try to change the parents' behaviour tend to have no measurable effects. "Programs that rely on visits by professionals to the children's homes can produce changes in the parents' behaviour - a significant reduction in child abuse, for example. But they have no noticeable effect on how the children behave when they are not at home or on how well they do in school. The programs that get the parents involved produce no better results than the ones that leave the parents out. (Effects on parents' behaviour: Olds et al 1997. Lack of effects on children: White Taylor Moss, 1992. Later research supports conclusions; see Duncan and Magnuson 2004, St Pierre, Ricciuti and Rimdzius 2005)"

Beyond The Nature/Nurture Divide

Harris blows away the smokescreen of our modernist ideological myths about motherhood. Using a range of examples, research results and studies of animals and evolution, she demonstrates that genetics and peer influence "groupness" are the two main influences on our life trajectories. But Dr Helene Guldburg, author of Reclaiming Childhood in her essay It's Time To Move Beyond The Nature/Nurture Divide, argues that neither Nature, Nurture nor "groupness" determine us as human beings. Citing developmental psychologists like Vygotsky, Luria, Tomasello - even Karl Marx - she says that humans go through "many transformations during their lives". At birth we are just a bunch of instincts. We then pass through a primal animal stage, before a transformation happens when we acquire language. Language transforms us from animal to our unique human capacities, ie for understanding that others are intentional beings like themselves. Therefore, humans beings are not passive recipients of genetics or "groupness", like animals are, but "active agents who engage with, and have the capacity to shape, the collective culture of our time." We end on a positive note: ie that human beings are not products of - and slaves to - biology and environment, like animals are, but are capable of transcendence above and beyond our genetics or environment.

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'Attachment Disorder' Lacks Scientific Proof: Rosemond

In a Baltimore Sun article, Sept 2nd 09, well-known child-rearing expert and author John Rosemond writes:

"As a psychologist, I am a member of what is called the "helping profession." The term is generally accurate: Most of us are helpful, most of the time. Nonetheless, it conceals the fact that when all is said and done, mental health care is a business. As such, entrepreneurial mental-health professionals are no different than other businesspeople: they try to create new "products" and new markets. An example is the relatively new field of "adoption specialist." The not-so-implicit message behind this specialty: adoption is a special circumstance fraught with psychological IEDs that cannot be negotiated properly without a constant vigilance; thus, the need for a specially trained professional to guide one through the adoption minefield.

I recently spoke with the parents of a 3-year-old whom they adopted from overseas shortly after she was born. Since then, several adoption specialists have told them that a rather nebulous condition called "attachment disorder" is an ever-present threat to their child's mental health. Apparently, her primary attachment is to her biological mother, even after three years. According to said professionals, she remembers her mother's face, smell, and voice and there is a part of her psyche that is constantly grieving the loss. This unresolved (unresolvable?) issue manifests itself in anxieties, fears, shyness, temper tantrums, defiance, moodiness and other behaviors associated with normal toddlerhood.

The little girl's parents have no reason to think that people with capital letters after their names are pulling things out of thin air, so this barrage of misinformation has kept them in a perpetual state of anxiety. They have come to see the issue of their daughter's adoption behind every imperfect behavior. In addition, they've been told that they should make every effort to compensate for the child's ever-present attachment issues, including allowing her to occupy the marital bed. When she misbehaves, they don't know whether to respond with understanding or discipline. Consequently, their attempts to discipline are generally ineffective. While they were talking with me, the mother's turmoil was especially evident. She exerted great effort to keep from sobbing.

These parents are not alone. Over the years, I've spoken to numerous adoptive parents who have received similar apocalyptic, anxiety-arousing information and advice from adoption specialists. To be fair, I've also met adoption specialists who do not hold to these views, but they testify to being in the minority and to not being well-received by their peers.

The facts: A consistent body of hard, objectively gathered scientific evidence to the effect that adopted children are more prone to psychological problems than children who live with one or two biological parents is lacking. On the other hand, there is significant evidence to the effect that even orphaned children exposed during their early, supposedly "formative" years to severe conditions of emotional deprivation and material neglect recover quite nicely when adopted by loving parents. For more on the subject, I highly recommend Dr. John Bruer's "The Myth of the First Three Years" (The Free Press, 1999).

The unscientific claims being disseminated by certain adoption specialists does no measurable good for adopted children and presents the potential of doing significant emotional harm to adoptive parents, the parents above being a case in point. As we are given to say in North Carolina, "It just ain't right.""

Finally the "child experts" have started to speak out.

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Pathologizing Motherhood ... to the max

Actually this book, Attachment Disorganization, only deserved one star at the most; for effort. But I gave it three stars because I felt bad for the authors. It didn't even rate for being interesting, meaningful, witty ... or beautiful. I read with an open mind, yet no new insights were revealed; it was dull, and its objectification of humans left me feeling cold. Here is my review at amazon.com
~~~~~

As a professional in this field of work I was interested in learning more about the relatively new attachment classification of "D" which supposedly leads to psychopathology in later life. The collection of articles written by various researchers in the field only confirmed how little we really know about the subject, and the articles are little more than guesswork and ideological interpretations dressed up as knowledge and science. At least the authors consistently suggest that more research needs to be done in this area. Particularly treacherous was the chapter on children with disabilities, and how D symptoms were separated from symptoms of a developmental/neurological disorder, ie ADHD, yet how they did this remains a mystery. Anyone familiar with developmental disorders, will find D traits suspiciously similar. The researchers then concluded that D is not neurological, suggesting it is learned behavior, but more recent research (2007-2008) has suggested this is far from clear-cut. Throughout the book, 'mother behavior' was scrutinized and analyzed to such an excruiating degree, that it was almost dehumanizing. The authors in some chapters concluded that, because there are so many differences in the behaviors of mothers with a "D" child, stopping short of using the word "unexplainable", there must be more subtle and covert behaviors that cause infant disorganization. Frightening or frightened behaviors in the mother were thought to be the cause, YET these same "frightening moms" also produced non-D kids! Wait a minute .... the D-offspring moms were frightening BUT they also did not allay the child's fears with the right facial expression, word or gesture at the right time after frightening their child. The consequences of mom not tweaking herself in just the right way so that the child won't be afraid, is a future psychopath? Sorry, but something is wrong here: people have been bringing up children for millennia in thousands of different styles. What of the millions of children in times past who were not brought up in such an anxious, child-centered, self-obsessed, mother-blaming cultures as the modern western anglo-saxon world? If their findings are anything to go by, humanity was already doomed to extinction 1000s of years ago from the mass production of pathological human offspring when children were nothing more than slaves. Even more confusing are the obscure 'symptoms' of D at the end of the book, which make objective observation almost impossible. Recent research has disproven a lot of this book's wishy-washy Freudian claims.

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The Myth Of 'Infant Determinism'

Here is an excellent essay on Infant Determinism by Dr Helene Guldberg.


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My Invitation

I welcome intelligent debate about anything I have said on this blog and I promise to respect your anonymity.

Recently, I received some emails from a senior lecturer in Attachment Theory and related therapies. He has a PhD in child development and runs an attachment centre. Here are some excerpts from the debate we have been having;

Dr P said: "The patterns of attachment described (Secure, the two insecure, and disorganized) are not mental health diagnoses, nor are they meant to define conditions that lead to mental health problems. The insecure patterns (dismissing and preoccupied) describe how one "manages" relationships and intimacy. Person's with such a state of mind with respect are not mentally ill or more likely to develop mental illnesses, the patterns merely describe how they enter into relationships."

Dear Dr P, If this form of relationship analysis is merely describing "how they enter into relationships", then why not use a book such as Personality Plus that analyses the four temperaments (choleric, sanguine, phlegmatic and melancholic) in terms of relationship needs? Why use ideologically-laden ominous words like "dismissing", "preoccupied", "insecure" or "avoidant"? These words hint strongly at pathologisation, so I remain unconvinced that these labels are simply descriptions of "how one manages relationships".

Dr P states that: “The fact that ASD and RAD share some similar surface symptoms is irrelevant because the causes are different.”

I am arguing that the cause is the same: ie deprivation of interactions, rather than 'bad' interactions. The same part of the brain is "deprived", ie the part that allows the child to "get inside the head of another" (or intersubjectivity). This deprivation delays the learning of reciprocal social exchange, whatever its content. Whether that deprivation occurred physically or neurologically, in more or less obvious ways, the result is exactly the same. Please see my posts; A Closer Look At Attachment Disorder Part One and Part Two.

I also argue that some people are naturally weaker in social skills, while strong in other parts of the brain. Computer Jobs for Autistic People is an article written by an autistic man, who says that on the internet he "found companionship in a setting where weak social skills don't matter". The individual with the more higher functioning forms of autism may not be so good socially, but can be a genius in electronics or mechanics. This is not a problem, because many of the greatest inventions were made by people whose minds were not distracted by social and emotional issues - ie intersubjectivity. But that part of the brain is still "deprived", as such, even though it presents no "problem" as a result, and therefore should not be pathologised, or given labels like "insecure" or "avoidant" etc.

Dr P said: “Even children who have experienced premature births and extensive medical interventions in a NICU can develop RAD (see refers).”

This one has been well and truly debunked, and it is only isolated cult-like practices that continue to believe this myth. Please read this article on biological determinism. Furthermore, autism experts like Tony Attwood and Stephen Gutstein will tell you that children with premature births and extensive medical interventions can develop autism, and this is far more plausible now we know more about the brain. "Diverse etiology: same results," says Gutstein. Anything that deprives that part of the brain necessary for development of intersubjectivity, results in autism - sometimes mild, sometimes severe. Autism is not a primary condition; it is always secondary to something else. As I have argued extensively on my blog: I believe that in most cases, attachment disorder is an underlying neurological disorder. I have also argued that some of the autism interventions are more effective, less stressful for the already stressed parents and less contrived, than focusing on attachment. Please read my blog post "Neglecting The Child's Role". That the child was maltreated does not make this condition become an attachment disorder.

Dr P said: “I encourage you to read the source material not secondary sources that purport to analyze the sources.”

If you wanted to learn about autism, I would never suggest to you that you read books by Leo Kanner or Bruno Bettelheim, even though they are the "source material" books. It is always better to read the latest research. Today we have better technology and more understanding of these matters from diverse approaches, ie linguistic, neurological and sociological, than we did fifty years ago. A lot of the older books on attachment and autism are fraught with cultural baggage and assumptions that today have been disproven. With subjective and ideologically-laden fields such as Attachment Theory, it is therefore essential to focus on the latest research and discard outdated theories.

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A Subtle Form Of Prejudice

"The claim that insecurely attached children are at psychological risk because they do not have sensitive mothers is an ethical judgement as to which maternal behaviours and infant reactions to parental absence are considered the most virtuous." (Dr Jerome Kagan)

The middle chapter of Kagan's refreshing book Three Seductive Ideas explores Attachment Theory and its handmaiden Infant Determinism. The crux of his critique can be summed up thus;

1. Attachment Theory is not based on evidence, but moral judgements about correct female behaviour.
2. It ignores the power of social class. Americans strongly wish to believe that their society is open and egalitarian. To acknowledge the power of class is to question this ethical canon.
3. The role of chance is not agreeable

Poverty vs 'Attachment'
Despite the lack of consistent evidence of the lasting effects on maternal and child behaviour, Attachment Theory remains alluring because it appeals to these cultural archetypes. “There is the assumption that if parents (read ‘mothers’) were doing their jobs well, we would live in a happier, safer, healthier world,” say the authors of this book. However, according to Dr Jerome Kagan, “The best predictor of later psychological problems was not attachment insecurity or insensitive mothers, but continued residence in a family of poverty, combined with prematurity or other biological stress surrounding birth." The book Charting a New Course for Feminist Psychology describes studies of various situations of severe child deprivation which the author says; “document the remarkable resiliency of children - an entirely different perspective on childhood than the fragile, vulnerable one that emerges from attachment therapy. The notion of both infant determinism and infant psychological fragility has dominated women's experience of mothering from the early 20th century to present. It has contributed enormously to women's stress and guilt about doing well by their children.”

Kagan, and many others in his league, argue that by focusing on mothers and the private sphere, the real problems of poverty and class in the public sphere can be deflected.

Pathologising Diversity
A study of the Strange Situation reveals that a meta-analysis of 2,000 infant-parent dyads, including several from studies with non-Western language and/or cultural bases found the global distribution of attachment categorizations to be A (21%), B (65%), and C (14%). This global distribution was generally consistent with Ainsworth et al.'s (1978) original attachment classification distributions. Does 30% of the world's population have attachment disorder, or are we seeing natural diversity?

Dr Jerome Kagan says that what professionals see in the Strange Situation is temperament, not attachment differences. “That's right. And so the reason why the measurement of attachment at one year will predict the future is not because the child is securely attached, it's because this child has a fearful temperament, and we know from the research of many, including my own laboratory, that very fearful one-year-olds are apt to be quiet, timid, less social curious.” (from a Radio National interview)

Dr Helene Guldberg views the assumptions of attachment theory as ludicrous; “Extreme conditions of emotional deprivation may be so exceptional that they tell us absolutely nothing about the situations where there is engagement between adult and child. There is a world of difference between being starved of human contact and having parents who do not match up to attachment enthusiasts' expectations - being continually loving, caring, expressive, and encouraging.”

These moral and political judgements about the acceptability and unacceptability of people confront us with the problem that these measures are likely to discriminate against certain human categories ..... and even invent new ones. “Of course, some parents will be awkward in the way they show their love for their children; others will fail to provide enough praise and encouragement. But even if emotional sensitivity is lacking", as psychotherapist Peter Hobson at the Tavistock Clinic in London argues, "One is constantly amazed by the resilience of babies and how effectively they can find ways round potential disadvantage and get much of what they need from people around them." "Much research contradicts the pessimistic belief in irreversible influences in early childhood, showing instead that children are psychologically resilient,” says Guldberg in her article about the myth of infant determinism.

The fact is that most parents have good days and bad days. "Most children can handle the fact that their carers are not perfect. It will not help parents if they are loaded with guilt for being insensitive to their children's every need," says Guldberg. “It is not entirely clear whether these ultra child-centered methods will ultimately produce healthy, well adjusted children or if their result, instead, will be the creation of self absorbed, narcissistic monsters”.

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The Medicalisation of Normality - BBC Documentary

Yesterday's BBC documentary:The Medicalisation of Normality discusses the inherent dangers in increasingly classifying people and, in so doing, alienating more and more people. A psychiatrist interviewed on the program points out that; "almost every possible piece of human behaviour can be classified as being in some way aberrant and there is a danger in this, and one of the dangers which is particularly apparent in the US is the tendency for new category to be invented." A mother of two autistic sons argues that autism should not be viewed as a deviation from human normality, and that many of the world's greatest inventions were made by people on the spectrum, because they have a unique perspective on the world. Within this trend to homogenise society, loners or eccentrics are increasingly seen as deviants and diversity is pathologised. The speaker ends the program by listing a range of acronyms of new "disorders" including RAD (attachment disorder).

What I don't agree with in this documentary, are the points made about medication and the suggestion that the drug companies that are behind all these new disorders. As a mental health nurse I have seen people get their dignity back from medication. The old "asylums" of the past, with crazed "inmates" in padded cells and straight jackets don't exist any more, simply because of medications. The speaker also did not differentiate between Major Depression, and depression resulting from a situational crisis. The former is genuine and does need medication along with lots of empathy and understanding. "Talking therapies" are a waste of time and would exacerbate his condition. But the individual with depression associated with a situational crisis does not need medication, and exercise is an excellent treatment. However, even calling such a situation "depression" is falling into the same trap of pathologisation of ordinary human experience, because it is normal and natural to be sad or upset when bad things happen! Re-creating what is natural and normal as a medical condition creates the very thing they're trying to avoid.

No, it is not the drug companies behind this plethora of new disorders and attempts to medicalise normality, but our cultural trends. It stems from the modern, western anglo idea that humans are inherently vulnerable, weak and incapable of dealing with ordinary hardships in day to day life, even though we have more comfortable and easier lives in the whole history of humankind. It is the fruit of the commodification of individual "happiness" as the purpose of life, and any sort of unhappiness as a sign of error.

The medicalisation of normality arises out of a collective delusion, based on an increasingly therapised view of ordinary human life, that we are victims ... victims of our past, of our parents, of events in life and other external forces, and that only through professional "support" can we escape this dilemma we have no control over. The drug companies simply follow behind, filling in the gaps in the market created by all the new "discoveries".

"I cannot believe that the purpose of life is to be “happy”. I think the purpose of life is to be useful, to be responsible, to be compassionate. It is, above all, to matter, to count, to stand for something, to have made some difference that you have lived at all." (Leo Rosten)

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Neurodiversity or more pathologisation?

Here are some highlights from the 2008 journal article: Social Communication Competence and Functional Adaptation in a General Population of Children

The researchers propose that the importance of autistic characteristics of lesser severity is underestimated, for two main reasons;
1. Mild or moderate deficits in social and communicative competence may be missed … especially if they are associated with conduct problems.
2. Diagnostic methods are designed to exclude conditions that don’t reach diagnostic significance.
Recent evidence suggests that ASDs are simply the extreme end of a continuous distribution of one or more dimensions of autistic behaviors.

Excluding environmental factors, the researchers found that social and communication skills in children were significantly associated with social behaviour, hyperactivity, emotional problems, conduct problems and peer problems.

In a study on Conduct Disorder in children, two thirds had pragmatic language impairment and other behavioural features that were similar in nature and degree to those of children with autism, independent of IQ.

The findings are consistent with recent reports that autism and autistic like traits lie on a continuum. The study suggests that even sub-threshold autistic like traits are associated with a small elevated risk of teacher reported problems with socialization, hyper activity and conduct problems. This suggest the value of clinicians assessing autistic traits dimensionally and acknowledging the potential impact on function and well being of even mild autistic difficulties.

The editorial about these findings: How Continua Converge in Nature: Cognition, Social Competence, and Autistic Syndromes describes the study as a “powerful confirmation” …. that autistic symptoms are quantitatively distributed in the general population”. It confirms that “social communicative deficits" that fall below the threshold for a clinical diagnosis of an autistic syndrome are nevertheless capable of incurring functional impairment in children”

The study found that ”children with milder autistic syndromes, are often misconstrued as antisocial – as opposed to “asocial” – in origin. The approach of teachers and family members to such children can vary dramatically on the basis of perceived origins of the behavior and recognition of the contribution of subthreshold autistic impairment can result in far more appropriate (and supportive) responses than typically occur when (for example) antisocial motives are presumed.”

“Will this mean more labels and pathologisation of childhood?” is an important question asked on blogs citing this article. That danger only exists if we continue to view these differences, especially the more milder ones, in terms of "inferior" vs "superior". This is a huge subject and will entail a new blog post once I have all the references etc.

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Journal Article: "Aspergers Syndrome: who is being abused"

“What we do need, in the 21st century, is a parents’ liberation movement, to take a stand against the infantilisation and repression of mothers and fathers that seeks to undermine both our family lives and our sense of self.” (Jennie Bristow)

This was a billboard posted around England a few years ago by a charity organisation. The rationale behind their campaign was to normalise this scenario, so these parents would "own up" to the abuse themselves. But the secondary message is more overwhelming: Anyone can be a child abuser, creating deep-seated suspicion about all parents.

In such a climate the results of a journal article: Asperger's Syndrome: who is being abused, are not surprising. Six children with undiagnosed Asperger's syndrome had been seen in a tertiary referral centre where previous professionals had felt either the parents were fabricating the difficulties or that the children's behaviour was the result of emotional or sexual abuse. Only after the child's admission did the nature of the behavioural abnormalities become clear. In most cases the parents' behaviour appeared at initial assessment to be either hostile, defensive .... or even bizarre. Only as staff became able to empathise with their frustration at trying to cope with their child did their despair and isolation become apparent. Within days, the staff, would change their view from puzzlement at how the parents could complain about such a child to exasperations as the repetitive unrewarding nature of the interactions undermined the attempts by nursing staff to get to know their new patient. The parents had all been overwhelmed by guilt. They had all suggested that something head been very wrong but in all cases this had been dismissed by at least some of the professionals who had seen them. In all cases the parents or foster parents were immensely relived when a formal diagnosis was given to them even though they appreciated its prognostic significance. When their longstanding anxieties were acknowledged, all became willing and keen to work with staff for the good of their children.

These histories point to the need to make formal mental state examinations of children. The milder forms of autism need to be recognised early so that parents can be helped to handle their unusual child and so that preventative work can be undertaken to stop severe behavioural problems being added to the underlying difficulty.

An excerpt from: Over anxious parent or perpetrator of abuse? about parents being accused of fabricating their child's condition when they went for help:
"A 1999 report showed that more than 40% of parents wait over three years for a diagnosis of autism (15% between five and nine years, and 10% more than ten years). They are likely to have to see several different practitioners before a diagnosis is confirmed: 65% saw three or more professionals before they got a diagnosis; 23% saw five or more (Opening the Door, Stirling and Prior 1999). This guidance indicates that these parental behaviours could be interpreted as further evidence of abuse on the part of the parent. Yet our evidence demonstrates that there are justifiable reasons for parents of children with autism to present their concerns in this way."

This journal article emphasises the importance of correct diagnosis and treatment; "Misdiagnosis or delayed diagnosis of (Aspergers Syndrome) is a serious problem, and the average age at diagnosis is several years later than for autism (Gillberg, 1989). Obviously, this can be traumatic for individuals and families; furthermore, the most effective intervention programmes begin early, and establishing management strategies at an early age can minimise later behavioural problems (Howlin, 1998)."

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"Autism Challenges The Validity Of Attachment Theory": study

A recent research paper in Holland: Parental Sensitivity and Attachment in Children With Autism Spectrum Disorder (2007) has found that attachment theory is unable to explain the 'disordered attachments' in children with a major social impairment.

The study reveals the following issues;
1. Viewing children’s behaviors via "attachment theory" can be problematic, especially if there is a hidden disability.
2. Parents do not cause ‘disordered attachments’ in ASD children.
3. Attachment based therapies are inappropriate and counterproductive for ASDs.

Children with autism spectrum disorders showed more "attachment disorganization" than typical children. One study (Capps 1999) found 100% of children with autism were classed as "disorganized", while the Ijzendoorn study showed 40%. They found no connection between parental "sensitivity" and attachment security in the group of children with ASD. "For children with ASD more sensitive parenting was not associated with more attachment security." The researchers made it clear that this lack of "cause and effect" was "significant", and that attachment criteria for "sensitive parenting" may be inadequate for developmental or neurological problems in children.

When a child’s senses are distorted, the usual social learning process is also distorted; "Neurologically based problems with emotion recognition may lead to less adequate processing of parental sensitive responses and thus to blocking of the expected linkage between parental sensitivity and child security." In other words; "problems processing social information may lead to a general decreased sensitivity to social stimuli in ASD children."


No wonder parents of ASD children feel so helpless and frustrated until they know what is going on. "Because of their inborn limited social information processing, children with ASD may challenge the established role of sensitive parenting obtained in studies on typically developing children." That is why it is essential that these children get an early diagnosis.

The researchers speculated that: "parents of children with ASD may be unable to overcome the biological constraints in communicative functioning of their children, and that individual differences in attachment relationships of children with autism are largely dependent on constitutional factors."

Furthermore, the study suggests that ‘attachment measures’ are limited; "attachment security in children with ASD may manifest itself differently from that in clinical children, and typical attachment behaviors such as proximity seeking and contact maintaining may have a different function." They pointed out that these children "tend to have muted responsiveness to external stimuli," and suggested that parents who were initially ‘responsive’; "might become ineffective in their interaction because of their unpredictable and unresponsive children."

Consequently, "attachment" interventions are inappropriate for children with developmental disabilities. "Children with ASD may need more explicit parental stimuli and a stronger emphasis on nonverbal input than children without ASD, and their parents may thus sometimes appear more physically intrusive (Doussard 1988)," ….. "Seemingly sensitive behaviours may at times be too low-keyed to reach the child with autism." …. "Attachment requires the understanding and appreciation of the perspectives of others, so researchers suggest that a secure working model of attachment comes later in children with ASD or it may never be reached."

Since autism is a "spectrum" disorder, a question remains. Are the observable behaviors associated with "attachment disorders" really just characteristics of neurological or developmental issues, or even neurodiversity?

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It's Still Happening

I never knew that the expression "Refrigerator Mothers" could be so funny until my autistic son read the cover of the DVD that lay on the coffee table. Amidst peals of infectious laughter, he kept repeating: "Refrigerator mothers! That's so funny!"

But this was deadly serious business for psychiatrists a few decades ago, and it continues today cloaked under names such as: "bonding issues" and "attachment disorder". The multi-award winning documentary DVD about mothers who were blamed for their child's autistic condition exposes this cruel victimization:

Lorraine: "I took (my autistic daughter) to a child psychiatrist. And he called us into his office and he addressed most of his remarks to me “Hi, Mrs.Roberts, we have noticed that with these children. They seem to reject the mother, they don’t want the mother’s comforting arms. Now why do you think that is Mrs. Roberts?” And I thought, well, if I knew, I wouldn’t be here. I met another mother, sitting in the hallway and of course, two mothers always start to talk in the hallway, and she said, uh…are you one of the Refrigerator Moms? And I said, what do you mean? She said, “Well, don’t you know, that’s what we are?”"

The psychiatrist tried very hard to get Lorriane to believe that her father was disappointed in her because she was not a boy; …"I knew that my father was not disappointed in me. And I knew he loved me. I tried to believe that he was a bad father…I really tried. And I tried to believe that my mother didn’t love me…I really tried. But I looked back and I thought…”I had a pretty good childhood.” I was a happy child." Not wanting to admit failure, the psychiatrist tried psychoanalytic gymnastics: "His reply was the fact that I was an only child made me forever in the middle the peacemaker…and so my personality didn’t develop.That was the crux of the whole thing ,that I was not as loving as I should be, because I really didn’t have much of a self esteem or much personality."

Meanwhile, on an autism forum in the UK, 2008, a mother of an autistic son describes a parallel experience;" (my son) was highly aggressive and extremely challenging towards me, attacking me on a regular basis, so the psychiatrist and her team thought he didn't attatch very well to me. .... they wanted to diagnose Attachment Disorder, .... I was deeply hurt when I discoverd this diagnosis meant I neglected or abused my son, yet I took excellent care of him throughout his early years .... struggled on a daily basis with his eractic challenging behaviour..... I couldnt believe I was now on a road to prove my worth as a mother when what we should of been doing was getting the correct diagnosis so we could best help him."

On another online forum, a mother had just been told her teenage daughter had autism: "I endured 10 years of being labelled a bad mom because of an incorrect diagnosis of attachment disorder."

The damage that psychotherapy does is evident: Lorraine (from RM): "... And I have fought this battle of bitterness within my soul…because I didn’t find out for 18 years that I wasn’t at fault for sure and I can’t quite overcome it…I’ve tried… I’ve taken a lot of classes, tookeverything they offered, I worked at the church for 5 years… that was very satisfying. But there’s no answer to this place inside my soul that’s my soul. I can’t get down there and dig it out…I just can’t its there and it isn’t—it is simply a result of the analysis."

"It's still going on today," says a mother at an autism support group shown in the documentary.
"You don't have to be told you're a refrigerator mother, but you still get that."

"I was told I didn't bond with my son," says another.

"They were too focussed on the little things like: ... "you're not holding his hand", or "you didn't kiss him" ...!" says another, incredulously.

"I was mired in guilt ... it was cruel. I felt deep pity, puzzlement, anger - its' very hard to sort out. I definitely loved (my son)," says another mother, blamed for her autistic son. "But it was so awful what they were saying, and I think a lot of the things they were seeing in parents was just a reaction to having a kid like this,"

"Psychoanalytic psychology and the extrapolations from it have destroyed thousands of lives," says Mary, mother to an autistic boy now adult, "Why couldn't they SEE?!".

A lone and brave psychiatrist from this era speaks out: Dr Coles: "I remember a social worker in the psychiatric clinic. I remember her saying to me, “look at some of the mothers coming in here…look at them. They feel overwhelmed by the experience. Their heads are bowed, they feel hurt. They come here feeling that they are going to be judged and that we are the ones who are going to judge them, and I still remember this. I remember it, thank God. But at the time I didn’t feel it was important. At the time what I thought is, I’ll unfortunately tell you, is, at the time I thought, “Why is she saying this.What is her problem that would make her talk like this?” "

But even those who see through the fog have their hands tied. Dr Coles continues: "This is a closed, totalitarian system. If you have any reservations or doubts or second thoughts, then the problem is yours and we’ve got to bring you into the system of judgment, at times, even accusations, this is not very nice. .......history teaches us our mistakes I was brought up in a tradition of psychoanalytic psychiatry, psychology, whatever. And not only was I brought up on that tradition, but the whole medical profession ascented to this…"

British Professor of Sociology, Frank Furedi (Paranoid Parenting), claims we have not discarded these old theories, we simply keep moving the goalposts: "The field of psychology is littered with parent pathologies announced as a major discovery only to be discarded as nonsense a few years later. In the fifties, the schizophrenic and the refrigerator mother were blamed for producing autistic children. The sixties was a decade of maternal deprivation, when working moms were held responsible for causing irreparable emotional damage to their children. Today, these pathologies stand discredited - instead psychologists have invented new ones, such as attachment disorder."

"Let's pray for those doctors to listen, and let's pray for ourselves that we speak out," says Dr Coles (from the documentary: Refrigerator Mothers)

Even further, perhaps we should take my son's lead and laugh at these absurdities.
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The Chicken Or The Egg? Does Attachment Disorder Even Exist?

"Up to 70% of post-institutionalization children may show no attachment disorder behaviors," Lewis's Child and Adolescent Psychiatry 2007. This is a rather large percentage for attachment theory supporters. And what of the other 30%? My question is "why were these children in an institution in the first place"? Were they abandonned, and if so why? Was the mother an alcoholic who drank during pregnancy, was too sick to look after the baby who later suffered from FAS? Were these children born somewhere on the autism spectrum already? Undiagnosed and untreated autism can be extremely difficult to cope with, even with family support. But what of mothers with no such help or understanding? Did they abandon the child because he or she was too difficult to deal with? In short, did this 30% of institutionalized children actually have undiagnosed and more subtle brain disorders that made them "appear" unattached when they were actually socially impaired because of a biological disorder? Or were they simply part of the general average third of all infants that are "insecurely attached" anyway? In this case, wouldn't "the institution", as a direct cause, be a redundancy?

Another cause and effect quandary is this study, which is dubiously placed in the Wiki entry for "Refrigerator Mother", under the title "Modern alternatives". Taking care to point out that it is 'distinct' from the original refrigerator mother, the study measured "maternal warmth and praise" with their ASD children and its 'effects'. It found more maternal warmth and praise resulted in; "reductions in impairments in social reciprocity and repetitive behaviors," and was related to a decrease in "symptom abatement in the repetitive behaviors domain". But anyone who is familiar with ASD is aware of the problems in recipocity. Were the researchers witnessing the parents' reactions to their children's autism, not the cause of it? This is what Grinker in his book Unstrange Minds says was Bettelheim's "classic example of confusing causes with consequences". In a 2007 indepth study of mother sensitivity and children with developmental disorders, researchers concluded that;"Autism seems to jeopoardize not so much the development of secure or insecure attachments but common relations between parenting and attachment development". What is needed here, is not extra parental sensitivity, but autism interventions like RDI, which work on the child's social delays like co-regulation and referencing. Without foundations like these, being extra sensitive or "warm", or dishing out extra praise, is only going to lead to frustration, confusion and feelings of inadequacy in the mother.

Back in the early 80s I spent a month spent in Alergia in a small village in the edge of the Sahara Desert. Children never spoke in the presence of adults and averted their eyes to older siblings and elders. They would sit quietly amidst the adults; seen but never heard. Social life was adult-centered. The children only tagged along with adults and there was not a toy to be seen. Despite this, the children seemed calm, unworried and happy compared to western counterparts. Babies were passed from woman to woman - anyone who had milk in their breasts fed them. Even old ladies still had plenty of milk and they would also join the nursing. Toddlers were oddly missing from adult daily life. Where were they? Looked after by girls around 6 or 7 years who balanced them on their hips, or who ran around after them while the women sat around gossiping or cooking or napping. Children were swapped between families and neighbours, and some would spend up to two weeks elsewhere before changing again. Young children were sent on long errands to fetch water or food, and stood or sat quietly waiting for their next orders from adults. As for "attachment", the idea would have seemed absurd to these mothers. No adult played with their child, nor did they practise being 'warm and sensitive', or look for emotional cues to validate .... and praise from adult to child was unheard of. Did this village produce a generation of 'unattached' juvenile delinquents? Not at all. In fact, they were some of the kindest, friendliest and hospitable people I've ever come across. Furthermore this article argues that ideological, value systems and cultural views about which characteristics a healthy child should have, are the driving force behind labelling certain children with 'pathological' attachment styles.

What of other cultures like the Israeli Kibbutzim where, until recently, babies and children were raised in nurseries night and day? They didn't end up a generation of unattached adults. What of the French who couldn't afford a wetnurse in the days before formula, who would send their children away to the country for the first few years to be breastfed (Breastfeeding: Biocultural Perspectives). If these children didn't see their parents for the first few years, where was the attachment disorder? And if it is an intergenerational issue, then why aren't French suffering a disproportionate amount of psychological disorders today because of this legacy?

And what of the past? If neglect and deprivation causes such severe symptoms in a child as 'attachment disorder', then what of the past when children were little more than slaves and had to work in mines, or survive conditions of severe poverty? What of the children who were swaddled and hung on walls during the Elizabethan era, or when they were treated as 'sinful souls' - the parents sometimes attaching wooden rods to their infants' backs so they couldn't crawl like animals. (from Unstrange Minds) If children were so vulnerable, humanity would have already been doomed thousands of years ago.

Frank Furedi in Paranoid Parenting believes that the idea of infant vulnerability and parental determinism; "is a powerful idea with which to frighten parents . If children are indeed so weak and fragile that they cannot overcome negative experiences of their early years, then parents need to be permanently on guard. Fortunately, this powerful idea has little fountain in empirical evidence. Parents would do well to ignore these frequent appeals to what is in fact a display of cultural prejudice"

Finally, in This blog post, by a survivor of Holding Therapy, argues that Attachment Disorder - at least in the form that most attachment therapists would define - does not even exist.

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Why Attachment Disorder Has Mainstreamed

"The idea of attachment has had a phenomenal impact on the western imagination," Frank Furedi.

Why would therapists mistake the far more common developmental and neurological disorders for "attachment disorder"?

In the UK and Australia, government and community funding is the driving force behind child assessment and therapy centers, so misdiagnosing a biological child with this disorder and blaming the mother does not disrupt the funding. In fact, the more these centers "discover" parents who need "support" the more funding and jobs it creates. Whereas, in the US, where such centers are privatized and in competition with each other, not many parents are going to pay big money to be blamed for their child's condition. However, it is common for foster or adopted children to be diagnosed with attachment disorder, and therefore private attachment therapy centers for adoptees are popular in the US. Noone wants to face conditions that last a lifetime, like autism, especially with all the bad press it gets. Parents want hope. Their children are their future. That is one of the reasons why attachment disroder is appealing. Here are some others;

1. Myths and lack of knowledge about ASDs - especially Aspergers and High Functioning Autism, and other developmental conditions. The myths include; these children are uncommunicative, can't learn to play imaginatively, don't want to socialize or have friends, don't have eye-contact, can't learn to reference facial expression, etc. Media presentations about autism often feed the stereotypes with like movies such as Rain Man or Black Balloon. In fact, although no disorder was mentionned, Forrest Gump and his literal approach to the world, was far more typical of HFA than Rain Man. Myths also exist around ADHD; that it is caused by parenting.

2. Boredom. Biological disorders are nowhere near as exciting as psychological ones. Psychotherapy is more challenging for the career-minded therapist. Development disorders require mostly practical interventions which parents can easily do themselves once they learn. Plus new medications can often work miracles for children with developmental or neurological disorders. (I will cover medication in a future entry)

3. Emotional appeal - children with autism look normal; in fact these children are often very attractive. Noone wants to pin a label that dooms such an appealing child to a life of ASD. So it is preferable to label a child with a disorder that at least gives them hope, while deflecting the pathology onto the parent(s).

4. A Job - "attachment disorder" will need a lot of "help" in the form of a long period of psychotherapy, and "support" from professionals. This ensures job security and a raison d'etre, and keeps the funding coming in.

5. Attachment Disorder can be "fixed" - it allays our fears that the world is a random place where we have no control, and gives us a sense that if we just try hard enough we can do anything - a message that has infused itself into the western collective unconscious from 1970s self-esteem enhancing psychology.

6. Yet another attempt to keep women "in their place"? Let's leave the past few millenia and just go back just as far as a century when women couldn't vote, and the great deal of fear about allowing it. Women were given the right to vote and world did not collapse; it fact we are far better off today than a century ago. Around the same time was the debate over women having other rights, such as access to pain relieving gas during childbirth. During post war years, when women were given the right to work after marriage, the debate was on again; what would happen to society?

This anxiety was reflected in the 1950s film genre Film Noir depicting frightening dichotomies between the 'homemaker' woman and the 'femme fatale', while the man is emasculated either paralysed in a wheelchair, or dominated by a woman stronger than himself. Today those films are deconstructed in universities as hilarious unfounded fears about women, but they still exist in more subtle forms like Sci-fis.

Until a few decades ago, single mothers and aboriginals had their children removed because they were considered inadequate mothers. The 'Refrigerator Mother' theory had been around well before Bettelheim came along and linked autistic children to the cold, insensitive, intellectual mother. Before autism, she was blamed for an array of child disorders, including schizophrenia. While the link to autism and schizophrenia has been disproven, the goal posts and labels simply keep changing shape. The "selfish" working mother putting her children into childcare became the next focus. Would these career-hungry women produce a generation of delinquent or unattached children? Yet, studies have recently shown that twenty years later children are happier and healthier. Meanwhile, Attachment Theory has been gathering momentum since the 1950s, where the Refrigerator Mother left off. Once regarded as a disorder caused by severe neglect and deprivation in an institution, the theory has now expanded its catchment outwards to include even children who live with their biological parents, and where there is no neglect or abuse: the mother just needs to increase her responsiveness and sensitivity, and do some psychotherapy. "The Institution" has been superimposed onto "The Insensitive Mother" - the cause of today's "unattached" child who is at "risk" of growing up with various psychopathologies. What better way to keep women in their place than a fear of an attachment disordered child?

7. Fear-mongering by the media about "children at risk", feeding the frenzy for "support" of parents, while disempowering parents and empowering therapists. This needs an entire post devoted to it, and is well covered in Frank Furedi's fascinating book Paranoid Parenting.

8. In South Korea Attachment Disorder is preferred over Autism because it places the blame on the mother, rather than on the precious family genes and family honor. Covered in detail in the book; Unstrange Minds by Roy Grinker.

9. Freudianism that refuses to die. That also needs an entire post.

10. Foster or adoptive parents can blame the previous caregiver for adaptation problems they are having with their new child. A little controversial, but also plausible.

Conclusion: It is essential that ASDs and other developmental/neurological disorders are diagnosed as early as possible in order to make way for appropriate interventions and specialist school supports, because, for one, "typical strategies often do not work for ASD kids," (Sue Larkey). Wasting time with fad diagnoses, pathologizing the parents or doing psychotherapy, and indulging in other quackery, is harming the child, as well as the parents. Tony Attwood even goes as far as saying that it is better that the child receives a false diagnosis of autism, than have to miss out on this crucial intervention that could alter the course of the child's life for the better.

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A Closer Look At Attachment Disorder – Part 2

Do children diagnosed with RAD or 'Attachment Disorder' actually have underlying neurological or developmental disorders that are being missed? I am proposing that the diagnostic criteria for RAD, when analysed in the light of the latest research on developmental disorders, describes social-brain deprivation, not a condition that is a consequence of a "parent pathology".

The onset of Autism Spectrum Disorder (ASD) can be likened to a 'computer crash', says autism expert Tony Attwood, or a 'tipping point' (Dr S Gutstein). Extreme sensory sensitivity, genetics, viruses, food - anything that can effect the specific areas of the brain crucial to social learning, sabotages its development. Whatever the cause; the results are the same. The social 'feedback system' between the child and others - essential for the development of "dynamic intelligence" (the ability to observe and continually regulate one's behavior in order to participate in spontaneous relationships) - is the first casualty. The child is unable, or only partially able, to understand the world through the mind of a more experienced person, ie a parent. This leads to literal thinking. The world - especially social situations, which are highly dynamic - is a scary or confusing place for autistics, so they spend a lot of energy either trying to control it, or running away from it, manifesting as fixations, rigidity, controlling behavior, even aggression. When the child applies this literal and static - one size fits all - approach to a social setting, the result is a "persistent failure to initiate or respond in a developmentally appropriate fashion to most social interactions" (RAD criteria).

It is easy to imagine then, how a child with "mind blindness", as Attwood calls it, can respond to these confusing social situations by "inhibition" - "persistent failure to initiate or respond in a developmentally appropriate fashion to most social interactions; "1. excessively inhibited, hypervigilant, or highly ambivalent and contradictory responses." (RAD criteria)

Dr Gutstein says; "Typical brains develop greater neural collaboration allowing for innovative responses to complex, novel problems and situations. (But) ASD brain development leads to over-reliance on previously learned rules and procedures."
Or 'disinhibition'?
Criterion 2 of RAD describes: "diffuse attachments as manifest by indiscriminate sociability with marked inability to exhibit appropriate selective attachments (e.g., excessive familiarity with relative strangers or lack of selectivity in choice of attachment figures)." This "unselective" behaviour is not the result of "attachment" difficulties. It is a characteristic of literal thinking of the more outgoing Aspergers child, who characteristically can't distinguish between stranger, friend or family. So what psychiatrists call "disinhibition" is nothing but pure logic to the child with a literal-minded "static" brain. And"inhibition" is the understandable fright-flight response of a 'static' brain to confusing "non-static" stimuli.

Because these "social impairments" logically originate from a lack of intersubjectivity, they can only manifest if either;
1. The child has a developmental disorder impairing the social part of the brain, or;
2. The child has a normal brain but has had NO interaction with others, or has been extremely deprived of it.

Even bad interaction is still interaction. Furthermore, Attachment Theory presupposes that the baby or child only exchanges subjective experience with the mother. But this is rarely true. The child has siblings, extended family, kindy peers and teachers, neighbours and so on. Therefore, "attachment" is not the issue here, but "intersubjectivity". But Freudianism, which refuses to die a natural death, has blinkered some therapists and mental health professionals.

Frank Furedi, in his book Paranoid Parenting, gives many examples of studies of children exposed to a variety of severely stressful situations, like natural disasters or deprivation, and argues that there is far more human psychological resilience than the mental health profession would like to admit: "When Bowlby attempted to test his theory, he was surprised to discover that youngsters proved to be far more resilient than he suspected. He found that children who were separated from their mothers for prolonged periods tended to behave in ways that were only marginally different from that of those who did not experience separation. Bowlby and his colleagues were forced to conclude: "Statements implying that children who are brought up in institutions or who suffer other formes of serious privation and deprivation in early life commonly develop psychopathic or affectionless character are seen to be mistaken." ..... No doubt a child systematically neglected by a brutal regime in an orphanage or raised alone in a dark closet for 36 months is unlikely to emerge a normal, healthy 3 yr old. However, such extreme examples offer little insight into understanding the general relationship of early experience to subsequent development. To associate the tragedies that emerge in extreme setting with the developmental problems confronting ordinary parents is to substitute scare tactics for reasoned argument."

Finally, another voice of reason in the wilderness, Tony Attwood in this online audio, says: "A mother's lack of love could not have such an profound effect on a child. .... we now know (Aspergers children) are neurologically different." He explains that the brain test profiles of these children clearly suggest neurological problems, not psychological ones or the result of bad parenting. But not everyone is happy with that: "... The parents are saying; yes yes yes, but the psychiatrists are glaring at me thinking this is taking away their livelihood," says Attwood.

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A Closer Look At Attachment Disorder – Part 1

The Diagnostic Criteria for 313.89 Reactive Attachment Disorder from the DSM IV, describes social impairments that are identical to Autism. The inhibited form would describe a less verbal, more fearful child with Autism. And the disinhibited form would describe a highly verbal child, typical of High Functioning Autism. Compare this with the first two parts of the diagnostic criteria for 299.00 Autism

Note that the DSMIV criteria for attachment disorders, explicitly excludes children with pervasive developmental disorders. Therefore, you cannot have both attachment disorder and autism.

Of particular interest – and danger - is the ICD 10’s Disinhibted Attachment Disorder criteria, which does not even include 'neglect' as a criterion. Disinhibited attachment disorder of childhood (DAD) according to the International Classification of Diseases (ICD-10), is defined as: "A particular pattern of abnormal social functioning that arises during the first five years of life and that tends to persist despite marked changes in environmental circumstances, eg. diffuse, nonselectively focused attachment behaviour, attention-seeking and indiscriminately friendly behaviour, poorly modulated peer interactions; depending on circumstances there may also be associated emotional or behavioural disturbance." – F94.2 of the ICD-10.

This description also fits perfectly with high functioning autism, since these behavior traits are common with HFA: A general lack of fear or fearlessness may be evident, and children with autism may talk openly with strangers, hug strangers, invade people’s personal space, bump into peers in lines, touch or climb people inappropriately, or have excessive or a complete lack of separation anxiety from parents or caregivers (Mayes, 2008). The Aspergers child is "Socially aware but unable to act appropriately with others".

Yet the very word "attachment" in the title automatically suggests that the behavior is a result of the environment, namely the mother, which is usually cloaked by the gender neutral terms; "caregiver" or "parent". Lack of the neglect or abuse criteria is problematic because it opens the door wide open to marginalising certain categories of people, while the child with an undiagnosed developmental disorder misses out on important early intervention.

Here are the remaining criteria for autism, where only one criterion needs to be met. These patterns of behavior, particularly in the high functioning and Aspergers types of autism, can be very subtle, and the child can be aware enough to hide these behaviors – at least in public. So, unless the child has a severe form of autism, you would not see these symptoms in a therapist’s office: Autistic Disorder continued (3) Restricted repetitive and stereotyped patterns of behaviour, interests and activities, as manifested by at least two of the following:a) encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focusb) apparently inflexible adherence to specific, non-functional routines or ritualsc) stereotyped and repetitive motor mannerisms (e.g. hand or finger flapping or twisting, or complex whole-body movements)d) persistent preoccupation with parts of objects

Conclusion: It is easy to see how these two disorders can be confused. From experience within the mental health field, I know how outdated Autism knowledge is within psychiatry, despite it affecting 1 in 100 children. It is quite easy to see, then, how such a therapist, keen to get stuck into some psychotherapy, which has been dying out, will see 'zebras' rather than horses.

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