Child Myths

Straight talk about child development.

Fatal Misunderstandings About Reactive Attachment Disorder

Dangerous misunderstandings harm foster children and others.

When I began this blog, I chose the name "child myths" because of my concern about misunderstandings that are potentially harmful to children. As some readers know, my interest in this issue began some years ago with a study of so-called Attachment Therapy and its role in the death of Candace Newmaker in 2000 (described in Mercer, J., Sarner,L., & Rosa, L. [2003], "Attachment Therapy On Trial". Westport, CT: Praeger). The fact that other children have also died at the hands of parents acting on the instructions of unconventional therapists has also motivated me to pursue the correction of "child myths".

A number of myths about children are part of mistaken beliefs about the childhood mental health problem called Reactive Attachment Disorder and given the code 313.89 in DSM-IV-Tr. The criteria for Reactive Attachment Disorder involve children's age-inappropriate relationships with adults, with behaviors that are either less engaged and dependent than is typical for the child's developmental stage, or, alternatively, excessively dependent and "clingy" compared to other children of the same age. Regrettably, these criteria are little understood by the general public, but are replaced by myths and misunderstandings that are reinforced by careless journalists. For example, the newsletter of a middle-western foster and adoption group (http://www.mfcaa.org/img/files/newsletters/2010/Feb%202010%20News... ) claims that Reactive Attachment Disorder is characterized by the following symptoms: superficially charming behavior, refusal to make eye contact on parents' terms, "crazy lying", and false allegations of abuse, among other things. This misinformation is repeated by print and television journalists until "everybody knows" it's true-- even though it's obvious that this set of behaviors has little or nothing to do with Reactive Attachment Disorder as defined earlier.

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The spread of misinformation is a problem for more reasons than one, and is especially problematic because misinformed people can easily make misinformed decisions. Such decisions have resulted in death and injury of children who have been mistreated systematically by caregivers, often with the encouragement of caseworkers. Michael Shermer, writing in "Scientific American" several years ago, referred to these adverse events as "death by theory", and indeed it is hard to see how such things could have occurred if the adults had not been blinded to the obvious by their beliefs about child development.

There have been quite a few reports of harm to children resulting from misinformed beliefs about Reactive Attachment Disorder. One account of an investigation of a foster home following the death of a child gives examples of these beliefs and their impact. Relevant correspondence and investigation reports may be seen at http://www.dleg.state.mi.us/fhs/brs/reports/CP140201012_SIR_2008C..., but I will refer to some of the important statements referring to beliefs held by the caseworkers in this situation. (I will omit some of the material dealing with carelessness in the original acceptance of these foster parents into the system.)

1. One child in the family had a tantrum in the car, and following the foster mother's actions to deal with this, complained that she had broken his leg. He was found to have a "linear displaced fracture of the proximal tibial epiphysis" [the growth plate area at the end of an immature bone] and a cast was applied. The caseworker said, however, "DHS believes it is possible that [he] never really felt any pain in his leg, that he was just using this as another control mechanism, and he is bewildered by the fact that he now has a cast on an injury that he was ‘inventing' in order to get the foster parent into trouble."
2. An anonymous referral said that a child had been locked out of the house on several occasions and had screamed and cried for close to an hour, begging to be let in (this was in December in Michigan). The caseworker, however, said the complaint was "consistent with her knowledge of [his] classic Reactive Attachment Disorder (RAD) behaviors, as he frequently yells and screams out toward foster mom, accusing her of mistreating him", and that he might have gone outside of his own accord and then taken the opportunity to accuse the caregiver.
3. One child was found locked naked in an abandoned outdoor shed. He was taken to the emergency room, where doctors expressed concern about bruises and bite marks on him. Two caseworkers stated their opinions that these marks were self-inflicted.
4. Another of the foster children stated that a foster parent had made her run barefoot in the snow for "discipline", made her run up and down the stairs in the middle of the night, dragged her through the mud as punishment, and sometimes withheld food. No investigation followed these disclosures.

Do these examples of mistreatment show anything other than the fact that human beings can be unbelievably cruel to children? I believe they do show something else: that the caseworkers who were supposed to advocate for the children believed that their treatment was appropriate. They had accepted some ideas current among unconventional therapists and frequently repeated by unwary journalists. These included the belief that complaints of pain or sickness by children said to have Reactive Attachment Disorder are all lies and attempts to manipulate and exploit other people. Also included was the belief that allegations of abuse by "RAD children" are always lies and attempts to cause trouble to their caregivers, even when there is physical evidence of injury. In addition, not only the individual caseworkers, but one or more of their supervisors apparently believed that pain, hunger, fear, and humiliation were appropriate treatments for children who were less than satisfactory to their caregivers.

Until we can correct these myths, and until we educate caseworkers, foster and adoptive parents, teachers, and the general public, about them, the most vulnerable of our children remain in real danger from those who are supposed to care for them. Please, journalists, take note, and do not exacerbate this problem by circulating dangerous mistaken beliefs!

[I regret that a series of personal attacks on colleagues and contributors, as well as on me, make it impossible to allow comments on this post.] 

Jean Mercer is a developmental psychologist with a special interest in parent-infant relationships.

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