[Graham]

I realize that I'm taking a huge risk in stirring up the attachment debate once again, but the following recent statements by a long-term professional friend of mine are important, and I have to share them with you. Dr. Richard Barth is the foremost researcher of adoption issues in North America. He was advisor on the issues to the Clinton White House and Congress, and his extensive body of work is cited in most of the serious adoption literature. He was founding professor of research at the School of Social Welfare, University of California at Berkeley, and is now chairman of the social work depatment at the University of North Carolina, Chapell Hill. His work was the academic foundation for the Adoptions and Safe Family Act (ASFA), and many previous pieces of legislation. In fact Hilary Clinton chose Berkeley as the venue to announce the passage of ASFA, with Dr. Barth at her side. His most recent research concerns what families need and want from post-adoption services. He is also a special needs adoptive father. So he's no slouch!

As cited in the "Voice For Adoption" newsletter, Rick was speaking before the National Conference of State Legislators when he remarked that the national emphasis on attachment is misplaced. "The adoption field's near obsession with attachment issues as the cause of difficulties in parenting is leading the field astray, in some cases with tragic results, " he says. "There is no scientific basis that I am aware of that points to attachment problems as a primary cause of parent and child problems or suggests that any of the attachment-based therapies are effective in reducing these problems." He feels that other proven interventions, such as multi-systemic family therapy and Assertive Community Treatment could be adapted to meet the needs of adoptive families.

I could add Wraparound and Family-to-Family as other powerful and effective strategies as well. I really hope we don't get into a "does it work or doesn't it" debate on this issue. Obviously some families feels that attachment therapies have worked for them, regardless of the research, and of course Dr. Art is professionally committed to his work. What interests me is that Rick's remarks really point up the fact that there is no single solution to the parenting and life needs of traumatized or seriously neglected children. Best thinking now is that we may have entirely underestimated the contribution of Fetal Alcohol Syndrome and Effects to not only a child's present behavior but also to his or her primary attachment process. Throw in ADD/ADHD, Sensory Integration issues and post-traumatic stress and its no wonder that no one can tell the chickens from the eggs. There was no single cause for a troubled child's adaptation to the world, and for certain, there is no single solution. We all have to be wise, open to possibility and ready to adapt if we are to do our jobs well.

Graham.

[Barksum]

You said a mouthful there, Graham! While I am not a professional and do not have much experience in the adoption field, I have often pondered the attachment/neglect/abuse/fetal alcohol conglomeration. I have been thinking long and hard on these issues of late not only because we have a DS who has FASD, but also because DH and I have been asked to sit on a forum of adoptive parents during a Q and A at the end of the training for new adoptive parents-to-be.

I agree that PEA (prenatal exp. to alcohol) is VASTLY, HUGELY, and SIGNIFICANTLY under-recognized. I'm not saying that this is the key component for everyone in special needs adoption, but I am aware at how little consideration it is given by cw's, therapists, and the medical profession, etc., so I believe that it is a sneaker wave that inundates many adoptive families. Many spec. ed. teachers are not even aware of FASD (fetal alcohol spectrum disorders), let alone the average teacher in the classroom. This is not a slam to the teachers; rather a disgusted nod to the powers that be who have not made the information garnered through years of research readily available, nor have they plastered billboards with it as we have seen for drug awareness and other issues.

In just the minute amount of research that I have done into FASD I've found shocking stats. For instance I now know that fetal alcohol is the NUMBER ONE cause of mental retardation in the western hemisphere. Hello?! Why isn't that being advertised? I also found out that the number of children affected is unknown due to a lack of physical manifestations in most people. And no, FAS (fetal alcohol syndrome) is NOT the most damaging form of the FASD, just the most recognizable.

As you can tell, this is a sore subject with me. As adoptive parents my Dh and I have been subjected to all kinds of rumor and inuendo, only to find that very few people actually know much about FASD. I'm just glad that we "stumbled" onto an aware therapist who was on the ball and who was able to tell us, "Life will be different, but not awful. Your child WILL LEARN, but differently and will take more time. He may also plateau, but let's work with things and take it as it comes."

I'm climbing down off my soapbox now. (I know I'm preaching to the choir! LOL) Anyway, Graham, I was interested to read your post.

[Dianna]

I agree with what you have said Graham. That has been our experience. especially the last paragraph.

[Jerry]

I certainly agree that there is no single solution. Any therapy worth investing in must take into consideration the total child. Another dated term would be the "baggage" a child brings with them. One serious mistake many people make is relying solely on the therapist to "fix" their child. Adopted or not a child needs support from every significant adult in their lives. For example look at the "participation" in parent teacher nights at many of our public schools. Saying you care and showing you care are two different things. Children are in tune with our actions, and as parent's we have to accept that what we do in any situation has a significant impact on them.
Far to liittle attention is paid to a wrap around approach. Pride, disbelief or ignorance stand in the way of some families helping a child develop into a loving, caring and responsible adult.
Unfortunately we don't know enough about human behavior, but at the same time we do know far more than we knew even ten years ago. Like any science mistakes are made, and assumptions are pressed to fact before adequate research is complete. Diagnostics criteria aside, diagnosis is subjective.
I would certainly support a broader wraparound approach in many circumstances. It can be difficult to live with a child suffering from emotional problems. Strained relations will lead to poor decisions for our children. It is exactly at those times that wraparound services are needed.
We do have differing opinions on the validity of some therapies. I certainly don't support any one therapy type as the single best choice! I believe the best choice is to work together with a team of service providers in the child's best interest. We need to not try and "make" the child into something , but rather look at who the child is (considering the abuse and disabilities they have), and help them develop into a person that has a good quality of life, is caring and loving in their relationships, and responsible with their choices "if" that is possible. When it isn't we need to determine what we can contribute to the child's growth. There can't be a standard measure of success either. What is a great success for one child may not be for another.
As we wait again to hear on whether we are selected for a placement we also research and look at how we will have to adapt and accommodate the children, and also consider how we will have a very short time to learn who they are and help them learn who we are. To a certain degree we have to rely on what others have assesed and I can assure you it's not always correct. It's our commitmant to who we are that keeps us moving forward.
I think this is an excellent topic and needs to be discussed, thanks Graham!!

[ladyjubilee]

I think part of the issue is that we all see what we know...Which means we tend to say "aha, FAS" if we know FAS, or "Must be AHDH" if we know AHDH, etc. I think Dr Barth has a wider persceptive because he doesn't "know" attachment (or others dxs) in the same way that someone who specializes (or has parented a child with x disorder) does. I think Dr Barth's insights are important because he does see those forrests, while others are are working with the tree....and can see some of the larger patterns.

[dadfor2]

our son was DX with RAD just to name a few of them......the social worker stated that alot of kids in the foster system are DX with RAD (which was the one i was worried about)

this kid has bonded to us so much. So im not really sure who DX some of these kids. plus, some of the other DX i question also, i researched all of them, and he doesnt seem to fit in the category all that much. He might have a 1 or 2 of the syptoms but then i agian.....so do i.....HA HA HA

I remember when he came, everything he did i questioned if it was normal, i read tons of books on adoption, and i looked up all the signs.....(i never had bio kids) then i finally got a book on normal kid development......guess what.....his behaviors were pretty normal. He will continue with play therapy to deal with his past and stuff, but he seems like a happy 5 yr old who is just thrilled to have a forever family.

just thought id add something, dont believe everything you read, alot of people love labels, it makes it easier for them to deal with, sometimes it could be just a kid who is being a kid, with kid behaviors.

[Dr. Art]

Who could argue with the idea that there are often multiple causitive factors for complex problems? Kids are complex, so are adults and families. Damaged kids often have many etiological factors present that new parents and families bring to the mix.

However, the comment, "There is no scientific basis that I am aware of that points to attachment problems as a primary cause of parent and child problems or suggests that any of the attachment-based therapies are effective in reducing these problems." I think does suggest the author's lack of knowledge and undermines his credibility as an "expert" as there is ample evidence in the literature on just this point. I'd draw your attention the work large body of literature by Dr. Mary Main at UC Berkeley and Dr. Hesse at the same institution, that of Dr. Dante Cicchetti, and nearly any issue you care to pick up of the Journal of Infant Mental Health, which anyone who is doing serious work in this field reads. An, of course, there was the land mark study for WHO by Dr. Rutter in right after WW II. If you go to my website you can find lots of references or you can read, Handbook of Attachment edited by Dr. Cassdy and Dr. Shaver, 1999.

Too many children's problems are inaccurately diagnosed and, therefore inaccurately treated with no effect. The children are then labeled as unadoptable. The only evidenced based treatment for Reactive Attachment Disorder is attachment-based therapy such as Dyadic Developmental Psychotherapy. Again, my websitte has references for peer-review professional articles on this point. Our own research found that the families who received this treatment had good results and measureble improvement as measured by valid and reliable instruments, while children who received "usual care" such as family therapy, play therpay, RCT, and partial hospitalization had no change in the measures.

What is vital is an accurate and comprehensive assessment that covers the forrest. For example, a substantial majority of the children we evaluate and treat have sensory-integration disorders that we screen and find. This is important as many "attentional" problems can be caused by sensory-integration. A complete evaluation must include a detailed and accurate history to consider all etiological factors such as medical condition, the effects of early substance exposure, neurological and psychological factors, the impact of trauma, parenting, placement history and much more. Most children have multiple difficulties with multiple causes that require multiple interventions. I's estimate that over 80% of the children we treat are also being treated for other issues such as neurological conditions, learning problmes, FAS related disorders, and sensory-integration.

I am hopeful that a lively debate will follow.

Regards

[Late Bloomer]

... if this topic is really about attachment therapy, Graham, I can't help wondering why you keep saying it's not effective.

It may simply be too early to have the long-term studies required for the "scientific basis" your friend Dr. Barth talks about. But meanwhile, there seem to be quite a few desperate adoptive families getting stuck with traditional therapies that don't work for attachment disorder (we were one). At the same time, there are many real-life situations described on these and similar discussion boards, by knowledgeable parents who apparently found attachment therapy to be a real turning point in their efforts. A few who come to mind here (please correct me if I'm wrong) are Susan Ward, LucyJoy, and DimasMom... How do you explain those?

[ladyjubilee]

Originally posted by Dr. Art
However, the comment, "There is no scientific basis that I am aware of that points to attachment problems as a primary cause of parent and child problems or suggests that any of the attachment-based therapies are effective in reducing these problems." I think does suggest the author's lack of knowledge and undermines his credibility as an "expert" as there is ample evidence in the literature on just this point. I'd draw your attention the work large body of literature by Dr. Mary Main at UC Berkeley and Dr. Hesse at the same institution, that of Dr. Dante Cicchetti, and nearly any issue you care to pick up of the Journal of Infant Mental Health, which anyone who is doing serious work in this field reads. An, of course, there was the land mark study for WHO by Dr. Rutter in right after WW II. If you go to my website you can find lots of references or you can read, Handbook of Attachment edited by Dr. Cassdy and Dr. Shaver, 1999.

Not to ask a stupid question, but wasn't Dr Rutter's work the stuff done to make women give up the work place to returning men?

Too, I have to be honest....if we consider multiple causation, how come when anyone posts a child behaviour problem we immediately say, "see the ATTaCH website and find a qualified attachment therapist", instead of "First, have your child's pediatrician do a thorough medical work up. Some behaviours may be rooted in physicial problems. Then have your child evaluated by a competent child psychiatrist. The psychiatrist may recomment attachment therapy"?

[louise]

and have so many thoughts I am not sure I can get them into one coherent post.

IMO attachment is of great importance and is what makes most of us enjoy the hard work of parenting. Attachment is what takes place in the days and weeks following birth and is so much about reciprocity, the give and take that is the hallmark of most successful relationships. We have seen attachment take place with older placed kids, albeit on a slower timetable and with many steps both forwards and backwards. I do think there is a specific way to parent attachment impaired kids in order to give them a real chance at success both in the here and now and in the future.

Here is where I am torn. There seems to be a tendancy to lump all adoption related issues into the "attachment box". Find yourself a good attachment therapist and all will be well. It seems nearly EVERY child adopted from the system is RAD as opposed to each child receiving appropriate individual diagnosis. The dilemma of placing all older children in the RAD category is that we can miss some really important other possibilities. One of those possibilities is of course FASD and all of the implications of such a diagnosis.

I would like to suggest that the interaction Dr. Art suggests, PLACE, is really plain old common sense parenting that we automatically do with infants. This kind of parenting seems awkward with older kids at first, in part because these kids can be so darned resistant to any kind of interaction that is not negative. I can attest that PLACE parenting works with not just difficult kids but with regular kind too!

If I may I would like to share a "Josh story".

Josh and Alex (one of our twins) had a verbal arguement. Words were exchanged heatedly, back and forth. Petty typical boy stuff until Josh blurted out "I wish I could kill you Alex!" Alex was completely taken aback and left the room. He went outside to the front yard where we have chairs and sat and wept. He really felt so hurt, he could not talk about with me or anybody else.

Josh arrived into where I was sitting and asked where Alex was. I told Josh he was outside and that he was really upset. Josh asked what he should do. I suggested he go outside to Alex and just listen to what his brother had to say. So, off he went, a little cocky not so remorseful.

In the meantime, a skateboard I had ordered for Josh, as a surprise, arrived by mail. (This fact will be of importance later in the story).Josh had received a skateboard for Christmas and had broken it within a week or so. He was so disappointed with himself, I ordered the new one without telling him.

After about twenty minutes of the two boys being together, Josh arrive back in the house. He was quite beside himself. You see he was crying and didn't know or understand why. He said, "Mom, Alex explained to me how hurt and upset he was and he was crying really hard. All of a sudden I started to cry too. I think I am feeling what he was feeling and it made me cry!"

I was so thrilled for Josh. He actually felt empathy for his brother! A breakthrough. What was even more amazing to me was his own surprise, he was beginning to recognize and feel the hurt of another person and his part in contributing to that hurt.

I presented him with his skateboard. "Why??" he asked. "Because I saw your hurt and disappointment when the other got broken" I replied. "And becuase I love you and you are my son". "But....I just told Alex I wanted to kill him???" "Yes, and here is your skateboard. I love you anyway".

I think I was able to show Josh empathy seperate from his own actions. He experienced his brother's hurt and his mother's care. A double whammy of empathy, if you like.

Alex, emotionally strong as he is, was able to recover from his brother's outburst. I told him how impressed I was that he was willing to share his true feelings with Josh and what gift that was for his brother.

For Josh, this was a turning point on his path toward emotional healing. Was it attachment "work"? Was it practical parenting? Who knows?

[lucyjoy]

While all medical conditions need to be ruled out, why wouldn't attachment come next? Attachment has to do with trust and a child who was abused, neglected, removed from a parent, and often had a number of foster placements will most likely have trust issues. An attachment therapist should be familiar with adoption and foster care and can evaluate wether attachment is a problem. I have had attachment therapist refer children to psychiatrists when they felt a mood disorder of some kind needed evalutation. The big issue is people lump RAD all the way to issues with attachment as all the same thing. It is not. True RAD occurs between birth and three years old. In my experience, in these cases, the abuse or neglect was severe(sexual abuse on children under three, children under three left for days at a time). The children I've taken with true RAD had multiple foster placements, severe abuse, and most had at least one adoption disrupt. Kids with attachment issues, exhibit some distrusting behaviors but are able to develop normal cause and effect thinking and empathy over time with adjustments in parenting and therapy that addresses trust. True RAD requires intensive intervetions. My opinion, of course.(I do have a child who is FAE but his RAD had to be addressed first)

[Mom_Of_Many]

I do not believe a blanket RAD diagnosis explains everything. Most dx. have many components to them. In the case of our very severe RAD, his birthmother had almost killed him as a child by feeding him too much water vs. forumula so that he actually had a convulsion and stopped breathing. Was this part of his later very odd behavior? She also used drugs. Does that also mean she drank? Probably. Is FAE maybe one reason he became a child who would be classified a perfect RAD? Nobody knows. The chld himself doesn't know why he acted like he did. He has no insight into his own behavior. Is this because he is also cognitively delayed? We all need to remember (even me) that some very complicated kids also come straight from birthfamilies and into loving homes....kids who are chronic behavior problems at home and school with no apparent environmental cause. I believe all of our kids we adopt deserve a total psychiatric eval when we get them (from a GOOD psychiatrist) to rule out or rule in EVERY psychiataric diagnosis we can find. That helps. But with some of our kid's very complicated histories, we will NEVER know what causes everything with some of our kids....and we can only help them so far. I have a complicated 9 year old, so far with bipolar, ADHD, and cognitive disorder NOS....why? What else? We don't know; may never know. All we know is we are committed to giving him a loving family and wonderful life and, if necessary, help him find assisted living when he is an adult. I believe RAD exists (no kids in my home have that dx. now, but we had two who don't live here now who did have it). But I don't believe RAD is as simple as just a lack of attachment, since these kids have been thru so much more than just the brutal abandonment of their birthparents. Ok, sorry about the long vent.

[rindava]

I was an FP for 5 years, I have adopted 3 children.

If that group in DC is going to blame behaviors on drugs and belittle attachment issues, then I really wonder why. Is it to cut funding or deny attchment therapy? IS it to say these kids are hopless and who cares if they grow up in group homes, rtc, permanent foster care, in their bio-drug addict parents homes, or hey if you used drugs or drank you sure as hell better go get an abortion because you are going to produce a burden on society?

One personal story here, I do realize it is an antidotial account and not "sound research" My girls were unquestionably exposed to drugs and alcohol and no really problems from it--- Man Julie's sever asthma cleared right up when she was not living with pot smokers.

My son's b-mom was a some kind strange as she did a lot of the usual scum of the earth stuff, but never drank or did drugs. Was even beat up by boyfriends for not using. She never took any of her medication either. It was her belief and was noted all over the place from high school to when her kids were in FC, by her parents, friends, everyone.

Both her birth children have RAD bad, I have one of them and it is not fun and it would be very wonderful if we could have gotten some real "attachment" treatment instead of me reading what I can get my hands on.

Drugs are a problem, and people don't need to be doing them when they are carring a baby, but foster kids have so many more problems then just drug exposure and it is not the main problem.

I have taught kids with severe FAS, and man it is such a cake walk compaired to RAD.
Mental health issues, bipolar, schizo, etc... can also be major issues

If people could just open their eyes and see. My son is in a constant state of I want to control, so he will not get controlled and hurt by another adult. I guess I am such a Bryan Post follower now.

I have a student right now with autism. I hate what is happening to her. I am poorly staffed and can't get one of the TA to stop yelling at her, this has triggered behaviors. She is also on the pill, what for I don't know I say kill the bastered that touches her. So now she is drugged out like a zombie and their is nothing I can do. If people would just open their eyes.

I am getting to be a very jaded 30 year old.

I just remember when I was a foster parent all the snid remarks from SW about foster kids----"They were raised that way, you can expect them not to be sluts," "Well most of them are dumb, you can't really expect them to do well in school," "Don't push the girls too hard in school, they probably won't go to college", etc...

It just seems to me they are sitting in their ivory towers say "Yes, yes the poor peasants take drugs and they are creating problems that cost money......." Instead of these kids have been treated like sh-- their entire lives and they need to heal from it and need to have a family that will be there for them their entire live (you know Thanksgiving, Weddings, College Graduation, etc....)

[Dianna]

rindava, Have you ever read a book called, "The Limits of Hope"? It really influenced me as to the influence of nature and nurture. A woman adopted two girls from the foster care system with significant neglect and abuse issues. One of them grew up to be a prostitute and remarkably like her other bio sister who was raised by their birthmom. All of the influence from this educated, nurturing family may have had some important influence but the outcome was very much the same.

My daughter is very interested in looking sexy. She gravitates toward the Spice Girls and wants all the revealing clothes. She is 10 years old. She does not watch much TV, is not exposed to this other than from school and friends. I talked to her psychiatrist about why she seems to gravitate toward the commercials so much without hardly any exposure. He said it was a type of mind set of people who go with the surface stuff of what is in and buy into it. I said that it seems quite shallow. He said they can't help it. So we accept that this is what she wants and we put limits on it while giving her the power to be who she is. In other words I don't judge and criticize. I keep trying to show her some of the deeper and more meaningful aspects of life.

I don't know how much personality stuff is genetic but it is more than I had originally thought. Just sharing some thoughts, no conclusions.

[JR_outside]

Our family was like a biosphere for nature vs. nurture. We had adopted kids, bio kids, foster kids. We ahd stranger adoptions and kinship adoptions. I have had the chance to talk to some of the bio sibs of adopted sibs and their families.

Bottom line seems to be, yes, kids can inherit amazingly detailed behavior patterns. Right down to using words and logic of bio parents they never knew. Eery, actually, to hear the same words decades later from a different person.

However, all the kids did better raised away from the bio parent than they likely would have (they are better able to cope with life than bio parent is). Many of them overcame substance exposure and genetic tendencies and are competent adults. Some of the bio sibs are less competent people than the adopted/exposed/"bad genes" kids. Kids with more than one abberant parent had a tougher time than those with presumably less genetic predisposition. (One set of kids had two mentally ill parents, others shared a mother but had different fathers who did not appear to be ill but are not known now.)

I say, you do your best, the kids make choices, their biology propels them in certain directions, they choose to follow it or not in some cases, in others they are not able to make that choice. So you do what you can, and in most cases the kids are better off for all that you can do for them.