Reflections on Beyond Consequences Volume 1: Pseudo – Science Intervention!!!

December 9, 2011

Recently, an adoptive parent came to session  with a number of adopted children of different ages. One of the presenting problems was night waking and binging on food. This is a common problem with adopted children who experienced neglect. The client had read “Beyond Consequences”, which is a well established model in our community. I had not read it. I read an article online by the author, Heather Forbes, and it was well written and mostly in line with attachment literature. So, I ordered the kindle edition (for my IPAD – I love Apple!) and opened to the chapter on “Hoarding and Gorging.”

As I was reading, I was stunned when I got to this part:

Begin bottle-feeding your child… yes, begin bottle-feeding your twelve or even fourteen year-old. 

If a child needs it, regardless of his age, he will take the bottle. The simple gauge is this: if he does not need it,

he will not be inclined to take it. Remember that if the child did not receive sufficient developmental nurturing, 

then he has a barrier in his development. Until the barrier is addressed, the other levels are going to continue to stagger. 

The bottle-feeding should only occur while the child is in the parent’s arms. Forbes LCSW, Heather T. (2010-07-01).

Beyond Consequences, Logic and Control: Volume 1 (Kindle Locations 1139-1143).Beyond Consequences Institute, LLC. Kindle Edition.

Stunned. I hope you are having the same reaction.

She refers to children as having “attachment challenges” in her article online. No attachment expert would support the use of regressive means to assist a child in developing a healthy, secure adaptation. In my opinion, she has taken the opposite stance of the more aggressive, coercive “attachment correction” interventions. This type of regressive intervention is developmentally inappropriate to use with any child past bottle feeding age!! This is an intrusive intervention at best and continuing along the path of insensitive interventions for children. Do not do this type of intervention. It is akin to blood letting with leeches. It is pseudo-science, even with the endorsement she received from the son of the late and great John Bowlby. I also reviewed the professional literature and the Advocates for Children in Therapy DO NOT RECOMMEND Beyond Consequences. 

Heather Forbes has the general idea that the interventions are to be relationship based and behavior should be viewed as a reflection of experience. This is true.

According to research,  behaviors are often attempts to communicate needs or get needs met, previous coping strategies, and miscues based on distrust and fear of adults and close relationships. Attending to internal states and needs is also important such as distress, apprehension, and feelings of being out of control.

A child with difficult acting out/acting in behaviors needs help from the caregivers linking behaviors, thoughts and emotions. Caregivers remaining in the “Bigger, Stronger, Wiser, and Kind” position need to remember to take the initiative in approach, interaction, and contact with sentivity to a child’s lack of experience, join with a child when the child is distressed, aggressive, or fearful, assist in interpreting patterns of behavior, name feelings/thoughts/and links to behavior, support learning to seek help and comfort from the caregiver, and assist the child with practicing new behaviors and new interpretations of events. Bottle feeding a child past bottle feeding age violates the “WISER” position of  “Bigger, Stronger, Wiser, and Kind” caregiving.

The social/emotional relationship interventions ought to communicate at the child’s level, use gentle encouragers through natural means of eye contact (play catch, hide and seek), joint/shared attention (looking out the window at the bird on the tree together and enjoying the moment), and social referencing (the child ‘checking’ back in with the caregiver). Caregivers ought to encourage smiling and positive affect, and talk to the child about feelings…types, parts, and dimensions.

BTW: While I do agree that sometimes, the night time waking behavior is a miscue, that is, the child is distressed (scared, anxious), needs comfort, and seeks comfort not in the context of a safe relationship with the caregiver but through some other means, there is also some research has show that children with the night waking, night terrors, and sleep walking have to go to the bathroom.

Interventions for children should always be sensitive to the development needs and age of the child, gentle, and pass the “common sense” test!!

Please email, call, or contact our office for child development expertise!!

 

Ted Stein, L.P.C, N.B.C.C, B.C.P.C.C, A.F.C is a marriage, parenting and development expert. He has advanced training in infant attachment (A, B, C, & D) from the experts at the University of Minnesota, Alan Sroufe and Elizabeth Carlson; in toddler age attachment from William Whelan (University of Virginia and Mary B. Ainsworth Attachment Clinic), and  in adult attachment from June Sroufe, University of Minnesota. He has practiced therapy for 17 years and currently specializes in marriage therapy, parent capacity/risk evaluations, custody assessments, and attachment assessments. He is Accredited Forensic Counselor.

 

Reflections on an article by Nancy Thomas: Reactive Attachment Disorder

September 16, 2011

I was reading an article online by Nancy Thomas called “What is Reactive Attachment Disorder” and find her pre – suppositions rather disturbing. Particularly, when she has NO formal training in the assessment of attachment that I can discern from the attachment AND child development experts in the field. When I reviewed the list of individual she has trained with, none of them that I was able to research had any formal training in the ASSESSMENT of attachment quality of children. I may have to dig deeper with whom she has trained and with her trainers have trained with…

1) She presumes attachment is an “all or none” construct. This is a false. She claims on her site ” Attachment is defined as the affectional tie between two people. It begins with the bond between the infant and mother. This bond becomes internally representative of how the child will form relationships with the world. Bowlby stated “the initial relationship between self and others serves as blueprints for all future relationships.” (Bowlby, 1975)”

Her citation by Bowlby is now an outmoded concept. Attachment researchers such as Sroufe, Carlson, Waters, Marvin, Siegel, Soloman, Bretherton and others clearly state that that attachment occurs along a developmental path, and should one have an insecure form of attachment early on, this does NOT preclude them from developing a secure attachment over their early life or later life with a trusted and sensitive caregiver, spouse, or therapist. For example, let’s assume a mother depressed during the first year of an infants life but during the second year, receives and responds positively to treatment and becomes sensitively attuned to her child – the attachment security and quality can be developmentally altered onto a more secure path. “Blueprints” can be changed. Very, very, very rarely does a child lack an attachment relationship to any caregiver.

2) Her statement: Attachment Disorder is defined as the condition in which individuals have difficulty forming lasting relationships. This is false. This is clearly know as a “hasty generalization” in logic and a fallacy. She has taken a very complex topic as attachment and made an over generalization about it.

3) She then launches into a discussion of “non-attached”. This is very, very rare and false and evidence of all or none thinking. Research is clear that children who have experienced maltreatment can and do often have an attachment relationship with there caregiver. It is often a form of insecure attachment with evidence of what is usually an organized pattern having disruptions to it (known as disorganization). A more accurate reference is a “child with distorted attachment that initiate a maladaptive pathway…(Alan Sroufe, personal communication 9/20/11)

4) Children with “non-attachments” are doomed. This is false. The University of Minnesota has done extensive work with children in orphanages in Romania who exhibited “no attachment pattern” who are now exhibiting increasing security in their caregivers. This is very promising. And, again, lack of attachment to any caregiver is extremely, extremely rare.  A more accurate reference is a “child with distorted attachment that initiate a maladaptive pathway…(Alan Sroufe, personal communication 9/20/11)

5) Attachment Disorder is accepted as a disorder by professionals with a clear definition and she describes the symptoms. This is false.   There is and continues to much debate about the diagnoses of RAD and while progress is being made in the upcoming DSM-V; there remains much work to be done.

6) She lists “causes” of attachment  “disorder.”  Again, the pre-supposition of disorder is rather disturbing. Attachment is a description of the quality of the relationship and how well a child has confidence in his/her caregiver to meet his/her needs consistently and sensitivity. The list she provides are certainly correlated with forms of insecure attachment, however; to claim  a cause is false. Also, children who exhibit secure attachment patterns can later develop an insecure pattern for various reasons: death of a parent, severe illness, divorce, etc.   Patterns of attachment security/insecurity occurs over a lifetime.

What does this all mean…be careful what you read on the internet. Do your research. Be critical. Ask questions. My friend is an author and said, “Writing a book has made me an expert.” I appreciated his comment on this – but writing a book makes someone a writer, not an expert. Only PROPER knowledge and PROPER training and PROPER ongoing research and experience make someone an expert. Clearly, Nancy may have some thoughts and skills on parenting techniques that are helpful, but an attachment expert, she appears very misinformed regarding what attachment is and  not. This is no fault of her own. It is a very misused and abused concepts among treatment professionals who lack specific training from experts in the field.

One more thing, she discusses her upcoming study on her effectiveness by reducing cortisol levels in parents proving her techniques work. The proper research based on her claims would be assessing the cortisol levels of the children and seeing if those are reduced combined with other measures of assessing attachment security in the children to determine their attachment security. After all, she claims on her website to “provide help for each wounded child….” See below for a direct pull from the site:

“We offer information on adoption / attachment and bonding issues, and Reactive Attachment Disorder (RAD) to families and professionals. We are also the official home of Families by Design providing educational materials and seminars.The goal of this site is to provide help for each wounded child with attachment disorderPTSD (Post Traumatic Stress Disorder)ODD (Oppositional Defiant Disorder)….”

Hot Topic: Mandated 50/50 placement legislature – Is it in the child’s best interest?

August 16, 2011

Legislating and mandating a 50/50 placement is flat out a bad idea, particularly for young children and especially for infants. I think the idea is well intentioned, but a friend once told me that the “road to hell is paved with good intentions.”  Each situation is unique and there are a myriad of factors involved.

First, early on attachments are developed uniquely with each individual  and attachment relationships are lifelong. The word attachment is often used and misused by professionals and non-professionals alike with many misconceptions surrounding it. Mary Main, Hesse, and Hesse in Family Court Review (July 2011) states “an attachment is one of a sub-set of bonds which tie one individual to another specific individual, binding them together in space and enduring over time….for young children, an attachment may be described as a bond which serves to focus attention on the physical whereabouts or accessibility of one or a few selected, non-interchangeable older individual(s),  whose proximity can then be  sought in times of danger or fright. Separations from the selected attachment figures and unfamiliar or otherwise threatening environments is therefore expected to arouse distress, anxiety, or fear (Bowlby, 1969/1982). ”

Therefore, when we measure attachment security,  what we are looking to measure and a non complex form is essentially, “how confident is a child in the caregivers ability to meet his/her needs and the child’s adaptation to the caregiver’s past history of attempting to meet those needs.”

Alan Sroufe,  professor of child development at the University of Minnesota M lead researcher on the Minnesota longitudinal study of childhood, which is a 30 year research program that has set out to explore the development of children by providing an organizational perspective on early attachment and ecological map of the child’s growing ability to cope with chronic environmental and family straight across lifetime (abbreviated from Sroufe and McIntosh, Family Court Review, July 2011).

Sroufe states the following:  “The major thing I think the judge would do well to know is that attached relationships are lifetime thing. The major  thing I want divorcing noncustodial parents now is that they can have the most full relationship with this child that any parent on this planet will ever have, if they had no overnights for the 1st 2 years. Depending on your age, you have the next 50 or 60 years for a relationship at this child. And they’re going to need you all the time. He will not be displaced: attached relationships aren’t interchangeable. The relationship with any parent is as much as they make of it. The step parent comes along, they can also be a really useful figure in a child’s life. But they’ll never replace that other parent. ….. It is true on the one hand that probabilistically, the attachment you have an infant is a predictor of important aspects of later development. But is also the case that is changeable. One reason is predictive is because often times, the circumstances of children  who have no secure attachments do not change, and  their lives go on being full of stress, the lack of social support from the families, and the general chaos does not change. As we have documented, if the family does experience significant changes, the attached relationship of the baby may change. His social and family support increases between 18 months and 5 years, those children who are insecure at 12 or 18 months,  are not so likely to have behavior problems at 5 years….. I do not like arbitrary guidelines about child ages and overnights, for example because you need to consider number factors and child, like language development in representational capacity to understand what they can handle. Okay, say, the child is 3, but his language is delayed. That makes a huge difference. The child can fully understand, “you can be here and moms at home, are going to take you there tomorrow, and then when you wake up in the morning, we’ll go see mom,” then we have something we can work with. Well 1st of all, 12 month old cannot understand that,., And had no concept of time like we adults do.  You might as well be saying, “you’re going to be here forever.” What would they understand about that? If for some reason the child is 5 days with mom and 2 days overnight with dad, which I’ll get used to it, can they survive? Yes, but you’re making their job harder.”

“You cannot form attachment without regular ongoing interaction. Attachment is built on the history of interaction. There is nothing about this work about the need to put a baby to bed and get them up…..”

He states in his opinion, ” informed by long years of research, is the infant better off having one base until that is completely consolidated, organized, and the bank, and they (the infant) know it. What secure attachment means is the child takes forward and abiding belief that things are okay, and will be okay. If something happens that things are okay, they will be okay again. I’m alright, I know I can get what I need from other people. That is what you want them to have, you do not want them to have doubts about that, uncertainty, ambiguity. So once they have that in the bank, which they can usually get in the 1st 2 or 3 years, then it is not the same type of a problem to start going back and forth.”

And, as such, I hope that all parents do not want to put their children at risk.

 

Help! My Toddlers Don’t Listen to Me in Public -Everyone is Watching!

March 23, 2009

Question

Recently, a question was posted to my facebook account  from a friend whose toddlers gain the upper hand while out in public. This is a very common occurrence and one of the most difficult for parents to navigate — that is– parenting on stage in front of a live audience!

Here’s the question verbatim (names have been replaced). “Lately my kids and I have been doing great. They have been listening to me and I have been really keying into their emotions, really listening to what they are saying and what they are asking for. They have responded well to this approach.

However, today at the library they would not leave when I told them it was time to go. Child 1 was pretty much smiling and laughing at the request. After a few warnings I put their movies back on the shelf and carried the kids out of the library. It was a horrible scene, everyone was looking. I got Child 1 in her car seat and she calmed down just fine. Child 2 on the other hand needed a lot more consoling, which I did lovingly. Finally, they were both in their car seats and we were on our way. When we were driving I told them that they did not get the movies because they did not listen to me, and when I asked them why they did not listen, they did not answer.

Do you have any input on how I should have handled them at the library? I did not feel good about picking them up and carrying them out, but I did not want to negotiate with two four year olds at the library.

Thank you so much,

Mother of four year old twins

Answer

Setting limits in public is often trying for most parents. As if setting limits was not challenging enough, now parents are forced to do it on stage with an audience. First things first. As my friend Dr. Bill Whelan would say parenting means “Always being bigger, stronger, wiser, and kind.” What you don’t do in these situations is as important as what you do.  Parents often feel very intimidated in public, thinking that the audience is saying, “What kind of parent are you if you can’t control your children” or “I can’t believe you just did that – look what an awful parent you are, denying your children something they would enjoy.”  Regardless of the location, children need to be able to depend on their parents to support their exploration – even when that support means prohibiting them from some goal due to a misbehavior or act of disrespect on their part. At the toddler age, it can seem as if they are like a  “big kid”, however;  they are still learning rules and testing boundaries. That means they may gleefully flaunt a parent’s directives and push the limits parents impose from time to time. Despite their seeming maturity,  toddlers are still ruled by their emotions and wanting what they want right now, and can turn on a dime from a happy-go-lucky kid to a pouting, defiant bug eyed monster. Let’s talk a minute about time-outs.

Understand what a time-out is — and isn’t.

Time out is not about punishment – it is about interrupting and helping your child cope with common frustrations and modifying their behavior. While your child is in a time-out, he/she is on his own for a suggested one minute per year of their life.  Therefore, resist the urge to  check on him every few minutes or try to encourage him into drying his tears. Although at times it may require all of your effort, if you find yourself having a difficult time managing your emotions – take a time-out yourself.  Quiet time alone allows your toddler to switch gears and calm down if he/she’s gotten worked up. And, it gives you the chance to step back and not get into a power-struggle with your child. The goal of a time-out is to manage and modify an escalating situation in an calm and kind manner, and to teach your toddler to behave and manage their emotions without regressing to your child’s age, the way yelling or hitting does. Following time out, you may elect repair – which is important. Repair comes after the time-out.  See Make Use of the Time-In below.

Using the time-out.

When a time out is necessary, impose a time-out swiftly — as immediately after the problem as possible.  Use a timer to track the minutes your child is in time out. Stick to the time – no cheating as much as any parent might like to leave them in the room all day and catch a break. Once you’ve set a time, stick to it.

Location of the Time-Out.

Location of the time-out may vary from family to family and place to place. There is always a room, something like her room, or symbolic place (Super Nanny promotes the idea of naughty mats, naughty chairs, and naughty stairs).  When you’re home, it is good to make use of one location if at all possible. This way, the child learns exactly where they need to go when you say “time out.” When you are out in public, however; this prevents parents from utilizing discipline and limit setting when they feel helpless. After working with parents and professionals for many years, ideas have been flowing for time and location. For example, there are always corners in stores, bathrooms, going to the car, sitting right where you are  quietly, or using a grocery cart for younger children. If you are a parent who is  concerned about her child playing up to the audience, then the car as a timeout location will be great for your child. Some people ask why they should have to go through all this hassle?  Remember, your job is to teach and train, and their job is to learn.  A parent’s job is to help children grow into responsible pro-social adults.  Remember to use some common sense and keep in mind their safety at all times.

Make Use of the Time-In.

Time-in may be a novel idea to parents who have not heard of this before.  Toddlers misbehavior (demanding, frustration, whining, withdrawn, out of control) means the child often “does not know what to do with how they are feeling and needs the parent to be calm, take charge, be kind, stay with the child until the child and parent understand this feeling seems too much for the child alone, and help them return to what they are doing with a new option. Invariably, this helps the child trust that the parent-child relationship will almost always set things right” (Dr. Bill Whelan; Personal communication).  This document explains the use of Time-In provided by Circleofsecurity.org.

Help! My 21 month old toddler is hitting me – what can I do?

March 18, 2009

Recently, an old friend posted a question on face book wondering what she could do  when her 21-month-old toddler has hit her. She was looking to join the “mothers of  toddlers to slap their parents group”, however; to her dismay there was none.

Two-year-olds  tend to be territorial. Everything is “it’s mine.” Typically, aggressive behavior may be a sign of an assertive child because more passive children often cry.  At this stage, they are  absorbing an incredible amount of information and realize that they can act upon the world to make things happen. They are beginning to experiment with cause and effect. Toddlers are typically beginning to interact with the environment to solve problems.  It is impossible to prevent children of the stage from hitting. Some children just don’t do it while others do. Parents often become alarmed and confused at this viewing these moments “acts of aggression”   and may be fearful that their  will be an aggressive person. While it is more likely that the child may be realizing  “I AM ME”   and you are witnessing the signs of booming individuality and  self-consciousness.  At the same time,  they are learning that they can’t do as they please. It is the parents job to begin teaching them about socialization, communicating in enforcing boundaries,   healthy expressions of emotion,limits, and the rules that govern  these expressions of independence.

The first thing to realize is that  toddlers don’t have the cognitive or language skills to express their emotions in meaningful and adult like manner.   They often experience strong feelings of frustration and inadequacy because  their cognitive abilities exceed their ability to express what they want to express. In other words, they often understand what is going on around them and what is being said, however; feel helpless to interact in a meaningful manner. Toddlers  also don’t realize that people have feelings. What I mean by this is they often play harshly with inanimate objects, such as toys, furniture and other items.   They do not view human beings or other live objects being any different than an inanimate object.  They don’t yet realize that people have feelings unlike inanimate objects.  Therefore approach people much as they would an object. That is another reason why children are so harsh on pets because they don’t realize that they are living animals.

Let’s get back to the question of what to do.   Parenting in 25 words or less described as my friend Bill Whelen, PhD.  Ph.D.from the Mary Ainsworth attachment Institute is “always be bigger stronger wiser and kind.”    This needs to be approached using this mindset. The parent ought to firmly state  on their level while making eye contact “it hurts mommy when you hit. There is no hitting!”  and then walk away. Do not continue to stand there and allow your child to hit you again or use any more words than described above.  one of the mistakes that parents often make us to believe that children are little adults and a good calm explanation of why what they did was wrong will just help them solve a problem and it will go away  never to return.

It is also important to recognize what was happening just prior to their hitting. Was this because they were frustrated about something or that they were prevented from achieving some goal and they needed some help that they do not receive? These are important questions that will also lead to how your address your child after being firm with them. This is where then understanding in helping a child explore their emotion world can be helpful.  Such as, ” I know you feel frustrated when you….”  this step is very important as research indicates that children who are able to be aware of their emotional worlds tend to be more successful later in life, academically, peer relations, and   engage in healthy coping behavior as adolescents and adults.

Lastly, keep in mind it will take many times for the child to learn us at that age. After the age of two, you may begin to introduce the concept of time out.  Professionals do not recommend using the concept of a timeout prior to that age.  There are many great resources  In self-help for child management after the age of two.  Feel free to check out some of the  resources at Amazon.com we have under parenting  on our website.

Homework Hassles: Parenting Children 2 to 12

August 28, 2008

Parenting_Counseling
Homework Hassles
August 2008
Website Images Top

School is right around the corner and brings with it some new challenges that you were able to take a vacation from during the summer – specifically, homework hassles! 1-2-3 Magic! offers various techniques for handling these hassles; routine, natural consequences, assignment sheets, the PNP method, rough checkout and charting for homework. I am going to revisit routine and the PNP method.

Mom and Child Nose to Nose Routine is Critical
As many parents can attest, the worst mistake is to ask a child is if she or he has homework. This simple question often provokes hostility in the child towards the parent and results in frequent arguments. Homework should be a daily routine – done at the same time and the same place as much as possible. Don’t let your child do homework with the TV on as it competes for the child’s attention. Music is fine and can be helpful. Music can help block out household noises and distractions so the child can focus on the assignment.

rachel at table with playdough The PNP Method
This method is one of my favorites. Most parents believe it is there job to correct and point out the mistakes their children make when the child brings the parent an assignment. Of course, it is our job to teach, but how many of you really enjoy when your boss points out the one flaw and overlooks the 10 things you did right. That’s what this method is about “Positive – Negative –  Positive.”
The rule for parents is; whenever a child brings any piece of schoolwork to you, the first thing said must be something positive – some type of praise (remembering to show you the work, their effort, or how well they did overall). After saying something about the child’s effort, you may then make a negative comment (if absolutely necessary). Finally, conclude the conversation with something positive again. This type of response will help your child continue to come back to you again and again. Kids will never want to bring you anything if you follow your natural parent inclinations and shoot from the hip with criticism.

mom holding daughter Other methods
There are other methods that are helpful as well. As experts in our field, our staff often recommend the least intrusive and the most simple to implement – one that leaves the parent feeling good about parenting and proud of their child and the child feeling proud of themselves. The other methods are discussed in the book below and can be discussed in our 1-2-3 Magic Parenting Workshop.

1-2-3 Magic: Effective Discipline for Children 2-12 (123 Magic)

by Thomas W. Phelan by Parentmagic, Inc.
Paperback

List Price: $14.95
Our Price: $8.42

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