help me with something

[TheWho]

Previous posters are correct: "RAD" is a 100% BOGUS dx.  Facilities claiming to treat RAD are by extension bogus.

The American Professional Society on the Abuse of Children and the  American Psychological Association’s Division on Child, Youth and Family Services do not agree with you DJ.

There has long been controversy in this area, which we all have read about here,  but this is to be expected when something new comes on the horizon.. (i.e. Autism Spectrum disorder).  Many people take sides and quote reputable sources to back up their beliefs and positions but at no time has "RAD" been off the table and considered Bogus nor has the APA turned their backs on these kids.

APA/APSAC report stated:  "It is important to note that not all attachment-related interventions are controversial"  and "Attachment problems, including but extending beyond RAD, are a real and appropriate concern "

These conclusions and discussions indicate that RAD is not only on the table but diagnoses and treatment are being discussed.

These are not my opinions but the results of studies performed by APA.



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[Troll Control]

Ummmm...OK.  I will repeat once more that this diagnosis is bogus.  It may take a few years for position papers to catch up, but they will.  

Folks were equally as adamant defending MPD as a dx and it has now been dropped and discredited.  Those of us who are or were in the MH field knew that MPD was bogus for many years before the DSM revision caught up and position papers were revised.  The same thing is happening with the bogus dx of RAD, only The Who doesn't know this because the extent of his education on the subject is a Google search.

The sentient point here is that there is no such thing as "Attachment Therapy" yet programs supported by people like The Who are actually practicing the dangerous and discredited methods that are together described as "AT."

In fact, the APA's position paper on RAD is that it exists as a dx, but there is no form of treatment to address it that is clinically sound or scientifically valid and that the "therapies" used by The Who's preferred facilities do not work and are dangerous or even deadly.  

Here's the APA's position on AT:

http://pn.psychiatryonline.org/cgi/cont ... l/37/16/23

Caution is the watchword for parents seeking evaluation and treatment for children with a rare psychiatric disorder that hinders a child’s ability to connect with adults.

Reactive attachment disorder (RAD) is a psychiatric condition affecting a small number of children and is widely misunderstood by the general public. In addition, unproven treatment strategies used in children who are suspected to have the disorder can be harmful and even fatal, according to an APA position statement released in July.

In response to a number of requests from psychiatrists to develop a policy on the disorder and provide the public with the most accurate information available, members of the APA Council on Children, Adolescents, and Their Families (now the Council on Child and Adolescent Psychiatry) worked in conjunction with the Committee on Preschool Children to craft the statement.

Term Misused

RAD is a complex disorder characterized by a child’s inability to form normal attachments to others, according to the statement, and a parent or physician may first notice problems in attachment to the caregiver in the latter part of the child’s first year.

"I think there is a lot of confusion in the public about the diagnosis of RAD, and the term is frequently misused," said David Fassler, M.D., an APA trustee-at-large and former chair of the Council on Children, Adolescents, and Their Families.

Fassler, who led the effort to create the position statement, added that council members "were also concerned over reports about the use of scientifically unproven and potentially dangerous approaches to treating what has been referred to as RAD."

The position statement warns both clinicians and caretakers of the dangers associated with so-called coercive holding therapies and "rebirthing" techniques that have sometimes been used to treat children with RAD.

In one recent case, such treatment proved fatal when uncredentialed therapists in a Colorado counseling center bound a 10-year-old girl in a sheet and sat on pillows placed around her head in an effort to simulate labor contractions. The goal? To let the girl be "reborn" into a world where past traumas would no longer exist for her. The girl died at a Denver hospital the day after the procedure.

Children with RAD may appear to be detached, unresponsive, inhibited, or reluctant to engage in age-appropriate social interactions. However, some children with RAD can be overly and inappropriately social, even with strangers. These problems may persist as the child grows older.

Many children with RAD have been physically, emotionally, or sexually abused, according to the policy statement, while others may have experienced long periods of isolation or neglect. In addition, some of these children have had "multiple or traumatic losses or changes in their primary caregiver."

Although there are no prevalence estimates available for the disorder, Fassler stressed that it is relatively rare and that not all children who have endured traumatic circumstances in early life will develop RAD. "The child’s temperament figures in his or her ability to cope with various stressful early life experiences," he said.

Interestingly, the specialty of The Who's programs is to use dx labels as "catch alls" to justify their programs.  So these facilities improperly label kids as RAD so they can apply AT, often resulting in deadly consequences.

My point is that a kid can be diagnosed as RAD according to DSM criteria (which I believe will be dropped as a dx very soon, probably in the next revision), but anyone claiming to treat the alleged RAD is a charlatan because there is no treatment for it (precisely the reason why RAD will be dropped and replaced by a combination of proven quantifiable diagnoses).

But, hey, when someone is paid handsomely NOT to understand this, you'll have a hell of a time getting them to understand.

The important theme here is that parents should be avoid TBS/EG because there is not a shred of scientific evidence to suggest that they will help your child, but evidence is mounting that they will harm your child, especially if they claim to treat RAD.

Anyway, this argument over the validity of the RAD dx will play out over the next few years, but the preponderence of the evidence thusfar examined suggests RAD will disappear just like MPD.  However, I will repeat, the most important point is that anyone claiming to treat RAD through AT is a quack and AT is the "treatment" that TBS/EG use and it is deadly.

[Troll Control]

RAD and the "program parent mentality"...  

From the APSAC Attachment Task Force Report:

According to proponents (of Attachment Therapy),
children with attachment disorders crave
power, control, and authority; are dishonest; and
have ulterior motives for ostensibly normal social
behaviors. The child with attachment disorders is described
by these proponents as completely selfcentered,
often exhibiting a sense of grandiosity, lacking
conscience, and posing a danger to other children
and, ultimately, to society itself. They are labeled
within some treatment or parent communities as simply
“RAD’s,” “RAD-kids” or “RADishes.” Thus, the
conceptual focus for understanding the child’s
behavior emphasizes the child’s individual internal
pathology and past caregivers, rather than current
parent-child relationships or current environment. If
the child is well behaved outside the home, it is conceptualized
as successful manipulation of outsiders,
rather than as evidence of a problem in the current
home or current parent-child relationship (Thomas,
n.d.-a). Proponents of this viewpoint may describe the
presenting problem as a healthy family with a sick
child. This perspective may appeal to some. As Barth,
Crea, John, Thoburn, and Quinton (2005) noted
“attachment therapies may be attractive because by
locating the blame for the child’s current difficulties
with prior carers, they appear to relieve adoptive and
foster parents of the responsibility to change aspects
of their own behavior and aspirations” (pp. 262-263).

This attitude is consistent with the program parent mentality - blame the kid or other circumstances, avoid responsibility, and send the "sick kid" away to be "fixed."

[TheWho]

Interesting DJ, nice cut and paste, your information is a little outdated (2002) though, but you are catching up.  After the paper that you sited was written the APA and APSAC got together and formed a task force to look at RAD and “Attachment therapy”.  The paper was authored by none other than Mark Chaffin OUHSC Center on Child Abuse and Neglect……. You should know this stuff DJ, if you are in the field I should not have to bring you up to date.  But anyway here are some excerpts:

in a review of over seventy studies of interventions designed to improve early childhood attachment, those interventions that most increased parental sensitivity were also the most effective in improving children’s attachment security.   Such parent-child relationship approaches would likely tend to favor maintaining children in their homes and families (either biological, kinship, foster or adoptive) over removing children to institutional care.

Recommendations from APA and APSAC:

Assessment should include information about patterns of behavior over time

Assessment for attachment problems requires considerable diagnostic knowledge and skill, both to accurately recognize attachment problems and to rule-out competing diagnoses.

Care should be taken to rule out conditions such as autism spectrum disorders, pervasive developmental disorder, childhood schizophrenia, genetic syndromes ……

Diagnosis of attachment disorder should never be made simply on the basis of a child’s status as maltreated, as having experienced trauma, as growing up in an institution, as being a foster or adoptive child, or simply because the child has experienced pathogenic care. Assessment should respect the fact that resiliency is common, even in the face of great adversity

Recommendations Regarding Treatments and Interventions.


Treatment techniques or attachment parenting techniques involving physical coercion, psychologically or physically enforced holding, physical restraint, physical domination, provoked catharsis, ventilation of rage, age regression, humiliation, withholding or forcing food or water intake, prolonged social isolation, or assuming exaggerated levels of control and domination over a child are contraindicated due to risk of harm and absence of proven benefit and should not be used.

So we can see that RAD and Attachment therapy is on the table and the APA/APSAC is currently recommending treatment and assisting in diagnosis.  We all know that the future may change all of this based on further studies and outcome.  It may go the direction of bloodletting or it may go the direction of “The Blues” which became depression, retardation being broken down into several nuances some of which are now under the umbrella of Autistic Spectrum disorder.  None of us know what the future holds.  What we “do” know is that RAD and attachment issues are real today and recognized by the American Professional Society on the Abuse of Children (APSAC) and the American Psychological Association’s Division on Child, Youth and Family Services (APA).
I appreciate your opinions DJ, that’s what these forums are all about, but I have to go with the professionals on this.  When studies come in suggesting that attachment is bogus then we can sit down and sharpen our pencils.


http://http://www.apa.org/divisions/div37/RADTaskForceManuscript.pdf
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[Froderik]

A lie gets halfway around the world before the truth has a chance to get its pants on.

[Troll Control]

A lie gets halfway around the world before the truth has a chance to get its pants on.

Indeed, this is true, Frod.  It'll all be sorted out over the next few years and RAD will be redefined accurately (insted of overlapping brtoadly with ODD, ADD, ADHD, etc) and will be recognized as a syndrome of comorbid valid diagnoses and the treatment will advance because the underlying issues will be treated instead of the bogus catchall "RAD."  It takes some time, but just as with other "diseases" like Drapetomania amd Multiple Personality Disorder it will be sorted out.

Here's what Mark Chaffin, et al actually have to say about Attachment Therapy and Attachment Disorders (quoted from the full text of the Task Force report):

ASSESSMENT AND DIAGNOSIS

As we have noted earlier, the term attachment disorder
has no broadly agreed-on or precise meaning. The
term is not part of any accepted standard nosology or
system for classifying behavioral or mental disorders,
such as the Diagnostic and Statistical Manual of Mental
Disorders (DSM)or International Classification of Diseases
(ICD). Officially, there is no such disorder.

And don't be misled by The Who asserting that the Task Force report is endorsed by the APA, as the authors clearly make notation:

This does not imply endorsement by the
American Psychological Association.

And again the report gives a strong warning about facilities The Who sells who claim to assess children for RAD practice "Attachment Therapy":

It appears difficult to diagnose RAD accurately. No
generally accepted standardized tools for assessing
RAD exist, and several interview procedures in the literature
misdiagnose inappropriately high numbers
of children as having RAD who, in fact, appear to have
only mild to moderate symptoms (O’Connor, Rutter,
Beckett, Keaveney, & Kreppner, 2000).

Plus the report specifically repudiates the methods used by The Who's clients when dealing with (most likely misdiagnosed) so-called "RAD kids" and sternly warns that there is no scientific evidence of efficacy:

Attachment therapies are viewed by
many in the mainstream professional and research
communities as presenting a significant physical and
psychological risk to children with little evidence of
therapeutic benefit. Critics have long argued that
these treatments are not based on sound or accepted
theory, are inconsistent with the general principles
of effective clinical practice, and are reminiscent of
other unsound and sometimes dangerous fad or cult
therapies that periodically arise in the mental health
treatment and self-help arenas.
(editor note: e.g. "Therapuetic Boarding Schools" or "Emotional Growth Programs")

(Professionals) note that even quackery or
demonstrably harmful treatments have their passionate
adherents (e.g. The Who) and can proffer many satisfied patients
who describe stories of miraculous cures (e.g. "Programs"). This type
of evidence simply cannot be considered persuasive
from a scientific perspective. Critics further note that
obtaining and using client testimonials in public
advertising may violate established professional ethical
standards (American Psychological Association,
2002, p. 9).

Chaffin, et al, on the "fashion in science" of psychology and how diagnoses are dicredited and discarded, even ones strongly held by many practitioners:

For example, recent history in the child abuse field has seen the rise
and fall in popularity of diagnoses such as dissociative
identity or multiple-personality disorder and concepts
such as repressed memory. Although fashionable
only a few years ago, some scientists now question
whether these phenomena actually exist at all, and it is
now generally accepted that neither is nearly as prevalent
as proponents once suggested. Arguably, both
of these diagnostic fads harmed some patients
(Dardick, 2004). Just as it is important not to miss the
presence of an uncommon condition in a child, it also
is important not to diagnose an uncommon and dramatic
disorder when the diagnosis of a common but
less exciting disorder is more appropriate.

Again, we can argue over the validity of RAD as a dx, but the major point to take away is that anyone claiming to treat it, especially in the manner The Who's programs work, must be considered a dangerous quack, as reported by Chaffin, et al, in the APSAC Task Force Report.

[Froderik]

Dysfunction Junction, what's your function?
Calling out Whooter on the Troubled Teen Forum..
Dysfunction Junction, how's that function?
I got three favorite ways
Of callin' Who on his bullshit..

[TheWho]

As usual it takes awhile for you to come around and typically you try to cover you errors with tons of cut and paste dialog, as we have witnessed.

As you stated :
“It'll all be sorted out over the next few years and RAD will be redefined”

What we "do" know is RAD currently is included in the DSM-IV  and is currently valid.  What DJ is trying to say is he “feels” RAD will be redefined and may not make the list under that name and that it may become bogus in the future.  It is great to speculate and we appreciate your input.  But as of today RAD is not considered “Bogus” according to the APA/APSAC and are currently working to hone and redefine treatment.  Personally I have my own feelings on the subject, as you do, but I have to yield to the professionals and DSM-IV list.  That is what the list is for, DJ, if we all speculate about future diagnoses making or failing to make the list and discard the ones we personally do not like then the list loses its credibility and becomes a worthless tool.  This applies to any set of standards laid out by organizations.

If a doctor feels Cancer is "Bogus" and will be removed from the list someday as a disease can he just decide to treat his patients with a placebo?  Of course not, he is bound by the rules laid out by the AMA otherwise they become useless.

As you move further into your career (if that is truly your path) you will learn that it is important to adhere to the boundaries laid out by APA ethics and the DSM-IV list as well as others.  You start speculating on your own and defining therapy and making diagnoses based on google searches which are not accepted and defined by the DSM-IV you will be labelled as a quack.  Lets not mislead the readers or play psycharist.  Any changes to the DSM-IV will most likely be backed up by clinical studies not a poster on fornits who feels it is "Bogus" (not even sure the APA or their profssionals use this terminology).



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[Troll Control]

For example, recent history in the child abuse field has seen the rise
and fall in popularity of diagnoses such as dissociative
identity or multiple-personality disorder and concepts
such as repressed memory. Although fashionable
only a few years ago, some scientists now question
whether these phenomena actually exist at all, and it is
now generally accepted that neither is nearly as prevalent
as proponents once suggested. Arguably, both
of these diagnostic fads harmed some patients
(Dardick, 2004). Just as it is important not to miss the
presence of an uncommon condition in a child, it also
is important not to diagnose an uncommon and dramatic
disorder when the diagnosis of a common but
less exciting disorder is more appropriate.

Once more, this is how dx's dissappear from the DSM and it happens regularly.  Considering that The Who has no understanding of the process or any information or ability to form a professional judgment, it's understandable to me that he doesn't grasp this concept.  And that's fine.  

To use an analogy that The Who loves to use, people in the auto industry know long before consumers that vehicles are faulty and will be recalled, but the driver of one of the vehicles will proclaim "It's great and it works great!" while in possession of none of the underlying facts.  They're simply ignorant, as is The Who.

Readers need to understand that The Who gets off on contrarianism and will say or do anything for the simple purpose of baseless argument.  Nonetheless, folks need to understand that his voice is one that comes from complete ignorance.

Bottom line: If a facility like Aspen (or any TBS/EG), which The Who pimps relentlessly, offers "Attachment Therapy" for your child, you had better be prepard to get back a seriously psychologically damaged child, or, God forbid, a dead one, as warns APSAC.

[Troll Control]

Dysfunction Junction, what's your function?
Calling out Whooter on the Troubled Teen Forum..
Dysfunction Junction, how's that function?
I got three favorite ways
Of callin' Who on his bullshit..

He will pretty much hang himself every time as long as he keeps responding.  He goes further and further out on a limb for the sole purpose of contrarianism and eventually directly contradicts himself (as well as the facts) and withers away whatever miniscule credibility some handful readers may assign to his drivel.

For example, he keeps hammering the point that APSAC's white paper on RAD is "endorsed by the APA" when the paper itself clearly contains the authors' notation that it is, in fact, specifically not endorsed by the APA and the intention of the authors is quite specifically not to imply that it is.

So, as he perpetrates falsehood after falsehood he eventually eviscerates himself and stumbles lurchingly upon his own offal.  It's his "pattern."

They got a program for people like him?  

[Troll Control]

Just another quick example of how The Who relies on the stupidity or shiftlessness of the reader to "prove" his point...

The Who on "Attachment Therapy":

Attachment therapy is on the table and the APA/APSAC is currently recommending treatment

In point of fact, this is contraindicative of the APA/APSAC position on AT.

APA/APSAC on "Attachment Therapy" (sourced from the APSAC Task Force Report):

(Attachment therapy) treatments are not based on sound or accepted
theory, are inconsistent with the general principles
of effective clinical practice, and are reminiscent of
other unsound and sometimes dangerous fad or cult
therapies that periodically arise in the mental health
treatment and self-help arenas.

And APSAC goes on to say:

Critics of
controversial attachment therapies or attachment
parenting have pointed to the child deaths as the predictable
result of combining (a) a belief in coercive
techniques, (b) negative conceptualizations of children
with RAD, (c) the isolated culture surrounding
these practice and parenting communities, (d) desperation
over very real child behavioral or emotional
problems, (e) a false sense of pessimism about the
child’s long-term future, and (f) a false sense of futility
about safer alternative approaches.

So, don't let The Who shine you on about the APA's or APSAC's postion on AT.  He's got it exactly backwards, just like the duck farmers for whom he toils.

Read the report for yourselves and observe how thoroughly APA/APSAC excoriate and discredit the usually unlicensed or delicensed practitioners of "Attachment Therapy."

Report of the APSAC Task Force on Attachment Therapy, Reactive Attachment Disorder, and Attachment Problems

http://works.bepress.com/cgi/viewconten ... thomaslyon

[TheWho]

Thanks DJ, didn’t want to stretch this out longer than needed.  I understand your frustration, but I am a purest when it comes to some things and believe we should adhere to the recommendations of professionals like APA and APSAC.  You finally came around to the latest reports I have been putting up.

It is important for the readers to review them for themselves instead of some unknown posters on the web.  As the reader will see there are many controversial interventions for RAD and attachment issues as well as non-controversial.  

And as part of the task forces recommendations they mentioned the following:

“Attachment problems, including but extending beyond RAD, are a real and appropriate concern for professionals working with maltreated children, and should be carefully considered when these children are assessed.”

So it is clear that RAD and attachment issues are presently a concern for professionals and are not considered Bogus (as was indicated).



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[TheWho]

Now that that is cleared up it would be nice to get back on topic…….  I believe Crapflower had indicated that the parents were looking into New Leaf Academy for placement for their friends child.  My personal view is that this is a mistake as I initially indicated to Crapflower that children with RAD do better if the problem is dealt with as a family.

 The Task force study had this to say:

in a review of over seventy studies of interventions designed to improve early childhood attachment, those interventions that most increased parental sensitivity were also the most effective in improving children’s attachment security. Such parent-child relationship approaches would likely tend to favor maintaining children in their homes and families (either biological, kinship, foster or adoptive) over removing children to institutional care.

I would be very interested in hearing from parents or kids who had RAD and/or attachment issues that attended a TBS or programs which tried to deal with this issue in the absence of their family.


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[Troll Control]

APA/APSAC on "Attachment Therapy" (sourced from the APSAC Task Force Report):

(Attachment therapy) treatments are not based on sound or accepted
theory, are inconsistent with the general principles
of effective clinical practice, and are reminiscent of
other unsound and sometimes dangerous fad or cult
therapies that periodically arise in the mental health
treatment and self-help arenas.  

I think this is pretty clear and unambiguous.

And so is this:

This Task Force was unable to
locate any methodologically adequate clinical trials in
the published peer-reviewed scientific literature to
support any of these claims for effectiveness.

Whoops!  The Who forgot to mention that not a single study reviewed by the task force was even methodologically sound.  Tsk, tsk.  The "research" provided by The Who is as equally faulty as his own judgment on this subject.

Parents should read the actual report and not rely on someone who has a financial skin in the institutionalization of children.

[TheWho]

You are looking and quoting a discussion, DJ, as I am.  You need to keep reading down to task force recommendations:

Here take a look:

“Attachment problems, including but extending beyond RAD, are a real and appropriate concern for professionals working with maltreated children, and should be carefully considered when these children are assessed.”

So it is clear that RAD and attachment issues are presently a concern for professionals and are not considered Bogus (as was indicated).

Show us where they concluded that RAD is Bogus.  You are reaching for straws, it is on the DSM-IV list.  I believe you are confusing therapy/treatment with diagnosis. The APA recognizes RAD as a diagnosis but are having difficulty finding treatment which has been effective long term.  Read thru the report again and I think you will see that you are confusing the two.  There are many diagnoses which are sound (i.e. Cancer) but treatments can run anywhere from very controversial to globally acceptable and medical professionals disagree with each other all the time on the effectiveness of treatments.  But that doesnt mean they should call Cancer Bogus, but maybe some treatments could be called that.



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