A letter bearing the names of 19 professors of psychology and social work from around the country has been sent to ABC to protest the television network’s flawed depiction of reactive attachment disorder, or RAD, a part of “20/20’s” coverage of the Rep. Justin Harris adoption story that the news magazine aired last month.
The letter was drafted by Jean Mercer, professor emerita of psychology at Stockton University, and signed by concerned professors of psychology from universities nationwide, including UNC-Chapel Hill, UCLA, Columbia and Ohio State. They say they are “deeply disturbed” by a video clip distributed by ABC online as a part of its coverage on Harris, which gives the impression that children suffering from RAD are violent by definition and appears to sanction harsh, unconventional ‘therapies.’
“The material in this clip conveys to the public a view of Reactive Attachment Disorder (RAD) that belongs to ‘fringe’ therapists and is not shared by professionals with serious training in psychology,” Mercer wrote ABC. “In addition, this view has been used to support the use of potentially harmful interventions with children … The opening scenes of the clip appear to show a method called ‘holding therapy’ or ‘attachment therapy’, which was strongly rejected in 2006 by a joint task force of the American Psychological Association (APA) and the American Professional Society on Abuse of Children (APSAC). This method has been associated with child deaths and injuries.”
Mercer told me the letter drew an encouraging response. “I had a phone call from one of the executive producers of 20/20. … He expressed considerable concern about the whole thing, and said they want to revise the video and add to it. They’re going to take down the screaming part,” meaning the opening segment in which a child is subjected to what appears to be ‘holding therapy,’ depicted in the screenshot above.
ABC is now planning on filming a segment with Mercer or a clinical psychologist explaining RAD, for distribution online. “I was very surprised and pleased [with ABC’s response],” she said.
Last month, I pointed out the misleading characterization of RAD when I harangued ABC about a litany of omissions in the “20/20” episode. But as the psychologists state in their letter, it’s more than a matter of just setting the record straight on principle. “Our concerns are not simply that there was some inaccuracy in the clip, or that the discussion of RAD was insufficiently nuanced. The problem is that the content of this video supports a common misunderstanding that, among other things, can cause people to fear and reject children who have histories of abuse or abandonment, or can lead the children’s caregivers to seek ‘fringe’ treatments that may cause real harm.”
There is tremendous confusion around the term “reactive attachment disorder,” a serious but rare psychological malady in which a child has difficulty forming relationships with caregivers. As Mercer writes, the disorder is not necessarily “characterized by aggressive and oppositional behavior … Sadness and social disengagement are in fact the leading features of RAD.” Of course, many children who have experienced trauma may also display aggressive and oppositional behaviors, but that isn’t a product of RAD.
Unfortunately, misinformation online perpetuates the falsehood that RAD is something else entirely: an almost otherworldly psychological condition in which afflicted children are devious, dangerous, even psychopathic. A cottage industry of “attachment therapies” has sprung up around this notion, equating disobedience and behavior problems with a pathological inability to form “attachments” with adults. In this line of thinking, children must be forced to submit entirely to the will of their parents — broken, like a wild horse. Mercer calls this wrongheaded diagnosis and its associated interventions “faux-RAD,” a useful term I’ll use from here on out. Adopted children with troubled pasts are often “diagnosed” with faux-RAD by parents struggling to comprehend alarming behavior problems. (This website helps set the record straight about the difference between RAD and faux-RAD.)
Recently, I had the opportunity to visit with two psychologists at UAMS’ Psychiatric Research Institute whose careers are devoted to diagnosing and treating child victims of trauma in Arkansas. When I asked about RAD, one doctor told me that she often has to correct misunderstandings among parents about what that term actually means. Most traumatized children don’t have RAD; instead, their most common diagnosis is far less exotic-sounding and more comprehensible — post-traumatic stress disorder, or PTSD. Just as veterans of war or victims of domestic abuse often carry psychological scars that can manifest in any number of ways — including aggression and violence — so do kids exposed to trauma, including abuse. (Of course, a child, like any individual, might legitimately have more than one psychological disorder.)
But those who promote the faux-RAD diagnosis often reject mainstream scientific consensus about psychology and its diagnoses. In the Harris case, Justin and Marsha Harris cited the work of one of the fringe “attachment therapists” opposed by Mercer, Nancy Thomas, in explaining their approach to parenting the two young girls they adopted and later rehomed. Multiple sources familiar with the girls while they lived in the Harris home in 2013 said the sisters were not allowed to speak to one another, and that the Harrises believed an incident as seemingly innocuous as a 3-year-old child peeing her pants was a sign of intentional, malicious defiance. Such thinking is right out of the faux-RAD playbook; in her book “When Love is Not Enough,” Thomas wrote that “a child with Attachment Disorder will often use body fluids to make parents angry and keep them away.” (According to several sources, the Harrises also believed their girls were demonically possessed, which they deny — but then, Nancy Thomas herself has written that children with her version of faux-RAD “often identify with the devil.” Really, is it that far of a leap from believing a toddler is a psychopath-in-training and believing supernatural evil is at work?)
Mercer said parents who buy the faux-RAD diagnosis are often “sensitive to anything they can interpret as a slur on their own behavior, their own character, their own loving-ness. … ‘Attachment therapists’ are really good at one thing, which is telling parents that it is not in any way their fault or their responsibility. When they go to a conventional therapist … he’ll say, ‘We’re looking at family dynamics here, and everyone has some input and some effect on what is going on, and everyone is going to have to alter their behavior.’ [Some] parents don’t like that. They say, ‘The therapist is blaming me.’
“If they go to a ‘therapist’ who says, ‘You are an awesome mom,’ and instead it’s the kid who’s bad,” Mercer said, that has a certain appeal — especially for adoptive parents who have reached the end of their rope trying to deal with troubled kids. But that can also be very dangerous. In the most extreme instance, said Mercer, one occasionally sees “the RAD defense” raised in child abuse cases — “the argument that children who have been mistreated are so dangerous because of RAD that their caregivers were forced to hurt them.” Consider the 1997 killing of 2-year-old David Polreis, whose adoptive mother claimed the child beat essentially himself to death. And for more examples of how the faux-RAD mentality among parents can spiral into tragedy, read Kathryn Joyce’s coverage of the topic.
Mercer said, “I tell [parents], ‘Don’t go to someone who says they specialize in RAD.’ There’s no such thing as a specialist in RAD within the conventional, evidence-based way of practicing psychology. [Parents] need to go to someone who can do a broad, general diagnostic workup on what problems there may be. Why is the child acting in the way they are acting? Is this something they’ve brought with them from their past history? Is it something that has been inadvertently fostered within the family they’re living with? … There’s no simple explanation here, and there’s no simple treatment.”
UPDATE: Mercer has written a post on her “Child Myths” blog exploring some of the assumptions behind the faux-RAD diagnosis she describes.
Here’s the full letter from Mercer to ABC Senior Executive Editor David Sloan:
David Sloan, Senior Executive Editor, ABC Nov. 5, 2015
Dear Mr. Sloan:
As psychology and social work professionals concerned about public understanding of childhood mental health, we are deeply disturbed by the video clip http://abcnews.go.com/2020/video/rad-explaining-reactive-attachment-disorder-34667787. The material in this clip conveys to the public a view of Reactive Attachment Disorder (RAD) that belongs to “fringe” therapists and is not shared by professionals with serious training in psychology. In addition, this view has been used to support the use of potentially harmful interventions with children and to argue that abused children have somehow forced their caregivers to harm them.
The opening scenes of the clip appear to show a method called “holding therapy” or “attachment therapy”, which was strongly rejected in 2006 by a joint task force of the American Psychological Association (APA) and the American Professional Society on Abuse of Children (APSAC). This method has been associated with child deaths and injuries.
A later part of the clip features women stating that their children a) had RAD, and b) were dangerous to other people and to animals, as has been suggested by “fringe” therapists. The implication was that the disorder itself is characterized by aggressive and oppositional behavior. This is not the case, as can be seen by consulting the Diagnostic and statistical manual of mental disorders of the American Psychiatric Association, 5th edition (DSM-5). Sadness and social disengagement are in fact the leading features of RAD. In addition, it has been recommended that RAD be diagnosed in young children and not in the teenagers some of the women mentioned.
Our concerns are not simply that there was some inaccuracy in the clip, or that the discussion of RAD was insufficiently nuanced. The problem is that the content of this video supports a common misunderstanding that, among other things, can cause people to fear and reject children who have histories of abuse or abandonment, or can lead the children’s caregivers to seek “fringe” treatments that may cause real harm. In addition, this content can be used to support the “RAD defense” in abuse cases— the argument that children who have been mistreated are so dangerous because of RAD that their caregivers were forced to hurt them.
Now that the inaccurate clip is on the Internet, it will be available for a long time. Taking it down from the ABC website will not get rid of it. For that reason, we would like to ask you to create an additional, accurate video about RAD, with our help, and to post it with a message that it is to correct the previous clip in a responsible fashion.
We hope that you will understand the reality of our concerns and respond positively to our request.
Jean Mercer, Ph.D.
Professor Emerita of Psychology, Stockton University, Galloway, NJ
On behalf of:
Anne Marie Albano, Ph.D., ABPP Professor of Medical Psychology in Psychiatry, Columbia University Medical Center
Jonathan Comer, Ph.D. Associate Professor of Psychology and Psychiatry, Florida International University; Board member, Society for Clinical Child and Adolescent Psychology
Mary Fristad, Ph.D., ABPP Professor of Psychology and Professor of Psychiatry, Ohio State University; Board member, Society for Clinical Child and Adolescent Psychology
Benjamin Hankin, Ph.D. Professor of Psychology, University of Denver; Board member, Society for Clinical Child and Adolescent Psychology
Mary Haskett,Ph.D. Professor of Psychology, North Carolina State University
Steven Hollon, Ph.D. Gertrude Conaway Professor of Psychology, Professor of Psychiatry, Vanderbilt University; President-elect, Society for a Science of Clinical Psychology
Stephen Hupp, Ph.D. Professor of Psychology, Southern Illinois University Edwardsville
Scott Lilienfeld, Ph.D. Samuel Candler Dobbs Professor of Psychology, Emory University
Linda Nielsen, Ed.D. Professor of Psychology, Wake Forest University
John Piacentini, Ph.D., ABPP Professor of Psychiatry and Biobehavioral Sciences, UCLA Semel Institute for Neuroscience and Human Behavior; President, Society for Clinical Child and Adolescent Psychology
Mitch Prinstein, Ph.D. , ABPP John van Seters Distingushed Professor of Psychology and Neuroscience, University of North Carolina at Chapel Hill; President, Society for a Science of Clinical Psychology
Andres de los Reyes, Ph.D. Associate Professor of Psychology, University of Maryland at College Park
Stewart Shankman, Ph.D. Associate Professor of Psychology, University of Illinois at Chicago; Board member, Society for a Science of Clinical Psycholog
David Smith, Ph.D., ABPP Professor of Psychology, Notre Dame
Bethany Teachman, Ph.D. Professor of Psychology, University of Virginia; Past president, Society for a Science of Clinical Psychology
Bruce Thyer, Ph.D. Professor of Social Work, Florida State University
Penelope Trickett, Ph.D. Professor of Social Work and Psychology, University of Southern California
Bradley White, Ph.D. Assistant Professor of Psychology, Virginia Polytechnic Institute and State University