by Liz Randolph, PhD

A frequent criticism heard by attachment therapists has to do with whether or not there is any research to show that attachment therapy works. Up until recently, the answer to this question was no. However, in June 1996 an outcome study was conducted by Loy Goodwin, PhD to examine whether or not attachment therapy is effective with severely disturbed children. Dr. Goodwin used the Attachment Disorder Symptom Checklist (ADSCL) developed by the Attachment Center at Evergreen, assigning a number value to the options of never, moderate, or severe (0, 1, or 2 respectively) to assess changes in the type and frequency of behavior problems exhibited by 38 children (ages 5 to 15) receiving intensive attachment therapy at ACE between 1993 and 1995. Parents completed the ADSCL in the week prior to the start of the intensive, and then again anywhere between two months and two years after completing intensive attachment therapy.

Because the reliability and validity of the ADSCL have never been investigated, the results of Dr. Goodwin’s study can only be interpreted descriptively. Although Dr. Goodwin used statistical procedures with the data she obtained, finding significant decreases in almost all of the behaviors described on the ADSCL (abnormal eating habits was the only item that showed no significant change), the lack of reliability and validity data on the ADSCL makes it inappropriate to interpret the data in this way.

However, what is important about the results of Dr. Good-win’s study is the finding that the ADSCL shows a 50% reduction in overall symptoms of attachment disorder following two weeks of intensive attachment therapy. In addition, behavioral changes continued to be present as much as two years following the completion of the intensive (13 of the children studied were reevaluated more than 18 months after the intensive was completed).

Dr. Goodwin’s study indicates the need for more outcome research about attachment therapy. Better designed and controlled outcome studies are currently under way by ATTACh, by Robin Meyeroff at the Attachment and Bonding Center of Ohio, here at ACE, and by this author. Results of these studies, although not yet ready to be published, are promising.

The complete text of Dr. Good-win’s dissertation is available from ACE for $5.00, plus .22 tax and $4.50 shipping and handling.

Foster Cline, M.D.

Excerpts from: Reasons and Significance of Societal Mayhem and Severe Disturbances in the Population

All over America, the pathetic scene repeats itself: The five or six year old dumps out the Tinker Toys and stares at them. Clueless. He doesn’t have the slightest idea what to do with them. For Christmas, a seven year old girl is given Lincoln Logs. She is mildly curious at first. She tries briefly putting them together and then quits. “It’s too hard.” In an unfocused way, she wanders into the bedroom, turns on the TV and watches a Disney video.

Out on the front line, our schools literally reel as across America hundreds of thousands, if not millions of kids are diagnosed with Attention Deficit Disorder. All across the land, parents seek answers to help them understand their learning disabled or attention deficit disordered children.

What is this epidemic of Attention Deficit Disorder?  How is it defined?  Briefly, the children’s thinking easily fragments. It is hard for them to focus and carry through a task. Their attention wanders. Often the children are impulsive and often they are behavior problems. It does not seem to be a problem borne solely of poor parenting, for high achieving, loving and responsive parents have children who are part of the epidemic. There is good indication that htmlects of Attention Deficit Disorder are genetic. As is the case in many learning disorders, the father or mother may have had similar problems when they were younger. But is genetics enough to account for this epidemic! No, for genetic disorders are never epidemic in nature. Purely genetic disorders tend to have stable numbers or, if severe, are self limiting. No, something other than genetics is accounting for the epidemic.

First, in attempting to understand the problem, it is important to see how the definition of Attention Deficit Disorder has changed with time. Twenty-five years ago, when I was a young psychiatrist in training at the University of Washington, Attention Deficit Disorder was seen as a true disorder of attention. That is, it was noted that the children’s attention fragmented easily and that they could not pay attention to television shows. This is no longer true. Modern authority after modern authority stresses that attention deficit disordered children can pay attention to TV and are able to play video games. As a matter of fact, far from not being able to attend television, the playing of video games or watching TV is often used in the primary grades as a reinforcer or reward for behaviorally disturbed and learning disturbed children. Video tapes are used as a teaching tool across the primary and elementary grade spectrum with increasing frequency. Far from now being primarily an attention problem, Attention Deficit Disorder could more correctly be labeled an intention disorder. That is, the children fragment when they should be intending to do something – to accomplish a goal, start or complete a project. In my experience as a child psychiatrist, it appears the majority of children labeled Attention Deficit Disorder have no problem at all if they are being entertained, playing a video game, or watching TV. The entire problem seems to revolve around getting the job done. Whether the job is putting tinkertoys together, building with Lincoln Logs, focusing on a monopoly game, or completing a school assignment.

Regardless of possible professional disagreements over symptoms, almost all professionals observers, in both the fields of education and child therapy are in unanimous agreement that there is an epidemic problem that effects the learning ability of America’s children.

Much of the societal breakdown that the United States is now experiencing is secondary to millions of infants and toddlers not being exposed to the appropriate environmental stimulation at the necessary developmental age.

The importance of the first year of life simply cannot be overemphasized. The first year lays the foundation for four essential and related human thought and personality traits: Causal thinking; Conscience; Basic Trust; The ability to delay gratification.

Upon these variables, civilization is built. If we meet a person walking the streets at night without them, we’re dead. Without them, civilization as we know it is lost!

The “normal” first year with it’s foundation of basic trust, and a “normal” second year with it’s essential elements of control, limits and rules which the child must internalize are essential for the development of a child who can focus and learn normally.

Poor experiences in the first two years explains the difficulty in learning of a large number of American children who grow up in abusive situations or with parents who are simply unable to provide discipline and have poor parenting techniques. Abuse and neglect which are accompanied by inconsistency and pain destroy the development of both causal thinking and conscience. Planful thinking is only possible if the infant lives in a consistent environment, and conscience can only develop in the presence of loving responses. Only individuals with a conscience can feel remorse, have a poor self image, feel honestly guilty, or want to mend their ways.

There are, nevertheless, a massive percentage of the children who are part of the ADD, impulse-ridden epidemic that have good parents. These are parents who did discipline the child during toddlerhood and who insure that the child developed Basic Trust during the first year. Many of these children were loving infants and responsive toddlers. It simply becomes obvious that the children have trouble learning, focusing, and thoughtfully carrying-through on tasks when they arrive in preschool and kindergarten. So what accounts for the large number of ADD children of loving parents who had adequately disciplined toddlers?

At an essential time of brain developmental readiness for task mastery, today’s three and four-year-olds, the children who Erikson characterized as being at the stage of Initiative and Industry are watching television and enjoying video tapes.

And therein lies the basic problem. In fact, reflecting the television and video game generation, most of the items for younger children in Toys-R-Us or any toy outlet reflect an emphasis on Sensory input, and rudimentary motor skills, but rarely encourage creativity, task focus, job completion and mastery. Even if they are offered for sale, tinkertoys, Legos, Lincoln logs, and alphabet blocks are not the big sellers. What sells big is the video films and video games. Game Boy, Nintendo, the Little Mermaid and Aladdin. Those are the items that make millions. And of course children are exposed to more child movies than ever before. When parents “do” something with small children now, it relatively seldom involves really “doing” anything. The parents watch TV with the children, enjoy the televised game together, go to the movies or maybe, more rarely, go to the zoo. Relatively rarely do today’s exhausted, single, dating, divorced, commuting parents actually sit down and do something with their small children.

But it is more than that! Today’s parents, who themselves grew up in front of the TV, themselves do not know how to do things with their children. Even if they knew of the importance of helping small children with focus and task completion, they, themselves, don’t know how to make a kite or tin can telephone. They don’t know how to cover chairs with masking tape, they don’t know about the corner grocery were the child sells cans of food opened from the bottom. They don’t know about sewing on buttons with their child or making paper dolls. But most importantly, they know nothing of the developmental necessity of doing something with their preschool aged child. They, themselves grew up with Big Bird and Sesame street. And now they go to movies and watch TV as a family. And when their three and four-year-old child gets bored, they, as good parents, have a library of “good” video – “Disney” video for their child to watch.

Real education is dialog!! – Real education involves a feeling of mastery, ability to respond to situations, to articulate ideas, and respond thoughtfully. Whether we talk about leadership, creativity, responsibility, or motivation we are describing action. Television encourages passive responses. Certainly it encourages absorption, and arguably understanding, but it does not, and cannot, by it’s very nature encourage doing, mastery, task completion, creativity, independent thinking – all those things associated with being a functioning and productively busy human being. Schools must by their nature focus on doing and task completion.

If kids have so little internal controls, and the parents so little discipline that such external devices must be used, the parent/child relationship is already shot. And for most normal children, they are far more affected by watching. It is the process, not the content. Particularly at the critical younger ages.