Misplaced Pages

Revision as of 01:10, 22 August 2006

do we need all of those footnots? -- from cleanup

my persional oppinion is yes, yes, YES. infact i would go as far to sa that this is what most wikipedia articals lack tooto 22:20, 23 Aug 2004 (UTC)

I agree. Footnotes add veracity to the material and allows readers to delve more deeply into the subject AWeidman 25 Dec 2005

Introduction

The first paragraph of this article is overly complex and does not give a clear description of this disorder that would be accessible to many people who do not have a background in the subject.

Reactive Attachment Disorder (sometimes called "RAD")(DSM-IV 313.89, ICD-10 F94.1/2) is a psychophysiologic condition secondary to pathogenic behaviour from a caregiver during the first three years of life which would, in the absence of such pathogenic behaviour, normally meet well-timed milestones, so that the developmental trajectory is qualitatively different from the superficially similar failures or deviances in Mental retardation and Pervasive developmental disorders). This pathogenic caregiving behaviour constitutes any form of neglect, abuse, mistreatment and abandonment.

The DSM-IV intro is much clearer.

The essential feature of Reactive Attachment Disorder is markedly disturbed and developmentally inappropriate social relatedness in most contexts that begins before age 5 years and is associated with grossy pathological care.

May I suggest this replacement:

Reactive Attachment Disorder (sometimes called "RAD")(DSM-IV 313.89, ICD-10 F94.1/2) is a psychophysiologic condition with markedly disturbed and developmentally inappropriate social relatedness in most contexts that begins before age five years and is associated with grossly pathological care. This pathological caregiving behaviour may consist of any form of neglect, abuse, mistreatment and abandonment.

In Mental retardation attachments to caregivers are consistent with the level of development. In Pervasive developmental disorders attachments to caregivers either fail to develop or are highly deviant, but this usually occurs in a context of reasonably supportive care.

--CloudSurfer 22:19, 7 Oct 2004 (UTC)

Thank you, CloudSurfer.

Imagine that, to have written a first paragraph to an article in an online encyclopedia that is much less clear than the DSM-IV. And that book is not a piece of obscurantist dogma, or it shouldn't be.

Still, four big words in the middle clause (the one that begins with 'so that'...)- I am not doing that again in a big hurry! The four were 'developmental' 'trajectory' (might have just said 'path', but that might have connoted spirituality), 'qualitiatively' and 'superficial'.

The lack of clarity was in part due to political correctness: or, more simply, not wanting to offend anybody in the three diagnostic categories mentioned. As you might see, 'markedly disturbed' and 'developmentally inappropriate' are very loaded words (though usually not meant so in the medical context), as when discussing Pervasive Developmental Disorders as being 'highly deviant' in this area. This is well-balanced by the 'reasonably supportive care'.

Apart from these points, I do agree with the replacement and the editing of the first paragraph. I suppose 'pathogenic' would be a loaded word too (as psychogenic had been), as compared to pathological, in terms of how things are caused.

As to the background thing would this 'markedly disturbed' and 'developmentally appropriate' be obvious to doctors, to parents, and/or to you and me?

Your edits make much better that point that Reactive Attachment Disorder is different, especially to the ordinary reader.

Just a little point: it is five years, not three, according to the DSM-IV?

EuropracBHIT

Thanks for that, so it seems you are happy with the suggestions so I have put it in, with 5 not 3 years. I just wanted to check that I wansn't missing anything crucial. --CloudSurfer 05:11, 9 Oct 2004 (UTC)

Hi, I don't know what 'grossly pathological care'/pathogenic caregiving means... would it be useful to have a link to a definition, or include the definition here? Nao* 14:50, 7 September 2005 (UTC)

Hi, I noted the thing about Randalph Questionnaire. But I saw a site that mentioned that this Questionnaire is ONLY used for attachment disorder. Reactive attachment disorder and ODD/CD togheter in one person are not common. However, the real Questionnaire can only be used for Attachment disorder (AD) and not RAD...

Actually, most children with a clinical diagnosis of Reactive Attachment Disorder would also meet the DSM IV criteria for ODD and/or CD. That is because DSM IV diagnoses are usually made solely based on the presence of absence of certain behaviors. RAD is one of the few diagnoses in the DSM that relies on cause or etiology. AWeidman 25 Dec 2005

Cleanup

The section under "Classification" that begins with "SUBTLE AND NOT SO SUBTLE SIGNS OF ATTACHMENT PROBLEMS" looks like it comes from a parent's manual on attachment disorder, not an encyclopedia article. I've listed this article under "inappropriate tone" cleanup to deal with that. Quinnanya 16:37, 1 March 2006 (UTC)

Introduction being too long?

I think we need to cut out the last two paragraphs of the introduction.

How long are introductions in regard to the major developmental disorders of infancy and adolescence, assuming an equal amount of development and time has been put in to this article?

Just would like a ballpark estimate.

--Bronwyn Gannan 03:37, 23 April 2006 (UTC).

Jean Mercer and the problem of fringe groups more generally

In medicine and psychiatry, there will always be fringe groups questioning the effiacy of a treatment or intervention. I think Children in Therapy is right on myself, particularly in view of the deaths and that they look down more generally on coercive therapy. Even the best attachment therapy is not evidence/research based. Where are the case studies? I read my first case study back in September 1998 in the Margaret Talbot article from the New York Times which was subsequently published in the Sydney Morning Herald/The Age magazine Good Weekend. Why are the few known case studies plagiarised from Milton Erickson? And it is not right to be discrediting a clinician because xe is a transsexual (female to male). It would be like discrediting John Money who was a very well known sexologist. To mainstream medical practice the fringe groups would appear to be ATTACh and the individual therapists and so-called 'attachment centres'. Thank you very much, I would welcome all your opinions on this matter. --Bronwyn Gannan 20:29, 23 April 2006 (UTC).

The section on fringe groups that stated "Jean Mercer, PhD, AKA Gene Lester. Mr. Lester/Mercer ... " seemed problematic because of concerns about defamation. It appears to imply that Jean Mercer is transsexual, transgendered, or something similar, which she is not. So, I reverted to the earlier version of this page that did not contain the defamation.

Fringe Groups...do we really need to list every nut?

Children is Therapy is an advocacy group and is not recognized by any mainstream group (AMA, APSAC, NASW, etc.) They have a specific agenda to attack all attachment based treatment. They state that there is no such thing as Reactive Attachment Disorder.

In all fields there will be pratcitioners who are unethical or who practice bad medicine or psychology. The deaths cited were all caused by unlicensed individuals or persons using "methods" that no professional group would sanction. But that is no reason to continue to debase a field because of a few bad apples. After all, medical malpractice does not prevent us from seeking medical care or considering research. It does lead us to be sure our physician is licensed, Board certified if a specialist, and related issues.

To "mainstream medical practice" ATTACh is seen as a leader in the field of treating children with severe difficulties. There is a substantial amount of research published in peer-reviewed professional journals about evidence-based approaches to the prevention and treatment of attachment disorders. See, for example, The Circle of Security Program (Dr. Robert Marvin, U. of VA.) or Dyadic Developmental Psychotherapy (Child and Adolescent Social Work Journal) or Theraplay, etc. A review of such professional journals as Developmental Psychology, Infant Mental Health Journal, Attachment and Human Behavior, just to name a few, will yield a significant number of evidence and research based effective prevention and treatment approaches. --User:AWeidman16:51, April 23, 2006

They say there is no such thing as Attachment Disorder beyond the confines of the DSM-IV diagnosis Reactive Attachment Disorder.

And don't you mean Attachment and Human Development if that's the journal you're thinking of?

They are recognised by people like New Jersey Infant Development. --Bronwyn Gannan 08:49, 25 April 2006 (UTC).

Mercer

I don't know what gender Jean Mercer/Gene Lester is or was. But Jean Mercer's C.V. clearly states that Jean Mercer and Gene Lester are one and the same person. Gene Lester had a name change to Jean Mercer. Jean Mercer's resume lists publications by Gene Lester and states that Jean Mercer was Gene Lester. So, this is not defamation, merely a statement of fact.

Jean Mercer's CV states that her previous name was Gene Lester. Her current name is Jean Mercer. At all times, Jean Mercer/Gene Lester was female. So, she should not be referred to as "Mr." and there is no need to say "AKA" because her current name is Jean Mercer. When someone who knows she is female intentionally refers to as "Mr.", is potentially defamatory.

I don't know if Jean Mercer is male or female. I do know from reading the bio's of Gene Lester on those books and articles that Gene Lester was male. So, Mr. may or may not be correct at this time. The material on the website at the school (Richard Stockton College) in NJ where Mercer is at is silent on gender.

Gene Lester was not male. You read the bio incorrectly. Regardless of whether you knew her gender before, you are now put on notice: She is and has always been female. If you had a question about her gender, you should have asked her about it instead of making an assumption.

An interesting exchange. Who are these people? Aren't we supposed to sign our talk references and edits? Anyway, obviously there are strong feelings here and we should be sensitive to them. I'm not sure what difference Dr. Mercer's gender makes anyway to this page or the content. I'd suggest we focus on the material at hand and not be side tracked. --User:AWeidman9:52, April 24, 2006

MEDIATION

Because of these continued Ad Hominem attacks I have turned this over to mediation. It would be helpful if you would identify yourself.

Given your past history of defamation, I prefer to remain anonymous. I think mediation is a great idea. The Misplaced Pages moderators should have a fun time reviewing the original edits you made implying that Jean Mercer was a "Mr."

The correct spelling is "ad hominem", and the remarks AWeidman has been making are "ad feminam." Jean Mercer

Jean, would you mind getting a Misplaced Pages account? We'd all benefit from your professional expertise, as well as Dr Weidman's.

I can't follow. Who has the past history of defamation? --Bronwyn Gannan 08:51, 25 April 2006 (UTC).

Whoever keeps referring to Jean Mercer as "Mr." -- which appears to be AWeidman in some cases and an unidentified person in others -- has the history of defamation.

Start over!

This entire piece, as well as the other material about attachment and attachment disorders, need to be scrapped and started over by serious professionals who have no commercial interest in these matters. These pieces have become a mish-mosh of unsubstantiated opinions and claims without an acceptable evidentiary basis. I note that my comments about EBT status have been deleted. As soon as this semester is over, I hope to offer some possible replacements. In the mean time, I hope readers will be cautious about what they read here. Jean Mercer

When will the semester finish at your university? --Bronwyn Gannan 10:11, 26 April 2006 (UTC).

Hi Bronwyn-- I have started an account, as you suggested, but when I tried to e-mail you separately it didn't seem possible. I could probably start to work on this toward the end of May and would like to hear your opinion on the direction it should go. Thanks for your earlier rebukes on the "transgendering" front-- if you'll look at the mediation page you'll see an explanation, but obviously the whole thing is irrelevant. I will say once again that EBT status for DDP is highly questionable, a point that my statement "EBT or not EBT?" on www.childrenintherapy.org examines in detail. Jean Mercer

I have a proposal for re-organizing the articles on attachment theory. The main attachment theory article will contain a brief introduction followed by sections that have summaries and links to related articles. I have already created a draft of the main article at User:Kc62301/Attachment Draft. The links on this draft are valid and take you to the actual proposed articles...not just stubs. I plan to finish the article on adult attachment by no later than July 4th. If the Reactive attachment disorder article could be merged into the Attachment disorder article, it would fit nicely into the scheme. I did something similar with the Monogamy article, and it has been well-received, since no one has objected or made major changes. What do you think? kc62301

Reactive Attachment disorder is a psychiatric diagnosis. It probably makes more sense to integrate material from attachment disorder into this article on reactive attachment disorder. However, if this is going to lead to problems with whether or not to include material on such reputable approaches as Floor Time, Theraplay, or Dyadic Developmental Psychotherapy as is going on with the Bowlby article, then I'd let sleeping dogs...sleep. MarkWood 15:03, 28 June 2006 (UTC)

I see your point after reading the discussion page on Bowlby. I decided to take your advice and have two main sections on the User:Kc62301/Attachment Draft page. One for basic attachment theory, and one for attachment theory in clinical practice. (I'm open to suggestions for alternative heading names, by the way.) I included both the Attachment disorder article and the Reactive attachment disorder articles on the main page...as well as two therapeutic interventions. I did not write the article on attachment of children to caregivers, so that has some clinical info that I don't feel comfortable moving without consensus. It might be okay as is. kc62301

Removed merge tag

There is serious disgreement between contributors about material that would no doubt be included in a merged article. Currently there appears to be consensus on how the Attachment disorder article and the Reactive attachment disorder article are written. I think anyone who wants to merge the articles should write a draft and get consensus on the draft. kc62301

I don't think that there is serious disagreement between contributos about material in this article...it appears to be only one contributor and I don't think that one loud voice should disrupt consensus. SamDavidson 17:18, 1 July 2006 (UTC)

Okay. You don't mind the merge tag being removed, though, do you? Please feel free to put it back if you prefer. I'll leave it alone. kc62301

I'd agree with SamDavidson that there isn't serious disagreement among contributors. I think the removal of the merge tag is fine, as far as I am concerned. I appreciate your work here. It's very good!! DPeterson 00:03, 2 July 2006 (UTC)

• • • Once again, this whole piece has been written from the viewpoint of practitioners far outside the mainstream. The reference to the RADQ and to "Attachment Disorders" ("tout court")indicates that the writers belong to the school of thought that has brought us a number of highly commercialized treatments sold to parents who are supplied with a checklist to demonstrate that their child needs treatment.Are readers aware that Elizabeth Randolph, developer of the RADQ (on the basis of an old checklist that would help you detect if your child was masturbating), claims that she can diagnose an attachment disorder if the child does not crawl backward on command or execute a cross-crawl movement? The only diagnosis against which the RADQ is validated is Randolph's own opinion; there is no independent assessment and certainly no double-blind design.As a result, using the RADQ as a way to evaluate treatment is a matter of garbage-in/garbage-out. This is only one of many problems with this page, and I think it is shameful to put this kind of disinformation out where the unsuspecting public can be influenced by it. Please understand that Candace Newmaker, the child who was asphyxiated by holding therapists some years ago, was diagnosed over the telephone by a practitioner who used the RADQ.

There is no clearly-described diagnostic entity known as Attachment Disorder. The symptoms of the DSM category called Reactive Attachment Disorder are rather general and certainly don't include anything about eye contact or disobedience. The DC: 0-3, a set of categories designed to use with children of the age when attachment develops, does not even include any form of attachment disorder.

"Everyone knows" all about attachment, but few people know much that is correct, especially about disorders of early development. (N.B. The bizarre statement about 80% of some groups being diagnosed with RAD is a typical contribution of the Practitioners Formerly Known as Holding Therapists-- they are fond of this proportion.) This whole piece needs re-writing. Is there anyone out there who would like to work together on this? You must know what you're talking about or be willing to do some reading. Keep in mind that there is a responsibility here to parents who might make some decisions based on material they read on Misplaced Pages. Jean Mercer

Removal of the merge tags is fine. The previous comments mirror those of Mercer's articles on the ACT website. I will have to see if there is a relevant citation for that 80% figure. I seem to recall reading it in an article by Dr. Dante Cicchetti, but don't hold me to that as I must check the reference...MarkWood 17:47, 9 July 2006 (UTC)

The reference is right there on the page, number 4, if you both would take a look. The reference by D.C. should be found in any library...at least ours has a copy. JonesRD 20:51, 9 July 2006 (UTC)

I have added some introductory material that I believe clarifies some issues. Disorders of attachment are not like chickenpox-- they my occur in many forms and may even amount to normal variations-- and this point should be included in the article.Jean Mercer 15:37, 10 July 2006 (UTC)

It might be better to put the material you suggest into a separate section labeled critics or something like that. Neutral point of view is generally preferred in articles, but critics should also have a clearly labeled place to put in their two cents. Also, self-promotion is to be avoided as well. JohnsonRon 20:01, 10 July 2006 (UTC)

Okay, good idea.Jean Mercer 21:49, 11 July 2006 (UTC)

Article is about the Diagnostic Category

I removed a section that probably belongs better in an article about treatment. In fact the material can be found in the article Attachment Therapy DPeterson 12:19, 11 August 2006 (UTC)

I added it back, as the article does contain a section on controv. and so references also belong. DPeterson 12:23, 11 August 2006 (UTC)