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Copyright
This is my article and I am the holder of the copyright. When the article was previously printed I allowed printing of the article, but retained ownership of the copyright.
Arthur Becker-Weidman, Ph.D., Center For Family Development 716-810-0790 AWeidman@Concentric.net
The comment above relates to an earlier version of the article, which had been marked as a possible copyright infringement. It was published on another site, but the assertion seems genuine enough to me. During the review, User:AWeidman followed the procedure given for rewriting the article on a /Temp subpage. As that version seemed to me more in the style of a encyclopedia article, and was better referenced etc., I moved it in place over the original version, which remains available in the page history. --Michael Snow 22:49, 28 March 2006 (UTC)
The claim that DDP meets the criteria for the EBT designation is a very questionable one, as I recently pointed out in a letter to the editorial board of the Child and Adolescent Social Work journal, cc'd to Becker-Weidman. My comments on the nature of evidentiary bases, especially as they relate to Becker-Weidman's publication, will shortly be posted on www.childrenintherapy.org -- under the title "EBT or not EBT?" I would appreciate editing of this page to include any rebuttal to those remarks that Becker-Weidman may be able to provide. Proof by assertion is not acceptable evidence, and if Misplaced Pages permits simple assertions on controversial issues, it may as well declare itself a blog. Jean Mercer.
The material was published in a professional peer-reviewed journal. Child and Adolescent Social Work found the study valid, reliable, and as meeting criteria for evidence-based-treatment as described in the article. Your comments have not yet appeared in the journal. Will they be published or was you letter dismissed as irrelevant. The article demonstrates that Dyadic Developmental Psychotherapy is an evidence based treatment and subsequent resarch that has also been published confirms that.
Please note that my comments were not written for publication, but as a letter to the editorial board, as I felt it would be desirable to allow the journal to handle the matter in a private way. I do notice that the article did not appear in the issue referenced in this article. Child and Adolescent Social Work Journal accepted the article; this is not an indication that they considered the material valid or reliable (and indeed i don't see what those adjectives have to do with a CCT study), or that they consider DDP to meet criteria for an evidentiary basis-- for example, meeting the TREND guidelines. As i am sure you know, I have commented elsewhere on this peer review issue. Not all journals have well-organized review procedures,and even when they do, mistakes can be made. You cannot segue from a journal's statement that it is peer-reviewed to the conclusion that any material published there automatically meets criteria for an evidentiary basis-- this is apples and oranges, even pineapples or kiwi fruit. In fact, DDP does not have a satisfactory basis of evidence for a number of reasons: 1)participants were self-selected, introducing confounding variables; no explanation was given for the failure of the comparison group to enter treatment, and no demographic comparison of the groups was presented; 2)there has been no independent replication of these findings; 3)researchers were apparently not blind to the treatment status of participants; 4)human subjects protection guidelines were not observed; 5)no specific description of treatment seems to be available, and the description given in the Wiki piece under consideration is at variance with the description in the "Dr. Art" book currently available on Becker-Weidman's web site; 6) the statistical analysis is problematic, substituting the easy but dangerous multiple-t approach to the ANOVA which should have been done here; 7) although the Wiki piece stresses the CBCL findings, the journal article (as it was posted on the web site) refers also to the use of the egregiously faulty RADQ checklist. If anyone would like to provide substantive counter-arguments to these points, as opposed to simply deleting my comments or mounting personal attacks, I would be very pleased to read them and to see them included in the article.Jean Mercer 15:52, 11 July 2006 (UTC)
Well, they obvioulsy rejected your "letter" and chose not to publish it. The journal, as far as I can see is a professional peer-reviewed journal that found Dr. Becker-Weidman's article worthy of publication and as providing substantive and valuable material that would be of use to professionals. The article did describe that those in the control group came for evaluation only and the statistics clearly show that the two groups did not differ in a significant way on a broad range of demographic, clinical, and test score data. CBCL scores are valid and reliable. Overall, the claims you make are irrelevant as the journal's acceptance of the article suggests your "issues" with the article are minor and do not take away from the scientific validity and value of this study. RalphLender 17:54, 11 July 2006 (UTC)
No, what it suggests is that CASWJ is not particularly concerned with research design. Not all journals have the same concerns. But from the point of view of establishing an evidentiary basis, my questions need to be addressed. Volunteers are different from non-volunteers, that's well known. So, why did some people come for evaluation only, and others for evaluation plus treatment? What were the basic differences between the groups? Did they have to do with family needs-- did some of the parents not like the offered treatment-- were other treatments chosen instead? All of those questions are relevant to interpretation of the outcome, as are the points that always go unmentioned, the transparency issues, the use of the RADQ, and the choice of statistics... not to mention compliance with guidelines for protection of human subjects.Scott Lilienfeld has been telling us that clinicians are not educated to understand these issues, and I'm afraid he may be right. Look, a lot of people have thought and written a great deal about establishing evidence to support the efficacy and safety of treatments. It's quite difficult to do a good CCT study. I don't demand that you randomize-- that can be almost impossible, especially in private practice. I don't even demand that you have a better design. But I do demand transparency in reporting, including appropriate statistical handling. By the way, it's really unconscionable to leave the incorrect reference information on this page and elsewhere, making it impossible for many readers to examine the paper for themselves. If you believe that there is really clear-cut evidence to support DDP, put it out there where readers can get at it, and explain why you think the design and analysis are acceptable. Once again, the real issue is not who is King of the Attachment Therapists or Big Expert on Research Design. The question is about protection of children and families, especially highly vulnerable adoptive families. It is a blow against those people to claim that a treatment is effective without unimpeachable evidence.To convince them of what is not true is to persuade them to spend their scarce resources and get nothing in return. I don't know what your ethics code says about that, but mine disapproves. Jean Mercer 20:25, 11 July 2006 (UTC)
Someone with an IP address from the Buffalo, NY, area seems to so much lack a secure base that s/he can't tolerate any discussion. So s/he deletes things (like the paragraph before last) in an Orwellian attempt to rewrite history. So I've put back the paragraph and remind that s/he can't rewrite the Misplaced Pages history. For the sake of his/her rapidly declining reputation, s/he should try explaining or justifying his/her editing behavior. 206.81.65.234 21:50, 24 April 2006 (UTC) A friend (not an alter ego) of Jean Mercer and of the truth
Page is growing nicely
This page is growing well. The evidence base for this form of treatment is rapidly expanding. Forgot to sign in RalphLender 20:41, 5 July 2006 (UTC)
I've read some very interesting material about this treatment and find it very compelling RalphLender 20:41, 5 July 2006 (UTC)
I have done some editng that I think reflects reality a bit better than the previous version. However, I notice a great deal of disorganization and repetition in the article. Are the original study and the follow-up really as identical as is presented here? One does think of Sir Cyril Burtt. Jean Mercer 22:13, 11 July 2006 (UTC)
I added a citation and cleaned up some of the material to be more neutral and correct DPeterson 00:34, 12 July 2006 (UTC)
Perhaps, if for "neutral" one reads "positive." however, I see you left the apostrophes I inserted-- that's a step in the right direction. My questions from 11 july still need to be answered, and the article is not well organized. I would propose the following parts: definition; description of treatment; theoretical background; evidentiary basis. Every point currently in the article could be placed in one of these categories. In the description and the theoretical sections, the material needs to be more concisely descriptive; presently there are a lot of words, but the naive reader would not know much after wading through them. The descriptive section also needs to clarify the work done with parents-- the "Dr. Art" book on Becker-Weidman's web site does not suggest much about this except that parents are apparently advised to bottle-feed school-age children. In the section about theory, I would think a reference to Stern would be a propos. Also, because of Hughes' remarks in his 1997 (I think) book, it would seem that Foster Cline's contribution should be acknowledged-- Hughes has never given a clear statement about his current view on this and why it has altered, if it has. Although the concept of attachment is shared with Bowlby, much of the background lies elsewhere; Bowlby never suggested that early stages of attachment could be re-worked by imitating the normal events of those periods. This is an important point to deal with, because the APSAC task force report specifically rejected the use of age regression techniques (see the november issue of Child Maltreatment for a LTE proposing a definition of age regression.)To claim compliance with APSAC, proponents of DDP need to offer a rationale for their use of bottle-feeding and similar practices.Jean Mercer 12:52, 12 July 2006 (UTC)
- As a reader of this, and other pages, it might be useful for you to read the book 'Creating Capacity For Attachment' edited by Dr. Becker-Weidman & Deborah Shell, Wood N Barnes, Oklahoma City:OK 2005 as that has an excellent description of the theory base for Dyadic Developmental Psychotherapy. I found nothing in that book that suggest the approach is coercive. I aldo found no references to Foster Cline. The book has an excellent chapter about work with parents too; this has nothing in it about "age regression," which, to my reading, is not a part of this treatment approach. The approach is consistent with APSAC and various other practice parameters. So, I think all your concerns have been addressed in that text. RalphLender 15:27, 12 July 2006 (UTC)
The reference to Foster Cline had to do with Hughes, whose work is said to be the foundation of DDP. I have no doubt that the B-W and Shell book does not index age regression or use this term, but there is some category of practices that APSAC termed "age regression" (and unfortunately, in the midst of their fine work, they neglected to define the term). I assume that no one is speaking seriously of hypnotic age regression, past-lives regression, or any of that stuff, so I see nothing else for age regression to mean except practices that treat the child in age-inappropriate ways such as bottle-feeding and prolonged gaze, with the intention of re-working emotional processes that are thought to have gone wrong long before. If I am wrong, perhaps you can tell me what APSAC meant by rejecting age regression, and what practices would be relevant here. Your explanation would need to include a rationale for Dr. Becker-Weidman's mentioning on his web site the practice of bottle-feeding a school-age child.12.75.151.203 16:12, 12 July 2006 (UTC) Sorry, i thought I'd signed in. Jean Mercer 21:52, 12 July 2006 (UTC)
Well, since the book does not referernce Foster Cline and does not include recommendations or treatment methods that meet 12.75.151.203's def. of age-regerssion, this is now a non-issue and not relevant to this discussion. So, this discussion can be closed at this time. RalphLender 17:07, 12 July 2006 (UTC)
Not quite so fast, perhaps. Examining the actual theoretical and historical background of an idea may take more time and work than the idea's proponents sometimes think. Often examination of earlier work from which a current author drew concepts will tell you a lot about a theme that's being elaborated. I'm suggesting that Hughes' past enthusiasm for holding therapy, in the Foster Cline pattern, is a foundation for DDP; this seems especially likely to be relevant because Becker-Weidman states that he received training in Evergreen. Of course, not too many people would want to cite Cline nowadays, so i don't expect this to be mentioned in the edited book. As for age regression, are you suggesting that the material on Dr. Becker-Weidman's web site is not congruent with his statements in his paper in that edited book? If that's the case, perhaps you'd better discuss the matter in this article. Treatment methods certainly evolve-- are you saying that's happened here? There is no question that the Dr. Art book refers to bottle-feeding, so perhaps there's more to be discussed about this treatment than has yet appeared. Jean Mercer 21:52, 12 July 2006 (UTC)
Incidentally, the report of the follow-up study has one quite remarkable characteristic, and other researchers would be most appreciative if Dr. Becker-Weidman would tell us how he managed this. It would appear that no participants from either the treatment or the comparison group were lost to follow-up after an interval of almost four years. Even in residential treatment this would be surprising.Jean Mercer 21:58, 12 July 2006 (UTC)
That is just silly. Must we discuss surgery pre-Anesthesia if discussing new developments in surgery? No, what you suggest is not relevant to articles here. The book speaks for itself. Dr. Becker-Weidman's credentials are extensive and impressive and his publications are compelling and well-respected in the professional community; at least as I read it. I am not going to answer every one of your questions as these are irrelvant and "red-herrings." In addition, you obviously did not read the two studies published by Dr. Becker-Weidman carefully as there is specific discussion of attrition. This now makes one wonder about the veracity of your other statements if you either did not read the material carefully ore are misrepresenting it. In any event you are incorrect. I'd say this line of discussion if completed...Next. DPeterson 22:25, 12 July 2006 (UTC)
This Wiki article, right here, says the two studies had the same numbers of people and appears to say that they were there both initially and at the later assessments. If this was not the case-- e.g. there were 100 initially in the treatment group, in the treatment goup, and this was reduced to 34 at the end of the treatment period with 34 still present a couple of years later-- this should be said, especially because there's so much detail being given. Why not just refer the reader to the published paper if a full discussion is not to be given? (Speaking of that-- got any page numbers for the CASWJ article? Without page numbers, you know, readers can't get it on interlibrary loan if that's what they need to do, and it is an obscure publication.)
As for the anesthesia analogy, no, of course, if you're talking about methods, there would be no reason to talk about history. But if you were talking about a theory of anesthesia and how it gave rise to current work in anesthesia, then you would need to talk about history. This article and other related pieces make a point of mentioning the theoretical background of DDP--- you needn't do this if you don't want to, but if you do it you need to discuss the historical development from one thing to another. Otherwise, you're just waving the name Bowlby around as a symbol of authority, not actually considering the development of ideas. In any case, it's an interesting question: how come Hughes was into holding ten years ago, now he's not? What is the explanation? Can Hughes or B-W explain this change of thinking? If they can, it's awfully important, because they are the people who might be able to turn around the group who still use coercive restraint. So the question about background is very meaningful at every level, including protections for children presently in treatment. Jean Mercer 23:45, 12 July 2006 (UTC)
Again, read the book and the articles so you have your 'facts' straight. An article about anesthesia would not include the material you describe...that would just be irrelevant. Dr. Hughes and Dr. Becker-Weidmaan do not need to describe changes in their practice. Do we ask the cancer surgeon to explain in excruiting detail, as you seem to want, why the surgeon no longer routinely does radical mastectomies when the surgeon did that routinely ten years ago? No, of course not!
The practice of Dyadic Developmental Psychotherapy appears to meet all professional standards, APA, NASW, APSAC, Amer Academy of Pediatrics, etc., etc., etc....
Again, raising "red-herrings," much as the ACT group and other fringe groups do is not productive here, so the discussion really ought to end...but if you insist on acting as a spokesperson for ACT, at least say so. A Neutral Point of View is much preferred....68.66.160.228 00:33, 13 July 2006 (UTC)
- When beliefs are diametrically opposed, the only neutrality involves two statements, each clarifying the stand of one group. Is that what you would like to do?12.75.168.251 17:55, 13 July 2006 (UTC)Jean Mercer (sorry , flubbed sign-in somehow)
- I agree. The book and articles are clear. The approach is not coercive and does not use "age-regression" as part of the method. I see no point in continuing this "dialogue" and giving validity to views that are not relevant. The facts, as previously put, are quite clear. RalphLender 13:57, 13 July 2006 (UTC)
Saying the facts are clear doesn't make them so, and repeating a claim of effectiveness is just a quaint rhetorical device. This is an encyclopedia article and therefore should be accessible to the lay reader. If that person wanted to read all the original material, he or she would go and do so; whatever is stated in the article should provide the information in a concise but complete form that the average reader can deal with. That means 1)the whole article needs to be re-written for organization-- I suggested earlier a format that would work; 2)if details of research are mentioned at all (and they need not be), necessary information should be included, and unnecessary repetition should be omitted; 3)where any point is made, it needs to be a meaningful part of the whole communication, not just a signal commanding belief; this is why I say, either remove the allusion to theory completely, or if you think it's important do a proper job on it.
I wouldn't expect a description of anesthesia to refer to background unless the writer alluded to it to begin with-- then I'd want to know what the connection was. You (or somebody) have made the allusion to theory, so either complete it or remove it. And, as for explaining why a change has been made, I'd say that a professional who has advised others to follow practices that the practitioner later sees as inappropriate, has an obligation to correct the ill effects of their earlier advice. Anyone can make a mistake, but people with fiduciary responsibilities have a particular obligation to correct theirs in public. With respect to age regression, the Becker-Weidman web site does refer to relevant practices, but they aren't mentioned here in this article. Does that mean that there's more to DDP than is discussed here? Or does it mean that B-W's treatment is not DDP? The latter would be of interest, because the data reported here all came out of his office as far as I know. Well, guys, this has been real, but you can't be having fun all the time. I'm going out of town for a few days. See ya next week, no doubt.12.75.168.251 17:55, 13 July 2006 (UTC) Comments by unknown persons are suspect...It would be better to sign in. RalphLender 18:05, 13 July 2006 (UTC) It was me, Jean Mercer-- I thought I had signed in Jean Mercer 19:23, 13 July 2006 (UTC)
But the facts are clear...continuing to say they are not does not make that true. Your suggestions are not helpful in creating a useful article. The inclusion to theory is well written. I disagree with your assessment. The article is good as it is. While you may have a particular point to advocate for, based on memberhip, etc., this is probably not the place to do so. I see no references to "age-regression" on the site for the Center For Family Development, of which Dr. Becker-Weidman is a member. The book he co-edited and his articles "speak for themselves," on this subject and clearly preclude coercive interventions. RalphLender 21:05, 13 July 2006 (UTC)
- I have to agree with RalphLender JonesRD 21:55, 13 July 2006 (UTC)
Yes, the article is very good: well written and with appropriate citations and support. I agree with the comments of RalphLender regarding Dr. Becker-Weidman. He is a licensed mental health professioal with many years experience and a number of publications to his credit. I disagree with mercer's comments and advocacy. DPeterson 02:34, 18 July 2006 (UTC)
Supporting References
I added a couple of references that show support for several of the principles of Dyadic Developmental Psychotherapy. If others have references or thoughts, let me know. DPeterson 02:39, 18 July 2006 (UTC)
I find it quite incredible that anyone thinks this article is well-written-- even those who are committed to the content. But, be that as it may, I repeat for the benefit of any newcomers that there is more than one point of view here. I am working on an additional section that will be a critical analysis of the existing material, including the Hughes work.I cannot believe that it would be congruent with Wiki principles for anyone to resist the inclusion of critical material of this type. I intend to include discussion of the age regression concept, by the way.Jean Mercer 14:15, 18 July 2006 (UTC)
I find the material on this page excellent. It is important that editors maintain a neutral point of view and not act as advocates or spokespersons for particular groups. Misplaced Pages articles should represent mainstream consensus views on topics and not be platforms for fringe groups or extreme points of view, which are not neutral points of view. RalphLender 16:11, 18 July 2006 (UTC)
Dyadic Developmental Psychotherapy Adherence to APSAC Task Force Report Recommendations
I ('MarkWood 20:32, 19 July 2006 (UTC)') thought it would be useful to put here material on how Dyadic Developmental Psychotherapy complies with the APSAC Task Force Report and Recommendations: Report of the APSAC Task Force on Attachment Therapy, Reactive Attachment Disorder, and Attachment Problems. Child Maltreatment, 11 (1), 2006, pp 76-89.
This important document presents several recommendations regarding the evaluation and treatment of children with disorders of attachment. While the report itself is based on old, and in some cases outdated and incorrect information, the recommendations are valid and should be followed by all clinicians who work with children.
The Report recommends the following regarding the diagnosis and assessment of attachment problems (pg. 86):
1. Assessment should include information about patterns of behavior over time, and assessors should be cognizant that current behaviors may simply reflect adjustment to new or stressful circumstances.
2. Cultural issues should always be considered when assessing the adjustment of any child, especially in cross-cultural or international placements or adoptions. Behavior appearing deviant in one cultural setting may be normative for children from different cultural settings, and children placed cross culturally may experience unique adaptive challenges.
3. Assessment should include samples of behavior across situations and contexts. It should not be limited to problems in relationships with parents or primary caretakers and instead should include information regarding the child's interactions with multiple caregivers, such as teachers, day care providers, and peers. Diagnosis of RAD or other attachment problems should not be made solely based on a power struggle between the parent and child.
4. Assessment of attachment problems should not rely on overly broad, nonspecific, or unproven checklists. Screening checklists are valuable only if they have acceptable measurement properties when applied to the target populations where they will be used.
5. Assessment for attachment problems requires considerable diagnostic knowledge and skill, to accurately recognize attachment problems and to rule out competing diagnoses. Consequently, attachment problems should be diagnosed only by a trained, licensed mental health professional with considerable expertise in child development and differential diagnosis.
6. Assessment should first consider more common disorders, conditions, and explanations for behavior before considering rarer ones. Assessors and caseworkers should be vigilant about the allure of rare disorders in the child maltreatment field and should be alert to the possibility of misdiagnosis.
7. Assessment should include family and caregiver factors and should not focus solely on the child.
8. Care should be taken to rule out conditions such as autism spectrum disorders, pervasive developmental disorder, childhood schizophrenia, genetic syndromes, or other conditions before making a diagnosis of attachment disorder. If necessary, specialized assessment by professionals familiar with these disorders or syndromes should be considered.
9. Diagnosis of attachment disorder should never be made simply based on 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.
The assessment and evaluation process recommended by Dyadic Developmental Psychotherapy, as described in the text, Creating Capacity for Attachment, edited by Becker-Weidman & Shell (2006)is a comprehensive evaluation of the child and family that considers strengths and weaknesses and that uses a variety of methodologies to gather information and evaluate the meaning of this data. Theassessment process is not limited exclusively to the assessment of attachment issues. Children who have chronic histories of maltreatment or institutional care may have a variety of issues that must be considered as part of a comprehensive assessment process. The evaluation inclues a screening for many issues including various mental health issues and diagnoses, sensory-integration issues, neuro-psychological issues, Fetal Alcohol Spectrum Disorder and the effects of prenatal exposure to alcohol and drugs, and various learning issues.
The assessment includes a comprehensive review of documents including adoption summaries, school records, health records, and previous evaluations and reports. Interviews the caregivers to get a full understanding of the child’s current functioning, history, and concerns are part of the process. As part of this interview there is an assessment of the caregiver’s capacity of provide an attuned and emotionally responsive environment.
The parent’s reflective function and family of origin are important dimensions to be considered. The interview with the child includes a mental health assessment and the administration of several projective tests. The child is observed with the caregivers, and finally a variety of tests and measures are used to gather information from the child, caregivers, and teachers. The instruments commonly used include the following: Child Behavior Checklist (caregiver, child, and teacher versions), Vineland Adaptive Behavior Scales, House-Tree-Person Projective Test, Child Apperception Test, Behavior Rating Inventory of Executive Function (parent and teacher versions), Biography of parents, Day in the life of the Child narrative, Parent Stress Index, and, when indicated, we use a variety of structured observational methods and procedures such as the Ainsworth Strange Situation Protocol. Other tests and observational methods are used as indicated.
A more complete description of this assessment process and methodologies can be found in Becker-Weidman (2005) “The Logistics of Providing Dyadic Developmental Psychotherapy,” In Creating Capacity for Attachment (Eds.) Arthur Becker-Weidman, Ph.D., & Deborah Shell, MA, Wood ‘N’ Barnes, OK: 2005, pp 43-56.
The Report recommends the following regarding treatment and interventions (pg. 86 - 87):
a. 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 because of risk of harm and absence of proven benefit and should not be used.
(1) This recommendation should not be interpreted as pertaining to common and widely accepted treatment or behavior management approaches used within reason, such as time-out, reward and punishment contingencies, occasional seclusion or physical restraint as necessary for physical safety, restriction of privileges, "grounding," offering physical comfort to a child, and so on.
b. Prognostications that certain children are destined to become psychopaths or predators should never be made based on early childhood behavior. These beliefs create an atmosphere conducive to overreaction and harsh or abusive treatment. Professionals should speak out against these and similar unfounded conceptualizations of children who are maltreated.
c. Intervention models that portray young children in negative ways, including describing certain groups of young children as pervasively manipulative, cunning, or deceitful, are not conducive to good treatment and may promote abusive practices. In general, child maltreatment professionals should be skeptical of treatments that describe children in pejorative terms or that advocate aggressive techniques for breaking down children's defenses.
d. Children's expressions of distress during therapy always should be taken seriously. Some valid psychological treatments may involve transitory and controlled emotional distress. However, deliberately seeking to provoke intense emotional distress or dismissing children's protests of distress is contraindicated and should not be done.
e. State-of-the-art, goal-directed, evidence-based approaches that fit the main presenting problem should be considered when selecting a first-line treatment. Where no evidence-based option exists or where evidence-based treatment options have been exhausted, alternative treatments with sound theory foundations and broad clinical acceptance are appropriate. Before attempting novel or highly unconventional treatments with untested benefits, the potential for psychological or physical harm should be carefully weighed.
f. First-line services for children described as having attachment problems should be founded on the core principles suggested by attachment theory, including caregiver and environmental stability, child safety, patience, sensitivity, consistency, and nurturance. Shorter term, goal-directed, focused, behavioral interventions targeted at increasing parent sensitivity should be considered as a first line treatment.
g. Treatment should involve parents and caregivers, including biological parents if reunification is an option. Fathers, and mothers, should be included if possible. Parents of children described as having attachment problems may benefit from ongoing support and education. Parents should not be instructed to engage in psychologically or physically coercive techniques for therapeutic purposes, including those associated with any of the known child deaths.
The Informed Consent Document addresses each of these recommendations. Dyadic Developmental Psychotherapy is an evidence-based treatment (See: Becker-Weidman, “Treatment for Children with Trauma-Attachment Disorders: Dyadic Developmental Psychotherapy,” April 2006 issue of Child and Adolescent Social Work. Becker-Weidman, “The Effective Treatment of Abused Children with Dyadic Developmental Psychotherapy,” in, Child Abuse and Its Impact, Frank Columbus, Ph.D. (Ed.) Nova Science Publishers, NY, 2006.). It is grounded in Attachment Theory and relies of the creation and maintenance of a safe and secure base from which the family can explore issues. Attunement, the reflective function, and developing and maintaining an emotionally sensitive and response environment are core features of the treatment and the parenting principals (See, for example, Miranda Ring, Ph.D., (2005), “For Parents,” in Creating Capacity For Attachment.).
Caregivers are always involved directly in treatment and are trained in attachment facilitating parenting methods that use an attuned sensitive and reflective approach. In no instances are coercive methods used. Dysregulation is never sought and on those rare instances in which a child becomes dysregulated, the therapist works actively and sensitively to re-regulate the child.
Other sections of the APSAC recommendations address the child welfare system and ethical standards. Dyadic Developmental Psychotherapy complies with those recommendations. Specifically, the report recommended the following for the child welfare system:
Recommendations for child welfare
a. Treatment provided to children in the child welfare and foster care systems should be based on a careful assessment conducted by a qualified mental health professional with expertise in differential diagnosis and child development. Child welfare systems should guard against accepting treatment prescriptions based on word-of-mouth recruitment among foster caregivers or other lay individuals.
b. Child welfare systems should not tolerate any parenting behaviors that normally would be considered emotionally abusive, physically abusive, or neglectful simply because they are, or are alleged to be, part of attachment treatment. For example, withholding food, water, or toilet access as punishment; exerting exaggerated levels of control over a child; restraining children as a treatment; or intentionally provoking out-of-control emotional distress should be evaluated as suspected abuse and handled accordingly.
The report recommended the following ethical standards.
Professionals should embrace high ethical standards concerning advertising treatment services to professional audiences and especially to lay audiences.
Claims of exclusive benefit (i.e., that no other treatments will work) should never be made. Claims of relative benefit (e.g., that one treatment works better than others) should only be made if there is adequate controlled trail scientific research to support the claim. Use of patient testimonials in marketing treatment services constitutes a dual relationship. Because of the potential for exploitation, the Task Force believes that patient testimonials should not be used to market treatment services. Unproven checklists or screening tools should not be posted on Web sites or disseminated to lay audiences. Screening checklists known to have adequate measurement properties and presented with qualifications may be appropriate. Information disseminated to the lay public should be carefully qualified. Advertising should not make claims of likely benefits that cannot be supported by scientific evidence and should fully disclose all known or reasonably foreseeable risks. the evaluation and treatment procedures and methodologies that are a part of Dyadic Developmental psychotherapy are all consistent with these recommendations. MarkWood 20:29, 19 July 2006 (UTC) MarkWood 20:32, 19 July 2006 (UTC)
I'll just comment on the informed consent issue for now. Becker-Weidman's i.c. document, as shown on his web site, does not meet guidelines for informed consent as given in the Federal Register and would not have been approved by an IRB. Of course, this work falls through a crack because there was no IRB consultation-- and because that is the case, the fiduciary obligations of the researcher become exceptionally serious, and all the more so because participants in this study were minors. However, I hope that more light will be shed on this when a member of the WikiProject Medicine group joins us.Jean Mercer 17:31, 20 July 2006 (UTC)
Again, mercer is wrong and 'misrepresenting the facts; raising red-herrings' again. The informed consent document on the website for The Center For Family Development is an 'informed consent to treat' document. It is typical of what licensed mental health professionals use and that many insurance companies require. This has nothing to do with research and so is a red-herring. The two studies published by Dr. Becker-Weidman were in prestigious professional peer-reviewed publications which determined that all relevant regulations, standards, and ethical considerations had been adequately and appropriately met. RalphLender 19:58, 20 July 2006 (UTC)
Excellent comparison of the APSAC recommendations and their concordance with the methods and approach of Dyadic Developmental Psychotherapy. SamDavidson 15:53, 21 July 2006 (UTC)
Adherence to American Academy of Child & Adolescent Psychiatry Practice Parameter
I thought the following would be of value in understanding this model of treatment. SamDavidson 15:52, 21 July 2006 (UTC)
The practice of Dyadic Developmental Psychotherpay is consistent with and in accord with the American Academy of Child and Adolescent Psychiatry’s “Practice Parameter for the Assessment and Treatment of Children and Adolescents with Reactive Attachment Disorder of Infancy and Early Childhood,” 2005.
The American Academy of Child and Adolescent Psychiatry’s practice parameter reviews the current state of assessment and treatment for Reactive Attachment disorder and provides specific recommendations.
Recommendation 1. “The assessment of reactive attachment disorder requires evidence directly obtained from serial observations of the child interacting with his or her primary caregivers and history (as available) of the child’s patterns of attachment behavior with these caregivers.”
In accordance with recommendations of Zeannah et. Al., 2000, typically, a full assessment takes place over a minimum of two or three sessions. Our assessment includes a review of a comprehensive history of the child’s early caregiving environment and information from a variety of sources. The assessment procedures recommended by Dyadic Developmental Psychotherapy (Becker-Weidman & Shell, 2005) include direct observations, clinical interviews, and a variety of psychometric instruments. The assessment of younger children involves direct observations in structured settings using formal methodologies, such as the Ainsworth Strange Situation Protocol (Ainsworth, et. al., 1978).
Recommendation 2. “A relatively structured observational paradigm should be conducted so that comparable behavioral observations can be established across relationships.”
Dyadic Developmental Psychotherapy relies on several structured and semi-structured observational methodologies to assess younger children. These include The Strange Situation Protocol (Ainsworth et. Al. 1978) and other methods. In addition, materials and observations from teachers and other caregivers are also used in the assessment process.
Recommendation 3. “After assessment, any suspicion of previously unreported or current maltreatment requires reporting to the appropriate law enforcement and protective service authorities.”
Dyadic Developmental Psychotherapy can only be provided by licensed mental health providers, who are mandated reporters.
Recommendation 4. “Referral for developmental, speech, and medical screening may be indicated.”
The assessment protocal suggested by Dyadic Developmental Psychotherapy includes screening for developmental issues, sensory-integration issues, neuro-psychological concerns, and a variety of mental health and related issues. When concerns in these areas are noted, referrals to the appropriate specialists are made and treatment is coordinated with those other providers.
Recommendation 5. “The most important intervention for young children diagnosed with reactive attachment disorder and who lack an attachment to a discriminated caregiver is for the clinician to advocate for providing the child with an emotionally available attachment figure.”
This may involve advocating for a child in residential or institutional care to be placed in an appropriate therapeutic foster home. The practice of Dyadic Developmental Psychotherapy advoctes working with the family to facilitate the development of such an emotionally available attachment figure by educating the parents in attachment-facilitating parenting methods and strategies. This is a vital component of treatment.
Recommendation 6. “Although the diagnosis of reactive attachment disorder is based on symptoms displayed by the child, assessing the caregiver’s attitudes toward and perceptions about the child is important for treatment.”
Reactive attachment disorder may be more accurately thought of as a disorder of the relationship. As such, interventions must address the child, parent, and relationship. We work extensively with the parents to provide specific parenting strategies and methods. Empowering the parents will often help parents who may be feeling disconnected, angry, or fearful to feel more competent; thus enabling them to act in a more healing manner. The model of parenting suggested by Dyadic Developmental Psychotherapy, creating a healing PLACE (Playful, Loving, Accepting, Curious, Empathic) and our model of treatment, maintaining a healing PACE (Playful, Accepting, Curious, Empathic), is designed to provide parents with the support and guidance necessary to facilitate a healing parent-child relationship. We build on the parents’ strengths.
Assessments may also include such formal methods as the Insightful Assessment or the Adult Attachment Interview.
Recommendation 7. “After ensuring that the child is in a safe and stable placement, effective attachment treatment must focus on creating positive interactions with caregivers.”
The model of creating a healing PLACE and maintaining a healing PACE re focused on creating a safe and secure base from which the child can begin to explore the world and develop appropriate and growth enhancing relationships. The parent training is focused on positive interactions. The approach does not use or condone the use of shaming or coercive parenting methods. The model provides training for the parents using modeling, coaching, and by providing reading material for their use. The recommendation goes on to state that, “Dyadic work, therapy with the child and primary caregiver together, is the second basic modality for working though address symptoms of RAD.” The approach, Dyadic Developmental Psychotherapy is consistent with this model (Creating Capacity for Attachment: Dyadic Developmental Psychotherapy in the Treatment of Trauma-Attachment Disorders, edited by Arthur Becker-Weidman, Ph.D., & Deborah Shell, MA, LCMHC, Wood ‘N’ Barnes Publishing, 2005.)
Recommendation 8. “Children who meet the criteria for reactive attachment disorder and who display aggressive and oppositional behavior require adjunctive treatments.”
Specifically, the parenting approach enables parents to address these issues. Furthermore, the assessment screens for such co-morbid conditions as Bipolar I disorder that may be causing aggressive behaviors. A variety of adjunctive approaches may also be used, as indicated.
Recommendation 9. “Interventions designed to enhance attachment that involve non-contingent physical restraint or coercion…are not endorsed.
The sample Informed Consent document (Creating Capacity For Attachment, 2005) clearly states that intrusive, coercive, and other non-contingent interventions are not used or endorsed. Dyadic Developmental Psychotherapy is based on Attachment Theory and uses a model of treatment that relies on contingent collaborative communication, reflective abilities, reciprocal interactions, and contingent interactions. SamDavidson 15:51, 21 July 2006 (UTC)
This is very interesting and helpful. Thank you. MarkWood 16:20, 22 July 2006 (UTC)
Good Material
The two sections above are good material and certainly provide excellent background information. Thank you both for taking the time to research and post that material. JonesRD 16:57, 22 July 2006 (UTC)
I agree...excellent material that clearly makes the point and address several of the "accusations" in preceeding discussion. DPeterson 01:05, 22 August 2006 (UTC)
Lacks Sources
This article lacks references. It starts out giving references and then just stops. shotwell 08:14, 8 October 2006 (UTC)
- Please do not remove the verify tag. I will place it in the specific places that need references so that my suggestion is more clear. shotwell 17:03, 8 October 2006 (UTC)
Verify tags put in as you did constitute Vandalism. You are being 'WARNED'for the third time to stop. There are abundent sources and references and much of the material is clearly a summary of material from professional peer-reviewed journals. I have added those in appropriate places. DPeterson 17:48, 8 October 2006 (UTC)
- It was not vandalism, it was a request for citations. There are currently very few citations. There is no need for hostility or accusations of vandalism. shotwell 18:57, 8 October 2006 (UTC)
- PLEASE. Let's Template:Assume Good Faith here and that Shotwell was only trying to improve this article with additional citations. I do agree that too many can be disruptive and can actually make an article too disjointed to read well. However, in this instance, what DPeterson has added should suffice. I would encourage DPeterson to just assume Good Faith as that makes editing and working with others go more smoothly. JonesRDtalk 22:24, 8 October 2006 (UTC)
- Thank-you. Let me ask, does one paper constitute a source for the claim "Dyadic Developmental Psychotherapy has been shown to be an effective treatment for children with Reactive Attachment Disorder"? Academic Search Premier and LexisNexis Academic seem to only bring up one article with the phase "dyadic developmental psychotherapy". Pubmed journal search does not bring up any results at all. Can you please point me to some more peer-reviewed sources that back this up (other then Dr. Becker-Weidman's paper)? I don't think that wikipedia should claim any particular therapy is "effective" unless it is widely accepted by the psychological community.
- PLEASE. Let's Template:Assume Good Faith here and that Shotwell was only trying to improve this article with additional citations. I do agree that too many can be disruptive and can actually make an article too disjointed to read well. However, in this instance, what DPeterson has added should suffice. I would encourage DPeterson to just assume Good Faith as that makes editing and working with others go more smoothly. JonesRDtalk 22:24, 8 October 2006 (UTC)
- Now, I'm not particularly wise in the ways of psych research, so perhaps I am searching the wrong places? If so, could you please point me in the right direction?
- Also, the tag is an accepted way of requesting a reference. shotwell 22:31, 8 October 2006 (UTC)
I appologize if I've over reacted, JonesRD. There are two papers regarding the outcome of Dyadic Developmental Psychotherapy cited in the reference section and in the article. One or two sources are adequate and acceptable. The peer reviewed articles in professional publications meet the standard of "effectiveness." The papers state that and those statements were accepted by professional peer reviewers. Too many tags have been found to be abusive in various situations. DPeterson 23:25, 8 October 2006 (UTC)
- Which two are you referring to? I'm looking for evidence that this statement (and others like it) is widely accepted by the psychological community. shotwell 23:36, 8 October 2006 (UTC)
"Treatment for Children with Trauma-Attachment Disorders: Dyadic Developmental Psychotherapy" Child and Adolescent Social Work Journal. 13(2), April 2006. Becker-Weidman, A., & Shell, D., (Eds.) (2005) Creating Capacity For Attachment, Wood 'N' Barnes, OK. ISBN 1-885473-72-9 This ia a peer reviewed publisher. Sturt, SM (Ed) (2006) New Developments in Child Abuse Research Nova Science Publishers, NY. ISBN 1-59454-980-X pp. 43-61, "Dyadic Developmental Psychotherapy: A multi-year follow-up study," This is a peer reviewed publication. One peer-reviewed publication is sufficient to support the statement that something is accepted. There is no statement in the article that the statement is "widely accepted by the psychological community. No evidence is such support is necessary either. The article is well sourced and referenced and meets the stqandard of Template:Verifiable. DPeterson 00:59, 9 October 2006 (UTC)
- Thanks, I'll check them all out. Could you possible provide references for all of the unsourced claims? It appears that you have the literature on hand. I don't know why this is so difficult. shotwell 02:21, 9 October 2006 (UTC)
- Yes, I think the addition of those references improves the article. I think that the unsourced claims are all largely found in the references cited above, in the article, and in the refernce list. It is a bit distracting as a reader to have a source put next to each sentance. I think what is now there provides a good basis and provides verifiability. Just my opinion as a reader. JonesRDtalk 20:10, 9 October 2006 (UTC)