Here’s another example of the inclusion of Reactive Attachment Disorder in the discussion of Attachment Parenting over at PhD in Parenting (which I posted about previously here) . See my response in the comments section.
Dr. Heather over at Baby Shrink has a great new post about Attachment Parenting, and how to understand it in terms of the progression of infant development. Her point is that though attachment is the foundation of emotional development, there is a need to appreciate the evolving balance between closeness and independence as children mature, and that AP sometimes may not fully appreciate this duality:
“Movement away from the parent requires a means of communicating over distance with that parent: When you crawl across the room, it’s nice to be able to say ‘Doggie!’ and to point at the doggie, to get your parents’ attention. Communication becomes more necessary when the child can move away from the parent. And communication is a symbolic way of continuing attachment. We can tell older babies I love you! And their ability to understand abstract communication helps them to feel the love, without being physically held. It’s not that physical comfort is no longer necessary, but rather, the baby now has a new, more advanced way to be attached; through communication. And that allows the baby to become more independent, and venture out, away from the parent…
… How is this different from Attachment Parenting? Yeah, I know that AP understands and appreciates the nature of ‘attachment’ — they used it in the name of the approach, after all. And I’m totally with them on the use of AP principles, but only with very young infants, and only when that infant is constitutionally amenable to the intense physical contact of AP. As I said in my previous post, AP comments very little on those infants who simply do better with a little time and space on their own; a little less handling — and little ‘breaks’ from being ‘attached’ all the time. Many of my readers have babies whose sensory systems simply could not handle all that attachment, and are so much happier with a little ‘breathing room’. And as infants become toddlers, they crave less and less dependence — and more and more independence. And we, as parents, need to walk that tightrope of ‘Rapprochement‘ with them.”
Really hits the nail on the head, if you ask me.
They took down the posting on RAD on the Parent Education page at the Ergo Baby site, so I guess that’s that. Score one for Psychology!
I received a response to my email to Ergo Baby the other day:
“I am the person responsible for the Reactive Attachment Disorder article by Nancy Thomas being published on our website under Parenting Education in late July of 2008. I assume that you checked out her bio at http://www.attachment.org/pages_nancy.php. A customer of ours, a foster/adoptive parent, suggested we contact Nancy as a part of our mission to educate. I had never heard of RAD and when I researched it, I felt it was appropriate to post the information as a counterbalance to Attachment Parenting, not Attachment Parenting versus traditional parenting.
It never occurred to me that it would be interpreted or implied that “not practicing attachment parenting could lead to the development of RAD”. I sincerely respect your response as a psychologist and as a parent and want to assure you that there was no intention to misguide or manipulate and in particular infer it as a “scare tactic”. The Parent Education section is simply to inform.
I appreciate your feed back and will endeavor to write some introductory text that will clarify that it is a rare condition as you described. Other information that appears on our web may well be deemed controversial as well: the Continuum Concept, Elimination Communication, even our support of LaLeche League’s commitment to Breastfeeding.
I am pleased that you enjoy and use the ERGObaby carrier and want you to know that none of our educational focus is meant to be construed as promotion of our products. We feel we have a responsibility to educate as an adjunct to providing the best carriers and accessories possible.Thank you for bringing our attention to the inclusion of RAD in our Parenting education material and I will take steps to modify it according to your input.”
I just came across this great discussion of attachment parenting on Baby Shrink, for those who are curious. I didn’t see any comments about the RAD issue, but a useful and balanced post nonetheless. By the way, after writing my previous post, I felt compelled to write to Ergo Baby to voice my complaint - no response from the company yet.
I’m all for the underlying tennant of Attachment Parenting, which is, according to Attachment Parenting International, to form and nurture strong connections between parent and child by employing approaches such as practicing positive discipline, using nurturing touch, providing consistent and loving care, and feeding with love and respect. As a psychologist and a parent I am all too aware of the importance of forming a healthy parent-child attachment to the emotional development of children, and have seen the devastating effects of having a childhood without such experiences of human connection. But I take issue (and apparently I’m not the first to do so) with the assertion made by some that not practicing attachment parenting (ie. practicing traditional or parent-centered parenting) can lead to the development of Reactive Attachment Disorder. I first came across this association at the website of the (awesome) baby carrier Ergo, on their “parent education” page (baby carrying is a big thing in the attachment parenting world):
“We are less familiar with Reactive Attachment Disorder and ERGO baby wants to inform our readers about this condition in which individuals have difficulty forming lasting relationships. ”
The implication that if attachment parenting practices are not employed in the raising of one’s children that there is at risk that they will develop RAD is misguided, manipulative and wrong. RAD is a rare condition that develops as a result of severe emotional neglect, like being raised in an orphanage with little social interaction with and emotional nurturing by caregivers. This early deprivation inhibits the development of the capacity for emotional connection with others (see this page by American Academy of Child and Adolescent Psychiatry for further explanation). To imply even indirectly that this disorder would be a possibility for a child raised in a loving home by parents who use a stroller, don’t sleep with their baby, and impose a parent-centered schedule is totally absurd and offensive. RAD has no place in the discussion of attachment versus traditional parenting, and to include it is a disservice to parents who are trying to make informed decisions about their parenting practices. I don’t understand why it would be part of such a discussion except as a scare tactic, which undermines the legitimacy of the argument for attachment parenting.
In pursuit of more information, I found this site by the Mother-Baby Behavioral Sleep Laboratory at the University of Notre Dame (by way of Wikipedia, I must admit). Among other things, it states:
“While advocates of solitary infant sleeping arrangements have claimed any number of benefits of infant sleeping alone, the truth o the matter is, none of these supposed benefits have been shown to be true through scientific studies. The great irony is that, not only have benefits of solitary infant sleep NOT be demonstrated - simply assumed to be true, but recent studies are beginning to show the opposite that is, it is not, for example, solitary sleeping arrangements that produce strong independence, social competence, feeling of high self esteem,good comportment by children in school, ability to handle stress, strong gender or sex identities - but it is social or cosleeping patterns that might, indeed, contribute to the emergence of these characteristics.”
Ok, but what about safety?
“No infant sleep environment is risk free. As regards cosleeping (in the form of bed-sharing) what we know to be true scientifically is that for nocturnal infant breast feeding and nurturing throughout the night both mothers and babies were designed biologically and psychologically to sleep next to one another. And while beds per se did not evolve mother-infant cosleeping most assuredly did-and not maximize infant and maternal health and infant survival! Infant-parent cosleeping with nocturnal breast feeding takes many diverse forms, and it continues to be the preferred “normal” species-wide sleeping arrangement for human mother-baby pairs. In the worldwide ethnographic record, mothers accidentally suffocating their babies during the night is virtually unheard of, except among western industrialized nations, but here there are in the overwhelming number of cases, explanations of the deaths that require reference to dangerous circumstances and not to the act itself…
… While there is evidence that accidental suffocation can and does occur in bed-sharing situations, in the overwhelming number of cases (sometimes in 100% of them) in which a real overlay by an adult occurs, extremely unsafe sleeping condition or conditions can be identified including situations where adults are not aware that the infant was in the bed, or an adult sleeping partners who are drunk or desensitized by drugs, or indifferent to the presence of the baby. In these cases often the suffocation occurs while the parent and infant sleep on a sofa or couch together.”
So I feel a bit better now, and I don’t know about you, but to me, Notre Dame is nothing to shake a stick at, so I trust the source. They also list some guidelines about co-sleeping:
“While mother-infant cosleeping evolved biologically, it is wise to recall that beds did not; whether sleeping in a crib or in the adult (parental) bed, the mattress should be firm and it should fit tightly against the headboard so that an infant cannot during the night fall into a ledge face down and smother. Since contact with other bodies increases the infant’s skin temperature, babies should be wrapped lightly in the cosleeping environment especially, and attention should be given to the room temperature. Obviously if the room temperature is already warm (say above 70 degrees F, the baby should not be covered with any heavy blankets, sheets or other materials A good test is to consider whether you are comfortable; if you are, then the baby probably is as well.”
When I read this article in the New York Times last fall, I couldn’t imagine that I would ever let my child sleep in my bed with me. Well, guess what? That’s where he spends most of the night. It didn’t start out that way, I think for the first week he was in his bassinet next to our bed, and I would get out of bed and go sit in the rocking chair to feed him every two to three hours. Then somehow, and I can’t really pinpoint how, we started to put him in the bed when he had trouble settling down, and it was SO MUCH EASIER. My sleep and his was greatly improved; he would wake up for 20 minutes to nurse and then fall quickly back to sleep, as would I. So there he remains today. Sometimes we’re able to start him off in the bassinet, but I’m searching for some sort of compelling reason to make the effort to get him to stay in the bassinet for the whole night that would be worth the grief that it would cause to get him there. When he naps during the day, he’s sleeps in the bassinet, though usually after some parental soothing and falling asleep on an adult shoulder or chest. One drawback I keep thinking about is that it’s going to get more difficult as he gets older to get him out of the bed, and I don’t want him to be 12 and still sleeping with us (I’m only half joking). So I’m thinking that a goal of three months is reasonable to get him out of the bed. But before I make a plan, I want to find out more about if it’s really so bad for him, or for us, and if this is something I should be concerned about at all, or just let evolve as it may.
According to the NYT article, the American Academy of Pedeatrics recommends that children do not sleep in their parents’ bed because of the risk of the parents smothering the child in their sleep, or the child getting caught up in the sheets, pillows, or in the space between the bed and the wall. But the research on this has been ”inconclusive,” except for parents who drink too much, smoke, or don’t make the bed safe (for the record, we use foam positioners made to keep baby in place, and presumably to keep parents from rolling on baby).
The article also cites a study which groups parents into three categories: intentional, reactive, and circumstantial co-sleepers. The greatest concern is about the reactive group, because they don’t really want their kids to sleep with them but it’s the only thing that works for them. Such an arrangement is most stressful for both parents and kids in this group. Oh crap, that’s us. Except that there is something I find to be enjoyable about it too. I realized this in the middle of last night, when the little dude fell asleep after eating, and I probably could have put him in the bassinet, but it was nice to have him there, comforting for me as well as him. When he was in the bassinet the whole night, I used to wake up periodically throughout the night to check if he was still breathing, and I don’t do that anymore. And it just feels good to have him there, at least for now. So that leads me back to my original question as to whether we should continue to do this, what the benefits and drawbacks are, and if we keep him there, how long should he be there. I’m going to have to do a bit more research…
Since we brought our little dude home from the hospital, I’ve been catching myself thinking about how sad parenthood really is. Don’t get me wrong, it is also filled with joy and hope and unbelievable love, but it is also tempered by a sense of loss. I’m not talking about the loss of my former life, that is certainly there as well, but about the nagging thought that one day this little guy, who is so totally dependent on me for everything, will not be. He will grow up, and we will grow apart, at least in the way that we are close now. And there’s something really sad about that, even though it’s totally normal and the way it should be. Human development and becoming an adult is about becoming an autonomous being, leaving the nest, and being independent of one’s parents. And I try to picture what he’s going to be like, what kind of person he will be, what our relationship will be like, which is at the same time exciting and scary. Maybe the loss of this dependence and closeness will be mitigated by the pleasure I take in his independence and the qualities of his personality that have yet to develop and the different kind of closeness we will have. And there would be something very unhealthy if this process did not take place, not to mention the toll it would take on me and his psychopapa. But it still makes me a little sad, because I don’t kow what it is going to be like in the future, but I know it will be different.