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Monday, July 29, 2013

Is parent alienation a child protection problem?

Imagine a parent who is so angry or so despises the other parent, that they are prepared to do all they can to ensure that the child or children do not want to have anything to do with the other parent. They begin a campaign to ensure that the other parent is seen for all flaws possible, real, imagined, exaggerated. The child will be told as much as possible and rewarded for efforts to avoid the other parent.

Now imagine that both parents are in this position and engaging battle with each other through loyalty binds.

Anyone who works in the area of divorce, separation and custody will tell you that these are simplistic examples of a common problem that they encounter constantly. The term Parent Alienation Syndrome was coined by American psychiatrist Dr. Richard Gardner in the 1980s.

Dr. Richard A. Gardner

His theories were controversial in that they were built upon clinical observation as opposed to rigorous research. Yet, to those working in the field, they became instantly recognizable to cases that  they were dealing with. The concept has not received recognition through the American Psychiatric Association's DSM system. Courts seem to accept that alienation occurs but PAS as a concept remains debatable/

At the heart of the problem is the child caught in the middle of parents engaged in unending war. They have lost sight of the needs of the child and are strictly focused on their own need to "win". Certainly, they will protest that they have the interests of the child at heart. 

Alienation cases are different from those where there is real reasons to keep the other parent away or with very limited contact. The legitimate cases involve sexual or other forms of abuse, drug addiction and alcoholism or serious unmanaged mental health issues. Alienation cases may involve allegations of this, but mental health and forensic experts will fail to find merit in the claims.

In alienation cases, children are emotionally abused by the alienating parent. They are deprived of a healthy relationship with both parents. One is kept at a distance and the other is involving the child in unhealthy loyalty binds. The child is denied an understanding of what healthy parenting can be and what a normative relationship can be like with a caring parent figure.  Instead, the child is exposed to a model of abuse, ego oriented parenting and often are allied into lies or misrepresentations. The child learns that it is easier to ally with the alienating parent - it is just less stressful to go along than try to fight.

Alienating parents can also subject their children to multiple court cases which may include multiple custody assessments. Many alienating parents will not give up if the courts or mental health professionals do not agree. They will fail to honour court rulings and orders. 

Child protection professionals have been loathe to get involved. They typically see this as a problem for the divorce courts. Certainly one would have to worry about the impact on child protection caseloads if they started to get more involved. However, there is every reason to suggest that the more extreme cases are abusive parenting and should be subject to child protection review. It is often a big hurdle to get CPS involved but there is good reason to push for it, at least in those more serious cases.

Custody assessors in divorce proceedings will speak about those cases where the parent does not give up and engages in these multiple court proceedings. This is abusive and may be one of the major criteria for CPS involvement. 

Tuesday, July 16, 2013

Harsh physical punishment creates long term problems

Many may be familiar with the Adverse Childhood Experiences research. This powerful, robust work helps us to see that negative events in childhood have long term implications for physical and emotional health. A new study published in Paediatrics online this week adds to the data that what goes on in childhood has significant implications for our health as adults.

Drawing on data from the US National Epidemiological Survey on Alcohol and Related Conditions, which has a sample size of 34,226 people, the researchers were able to conclude:

Harsh physical punishment was associated with higher odds of cardiovascular disease (borderline significance), arthritis, and obesity after adjusting for sociodemographic variables, family history of dysfunction, and Axis I and II mental disorders (adjusted odds ratios ranged from 1.20 to 1.30).

This is important as we really come to understand that even in the absence of childhood maltreatment, harsh physical discipline does not lead to the desired outcome of better adults. This is important data in the ongoing debate about the use of corporal punishment. Consistently we see little objective data that supports its use.


Harsh Physical Punishment in Childhood and Adult Physical Health
    , PhD, 
  1. Jitender Sareen, MD, FRCPC

Saturday, July 13, 2013

Methadone maintenance and pregnancy

It might be a common perception that methadone maintenance is a good way to stabilize people who have long term addiction problems with drugs like heroin. Research still tends to support that notion. But there is one small study in the U.K. that should cause us to take a hard look at mothers on methadone maintenance programs who are pregnant.

This study of 56 mothers raises some very specific concerns that their fetuses have been exposed to multiple drugs beyond the methadone. This study, to be published in the Archives of Diseases in Childhood, Neonatal and Fetal edition shows that:

Most of the babies (51; 91%) had been exposed to other illicit drugs while in the womb, mostly opiates (73%) and benzodiazepines (70%). And 59% had been exposed to cannabinoids, 14% to amphetamines, and 7% to cocaine. The most common drug combo was opiates, benzodiazepines, and cannabinoids.
Almost half the babies (47%; 21) also had high FAEE levels, although only 5% of their mums admitted to drinking more than 7 units of alcohol a week during their pregnancy, a finding that has "significant implications" for the longer term health of an already vulnerable group of babies, say the authors.

This is not a study to draw widespread policy options from, but it does open up a need for careful consideration of a population that may present real risks to fetuses.  Given how significant these issues can be to the child protection population, one hopes that larger scale research will now follow.

Tuesday, July 9, 2013

Child molesting, pedophiles and grooming

A recent inquiry led me to think about how people perceive sex offenders. Based on what the media writes, one would have to conclude that the group is viewed very homogeneously  - all are pedophiles. However, there are real distinctions between a pedophile and a child molester. To the victim, the difference may not seem important, but to those of us who assess these individuals the differences are quite important - in terms of motivation, risk and treatment.

A pedophile is an individual who has a predominant or exclusive sexual attraction to children or minors. It is that population that gives them sexual stimulation and gratification.  While they can certainly be opportunistic in their offences (in other words take advantage of an opportunity that presents itself) they often engage in grooming behaviours. They will take time to get a trusting relationship to gain access to their victims.

This can be done from a position of being a valued family friend, a committed volunteer in a community or an organization or by having a position of trust in the community - a teacher, a coach, a religious figure, for example.

Anne-Marie McAlinden from Belfast University also notes an emerging trend in grooming: and emerging forms of grooming including 'street' or 'localised grooming' as typified by recent cases in England and Wales, 'self-grooming' by offenders, 'peer-to-peer grooming' among children and young people, and what I have termed 'institutional grooming' (McAlinden, 2006) where sex offenders may seek to exploit organisational features or relationships in order to minimise the perceptions of others about potential risk.

Either way, the goal of grooming is to accomplish certain essential goals. The first is to gain predictable access to the child. The second, and this is crucial, is to gain a trusting relationship with the child. In many cases, the groomer also seeks to ensure that those around the child, such as parents, will see the groomer as someone to be trusted. This is why they use things like their position with the child or the community as evidence of their trust worthiness. This helps them to be seen as above reproach. The idea being, who would not trust the child's favourite teacher who spends extra time ensuring that the child is successful at school? Who would not trust the coach who builds the child's talent?

The next crucial element is building a secrecy between the pedophile and the victim. The purpose is obvious but it is such a powerful element in allowing the pedophile to carry on. Sexual activity may come slowly with many enjoyable, but secret activities occurring beforehand.

Grooming can be done in person, but with the advent of internet technology, this is also a potent form of building relationships. Not often discussed is peer to peer grooming where one victim slowly brings another into the equation. The first victim, now fully under the influence of the pedophile, will draw in another friend.

There is another form of grooming which requires attention and reflects some cases which I have seen recently. It is the young adult male who is grooming for prostitution but is using pedophiliac behaviour to gain trust. These victims are brought in through a friend or through drug related street connections. The perpetrator will gain trust through access to drugs and gifts which result in the victim being indebted to the perpetrator. This then leads to demands for sex in exchange going on to sexual favours for friends and then to prostitution.

One  of the greatest powers that pedophiles have in grooming is the naiveté of the victims and those around them. They miss the grooming as grooming.

It is essential that professionals working with vulnerable children recognize that grooming is a conscious process. The groomer is quite aware of what they are doing and what their ultimate goal is. Pedophiles do not enter sexual behaviour by accident or as one off mistake.

Child molesters can be just as damaging although they have sexual attraction to adults. They are not exclusively interested in children. They may also be more prone to opportunity that makes itself available. In my clinical experience, this group is also more willing to place the blame on the child as having come on to them or having initiated the sexual activity. This is simply an effort to shift blame.

Once an offender has begun to victimize a child, the difference between a pedophile and molester may make little difference. Child molesters (as they have come to be known) tend to operate within family systems where they have also sustained "healthy" adult relationships. It is also vital that there be recognition that the child molester in the family system can have many victims.

Either way, sexual offending against children has long term significant damage to the victims. It impairs their sense of safety, seriously disturbs their understanding of relationship , hampers their ability for healthy peer to peer and adult intimate relationships and badly hampers their sense of self.

Most of the pedophiles I have assessed have had strong attractions to children but I have certainly met several who have also sustained long term adult relationships. A hypothetical example illustrates the point:

Joseph is a 58 year old man who has been married to Jenny for 32 years. They had 2 children who both grown up to be quite successful. They went to university and are working professionals. Joseph enjoyed a healthy and appropriate relationship with both children. Joseph, also a professional, has a successful career and is a leader in the community. He has 3 grandchildren, all of whom are quite close to him. The oldest, Sally, aged 6, recently mentioned to her mother that she and grandpa have very special private time. This concerned her mother who inquired further and learned that grandpa (the mother's father) had been touching Sally inappropriately, although there had been no sexual contact. The mother called the police and Joseph was charged. A careful investigation which coincided with a great deal of publicity in the community, yielded no suggestion that there were other victims.

Joseph may well be categorized as a child molester. He does not fit the profile of a pedophile, although to Sally there is little reason to see the difference. She was violated by her grandfather and that will be a long legacy in her life. Fortunately, her mother responded quickly and appropriately. I have seen many cases where the disclosing child was not believed which meant that the child remained in the clutches of the offender. The statistics clearly indicate that false allegations are few.

Professionals need to help families and communities see grooming behavior and focus on steps to stop the offender and protect the child.