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Taming The Problem Child
BBC2 9.00pm Thursday 8th March 2001

Dr Federici believes he can re-program problem children through strict control CHARLIE MORTON: When he comes into the room he wants what he wants now and if he doesn't get it he's liable to attack you. He's 12 years old and the kids that did Columbine shot those people in the school at 14 or 15, and I'm not saying that that's where he's going to end up, but if you ask me could it happen I'd have to say yes.

(HAYLEY KEW'S TANTRUM)

JULIE KEW: People have said to us it, it's a phase, she'll grow out of it, but she's been like it since she was four months old. She'll, she won't grow out of it.

(TANTRUM)

IAN KEW: The progression is, is, it's just been steady.

(TANTRUM)

JULIE: Something goes and you're not quite sure why and you can't even see it coming a lot of the time. For no reason she'll just, you know, just hit out.

NARRATOR (ADEN GILLETT): Coping with children with severe behavioural disorders is becoming a widespread issue. These parents are now forced to live with their children's increasing aggression and violence. It's a complex problem with no easy answers. Now one man is offering an extreme solution, but it requires parents to go against their deepest instincts.

DR RON FEDERICI (Neuropsychologist): There is a solution. The solution lies within the family. It's difficult for the parents to hear, but parents have to be able to give up what they believe is the right way to parent their child.

CHARLIE MORTON: It's a real hard question to answer what is in his mind.

GLORIA MORTON: There's just a lot of anger, a lot of contempt for people, a lot of hate.

NARRATOR: Sergei was found at five years old on the streets of St Petersburg. Very little is known about his childhood, but it was clearly traumatic. He was adopted by the Mortons from a Russian orphanage four years ago when he was eight. The Mortons have adopted two other Russian children, but they behave nothing like Sergei. His adoptive parents say that he is depressed, violent, that he hates being near them and isolates himself.

SERGEI MORTON: That's what I said. I don't want that piece (MUMBLES) that's what I got this for.

CHARLIE MORTON: When he came we knew that he was going to have problems.

SERGEI MORTON: (INAUDIBLE REMARK)

CHARLIE MORTON: But we came with the same opinion that probably 90% of adopted parents. That we just give him enough love, enough attention, embrace him and they'll grow out of it.

SERGEI MORTON: Shut up. You're just wasting my time doing this crap.

CHARLIE MORTON: When we were coming home from a dinner one night he attacked both his brothers, tried to choke his younger brother and even attacked his big sister. Now how much more violent is he going to be than he is now, when he's stronger and bigger and maybe find a gun some place.

Are you done? You don't want to sit and talk?

SERGEI MORTON: No.

NARRATOR: His mother is frightened of him. His father, not wanting to physically fight with Sergei, no longer confronts him. The parents assumed that his troubled childhood was the cause and sent him to psychotherapy for four years. However they feel it changed nothing. Sergei is getting more violent.

INTERVIEWER: Do you understand why your mum and dad get upset with you sometimes?

SERGEI MORTON: Yes.

INTERVIEWER: Why do you think that is?

SERGEI: 'Cos I'm nasty to people.

(HAYLEY KEW'S TANTRUM)

IAN KEW: She's a lovely little child, but has an explosive behavioural problem.

JULIE KEW: She comes up to you and, and she says, "I love you Mummy." She gets hold of you and she gives you a squeeze and then it'll turn to a pinch or she'll headbutt you.

IAN: The kicking is there, the biting is there.

JULIE: Spitting.

IAN: Trying to get her dressed she would kick out violently.

JULIE KEW: Don't do that.

IAN KEW: The progression, it's just been steady.

NARRATOR: Hayley is nearly six years old. She rages half a dozen times a day without provocation. She regularly attacks her mother, punching and biting her for no reason. Because her aggression has extended to attacking other children, Hayley has now been excluded from the school playground.

JULIE KEW: I went in the first day and I was with her and while I was there she'd turned round and bitten the little girl next to her and poked her eye.

(HAYLEY KEW'S TANTRUM)

NARRATOR: Hayley has been diagnosed with learning disabilities and a mild form of autism. This tends to make her inflexible and hyperactive. Her parents have sought help from many doctors, but none has offered the hope that her behaviour could really change.

IAN KEW: The last specialist we saw, a specialist psychologist, he, I actually asked him where do we go from here and he actually said I don't honestly know.

NARRATOR: These are not isolated cases and conventional psychology does not have any simple solution, but now there is an American psychologist who believes he has the answer. Dr Federici has an international reputation for working with institutionalised children and it is through his work with these children that he developed his unusual treatment plan.

RON FEDERICI: Most of my experience has been working with very damaged children in institutional settings in Eastern Europe such as Romania and also within the United States, seeing many children abused, neglected and severely deprived. They often do not leave the confines of their room, they often remain cribbed for 23 or 24 hours a day, 40 children to one caretaker. The earliest memories are of noise, lack of affection, lack of caring, fearfulness, fright about what may happen to them, hunger, thirst, things that are early, that are normally given, these children are deprived of.

NARRATOR: In these orphanages the basic rules of child development have been broken. All babies have an innate instinct to bond and seek attachment with the person who consistently feeds and comforts them and this first bond forms the basis for all other relationships. There are many reasons why this bonding may fail to happen, but in places like this it is often because of neglect and so the children do not learn to feel secure or attach. They can become isolated in their own frightening and chaotic world.

RON FEDERICI: I remember my initial experiences were of, of, of great trauma saying how could anyone live in this type of environment and survive, so it started the, the concept of pondering how do they survive and if they do, how do you get them back to where they were from the beginning?

NARRATOR: From what he has learnt in these orphanages Dr Federici has come to believe that many child behavioural problems stem from a lack of attachment and he has now developed a theory about how to help all unattached children, no matter what the cause of their problem. He believes unattached children do not really understand love and caring. They have not learnt properly to recognise or give it. Where Dr Federici is radical is that he believes children can learn to feel secure and attach in a different way, through rigid controls and rules. He now applies his theory beyond the orphanage to children who have failed to attach, for whatever reason, even to those brought up in ordinary homes. From his Washington practice, Dr Federici claims an 80% success rate in his treatment of thousands of children in America suffering from what he believes are attachment disorders. His treatment is totally surprising. Where conventional psychology would emphasise love and understanding he insists the answer is not love.

RON FEDERICI: So often families feel that the best intervention they can give is unconditional love, affection, patience, time and talking to their child and that turns out to be the incorrect mode of dealing with the child.

NARRATOR: Dr Federici's treatment means reversing the normal rules of parenting. He believes the starting point is not love, but control, that through the parents' almost military control these children will grow to trust, feel secure and ultimately attach, but will it work? Hayley and Sergei have now been diagnosed by Dr Federici as having attachment problems and are about to start this radical treatment.

RON FEDERICI: What's most important is to start a programme which allows the parents to take total charge and structure and organise this child's thinking, reasoning, behaviours and role within the family where adults become the strong role models and re-parent the child all over again.

GLORIA MORTON: Can you calm down just a little?

SERGEI MORTON: Shut up.

CHARLIE MORTON (voiceover): We probably need to give him a note…

NARRATOR: The first stage of the treatment plan starts at level one. Sergei will be confined with his parents for at least four weeks. He must stay within three feet of them 24 hours a day. They will be his sole influence. He will be forced to give up his private world, his games, TV, computer, his possessions. His world will be replaced by his parents' world. His own will be taken away, along with his identity.

RON FEDERICI: One of the most simplistic parts of this entire programme is taking away the problem identity of the unattached child. Many people would say that should be preserved, it's their identity, but if they're off the track, that has to be taken away, aligned with the parents identity. But it requires a tremendous amount of pressure on the part of the parent to the child.

NARRATOR: Dr Federici has travelled to Texas to instruct the Mortons on how to force Sergei to surrender control of his life. It all begins with the three feet rule.

RON FEDERICI: The three feet rule with a child like Sergei is going to be very important because he's a drifter. He prefers to be in his own fantasy, isolated world filled with depression, despondency and loneliness. The most important thing of this programme is for the child to enter the world of the parents.

Show me three feet. Three feet means three feet. If I cannot touch you then you're too far away. Follow instructions right away. Serge, get up, the answer is?

SERGEI MORTON: Yeah.

RON FEDERICI: Yes sir, I will. Your Mom and Dad are in charge of everything, meaning that you have to ask for permission. Excuse me, may I go to the bathroom? Excuse me, may I have a drink of water? Excuse me, may I eat dinner? Excuse me, may I read a book? The answer is no unless your father says Serge, you can read a book with me. You cannot do anything alone. He cannot do anything alone because he likes to run away and if he runs to his room, take the doors off. Now you can be mad all you want, you can be mad, scream, fight, run away from home, you can do anything you want. It does not matter what you do because I know you will be unhappy.

NARRATOR: The next step is to take away Sergei's world and replace it with that of his parents. From now on they will be his life, they will even sleep here in his room. Everything else will be removed.

RON FEDERICI: OK, but this is Serge's room, right? OK, beautiful room. Lights, OK. Serge, bed is for what?

SERGEI MORTON: Sleeping.

RON: Only sleeping, only sleeping. Everything gets boxed up, taken, toys, everything off the wall and we just have bed, pillow, Mom's bed, sorry, Dad's bed. Very good, he likes to keep neat. Everything will be boxed up, OK. We don't mind if you fight, yell, scream, your choice.

INTERVIEWER: What worries you about the programme?

SERGEI MORTON: That I have to always stay by them.

CHARLIE MORTON: We're going to start the programme off bad today? Do you have any homework?

SERGEI MORTON: I do.

CHARLIE: Go get it.

SERGEI: No.

CHARLIE: You don't tell me no. Now go get your assignment. That's it, throw it, that's one demerit.

SERGEI: I'm not doing it with you Dad.

CHARLIE: You are doing it with me.

SERGEI: No I'm not.

CHARLIE: That's two demerits.

NARRATOR: Charlie is trying out the three feet rule. He must continually monitor and instruct Sergei on how to behave well. Controversially for a child treatment programme there is no school, no peer activities, no privacy. Three acts of disobedience and an extra day is added to the programme. 30 days becomes 31.

RON FEDERICI: What's more important, what you like or what you have to do?

SERGEI MORTON: What I have to do.

RON: So if they tell you Serge, come to dinner and sit down, what do you do?

SERGEI: I don't know.

RON: Listen the first time. Don't play I don't know. What's the rule? I'm sorry.

SERGEI: Yes.

RON: That's not an answer. Whole sentences always. You're going to sign your name to the bottom of all of these pages saying that you understand everything. Serge, you tell us. You know what they are. What are some of your other rude words?

NARRATOR: Dr Federici believes that Sergei barely has an identity and that a new one must be imposed.

RON FEDERICI: Serge had nothing. His slate was clean, he has no memories, he has a failure in his history, he has none. We have to create one.

Let me tell you what buddy, you're going to have so many demerits. You might be on level one until you're 18 years old.

Critics may say that to control a child's every movement in time and space is taking away his identity. Well we've established very clearly that he doesn't have an identity and he's an empty slate and what we are providing is not a control really per se, but a management and a structural modification of his day-to-day, hour-to-hour routine so he does not deviate and it may be dictated by the parents, but it has to be because left to his own devices he's random and confused. He needs to be dismantled and taken apart.

NARRATOR: Dr Federici's aim to dismantle Sergei, to disregard identity is the opposite approach to mainstream psychologists.

PROFESSOR PETER FONAGY (Psychoanalyst, University College, London): I've major worries about this notion of knocking things down in order to build them up. The normal approach to cheating behavioural disorder of this kind is to help the parents understand the child better. What is so vulnerable in these children is their sense of themselves, their sense of who they are. Now if you are systematically undermining that very fragile, that very vulnerable sense of who that child is you could end up in the situation where the child becomes really very much more depressed and hopeless and helpless. My concern about it is that you are destroying something in the child that is the child's own. However distorted and however maladaptive it is, it is the child's own.

RON FEDERICI: So many families believe that it may be inappropriate to take away a child's identity even if it's an inappropriate one, where they're acting out, but what's so important is to realise that this is a superficial posture that the most important thing is to bring them back into the adult world where adults become the strong role models and re-parent the child all over again, which is the starting point of a stronger and more solid attachment.

(ACTUALITY CHAT)

HAYLEY KEW: I, I want to make you well.

JULIE KEW: So what are you doing then?

NARRATOR: Desperate for a solution, the Kews have also turned to Dr Federici. He's aware of Hayley's autistic traits and believes they have inhibited her attachment to her parents. To put the parents in control Dr Federici believes Hayley must learn to obey every instruction. Her parents must no longer negotiate, but dictate to her. Even though Hayley can be loving, he believes that she uses this to manipulate and gain control and so with Hayley the three feet rule will serve to create a distance. Today at their first meeting he will teach the Kews how to do this.

HAYLEY KEW: I'm not going to go out and find a lorry.

RON FEDERICI: OK, so if we talk about breaking Hayley down, which she will not like, you have to maintain a boundary with Hayley and that you have to take a break on hugging her and letting her sit on your lap. Be a bit detached and watch the I love yous, the pleasantries, the honeys. She uses that to reinforce her bad behaviours. I'll be nice for Mom for a minute and then I'll do something terrible and then I'll say I'm sorry Mom and I'll sit on her lap again. OK, Dad, if you were to practise right now and say Hayley, you will sit on the couch now and if she does not you pick her up and sit her on the couch.

IAN KEW: I mean I'd tell her, but she wouldn't do it.

RON: I understand that (TALKING TOGETHER)

IAN: Hayley, you go and sit on the couch over there.

HAYLEY KEW: I don't really.

RON: See we have a problem. If you would do that now.

IAN: Hayley, go and sit on the couch.

HAYLEY: No, no, I want Mummy, (REPEATS THIS MANY TIMES)

RON: Just the way she should be. (TANTRUM) It's very painful for you to watch. (TANTRUM)

NARRATOR: Dr Federici believes a child will only learn to comply when it realises its parents are dominant. Controversially, Hayley is to be placed face down in a hold every time she disobeys. When she is calm she is to be comforted.

RON FEDERICI: Now we'll practise this and she won't like this. Hayley, you need to sit on the couch now. Now of course I expect her to bawl me out.

HAYLEY KEW: (INAUDIBLE REMARK)

RON: And Mom, we'll both take her to the couch.

IAN KEW: Are you going to come to the couch Hayley?

RON: No don't, Dad, we won't even, you have a question. Hayley, we're going to the couch. (HAYLEY KEW'S TANTRUM) OK Dad, since I won't grab her I'll let you grab her and Mom will help. Mom, no.

She will have to learn and Mom will have to have her hands on here, so Hayley has some control from both parents. She could not transition from sitting on your lap to a simple order of sit on the couch. Give her an order to sit up on the couch and she…

IAN: Hayley, sit up on the couch darling.

RON: No, no darling. Just sit up on the couch.

IAN: Hayley, sit up.

JULIE KEW: Hayley, sit up.

IAN: Sit up.

RON: Sit up on the couch. On the couch. Dad, move away from her. Mom move away. Please go back to your seats. Sit on the couch Hayley. We'll be back in one minute. Very good. That was called a sequence one hold. During this retraining phrase…

NARRATOR: Dr Federici believes that for his plan to work parents must gain instant and unquestioning obedience. Other psychologists do not think such obedience is even desirable.

JULIE KEW: …well we're both home quite a lot…

DR STEPHEN SCOTT (Consultant Child Psychologist, Maudsley Hospital, London): I can see the attraction for a very frustrated parent with a child who's being very aggressive, kicking and spitting, that you do indeed need to get control and certainly I would agree one needs to have firm boundaries, but not an arbitrary set of boundaries. So just to say I want to see, you to sit over there for no apparent reason and to have instant obedience to that, it's not something they usually do and the child can't see a reason for it.

RON FEDERICI: Did Hayley go sit on the couch? Say yes. Say yes.

HAYLEY KEW: Yes.

RON: Are you tired? Say I am tired.

HAYLEY: I'm tired.

RON: Yes you are tired. Very good girl, very good girl. You're tired.

NARRATOR: Dr Federici believes obedience is the first step to attachment.

IAN KEW: I've wasted time sitting there trying to explain to her what to do and now it's precise, direct action. The whole programme's going to be hard for her, not just anything particular. It's the whole thing. She's not going to know what's hit her.

NARRATOR: A sequence one hold will be used with Sergei, as with Hayley, to put the parents in control.

RON FEDERICI: I just want to show you something. There's no problem now because you're not fighting or being angry, so I'm showing and I'm not going to hurt you. We would never, ever, ever hurt you. Never. But you can never hurt us because the most important thing is to go down. You can go down, go down.

SERGEI MORTON: I have to?

RON: Yes. Down. (OK) Down, down, lay down. You do anything violent, Mom and Dad will take you down to get you in control. There will never be fights. If he tries he goes down. He goes down for hitting, kicking, spitting, cussing in your face, screaming, breaking property, slamming doors. Where he's out of control he must go down immediately. Now how do you feel Serge? Do you like this? Not bad huh.

SERGEI MOTON: No.

RON: No, OK.

SERGEI: Can you get off me now?

RON: No.

SERGEI: Guys.

RON: There's not being hurt.

SERGEI: No my toe is twisted. It still hurts (MUMBLES)

RON: He may choose to make up all kinds of stories.

SERGEI: It's not, I'm not making it up.

RON: He's very angry.

SERGEI: I'm not making it up.

RON: I don't, just, just…(TALKING TOGETHER) I'm just going to let him sit there 'cos I'm talking to him and he needs to be calm for a bit.

I think emotionally this was a very heart-wrenching and quite intense day. Once he was down I think he felt, it was the first time I'd seen the boy cry at that level. The parents said they'd never seen him cry those type of tears. He didn't complain of being hurt aside from some ridiculous statement that his toe was hurt and there was no pressure, there was no force, there was nothing dangerous. I think he felt safe for the first time and also that his parents cared enough for him to be on top and in charge of him because he's not in charge of himself.

Mom, you can let one arm…

NARRATOR: Most psychologists only accept the use of restraint in the most extreme circumstances. They would not accept that a child would find a hold reassuring.

RON FEDERICI: ...and Serge, don't move.

PETER FONAGY: I think there's a real danger in assuming that we know what's going on in the child's mind. How do we know that that child is going to interpret two parents trying to restrain him physically as an act of affection?

RON FEDERICI: You understand that this is practice, but you know it's for real under…

PETER FONAGY: It's presumptuous of us to assume that just because it involves that close physical contact it will undoubtedly be interpreted as something that's positive.

RON FEDERICI: Very good.

They are looking for someone to stop them. Properly trained, a parent who is able to restrain or use a sequence one hold, the child eventually feels safe and secure in the parents arms as opposed to being out of control where they know they are hurting people.

NARRATOR: The Kews are two weeks into the programme. Both parents have taken time off work. Hayley's room has been stripped.

JULIE KEW: Let me show you first. Let go.

NARRATOR: She's been taken out of school. Her world is her parents and they must be emotionally distant.

JULIE KEW: We have to try and be aloof from her which I'm finding very difficult. We've always talked to her a lot, we've always kissed and cuddled and it's been a natural thing and it's very unnatural that we have to, to say stop, that is not behaviour that we want. That is, that is extremely difficult 'cos you want to sort of like reassure her and, and kiss and, and cuddle her.

HAYLEY KEW: That's a little mouse.

IAN KEW: No, quiet, quiet, stand up properly.

NARRATOR: Because the treatment aims to replace Hayley's world with that of her parents she must stand quietly by their side at all times, no matter what they are doing.

JULIE KEW: She has no toys, she, she doesn't see any friends, she does no activities. We have to control her singing and her talking because when she does these things she's actually in her own world where she has to be in our world and she finds that very difficult.

HAYLEY KEW (INAUDIBLE REMARK)

IAN KEW: Let go.

HAYLEY: I want it, I want it, I want it.

NARRATOR: When Hayley disobeys her parents are instructed to put her in a sequence one hold. This is happening several times a day.

(HAYLEY KEW'S TANTRUM)

IAN KEW: She always plays either me or Julie off against each other. If I'm holding her she'll scream for her mother and you know that hits you at the back of the throat. (TANTRUM) I mean you know you're taught to love your child, hold your child, kiss her, cuddle her, give her all the support possible and this totally throws that out the window. (TANTRUM)

JULIE KEW: Some of the things that we have to do, you know it's like will we have a different Hayley at the end of the day. It, it's, it's like you're, you're, you're chipping away at something and taking things away from her and telling how to do things. Are we destroying her? I want a better behaved Hayley, I don't want a different Hayley.

IAN KEW: Are you going to sit up and give me the book?

STEPHEN SCOTT: My worry about such a severe approach is that it is actually at risk of being quite punitive, of frightening the child and of just repressing their behaviour so that they learn if they don't immediately jump to their parents' command, they have a rather terrible thing happen. They get pinned down to the ground, their parents come and sit on them, so the kind of child this is bringing about is one who is instantaneously obedient, who doesn't start thinking for themselves and doesn't start adapting to their environment.

(HAYLEY KEW'S TANTRUM)

IAN KEW: I mean the emotional bit bites you, especially if I'm actually standing out of the room watching Julie do it 'cos if Julie is controlling herself and she doesn't need my assistance I won't come in, but if Hayley is really starting to kick around and fight then I come in and give Julie a hand.

(TANTRUM)

HAYLEY KEW: When can I get up Daddy?

IAN KEW: When you're calm and five minutes.

HAYLEY: But I am.

IAN: No you're not. You stay quiet. Yes.

HAYLEY: (INAUDIBLE REMARK)

IAN: Look at me.

NARRATOR: Dr Federici believes the child needs to feel its parents physically in control to feel secure.

IAN KEW: It has proved putting her into that position is very therapeutic. She does relax in that position and after she has relaxed and gone calm the child is a totally different child.

NARRATOR: Julie's experience with Hayley is very different from Ian's.

JULIE KEW: After she's been down on the floor and she's calm I'm asking her to get up and talk to me and she's, she's obviously still not calm because she won't look at me and she's, she's still not complying. (HAYLEY KEW'S TANTRUM) She just is, is making a farce of it with me, so I have to be more strict with her. I have to do it with her more and she has to learn to comply with me, as well as with Ian.

INTERVIEWER: Does it upset you that she won't respond?

JULIE: I feel as though I'm failing, that I'm not doing it properly, that I'm not, you know I'm not as strong as what he is and she knows my weaknesses. So… I'm going to have to be stronger with her and let not, not let her walk over me which she's doing, all the time.

SERGEI MORTON: (ANGRY REMARK)

CHARLIE MORTON: No, no, no, no, right here. Sergei, you're going to do it at the table. Put the pencil down, put the paper down.

SERGEI: It is down.

CHARLIE: That voice will get you a stage one hold on the floor.

NARRATOR: Dr Federici is still at the Mortons. Today he will teach them a new technique, a sequence two hold. This requires Sergei to sit on his parents lap to learn about closeness and attachment. Sergei will find it hard as he has not let his mother embrace him for over a year.

RON FEDERICI: Eyes, only eyes, only eyes. Stand up.

NARRATOR: Dr Federici believes Sergei can be taught how to feel and understand emotion by looking at his parents facial expressions and feeling their embrace.

RON FEDERICI: Is he looking at you Mom, or looking around you?

GLORIA MORTON: He's looking at me.

RON: OK, good. This is a lot better for him than being on his own. This, this is much more positive than fighting with you. Is he still looking?

GLORIA: Yes he's wandering a little.

RON FEDERICI: What they're learning basically is a new language called emotions. They may have learned English, they may have learned another language, but the new language of emotion is one of the ones that's the most important they will learn by practice.

I'm very proud of you when you do that.

Whether it's called brain-washing or re-programming or practising or rehearsal, which I tend to prefer, is very appropriate for a child like Sergei who has, literally, a blank slate when it comes to human emotions and feelings. He's been devoid of many of these feelings and expressions for so long he has no clue on how to do those, unless it's taught and practised and rehearsed.

NARRATOR: Dr Federici believes that Sergei must be trained to understand emotions. Critics believe this is not possible.

STEPHEN SCOTT: They're not rewriteable like some computer disc. Nearly all children who are behaving anti-socially do have a full range of emotion, they do understand happiness and sadness, so the notion that they're all scrabbled up inside you've got to cut through all that I think is a mistaken one. I think it's about reshaping and re-directing their emotions.

NARRATOR: Dr Federici would disagree. He has now left the Mortons and the treatment is in their hands.

GLORIA MORTON: I was surprised at the look of fear on his face when he sat on our lap, that he didn't know what we were going to do and then just to sit there. I hope he becomes more and more comfortable.

CHARLIE MORTON: I don't think it's going to be easy, but it's step by step. I mean he's even reverted already. He's telling us what to do and, and the doctor hasn't been gone two hours, so we can expect that.

NARRATOR: The Kews are six weeks into the treatment. Hayley's non-compliance has added another three weeks to level one. Nevertheless, her parents now feel she is showing an improvement.

(ACTUALITY CHAT)

JULIE KEW: I think, I think genuinely she has improved. She's doing as she's asked and very happy doing what she's been asked to do as well. (ACTUALITY CHAT) I've backed off from her a lot. I'm not her toy and I don't want to go back to being her toy where she could just pull me around and, and generally do what she wanted.

HAYLEY KEW: (INAUDIBLE REMARK)

JULIE KEW: No fingers.

NARRATOR: Sergei is two weeks into level one and still staying within his parents' reach. The aim is that he should no longer miss all that has been taken away, as every minute of his day is occupied with his parents. He should come to feel secure with them and ultimately attach.

SERGEI MORTON: So where is a man?

GLORIA MORTON: Serge, you don't have permission to talk to me.

SERGEI: Oh.

GLORIA: Cut that streak.

SERGEI: What is? (INAUDIBLE) the ground and it slipped.

GLORIA: (INAUDIBLE REMARK)

NARRATOR: Gloria decides to attempt a sequence two hold.

GLORIA MORTON: (INAUDIBLE REMARK) Turn around.

SERGEI MORTON: No.

GLORIA: Yeah, you're doing it.

SERGEI: No.

GLORIA: Turn around. (TALKING TOGETHER)

SERGEI: …you're doing this to me.

GLORIA: I'm just having you turn around.

SERGEI: Mom, your nails.

GLORIA: Put the (INAUDIBLE) down. On the table. That's the floor isn't it? Is that the floor? What is it?

SERGEI: (ANGRY REMARK)

GLORIA: Come here, turn around.

PETER FONAGY: If you are imposing proximity in the hope that you will impose attachment then you will quickly realise that that's a paradox. Attachment is perhaps one of the only things in life that one cannot impose. It's a sense of being understood. If you are forced to sit in somebody's lap, that's perhaps the last thing that will make you feel loved by that person. I mean that was the last thing that you wanted. If that person tells you look, the last thing you want to do at the moment is sit on my lap isn't it, then you actually feel understood. Yes Mum, it is the last thing.

GLORIA MORTON: I can put my arm on your arm. Right, I will put my hand on your arm.

SERGEI MORTON: (INAUDIBLE REMARK)

GLORIA: No.

SERGEI: (INAUDIBLE REMARK)

GLORIA MORTON (ON PHONE): One time he was getting pushy with me. Charlie was out of town so I didn't want to do level one. There was just too much adrenalin with it, so I, I did a level one hold. That seemed to calm him down some. He was still upset and you know elbowing me I guess.

RON FEDERICI (ON PHONE): Yeah, now Gloria you know we, we discussed that and that's certainly OK because we know Sergei has been violent and aggressive but also too he is quite irritable and that may be his way of trying to let you know that he is in need of more contact or connection.

NARRATOR: After ten weeks of the treatment the Kews are optimistic and have travelled to Washington for a thorough assessment of Hayley. This will expose her to a very different world from her stripped down room. By now she should be starting level two where she will be gradually reintroduced to normal life. The challenge is that even with all the extra stimuli she should still obey every one of her parents' orders, no matter what. It will be a test for Hayley.

RON FEDERICI: Well Hayley, have you had a lot of fun being here?

HAYLEY KEW: Yeah.

RON: You have? I heard from your Mommy and Daddy that you've learnt to listen very well. Is that true? So if they tell you something to do, like sit over there with your, like we practised, our hands in our laps and not in a rut, could you do that? (Yeah) Yeah.

HAYLEY: Yeah, I'm doing it.

RON: OK, but if your Dad says Hayley, I want you to sit over here just to tell you to do something different, sit over there right now, will you do that for him? We'd like you to do it rightaway like you're told, or Daddy has to do it for you. Which one is it?

(ACTUALITY CHAT)

IAN KEW: No stop it, stop it. Sit down. Right, want a hold position? Do you want to go in the hold?

RON: OK, Daddy will go back over to his side (Right) and Hayley, you'll stay back.

IAN: You stay there OK. OK.

RON: She has to practise doing some things even if you just tell her to do 'em for no specific reason. It's been one of her problems. We see that abrupt changes for her are difficult, but if we practise with her ahead of time and I think even if we did some things like and if I said I know Hayley, and if I hold Hayley then I'll pick her up and if Hayley, if you look at me we're almost ready to… (HAYLEY STARTS TO CRY) Ah, you can cry. OK, OK, but I, if I hold you, you can cry or when are you ready to go to your Mom. (TANTRUM) Daddy can help me.

IAN: Daddy's got you in the hold. Daddy's got you in the hold.

RON: It's your choice. You can yell and be in a hold or calm down and get out. You put yourself there Hayley when you scream like that.

NARRATOR: Despite Hayley failing to follow the instruction, the Kews and Dr Federici are pleased with Hayley's general progress.

RON FEDERICI: In the ten weeks that Hayley has been on level one, now moving to level two, she certainly has some issues of impulsivity and out of control but they are far less. The parents report almost an 80% reduction in the frequency which is tremendous for ten weeks and they are ready to move on to level two. The most important thing is to start challenging Hayley to move forward and take gradually more responsibility for her behaviours and make some choices that, where on level 1 we took charge of everything and she was in control based on our supervision at all times. Now we let her break away a little bit, so we are giving her many tests.

NARRATOR: After four weeks Sergei is struggling on level one, but his parents believe they see some changes in his behaviour.

GLORIA MORTON: I think our ideal would be for Sergei to blend in with the rest of the children and, and not stick out like a sore thumb. I don't know as he's going to blend in 100%, but I'd settle for 50. I think we've, we've come about ten. I, I don't feel the, the threat to myself that I felt before. He would get very aggressive with me, pushing or hitting or shoving and I, I don't feel that way now.

NARRATOR: Critics say that any dramatic intervention can improve behaviour in the short-term. The question is whether the changes are genuine and will last.

STEPHEN SCOTT: My concern of a total adherence programme of the kind of Dr Federici's is that the child may behave that way while they're in the context with the parents, but phew, the minute their parents back at home then they're going to resort to their old behaviour. They haven't really internalised a better way of behaving and being.

GLORIA MORTON: Sergei's counting the days till he gets back to school and I'm, I'm asking him well are you, are you going to be changed or are you just going through the, the steps that you know that will get you back to school. Oh I'm changing Mom.

INTERVIEWER: Are you looking forward to finishing the programme?

SERGEI MORTON: Oh yeah.

INTERVIEWER: And, and what are you most looking forward to getting back to do?

SERGEI: Watching TV, computer, getting messed up back.

CHARLIE MORTON: I can't hear any can I go or go…

SERGEI MORTON: Can I go please…

CHARLIE: There was just you were leaving.

SERGEI: …sir.

CHARLIE: Sure.

SERGEI: Thank goodness.

NARRATOR: After four months Hayley has started back at school away from her parents watch. If level one has been effective she should be able to control her behaviour outside the home. It's a big test for Dr Federici's treatment.

JULIE KEW: Since she's been back at school we still get the reports back that she's hit somebody, she's pushed somebody and that she's bitten a child. I thought that maybe that she'd learnt that obviously she hasn't, we've gone back a bit, I must admit. The first day Ian was away was horrendous and I think we've, we've had quite a few hold positions and I think when Ian comes home we're going to have to do the three feet away again, so it's always, you know it's, it's like two steps forward, one back all the time.

NARRATOR: Dr Federici says that setbacks don't matter. If a child fails it must start again. He would not see the treatment as failing, rather that they need more of it.

RON FEDERICI: Failures happen all the time. People go back to level one all the time if they violate the major rules which are resurgence of aggression, violence, lying, cheating and manipulation, because that gives the parents the message that the child needs even more time with them to help break down further barriers which have been left untouched because that means the child still has some deeper layers of problems.

NARRATOR: The ultimate effect of the treatment on Sergei and Hayley cannot yet be known. Hayley's parents are pleased that they have a way of controlling Hayley at home, although outside is still a problem. After three months Sergei's parents report that he seems to have deteriorated and that his behaviour is almost as bad as before. they are continuing with the treatment. However, what concerns critics is that there have been no control trials to measure independently the effect of the treatment.

PETER FONAGY: Because it's such an unusual intervention I would really want to know in a properly conducted randomised control trial that the treatment is (a) safe and (b) effective in the long run. You see it seems to me that the treatment is actually based on a misconceived metaphor. There's no way that you can take a child back. You can't wind it back like you'd wind a tape back and replay it. What you need to do, maybe somewhat less dramatic, maybe somewhat less eye-catching, but something that helps build up the relationship between parent and child, but with half the possibility of really undermining that child's future.

NARRATOR: Dr Federici eventually plans to have control trials. Meanwhile he continues to gain a wider following of parents desperate for help and believes he can treat successfully even the most difficult cases.

RON FEDERICI: Even in the most difficult of situations where the child has been written off as being totally unattached and irrecuperable I believe very strongly that any child, even that level of damage, by hard work and very unorthodox and aggressive and innovative techniques will often bring that damaged child to an 80% solution with the family.

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