Crying It Out- Misuse of Medical Studies.

marina

Sun, Jan 24 2010, 3:37 pm

There is a controversial article being discussed in another forum. Those posters would like for their thread to remain free of criticism, which is why I am posting here.

This article is a good example of how well-meaning people can misuse statistics for their own purposes.

I wil go through some of the ways this article invents conclusions to suit the author's purpose.

Quote:

1. The argument goes that if you leave an infant long enough to cry for you and don't meet his needs, he'll eventually "learn to self soothe." This is code for "give up expecting you to care." What a tough lesson to learn about your parents at a few months old!

This is a conclusion that the author made up. Children do not give up expecting the parent to care just because they learn to self-soothe. If they did, they would not cry at any other time, like during the day.

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2. Infant distress interferes with brain development

Eh, okay. I can't access whatever studies this refers to. But let's say that distress does interfere with brain development. So what? Should we now NEVER let our children cry? Should we give in to their every immediate desire? My kid cries when she doesn't get a lolly. Should I rush to provide her with everything she immediately wants? What does growing up bratty and spoiled do to brain development? What does having a self-indulgent, dependent child do to the parent's brain development? How can we teach our children to handle stress effectively if they cannot be exposed to it?

Quote:

3. Babies cry to express needs and if we fail to respond to them, we don't meet their needs. A baby may cry because she has an ear infection, is hungry, is in pain from teething, is feeling lonely or is scared. When nobody comes to feed her, comfort her, reassure her or otherwise meet her needs she may give up crying but she is still hungry, sad, afraid or in pain. The only thing that is "better" is that parents get to sleep through it.

Again, what exactly is the right age to teach a child to self-soothe? To deal with her own sadness or fears or needing to be held? If I am a child over six months of age, why should I ever bother to learn to cope with my negative feelings, if those feelings are immediately taken care of?

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4. The fundamental message of CIO is that the parent's needs and wants are more important than the baby's.

Well, yes. The parents' needs are in fact more important than the baby's. That's why we are the parents. That is why children do not have the same rights and privileges and responsibilities as adults do. That's why the baby doesn't get to choose when to learn to drive a car or when the parent should go shopping for a new washer and dryer.

Quote:

5. Researchers found that during CIO, young children went through four predictable phases. The first phase, labeled “protest”, consisted of loud crying and extreme restlessness. The second phase, labeled “despair”, consisted of monotonous crying, inactivity, and steady withdrawal. The third phase, labeled “detachment”, consisted of a renewed interest in surroundings, albeit a remote, distant kind of interest. They concluded that while leaving babies to cry it out can lead to the eventual dissipation of those cries, it occurred due to the gradual development of apathy in the child. (J. Bowlby, "The Nature of the Child's Tie to His Mother," International Journal of Psycho-Analysis 39 (1958): 350-373.)

This doesn't even deserve a response, really. You are quoting a psychoanalytical article from 1958. Read up on what 1950s psychoanalysts think little boys want to do with their mommies and get back to me. Read up on what they think causes autism. Psychoanalysis has been almost fully discredited.

6.

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Researchers found that babies who had been raised with CIO methods were ten times more likely to have ADHD later in childhood. (Wolke, D, et al, Persistent Infant Crying and Hyperactivity Problems in Middle Childhood, Pediatrics, 2002; 109:1054-1060.)

So wrong. So wrong to take a scientific study and completely misrepresent it. Here is the study.. It says nothing about crying it out or being raised with it. Instead, the study is about children who persistently cry during the day for more than 3 hours per day for 3 weeks in the first 3 months of life. This has nothing to do with crying it out methods which last a week at most and are not used on children younger than 6 months. So yes, kids who do a lot of crying when they are babies may actually have some underlying condition that translates into ADHD or whatever. I don't know how accurate that is, but such a conclusion has nothing to do with crying it out.

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7. Crying it out desensitizes parents to their babies. Babies' cries are designed to be hard to listen to on purpose, so that parents will come to them and meet their needs. When parents have to listen to screams from the next room repeatedly and do nothing about them, they generally have to turn off their natural empathetic response and try to numb themselves to the sounds of their children in distress. There isn't an easy on/off button to rebuild the natural connection during daytime or more convenient times.

Right. So because I don't come running every time my toddler decides she has a scratch that needs my immediate attention, that means I have damaged our natural connection? Give me a break.

Quote:

8. One study found that babies who had been left to cry excessively (who did not have colic) later scored an average of 9 points lower on IQ tests and had fine motor delays. (M R Rao, et al; Long Term Cognitive Development in Children with Prolonged Crying, National Institutes of Health, Archives of Disease in Childhood 2004; 89:989-992.)

Another example of how wrong it is to take medical studies and twist the conclusions. The study is here..
The study is primarily about colicky infants. There are 15 children included who are persistent criers- that means daily uncontrolled crying without any obvious reason for more than 2 weeks. So after 5 years, the researchers give the kids an IQ test and find that among other things, that those 15 scored lower by nine points. Nothing about crying it out- nothing about "being left to cry excessively"- in fact those persistent criers could have been held all day by mom and still be included in their study. So again, the fact that these children cry so much may just be an indicator of an already existing problem that later manifests as a lower IQ. Which is what the researchers concluded anyway- that excessive crying can be an indicator of an underlying problem. Although making ANY conclusions about a 5 year old's IQ from a WPPSI is ludicrous to begin with- a child's IQ is completely unstable at that age.

Basically, I am appalled that someone would take scientific studies and twist them that way. I hope this is an abberation and doesn't represent general data-based decision making processes in the natural parenting community in general.

ora_43

Sun, Jan 24 2010, 3:44 pm

marina.

I don't use "cry it out," for reasons that are irrelevant here. But misquoting studies bothers me even if I mostly agree with the point the studies are brought to support.

Ruchel

Sun, Jan 24 2010, 3:45 pm

sarahd

Sun, Jan 24 2010, 3:55 pm

The ends justify the means, naturally.

soulful music

Sun, Jan 24 2010, 4:12 pm

ora_43 wrote:

marina.

I don't use "cry it out," for reasons that are irrelevant here. But misquoting studies bothers me even if I mostly agree with the point the studies are brought to support.

What she said!

Israeli Mother

Mon, Jan 25 2010, 10:21 am

marina wrote:

This article is a good example of how well-meaning people can misuse statistics for their own purposes. ...
Basically, I am appalled that someone would take scientific studies and twist them that way. I hope this is an abberation and doesn't represent general data-based decision making processes in the natural parenting community in general.

I have found this to be a common problem. I just answered an email from someone today who was advocating idiotic and dangerous behavior to expectant mothers using both twisted studies and just plain wrong information. I don't think that I would say that this represents the "natural parenting community" though davka; I think that there are ignorant people in every group and of every opinion.

Generally it is only those people who are uneducated, inexperienced, and or ignorant of whatever the subject is that fall for these articles. In the case of leaving children to cry it out, it is generally only people who have just had their first child that are reading them.

Like anything else, the middle road is the more secheldik one. Sometimes you have to go to your child and sometimes you can let them cry it out.

I do wish though that more people were taught critical thinking skills and basic science in school. Or who knows, maybe they were and it just didn't sink in... Study

gryp

Mon, Jan 25 2010, 10:31 am

I didn't read the study the first time (I commented on the parts of the article I agreed with because I know it from experience), but now that I'm reading it I can see why there may be confusion about it. It seems to me that it flips back and forth between "uncontrolled crying" (which is not Ferberizing) and "prolonged, excessive crying."

Secondly, please don't stoop to a level of low intelligence and pretend this has anything to do with natural parenting. I can show you plenty of studies on the other side which don't make much sense either but are regarded as the Ten Commandments of the AMA. We all should be smarter than that.

BeershevaBubby

Mon, Jan 25 2010, 10:39 am

marina wrote:

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Unless I'm missing something here, they're missing a phase...

marina

Mon, Jan 25 2010, 7:22 pm

Quote:

Secondly, please don't stoop to a level of low intelligence and pretend this has anything to do with natural parenting

I specifically said that I hoped this had nothing to do with general levels of scholarship in the natural parenting community.

Quote:

The articles say nothing about night time sleep or sleep training methods. The babies in the studies cry DURING THE DAY when it is not naptime or bed time. The kids in the study could be crying while they are being held or attended to. In contrast, CIO is specifically a sleep training method. Parents who use cio do not let their kids just cry during the day for hours on end.

Last edited by marina on Mon, Jan 25 2010, 7:58 pm; edited 1 time in total

BusyBeeMommy

Mon, Jan 25 2010, 7:44 pm

Wow Marina, you are good! This article is so slanted, it is sick!

BTW, to add my own two cents to #4, it is so not that parent's need and wants are more important than the child's. I do the CIO method after my babies are 6 months old because if I get some sleep I will be a better mommy to the baby and to the rest of my children. Maybe we should never get babysitters because it is selfish to spend time out with your husband alone and let your kids cry with a babysitter because they prefer you. Your needs should never come before your children's!

Also, to further enlighten those opposed to the CIO method (I don't care to convince others, I just care to make them aware), before you put a child to bed, you make sure they are diapered, fed and healthy. You do not do it otherwise. And ultimately a child may end up crying less if they can self-soothe. My SIL's kid is 2 1/2 and still cannot sleep through the night because his mommy comes running to him if he wants a bottle in middle of the night. He wakes up at least twice, CRYING, in middle of the night until his "needs" are tended to.

marina

Mon, Jan 25 2010, 7:55 pm

Thanks busy bee!
I just want to emphasize here, like you said, that cio is not used at all for children under 6 months old b/c they generally don't have the memory skills to remember that crying won't work and what they used last time to self soothe. If a child doesn't have the memory and cognitive skills needed, behavioral training usually won't work.

Maya

Mon, Jan 25 2010, 8:04 pm

Excellent points, marina.

WriterMom

Mon, Jan 25 2010, 8:20 pm

GR wrote:

Secondly, please don't stoop to a level of low intelligence and pretend this has anything to do with natural parenting. I can show you plenty of studies on the other side which don't make much sense either but are regarded as the Ten Commandments of the AMA. We all should be smarter than that.

Yeah, that.

Now, if only science could tell us how to raise people who are secure enough not to need to attack strangers online for their parenting practices. LOL

gryp

Mon, Jan 25 2010, 8:38 pm

marina wrote:

Quote:

Secondly, please don't stoop to a level of low intelligence and pretend this has anything to do with natural parenting

I specifically said that I hoped this had nothing to do with general levels of scholarship in the natural parenting community.

Quote:

I agree with you about the article being misused (I don't agree with the rest of what you wrote, but that's besides the point). My point was that the article itself can be a bit confusing.

I've heard lots of stories about parents who do let their kids cry for hours on end because instead of learning the exact method Ferber actually suggests, they only know the "let the baby cry" part.

marina

Mon, Jan 25 2010, 8:51 pm

WriterMom wrote:

GR wrote:

Yeah, that.

Now, if only science could tell us how to raise people who are secure enough not to need to attack strangers online for their parenting practices. LOL

Was this directed at me? I am attacking the authors of the article for their shoddy scholarship here and no one else. Perhaps I misunderstand your ambiguous comment, yet again.

marina

Mon, Jan 25 2010, 8:55 pm

sorry GR, I misunderstood which article you were referring to, I thought you meant the studies.

Anyway, ferber is one cio method, there are other more cold turkey ones which do involve baby crying for one or two nights for hours. But one or two nights of that followed by peace is better than 6 months of patting on the back and trying to sneak out and having her start crying all over as soon as the floorboards creak. We did that with my 1st - I was exhausted OMG, I could not keep my eyes open.

gryp

Mon, Jan 25 2010, 9:30 pm

I understand that different strokes for different folks. All parents and babies have different temperaments, and whatever works- works, as long as it's not abuse.

I did mean the studies, sorry I was distracted as I was posting.

imasinger

Mon, Jan 25 2010, 9:48 pm

Nicely summarized, Marina. You might be interested in seeing what another rational parent had to say in further investigating, here

ETA: Here's the text; I doubt the links will work here, though. I messed up which thing I copied and pasted at first, sorry.

Cry it out method not as harmful to babies as critics claim

By Chad Skelton 30 Jun 2009 COMMENTS(16) Parenting: Curious Dad

Filed under: health, sleep, cry it out

Crying babyOver the past couple of weeks, I've read a number of Twitter and blog posts (like this one) claiming that the "cry it out" (or Ferber) method of getting babies to go to sleep can cause long-lasting harm to a child's development.

Given that my wife and I have ocassionally let The Boy cry it out, I thought I should do some digging and determine whether the method -- widely recommended by experts and doctors (including ours) -- is actually bad for our kid.

There are a lot of angles to explore here and I expect I'll write a number of posts on the issue in the coming weeks.

But just a few days into my research I've discovered something that I thought warranted immediate comment: it's clear that at least some of the research cry-it-out opponents rely on doesn't say what they claim it does.

One of the most prominent opponents of the cry-it-out method is pediatrician Dr. William Sears.

And one of the most cited pieces of evidence linked to by cry-it-out opponents and bloggers is an article by Sears titled Science Says: Excessive Crying Could Be Harmful to Babies.

And, indeed, the paper includes a lot of information that would give anyone thinking of trying the cry-it-out method pause. The article begins:

Science tells us that when babies cry alone and unattended, they experience panic and anxiety. Their bodies and brains are flooded with adrenaline and cortisol stress hormones. ... Is it therefore possible that infants who endure many nights or weeks of crying-it-out alone are actually suffering harmful neurologic effects that may have permanent implications on the development of sections of their brain? Here is how science answers this alarming question.

Sears then lists a number of points about the dangers of crying-it-out, two of the most troubling of which are:

One study showed infants who experienced persistent crying episodes were 10 times more likely to have ADHD as a child, along with poor school performance and antisocial behavior. The researchers concluded these findings may be due to the lack of responsive attitude of the parents toward their babies. 14
...
Researchers at Pennsylvania State and Arizona State Universities found that infants with excessive crying during the early months showed more difficulty controlling their emotions and became even fussier when parents tried to console them at 10 months.15

On the face of it, these two studies are terrifying: they suggest that letting your baby cry it out could make them dumb, emotionally fragile, hyperactive and antisocial.

Curious, I tracked down the two studies to see if I could learn more (the numbers beside each statement corresponded to two specific studies included in Sears' footnotes).

To my surprise, neither study (which you can read for yourself here and here) appeared to have anything at all to do with the cry-it-out method.

In fact, rather than looking at whether leaving children alone to cry (for whatever reason) caused problems later in life, both studies instead examined whether persistent crying in infancy was a symptom of underlying problems, like hyperactivity, that could crop up later.

Indeed, the Penn State study even made a point of noting that how responsive a mother was to her chid's cries didn't appear to make a difference, since "the infant who cries excessively in early infancy will be likely inconsolable."

I was so surprised that cry-it-out opponents would use such studies to prop up their arguments that I half-wondered if I might be missing something. Maybe there was some aspect to the study that I didn't fully appreciate.

So I emailed the authors of both studies, mentioned that their research had been quoted in connection with the cry-it-out debate, and asked a simple question:

In your view, does your study say anything about the wisdom of parents using the cry-it-out method to get their children to sleep? If so, what?

Professor Cynthia Stifter, lead author of the Penn State study, responded as follows (my emphasis added):

You are correct, there is nothing in the paper to suggest either 'crying it out' is an effective or ineffective method for getting children to sleep. We did not look at the sleep of excessive criers. Our study suggests that children who cry a lot in the first 3 months (often called colic) may not develop emotion regulation strategies as early as those who do not cry a lot.

And the response from Professor Dieter Wolke, author of the ADHD study, was similar (again, my emphasis added):

Our 2002 study showed that infants continuing to cry persistently beyond the usual colic period (I.e. beyond the first 3 months) are at higher risk to develop ADHD by middle childhood. It does not say anything about the “cry it out” method! The article refers to children who are excessive criers (no parent sleeping intervention etc.) beyond the colic period.

Indeed, Wolke, completely unprompted by me, went on to say that he thought the cry-it-out-method -- also known as "extinction" -- could be an effective strategy for children 7 months or older (those younger, he said, are too young to sleep through the night):

Extinction is a powerful learning method. However, in clinical practice, most parents find it very difficult to apply as they are very distressed by their baby’s crying. Thus, a staged process of “crying it out”, the checking method has been developed that is much more acceptable for many parents (I.e. check after 10 mins when baby is crying – but no reinforcement, I.e. no touching or picking up; next time after 15 mins checking, next time 20 mins etc.)

In fairness, I haven't had time to closely read all the other studies cited in Dr. Sears' article (there are 19 in all), though one I glanced at about stress in early childhood appears to be primarily about the effects of child abuse.

But I find the fact the first two studies I looked at were not as advertised deeply troubling.

And it will make me take any other "proof" I'm given about cry-it-out's harms with a healthy dose of skepticism.

(While she might well disagree with every word in this post, I would be remiss if I didn't thank cry-it-out opponent Annie over at PhD in Parenting for providing me links to several useful articles and studies on the cry it out debate. I'll likely be referring to some more of what she sent me in future posts on this topic.)

This is one of a series of blog posts on the cry-it-out method. Other posts in this series surveyed research showing how letting your child cry doesn't do long-lasting harm, addressed whether it's cruel to let your baby cry themselves to sleep and looked at research showing men and women hear a baby's cries differently.

If you enjoyed this blog post, you can subscribe to Curious Dad to automatically get more like it, or check out the latest posts from Curious Dad.

Last edited by imasinger on Mon, Jan 25 2010, 9:55 pm; edited 2 times in total

Tova

Mon, Jan 25 2010, 9:51 pm

ora_43 wrote:

marina.

I don't use "cry it out," for reasons that are irrelevant here. But misquoting studies bothers me even if I mostly agree with the point the studies are brought to support.

You said it well!

marina

Tue, Jan 26 2010, 1:00 pm

thank you imasinger- it was interesting to read the authors of the studies themselves on the cio issue.