#171 - Denmark is NOT going to ban cry-it-out
The above image has been circling around social media networks for months now. But is it true? Well, yes - it has been circling around social media circles - and causing many people to ask is it true?
So here we are - once again - where a multi-step statement has caused controversy in the infant sleep world.
If you missed a previous one - I spoke to it here - where a subgroup of the population claimed that sleep training infants causes the stress hormone (cortisol) to increase, and subsequently the infant becomes detached from its parents and experiences heightened emotions and disruptive behaviours.
So the current blog is going to test the different steps conatined in the above piece of propaganda, starting with …
Denmark is going to stop cry-it-out …
The world’s awareness of Denmark rose at the beginning of the Orange Idiot 2.0 when claims were made about the US taking over one of its Kingdom’s territories - Greenland.
The Danes responded sensibly to this idiocy.
And thus when it comes to the Danes banning an evidence-based technique for infant sleep problems, you should expect them to also be sensible about such an idiotic claim.
Let’s explore this.
First, the Danes' Ministry of Social Affairs and Housing would either have to lead the introduction of new legislation to ban the cry-it-out (CIO) method - or make amendments to their current child protection laws (Barnets Lov).
If you were ‘aiming’ to ban CIO, the quickest path would be to make an amendment to Barnets Lov.
In making an amendment, the Ministry of Social Affairs and Housing would likely undertake both expert and public consultations. And because CIO is controversial, it is likely these consultations would need to be extensive - that is, they would need to review and hear opinions across the spectrum - and likely review the evidence.
Before doing so, some questions would need to be asked. These include:
What is CIO (and what isn’t CIO)? - well, this one’s easy, based on the assumption that the Ministry obtains the definition of CIO from the scientific literature (and not Instagram).
How many minutes of crying would be deemed as causing harm? This ain’t easy. What is the maximum duration (in minutes) of unattended crying for CIO (aka, extinction)? They’d have to be careful here, because what if that maximum occurs during sleep training (graduated extinction) or worse still, if a child cries for this amount of time during the day. Even in public! This leads to …
How do you prove CIO or the max duration of crying occurred? Will neighbours begin recording the sounds of infants crying through neighbouring walls? The legal and social pros and cons of such neighbourly behaviour has already been explored in Denmark, if you’ve seen the documentary A Friend, A Murderer. How do you know if the parent is there or not? Or whether the child is sick and upset?
OK, so rather than explore the rabbit-hole debates resulting from the above - let’s make it easier and just use the definition of CIO from the scientific literature to guide our consultations.
Oops, we just acknowledged the importance of scientific evidence (Science = 1, Instagram = 0) …
Public Consultations?
In the public arena, you’ll likely get two opposing crowds when it comes to a controversial topic like CIO. These subgroups are highly motivated to provide their opinions.
My former PhD student - Dr Kate Jackson - saw this in her data when she surveyed people’s opinions about Controlled Crying (aka, graduated extinction). Kate surveyed 470 parents back in 2009 - with some of the questions being ………
But Kate surveyed parents from around Australia. What about scientific data from Denmark?
I could only find one ‘study’ that surveyed parents in Denmark - and in this study, 38% of parents were recommended CIO by family members or friends.
note: parents could provide more than one answer.
It is intuitive that if family or friends recommend a technique, or service, that they had a satisfactory experience - and indeed, research supports this link.
Ergo, this 2020 survey data from 2,711 Danish parents suggests around one third of the public may be supportive of CIO.
Then again, this is just one ‘study’.
And calling it a ‘study’ is generous - given it hasn’t been published (ie, it hasn’t undergone expert peer-review and published in a scientific journal).
By the way, it’s the same ‘study’ that surveyed the 700 psychologists mentioned in this propaganda poster.
Professional Consultations By 700+ PSYCHOLOGISTS
Although this propaganda poster has been active in the past few months, it appears the supportive statement from 700+ psychologists was born several years ago.
Circa 2019, there was an Open Letter from 723 psychologists who were a bit ticked off by the publication of a Danish book - Godnat og Sov Godt: Dit Barn Gode Sovevaner - which my rudimentary Scandinavian interprets as Good night and Sleep Well: Your Child Good Sleeper.
First, this book appears to be originally written in Spanish by the pediatrician Dr Eduard Estivill in the 2000s. What likely happened is that there was an offer from a Danish book publisher to purchase the rights to a Danish translation of this book, and - voila - the match was lit.
Second, the book’s overall success in Denmark clearly pissed off some people. They were so upset that they sent a letter to the Danish National Board of Health …
Now Kate and I had seen this sort of shit before.
When Kate was recruiting for her clinical trial evaluating the effects of sleep training (graduated extinction) on sleep and stress, our recruitment ad caught the eye of an online mother’s group (Joyous Births) who amassed an online petition to stop Kate’s study. They sent this petition to the Flinders University Social & Behavioural Ethics Committee (SBREC).
SBREC asked Kate and I to ‘please explain’.
And so we did - in writing.
SBREC replied with ‘you’re OK to keep researching’.
Why? Because we stated from the outset what we intended to research - and we had not deviated from that ethically-approved protocol.
And in response to this Danish Open Letter, guess what the Danish Board of Health did?
They stated - “The Danish National Board of Health only recommends methods that are evidence-based and validated in Denmark.”
Whilst Dr Kate Jackson happens to be in Denmark working as a Psychologist - I’m pretty sure she wasn’t one of the psychologists that agreed with this Open Letter. Here’s why …
CONCERNS ABOUT BRAIN DEVELOPMENT AND ATTACHMENT
Returning back to Kate’s clinical study, she persevered and completed it despite the e-petition.
And in 2016, not only was it published in the prestigious scientific journal Pediatrics, it got a shitload of world-wide attention.
In short, graduated extinction was found to improve the infant’s sleep, yet cortisol levels did not increase. Nor were there later attachment issues nor emotional-behavioural issues in the children 12-months after graduated extinction.
Whilst our study provided a lack of support for effects on development and attachment - and there have been other studies that concur with our findings - those against CIO often state that a 2012 study supports their claims - even though attachment and development were not measured (the study was conducted over 5 days).
In summary, there’s a lack of published scientific evidence to support the notion that CIO or its derivatives affect human development and attachment.
Now there remains just one more piece of the multi-step argument to consider …
CIO CONTINUES IN THE US
So far we’ve managed to unpack and counter the claims made by this propaganda poster.
But for this final sentence?
Well, I’m not about to defend what the current US government thinks or decides.
Ask me again in another 2 and half years …
CONCLUSIONS?
Whilst one-side of the argument tries to ban books and stop research dead in its tracks, I think I can safely say that my colleagues and myself won’t reciprocate.
We believe in scientific evidence and the scientific process. It seems the Danes do too.
So you won’t see us stopping the research of those who wish to ban a technique - that to this date - has shown to improve sleep, and yet there appears to be no record of it causing a death.
Truth is - these folks who oppose CIO seem fucking hopeless at knowing what research is, let alone getting their own ‘studies’ published in a scientific journal.
But one thing they are damn good at is spreading a message - even if it isn’t backed by peer-reviewed evidence.
So feel free to download and spread the evidence-based message below …
Prof MG
