The (not quite) anti-CIO poster child: Macall Gordon, Part I

I’ve been aware of this poster for a while now. Macall Gordon, an ‘academic’ (at the time of the poster’s making she was studying for her Master’s degree in Antioch University, Seattle) presented it at the 2007 Biennial Meeting of the Society for research in Child Development, and chaired a roundtable discussion symposium on the subject of “Crying Before Sleep: What Do We Know About Behavioral Sleep Training in Infancy?” there.

The poster’s claims, supposedly, lay a foundation for claiming there is no evidence in the research for using CIO methods in children under 12 months of age, because we don’t know what the psychological effects will be.

Gordon claims there is no basis for the recommendations of sleep experts that parents can implement CIO techniques starting at 3-6 months, and that animal studies suggest that extinction (not necessarily in the context of sleep, mind) is stressful. She doesn’t quite go as far as to claim that the stress will bake babies’ brains in a cortisol bath, turning them into mush, in the manner of Dr. Sears and other hysterics…but it’s implied.

Gordon has reiterated her ideas in an interview with the Talaris Institute, and on her own website and blog. She, to be fair, stops short at claiming outright that CIO should never be done, but it’s clear she’d like to undermine parents’ confidence in the method.

In this post, we’ll have a look at Macall Gordon’s claims and see if there is any merit to them. But before that, you might want to know that Gordon is/was an executive editor at Attachment Parenting International and an advocate of cosleeping – and I might add that she doesn’t seem to have looked at the quality of research in support of cosleeping quite as closely or critically as she has done with CIO (Note the inclusion of two non-peer reviewed master’s theses making claims that cosleeping makes for psychologically superior children, and the usual baseless “cosleeping may prevent SIDS” claim). Not that this disqualifies her from analyzing the literature regarding CIO, but knowing her bias is always helpful.

Claim #1: There is no basis for recommending parents start CIO methods between 3-6 months, as suggested by many popular parenting books.

Actually, there is very good physiological evidence that by age 3-4 months, and certainly by 6, a baby is ready for CIO. That doesn’t mean you must CIO the instant baby turns the requisite age, of course, but this is the minimal age for using these techniques. It’s not exactly a secret, as Ferber (at least) does partially explain the rationale in his book. Reasons of psychological safety have never really come into the equasion because, well, one would think the generations-long experience with the practice should speak for itself.

*Babies are born with sleep cycles that are different than those of adults:

Normal Sleep Development
Neonates cycle through rapid–eye-movement (REM) and non-REM (NREM) sleep differently than older children or adults. In the first few months of life, infants have not yet become fully adjusted to a day-night cycle, and more of the control of sleep is internal. Full-term infants can spend as much as 50% of their total sleep time in REM sleep. At this age, the term used is active sleep. The infant often enters the sleep cycle in REM. By about 4 months of age, as sleep cycling approaches the adult mode, sleep-state progression matures and NREM sleep typically precedes REM sleep.

*Newborns have very labile emotional and hormonal responses to stressful events – even a diaper change can be interpreted as a stressor. By 4-6 months, this behavioral and hormonal response is much attenuated, and is similar to that of older babies.

*Smaller babies (under 3-4 months) often need to wake up in the night to feed, and may become malnourished if prevented from nursing at night.

(Yes, I know about Babywise and the like. I don’t endorse such methods, for all the reasons detailed above).

Claim #2: Most of the studies done regarding CIO don’t examine babies under 1 year of age, and those that do, don’t do so exclusively and we don’t know how many babies were looked at. Very few look at the psychological effects of CIO.

Gordon lists a whole bunch of studies which really do deal with older children, the majority of which relate mostly to whether the method is effective, not the effect on the child’s psychological wellbeing. So in a sense, she’s right. But that doesn’t change the fact that there were two (and now are 3) studies which examine this question in populations of infants, and all of them have found no negative, and even some positive, psychological effects. They are France et al and Eckerberg et al. While the former does not state the proportion of children in each age group, the latter states clearly that over 2/3 of the children studied (67/95) were between 6-17 months of age, and the results were also stratified by age (6-18 months and >18 months, respectively). The last study, which has since been published and which I’ve looked at here, deals exclusively with infants who were 6-12 months old at the time of the sleep intervention, with, yet again, no evidence of psychological harm to them. (Interestingly enough, Sarah V., who addressed the issue long before I did, managed to come up with exactly the same two studies that were around at the time. Imagine that – both of us managed to bring up only the relevant literature…)

So despite the fact there are not oodles of supportive research dealing with our specific issue – when one considers there are exactly ZERO studies that have found the opposite, and adding 90 years’ worth of observational data with no negative effects shown…I dunno, but it seems that right now the scales are tipped rather firmly towards no evidence of harm from CIO, and it’s up to the anti-CIO crowd to prove (not make theoretical claims, prove) the contrary if they want to claim otherwise.

Claim #3: The psychological test used doesn’t actually measure infant psychological wellbeing, but rather describes behaviors more related to regulatory capacities, temperament, and developmental level (e.g. “Can accept sudden advances of a stranger.” “Enjoys a crowd.” “Can recover easily when upset.”) Nor does it prove that CIO doesn’t cause attachment problems.

The first two studies mentioned (France and Eckerberg) used a modified questionnaire based upon the Flint Infant Security Scale. Neither of them are solely reliant on that measure, however: Eckerberg et al correlates the Flint scores with Visual Analogue Scales (VAS) the parents used to assess their own and their baby’s mood, and maternal emotional status (which might have affected the scores the mother gave) was tested with the Swedish Parenthood Stress Questionnaire. France et al augmented the results of the Flint Test with the Child Behavior Characteristics scale (according to Borgatta & Fanshel), another test that, like Flint, has been used for decades to assess infant emotional status. (The third study by Hiscock et al assessed infant mental health only at the end of the followup using tests appropriate for older babies and children, not the Flint test, and compared the results to the population at large.).

While it’s true the items on the Flint scale (and most of the other scales designed for use in this age) mostly assess ‘regulatory capacities, temperament and developmental stages’…what exactly would Gordon have them assess? It’s not like you can ask babies how they feel.

But when a baby that age shows evidence of emotional trauma, it’s usually in the form of emotional dysregulation, irritablility and being difficult to soothe, social withdrawal and regression in developmental stages. The Flint and other scales assess exactly these elements. The fact that the researchers were using at least two different tests in each study, all of which spotted no evidence of trauma, is suggestive that CIO is not emotionally traumatic (and may even be beneficial). But hey, if Gordon has some other test she’d like applied to babies undergoing CIO which she feels would better assess this…she was welcome to suggest it. Yet she didn’t.

But what about attachment? Well, the Hiscock study, having assessed the children at an older age and compared the to the general public, could theoretically have done so, but being that you can’t do a Strange Situation test in babies younger than 9-10 months or so, there would have been no way to assess the babies’ attachment beforehand and compare. Still, it might be worth doing and comparing the results to the control group.

There are other, more subtle signs in the Hiscock study which suggest attachments were not ruptured (and perhaps improved) as a result of CIO, though; more on that in Part II, in which I will continue wading through Gordon’s pseudo-academic claims of possible harm from CIO.


21 Responses

  1. Interesting stuff! I also really enjoyed your post on observational data.

    CIO sleep training is one of those things where, given the absence of really good evidence, I have to go with the anecdotes. My friends who have used Ferber? Have happy kids who don’t appear to have suffered any damage (and who sleep really well!). My older daughter, who was Ferberized at 7 months? No apparent ill effects. lots of positive effects, too

    The assumption that CIO most likely causes harm just doesn’t seem to be born out by the anecdotal evidence, at least. And man, the value of everyone in the family getting a solid night’s sleep is something I really don’t think should ever be dismissed.

  2. You are right. My poster on CIO is not an “anti” oriented work. My only goal has been to raise some questions without engaging in personal condemnation of any approach to infant sleep or of anyone who has differing opinions…. I had hoped through this work to begin a dialogue about whether or not there might be situations (family context, individual infants) where CIO would not be appropriate or could be counterproductive. CIO is currently portrayed as universally effective and without side effect for any infant or parent. I continue to maintain that research has not thoroughly investigated this, nor does it take into account how difficult this is for many parents, especially those who find that it does not work the way the book says it will.

    I have found it challenging to keep the discussion of this topic in an objective middle ground and instead find myself in the middle of two very contentious sides who appear to have little interest in open-minded dialogue. Though you have tried to put me on a side and thus discredit my point-of-view, in reality, I’m not on a side. I remain firmly in the middle. We have to be able to ask questions and look critically at the research that exists. When mere questioning receives such strong and personal response, it is curious.

    I would encourage readers to look at the work of myself and Dr. Sheri Hill ( and the way we address some of these questions and issues.

    • Ms. Gordon, thank you for coming to respond.

      I’m sorry to say this, but you are not coming at this from an objective middle ground, and you are not ‘firmly in the middle’ on this issue. I’ve listened to your interview at the Talaris website. You didn’t approach your pediatrician for advice in dealing with a sleepless baby because you “knew” what she would say, you have misgivings even about positive routines (because how could you not nurse your baby to sleep?!), and you try your best to diminish the results of the three studies which have shown no ill effects from sleep training by lumping them in with other research irrelevant to this question, ignoring the lack of observational evidence for your position, and falsely finding fault with some of the psychological testing used to assess wellbeing. It is clear to me that your assumption is that CIO does cause damage to at least some children, and not the proper ‘null hypothesis’. You may not be quite as strident about it nor misuse the research quite as blatantly as Margot Sunderland and Dr. Sears, but you definitely seem to be working out of the same paradigm.

      You also are incorrect when you say that “CIO is currently portrayed as universally effective and without side effect for any infant or parent.”. Ferber and Weissbluth, in fact, have stressed the opposite (and so have I on this blog). If a parent is reluctant to use the method, or the baby does not respond to it after a short period, it’s time to try something else. CIO is a tool, a fast and often effective one, but it is only one tool. It is stressed the baby should be healthy and not undergoing any other developmental issues at the time. (I won’t refer to Babywise or sleeping 12 hours by 12 weeks, because at least Babywise has demonstrated side effects and most pediatricians do not endorse it as a result). [ETA:Just checked What to Expect – they have the same caveats and offer multiple options.]

      Certainly there is room for ‘begin[ning] a dialogue about whether or not there might be situations (family context, individual infants) where CIO would not be appropriate or could be counterproductive’. I think the answer is a resounding yes, and I think Ferber and Weissbluth would agree with me: in the case of a parent who isn’t capable of committing to the method or just doesn’t want t, or a child who is demonstrably not responding to it (crying is not diminishing over time, a child who responds in a very extreme manner). I don’t think that’s really what we’re discussing here, though. Not due to claims of future damage, simply because this tool is not suitable for this parent-child setup.

      The actual question is, though – where is the evidence that CIO damages any baby in any context? I could begin a dialogue with the Israeli Water Authority about whether our local tap water might be dangerous to some people’s health (it certainly tastes bad enough unfiltered!), but without some cases of people showing evidence of harm that could plausibly be attributed to the water, most people would, justifiably, consider me a crackpot.

      Also, given that you can’t conclusively prove a negative – answer me honestly: what evidence would convince you that CIO does not have harmful psychological side effects in babies? How would you design a study to examine this question and what tests would you apply to prove or disprove the existence of psychological harm? At what point would you be convinced that CIO is safe?

      (I ask the latter to ward off what Orac likes to call “The incredible shrinking causation claim” – that though CIO does not cause harm in general, it might in some extremely rare case we haven’t encountered yet in the studies) .

  3. Hi Estherar,
    It’s Hugh again. It’s been nice not coming across any of your anti-child rhetoric for awhile, but here we are again. Science has a funny way of bringing people together. It also serves an excellent purpose of helping us sheep figure out what is going on in the “just too difficult to understand” world that we all live in. I especially enjoy seeing it’s noble creation to justify parental abuse and neglect. After all, what are we supposed to do when the old cognitive dissidence sets in….lets analyze until we come up with something that justifies our actions. With infants having NO developed language skills, they cry. So, without one of your handy posts, or a parents pediatrician’s advice, how does a parent know exactly why a child is crying? I get that many times children have childish needs (maybe something like…mommy I’m new in this world, I love you and want to be with you). However when it’s not something simple, when there is real crisis, we should just let it drag on until they exhaust themselves? Cry it out…cry what out exactly? If a child does experience some sort of stress, we won’t know, because we didn’t have it studied, in that room, on that night… right? I think science would help itself if when doing a proper SIDS scene examination there was a field for “did your child CIO the night of the incident? Maybe they could put it right after the field where a parent is asked, was your child sleeping alone? I wonder if the internal doubt that any parent would have would produce an honest answer…why yes, I did let my child cry for a couple of hours that night, in a room all by itself, alone. Not because it felt right, but because some people told me it was good for them.

    • Hugh,

      You have some serious chutzpah calling me ‘anti-child’ when you advocate a practice that can and does KILL babies. While I can’t find any credible reports of babies damaged from CIO, I’m sure if I went to the Health Dept. of the state of Maine or any other state, I could find cases of babies who suffocated in bed even when their parents did everything ‘right’ and followed all the rules. I wonder what you’d like to tell this mother, for example. That she must have been doing it wrong?

      Now, I don’t call you ‘anti-child’ for advocating cosleeping. But at least ackowledge that what you’re advocating has a much more solid track record of harming children that what I am.

      Now as to your questions:

      “With infants having NO developed language skills, they cry. So, without one of your handy posts, or a parents pediatrician’s advice, how does a parent know exactly why a child is crying?”

      See, some of us, having lived with our children for several months, manage to figure out what their different cries mean – whether they’re hurt, angry, hungry, dirty, or overtired. It’s called ‘following your infant’s cues’ or ‘being attached to your baby’. You might want to try it sometime ;).

      Also, there’s a bit of simple common sense invloved: if your baby has just been fed, changed, is healthy and is happy up until the moment you put them to sleep, the reason for the crying seems pretty straightforward. I would even be cool with parents visiting the pedi the day before they CIO for a checkup.

      As for why people CIO? Well, I can’t speak for everybody, but just because a baby’ doesn’t want to sleep in stretches through the night doesn’t mean he can’t. And if parents are tired and depressed (because not everybody can ‘sleep when the baby sleeps’ – people who have stuff like jobs or other children to deal with, for example), the whole family, including the baby, suffers. Not to mention that many babies simply need someone to help regulate their sleeping times, or they end up with insufficient, broken sleep and are fussy and crabby all day long as a result. So CIO – at least for most parents I know – is done for the whole family’s sake, including the baby’s. And while crying is unpleasant to hear, the end result makes it feel very right. Not because we’re sheeple who do something because their doctor/BFF/MIL told them to.

      And if and when CIO (a la Ferber) is working, the baby doesn’t cry ‘for a couple of hours’, nor is he alone all of that time. The crying diminishes day by day because the baby is learning that Mommy and Daddy will come back.

      Breastfeeding may reduce SIDS (though the apparent reduction may be due to confounding factors), but you can breastfeed with your baby in a sidecar or a bassinet next to your bed as well. And the breast cancer issue (ditto) is one I brought up a few posts back, but that really is a decision a mother can make for herself about herself.

      As to how many babies have died after a night of CIO…well, since the peak incidence of SIDS/SUDI happens at a younger age than most parents use CIO to get their child to sleep through the night, I doubt very much that there’s a connection. But I’d be fascinated to hear your theory and the evidence supporting it. Or is this just another angry lashing out on your part?

      And Hugh, maybe you want to tell me how many of those cosleepers in your little survey know how to cosleep safely? How many of them actually do?

      Oh wait….you never even asked.

  4. Hugh – Just to clarify, may I ask how you would define ‘CIO’?

  5. And while you are at it, Hugh, perhaps you would like to share your definition of “parental abuse and neglect”, your handy guide to reading your infant’s mind, your theories on SIDS, and the benefits of inducing guilt in bereareved parents.?

    Dear me. So few of us fit to parent. Without the enlightened AP ers, the world would go to hell in a hand basket.

  6. Hi Sarah, and Liz,
    Sarah, I would define CIO as a parent-centered rationalization to “break” your child of a habit that does not conform with a “parents” master plan to raise their child. It is generally developed because the child is not doing something that the parent thinks it should like sleep. To be clear, a parent should expect that while raising a child, it will cry many times, for many reasons. The idea of developing a “method” of ignoring your child because you know better sounds abusive, and if there is a need that is not being met, then it sounds neglectful. Thanks for letting me parlay that info to you, I’m guessing that you have a different definition.

    And Liz, My definition of abuse and neglect has been developed during my time working for the state health dept of Maine. It mirrors that of many States…

    “Any recent act or failure to act on the part of a parent or caretaker, which results in death, serious physical or emotional harm, sexual abuse, or exploitation, or an act or failure to act which presents an imminent risk of serious harm”

    So, I’m sure that you are developing in your head right now, how your treatment of your child does not fall into it. Good for you, and maybe Estherar can help you with some stats on how you are “OK”.

    It’s really not about reading your child’s mind, but about reading your own. What are your intentions with CIO? Are they to benefit you, or your child? Maybe someone can come up with a study that says CIO is not harmful. And SIDS…well maybe, newborn humans, especially ones with risk factors, shouldn’t be left without a human regulatory standard. I understand that this conflicts with modern parents plans on childrearing, but O well. And the guilt issue, I am unaware of the bereavement benefits that come from telling someone “there was nothing you could have done”. There is enough information that shows a baby that is breastfed has a better chance against SIDS. And how breastfeeding can reduce cancer risks as well, but I’m sure you don’t want to hear that. So, I know it’s a lot to do, but maybe the life of your child would be worth it. They are only young for a short time.

    I didn’t call anyone unfit to parent, it’s just the other side of the coin…the one you can’t stand to hear because it conflicts with your parenting ideas.

    And, as for babies crying, yeah it gets frustrating and it happens. But, it does not call for a “parenting plan” to ignore them.

  7. The common-usage definition seems to be about on the lines of leaving your child alone to cry, usually as a way of getting them to sleep. I’ve done that with both children at different times for various reasons, though not the one you gave. I’d be happy to tell you more about it when I have more time (it’s 11.30 here, my alarm’s set for 4.00, and I still need to grab a shower before bed…)

    Why would you think that I wouldn’t want to hear about breastfeeding reducing cancer risks? Or about parenting ideas that conflict with mine?

  8. Hugh, both of my daughters are adults, and do not seem either more perfect or more flawed than anybody else. Nor am I defending my own theories of childrearing, because I didn’t have any. I loved them, did the best I could, and didn’t beat myself up over imagined traumas. I didn’t leave either to, in that rather ridiculous phrase, cry it out. One was rather keen on sleep, the other cried in my arms, in my bed, wherever, and is now a rather cheerful, optimistic character. Far as I remember, she had virtually every risk factor in the book for SIDS, but we all managed to survive, despite my lack of an overarching philosophy which seems to engender fear and complacency in tandem.

  9. Hugh,

    What contempt you have for parents. Is it so inconceivable that the interests of parents and children coincide? Is any thing that doesn’t conform to your view of what is appropriate just a rationalization parents’ part?

  10. Yeah, I don’t get why you think a perpetually tired child is such a great thing. Sleep deprivation is a torture technique and why does the state of Maine support it?

  11. One thing that has occurred to me about crying, at least with my children, is that the more tired they get the more likely they are to cry. I have often wondered if the ability to calm down takes energy in and of itself. Crying seems to act as a sort of release of tension when they are too tired to do anything else. I read recently that tears cried in grief have a different chemical composition than those cried in pain (richer in manganese). I suspect that there’s far more complexity to crying than we know. There’s also far more to human relationships that narrow self-interest and rationalization.

  12. It is generally developed because the child is not doing something that the parent thinks it should like sleep.

    Okay, I’m in the trenches of CIO right now with my 7-month-old son, so this hits me where I live.

    I’m not CIOing just because it’s convenient for me to put him to bed at 7 PM. I’m CIOing because he’s EXHAUSTED, and I don’t know what else to do. He’s rubbing his eyes, thrashing and wailing in my arms, dark-circles-under-his-eyes miserable, and he simply can’t get himself to sleep. He was napping in the swing for a while, but he’s big enough to wiggle into unsafe positions, so that’s out. Nursing and rocking doesn’t help any more, because he wakes up as soon as I put him down — nor can I abandon my two-year-olds to the wolves for an hour while I rock and rock and rock the baby, or while I try to pat and shush him to sleep (which doesn’t work anyway). He won’t sleep in a sling or in my arms, because of the aforementioned two-year-olds, and co-sleeping for naps is also a no-go for the same reason.

    I love my son, and I hate letting him cry for 35 minutes, 1:15 minutes, 25 minutes. Frankly, I cry too. If I thought there were anything else to do, or if I didn’t think he needed the sleep, I wouldn’t let him cry like that. But what, precisely, am I supposed to do? Let him be wretched because he doesn’t nap AT ALL, from 7 AM to whatever godawful time of evening he’s so tired that rocking finally works (10 PM last night)? Is the 35 minutes of concentrated screaming at bedtime really worse than the 45 minutes of inconsolable crying in my arms this afternoon, because he was so tired he couldn’t see straight? Of course he wants his mother close at all times, and to be held while he sleeps. However, that’s simply not an option. If a few days of crying can teach him how to get the sleep he desperately needs, isn’t that the responsible parenting choice, versus letting him spend half his life exhausted?

  13. Well said, Emma B. I’m not a great fan of CIO, but really who is? Parents don’t leave their children to cry for the fun of it. And most parents don’t let their babies cry, shut the door and forget about them. They are reviewing the situation minute by minute.

    Many times children have childish needs (maybe something like…mommy, I’m so tired it makes me want to scream so please stop messing about with me and picking me up and sticking that breast in my gob each and every time I squawk. I’m new in this world and I need to learn how to get to sleep by myself sometimes.)

  14. I promised myself that I would not come back to this blog. I do agree that all parents should do what they think is best for their child. I get carried away when I think people are being mislead. Unbiased information is more available to us in this day and age then ever before. Getting a hold of someone else’s tainted point of view can be bad for you, so beware. If people want to feel good about their decisions they should investigate (both sides) for themselves. If you are not currently raising a child, keep your past to yourself (I have 6 kids). My opinions rest like this….

    If you want to CIO, please please please look into learned helplessness. If sleep for your child and you is what YOU are sincerely looking for, safely bed-sharing works, period. If you can’t do it, ask yourself why. If the answer starts with anything that looks like a parents need, then please understand your child will not understand your perspective, so you WILL have to “train” or “break” them to your will.

    Important lessons are going to be the main diet in your child’s life for the entirety, even when they have kids of their own. If you allow them to gain this knowledge on their terms, it will be more likely to be in the form of something they can understand. Being told, or force-fed information at the wrong times (non-verbal) is not beneficial for anyone (they don’t really “get it’ it’s given to them, and the doubt of it’s effectiveness will remain in your hands, hence justification). You only get one shot at life, and raising a particular child, ONE. Raising a child IS really about them, not you. What other thing in this world is more important that raising your descendants kindly?

    • Hugh, understand that merely claiming CIO causes learned helplessness does not make it so. You’ve claimed in the past to be a scientist, but you seem to have no understanding of the scientific method or much about infant development. Which, presumably, made you the perfect dupe for Sears et al‘s scaremongering. “Getting a hold of someone else’s tainted point of view can be bad for you, so beware” is advice you yourself need to heed.

      Emma, my sympathies. There are several ‘no cry’ solutions out there, including in Teh Ebil 😉 Weissbluth’s book BTW. They generally involve more time to eliminate the baby’s wakings and more personal involvement in the process (e.g., spending long amounts of time by your baby’s side at might and naptime to get them to sleep).

  15. If sleep for your child and you is what YOU are sincerely looking for, safely bed-sharing works, period. If you can’t do it, ask yourself why.

    There are plenty of legitimate reasons why it might not work, and then what do you suggest for the baby who isn’t a naturally good sleeper?

    We actually did co-sleep until Andrew was reliably sleeping through the night, with him in a sidecar crib — nighttime bed-sharing isn’t a safe option for us. It was a great way to have the minimum amount of midnight sleep disruption, but it didn’t do much to help him *go* to sleep. It didn’t help our nap scenario, either. I wish it did, because I could use some naps myself, but I can’t leave my toddlers alone, and he wakes back up if I try to get up.

    There are times and places and situations where co-sleeping is the right option, but it’s not always the answer to every sleep problem. And if it’s not, how do you reconcile your baby’s physical needs with his emotional ones?

  16. “If you are not currently raising a child, keep your past to yourself .”

    Why? I would not, under any circumstances, advise anyone on how THEY should bring up their children, being a firm believer in “Whatever works for you”, but the perspective on different approaches and fashions in childrearing that time brings I believe to be quite useful. I have watched with interest my daughter follow some quite different approaches and diktats – some of them quite a big improvement on those of my day, my much older sisters, my mother’s, some rather obsessive and rejected by her. I happen as a personal opinion to believe that excessive maternal devotion and anxiety may well bring some problems of its own in its wake – but of course, we would no doubt have some trouble agreeing on what was excessive. It seems to me that Emma’s concern for the welfare and feelings of her older children is rational and understandable, and that wearing oneself to a frazzle trying for an impossible perfection does neither mother nor child much of a favour.

  17. In my little experiment, CIO didn’t work for one kid, has worked well for the other. Turns out, the one for whom it didn’t work has PDD and related issues with self-regulation. Damn those confounders!

    (It’s Squillo, BTW, Esther–it’s using my WP login.)

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