Estimates of the incidence and prevalence of PA in high conflict cases vary from study to study. For example, Janet Johnston and her colleagues reported the prevalence of alienation in several studies. Johnston and Campbell (1988) said that alienation was seen in as many as 40% of high conflict cases. Johnston (1993) reported that 7% of the children in one study and 27% of the children in a second study had “strong alignment” with one parent and rejection of the other parent. In 2003, Johnston reported on an “alignment” study. She defined alignment as the “child’s behavioral and verbal preference for one parent with varying degrees of overt or covert negativity toward the other parent.” She found that 15% of children in a community sample of divorcing families and 21% in contested custody cases experienced either “some” or “much” alignment with one parent or the other. In 2005, Johnston, Walters, and Olesen reported rates of PA of about one-fifth of high conflict populations.
Clawar and Rivlin (1991) found that in about 80% of 700 counseling cases, there was some element of parental programming in an effort to implant false and negative ideas about the other parent with the intention of turning the child against that other parent. Their work focused on emotional issues, persistent programming, and brainwashing, which sometimes resulted in severe PA. Leona Kopetski, Deirdre Rand, and Randy Rand (2006) identified PA in 20% of the 413 families they evaluated between 1976 and 1990. Sandra Berns (2001) reported on a study of divorce judgments from 1995 to 2000 in Brisbane, Australia, where PA was found to be present in 29 percent of reviewed cases.
Hetherington and Kelly (2002), in discussing findings from the Virginia Longitudinal Study of Divorce and Remarriage, wrote:
As obviously destructive as conflict is to all involved in this dilemma, it was surprising to discover that six years after divorce, 20 to 25 percent of our couples were engaged in just such conflictual behavior; former spouses would make nasty comments about each other, seek to undermine each other’s relationship with the child, and fight openly in front of the child. Aside from being damaging, constant put-downs of the other parent may backfire, producing resentment and a spirited defense of the criticized parent by the child.… Conflictual coparenting distresses children and undermines their well-being, and it makes parents unhappy, too (p. 138).
Amy Baker (2007b) reported research wherein she surveyed 106 MHPs who conducted custody evaluations. The respondents reported that PAS occurred in as many as 55% of their cases. An average rate over all respondents, whether skilled or unskilled in the differential diagnosis of PAS, was 11.2% (SD = 13). Baker found that the evaluators who identified PAS more frequently were more familiar with the concept of PAS, were more likely to assess for PAS, were more likely to believe that one parent can turn a child against the other parent, and were more confident in their evaluations. In 2009 Bow and colleagues (Bow, Gould,& Flens, 2009) reported on their survey of 448 mental health and legal professionals who were experienced with parental alienation. They wrote, “When respondents were asked [in] what percentage of child custody cases was parental alienation an issue, the mean reported was 26%.”
The great disparity in these results reflects: varying definitions of “parental alienation,” different populations being studied, and different levels of experience in identifying PA. We conclude that some degree of PA (that is, mild, moderate, or severe) occurs in approximately 20-30% of high-conflict separations and divorces.
“Contact refusal” refers to the behavior of a child who avoids spending time with one of his parents. There are many reasons that children may not want to see a parent after separation or divorce. Most authors make a distinction between “estrangement” and “alienation.” Estrangement refers to a child’s rejection of a parent that is justified “as a consequence of the rejected parent’s history of family violence, abuse and neglect” (Johnston, 2005).In contrast, alienation refers to a child’s rejection of a parent that is unjustified, i.e., “unreasonable negative feelings and beliefs…that are significantly disproportionate to the child’s actual experience with that parent” (Johnston, 2005). With that distinction in mind, estrangement is not a diagnosable mental condition because it is normal behavior. Alienation, on the other hand, is an abnormal mental condition because it consists of maladaptive behavior (refusal to see a loving parent) that is driven by a false or illogical belief (that the target parent is evil, dangerous, or not worthy of love).
The differential diagnosis of contact refusal includes a child’s normal preferences for one parent over the other or one household over the other. The differential diagnosis also includes mental disorders such as separation anxiety disorder or oppositional defiant disorder. The child might properly refuse to visit a parent who has been abusive or very neglectful. The child might be manifesting PA, which could have been brought about by the child’s removing himself from the battle scene by gravitating to one parent and shunning the other, by the accidental indoctrination of a naïve alienator, by the purposeful indoctrination of an active or obsessed alienator, or perhaps because of a shared psychotic disorder with the alienating parent. (See Chapter 2, “The Psychosocial Assessment of Contact Refusal,” for a fuller discussion of this topic.)
Baker, A. J. L. (2007b). Knowledge and attitudes about the parental alienation syndrome: A survey of custody evaluators. American Journal of Family Therapy, 35(1), 1-19.
Berns, S. S. (2001). Parents behaving badly: Parental alienation syndrome in the family court – Magic bullet or poisoned chalice. Australian Journal of Family Law, 15(3), 191-214.
Clawar, S. S., & Rivlin, B. V. (1991). Children held hostage: Dealing with programmed and brainwashed children. Washington, DC: American Bar Association Section of Family Law.
Hetherington, E. M., & Kelly, J. (2002). For Better or For Worse: Divorce Reconsidered. New York: W.W. Norton & Co.
Johnston, J. R. (1993). Children of Divorce Who Refuse Visitation. In C. E. Depner & J. H. Bray (Eds.), Non-Residential Parenting: New Vistas in family Living (pp. 109-135). Newbury Park, CA: Sage Publishing.
Johnston, J. R., & Campbell, L. E. (1988).Impasses of Divorce: The Dynamics and Resolution of Family Conflict. New York, NY: The Free Press.
Johnston, J. R. (2003). Parental Alignments and Rejection: An Empirical Study of Alienation in Children of Divorce. Journal of the American Academy of Psychiatry and the Law, 31(2), 158-170.
Johnston, J. R., Walters, M. G., & Olesen, N. W. (2005). The Psychological Functioning of Alienated Children in Custody Disputing Families: An Exploratory Study. American Journal of Forensic Psychology, 23(3), 39-64.
Kopetski, L. M., Rand, D. C., & Rand, R. (2006). Incidence, Gender, and False Allegations of Child Abuse: Data on 84 Parental Alienation Syndrome Cases. In R. A. Gardner, S. R. Sauber & D. Lorandos (Eds.), The International Handbook of Parental Alienation Syndrome: Conceptual, Clinical and Legal Considerations (pp. 65-70). Springfield, IL: Charles C Thomas Publisher.