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Parental alienation syndrome (abbreviated as PAS) is term coined by Richard A. Gardner in the early 1980s to refer to what he describes as a disorder in which a child, on an ongoing basis, belittles and insults one parent without justification, due to a combination of factors, including indoctrination by the other parent (almost exclusively as part of a child custody dispute) and the child's own attempts to denigrate the target parent. Gardner introduced the term in a 1985 paper, describing a cluster of symptoms he had observed during the early 1980s.

Parental alienation syndrome is not recognized as a disorder by the medical or legal communities and Gardner's theory and related research have been extensively criticized by legal and mental health scholars for lacking scientific validity and reliability. However, the separate but related concept of parental alienation, the estrangement of a child from a parent, is recognized as a dynamic in some divorcing families.

The admissibility of PAS has been rejected by an expert review panel and the Court of Appeal of England and Wales in the United Kingdom and Canada's Department of Justice recommends against its use, but has appeared in some family court disputes in the United States. Gardner portrayed PAS as well accepted by the judiciary and having set a variety of precedents, but legal analysis of the actual cases indicates this claim was incorrect.

No professional association has recognized PAS as a relevant medical syndrome or mental disorder, and it is not listed in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders.

Initial description
Parental alienation syndrome was a term coined by child psychiatrist Richard A. Gardner drawing upon his clinical experiences since the early 1980s. Symptoms similar to PAS had been described in the mental health literature since the 1940s, and in a 1985 journal Gardner defined it as "…a disorder that arises primarily in the context of child-custody disputes. Its primary manifestation is the child’s campaign of denigration against the parent, a campaign that has no justification. The disorder results from the combination of indoctrinations by the alienating parent and the child’s own contributions to the vilification of the alienated parent" also stating that the indoctrination may be deliberate or unconscious on the part of the alienating parent. PAS was originally developed of as an explanation for the increase in the number of reports of child abuse in the 1980s. Gardner initially believed that parents (usually mothers) made false accusations of child abuse and sexual abuse against the other parent (usually fathers) in order to prevent further contact between them. While Gardner initially described the mother was the alienator in 90% of PAS cases, he later stated both parents were equally likely to alienate. He also later stated that in his experience accusations of sexual abuse were not present in the vast majority of cases of PAS. The initial work was self-published by Gardner, but later papers were released in peer reviewed scientific journals.

Characteristics
Gardner described PAS as a preoccupation by the child with criticism and deprecation of a parent. Gardner stated that PAS occurs when, in the context of child custody disputes, one parent deliberately or unconsciously attempts to alienate a child from the other parent. According to Gardner there PAS is characterized by clusters of eight symptoms that appear in the child. These include a campaign of denigration and hatred against the targeted parent; weak, absurd, or frivolous rationalizations for this deprecation and hatred; lack of the usual ambivalence about the targeted parent; strong assertions that the decision to reject the parent is theirs alone (the "independent-thinker phenomenon"); reflexive support of the favored parent in the conflict; lack of guilt over the treatment of the alienated parent; use borrowed scenarios and phrases from the alienating parent; and the denigration not just of the targeted parent but also to that parent's extended family and friends.

Gardner and others have divided PAS into mild, moderate and severe levels. The number and severity of the eight symptoms displayed increase through the different levels. The recommendations for management differ according to the severity level of the child's symptoms. While a diagnosis of PAS is made based on the child's symptoms, Gardner stated that any change in custody should be based primarily on the symptom level of the alienating parent. In mild cases, there is some parental programming against the targeted parent, but little or no disruption of visitation, and Gardner did not recommend court-ordered visitation. In moderate cases, there is more parental programming and greater resistance to visits with the targeted parent. Gardner recommended that primary custody remain with the programming parent if the brainwashing was expected to be discontinued, but if not that custody should be transferred to the targeted parent. In addition, therapy with the child to stop alienation and remediate the damaged relationship with the targeted parent was recommended. In severe cases, children display most or all of the 8 symptoms, and will refuse steadfastly to visit the targeted parent, including threatening to run away or commit suicide if the visitation is forced. Gardner recommended that the child be removed from the alienating parent's home into a transition home before moving into the home of the targeted parent. In addition, therapy for the child is recommended. Gardner's proposed intervention for moderate and severe PAS, including court-ordered transfer to the alienated parent, fines, house arrest, incarceration, have been critiqued for their punitive nature towards the alienating parent and alienated child, and for the risk of abuse of power and violation of their civil rights. With time, Gardner revised his views and expressed less support for the most aggressive management strategies.

Reception
Gardner's original formulation, which labeled mothers almost exclusively as the alienating parent, was endorsed by fathers' rights groups, as it allowed fathers to blame their former wives and to explain the reluctance of their children to visit them. In contrast, women's groups criticized the syndrome, concerned that it permitted abusers to claim that allegations of abuse by mother or child were reflective of brainwashing. Gardner himself emphasized that PAS only applied in situations where there was no actual abuse or neglect had not occurred, but by 1998, noted an increase in the awareness of PAS had lead to an increase in its misapplication as an exculpatory legal maneuver.

PAS has been cited in high-conflict divorce and child custody cases, particularly as a defense against accusations of domestic violence or sexual abuse. The status of the syndrome, and thus its admissibility in the testimony of experts, has been the subject of dispute about the extent to which PAS has been accepted by the professionals in the field, as well as a scientific methodology that is testable, has been tested, has a known error rate, has been published and peer-reviewed.

PAS has not been accepted by experts in psychology, child advocacy or the study of child abuse or legal scholars. PAS has been extensively criticized by members of the legal and mental health community, who state that PAS should not be admissible in child custody hearings based on both science and law. PAS is not recognized by the American Medical Association or the American Psychiatric Association. The American Psychological Association declined to give a position on PAS, but raised concerns over its lack of supporting data and how the term is used and the APA's 1996 Presidential Task Force on Violence and the Family expressed concern that custody evaluators use PAS as a means of giving custody to fathers despite of a history of violence, a concern shared by other commentators. The United States National Council of Juvenile and Family Court Judges rejected PAS, recommending it not be used for the consideration of child custody issues.

Relation to the DSM
PAS is not included in the Diagnostic and Statistical Manual of Mental Disorders (DSM). In 2002, Gardner urged therapists, parents and lawyers to write to the committees working on the fifth publication of the DSM to give evidence that it exists and to include PAS in the next version. Gardner stated that it was not included in the 1994 release of the DSM due to a lack of peer reviewed articles, but since then many new publications and court rulings have been released. In 2008, psychiatrist William Bernet argued PAS should be included in the next version of the DSM to allow for more research on the topic, reduce its misuse and improve treatment. In a survey of American custody evaluators, half of the respondents disagreed with its inclusion, while a third thought it should be.

Scientific status
In order for PAS to be accepted as a new diagnostic category, it would need to viewed by mental health professionals as (1) an existing phenomena, (2) an abnormal disturbance of the child and (3) a useful diagnostic category that is not better explained by a different description of the symptoms or subsumed by an existing diagnostic category. PAS is not accepted as a syndrome, but most mental health and legal professionals do agree about the existence of the phenomena: some children become alienated from one parent, the alienation is not justified by that parent's behavior and, the alienation is promulgated or supported by the other parent.

PAS has been described as incomplete, simplistic and erroneous for ignoring the multiple factors (including the behaviors of the child, parents and other family members) that may contribute to parental alienation, family dysfunction and a breakdown in attachment between a parent and a child. PAS has been described as a hypothesis that has not met the burden of proof required to demonstrate that it is true by psycology professor Roger Emery,  and research by other professionals has also not substantiated some of its tenets. Also cited are a variety of theoretical and practical problems - PAS confuses a child's developmental reaction to a divorce with psychosis, vastly overstates the number of false allegations of child sexual abuse, ignores the scientific literature suggesting most allegations of child sexual abuse are well founded and efforts by one parent to protect their child from the other, abusive parent, exaggerates the damaging effects of parental alienation on children and proposing an unsupported and endangering remedy for PAS. Concern has also been expressed that PAS lacks adequate scientific support to be considered a syndrome, and that Gardner has promoted PAS as a syndrome based on a vague clustering of behaviors.

Though Gardner's initial books on PAS were self-published and not peer reviewed, subsequent articles have been published in peer reviewed journals, though some of these were based on anecdotal evidence in the form of case studies. Gardner's writings published in both peer reviewed journals and legal decisions have been described as lacking both validity and reliability but despite this testimony regarding the evaluation of PAS is inappropriately viewed as reliable by family court judges. As of 2001 no studies had been published that directly evaluate whether different evaluators can arrive at the same diagnosis of the existence and severity of PAS though a single problematic study in 2004 suggested practitioners could come to a consensus based on written reports.

Clinical status
PAS has been criticized for making clinical work with children who are alienated more confusing and Gardner's analysis as been criticized for inappropriately assigning all responsibility of the child's behavior to one parent when the child's behavior is oftentimes, but not always, the result of a dynamic in which both parents and the child play a role.

Gardner disagreed with criticism of PAS as overly simplistic, stating that while there are a wide variety of causes on why a child may become alienated from a parent, the primary etiological factor in cases of PAS is the brainwashing parent, and that otherwise, there is no PAS. Gardner also stated that those initially critical of PAS for being a caricature were not directly involved with families in custody disputes and that criticisms of this nature faded by the late 1980s because the disorder was widespread.

Views of PAS as sexist
PAS has been criticized by for being sexist, being used by fathers to marginalize legitimate fears and concerns about abuse, and women's groups and others oppose the legitimacy of PAS as a danger to children. After his initial publications, Gardner revised his theory to make fathers and mothers equally likely to alienate or be indoctrinators. Gardner disagreed that recognition of PAS is sexist and in later discussions, indicated he believed men were equally likely to be PAS indoctrinators, and the deniers of PAS are hurting women who are victims of their husbands' PAS indoctrinations.

However, studies of PAS-diagnosed children and adults found that mothers were more likely than fathers to be the alienator.

Canada
Early Canadian court cases accepted expert opinions about PAS, used the term "syndrome" and concurred with Gardner's theory that only one parent was fully responsible for it. Gardner testified in one case (Fortin v. Major, 1996) but the court did not accept his opinion, concluding that the child was not alienated based on the evaluation of a court-appointed expert who, unlike Gardner, had met with the family members. Cases involving possible parental alienation have increased in frequency in Canadian courts overtime. More recent cases, while accepting the concept of alienation, have noted the lack of recognition in the DSM-IV, and have generally avoided "syndrome" terminology, emphasizing that changes in custody are stressful for the child and should only occur in the most severe cases. A 2006 research report by the Canadian Department of Justice described PAS as "empirically unsupported" and favored a different framework for dealing with issues of alienation that has more research support. Decisions about possible parental alienation are considered a legal decision, to be determined by the judge based on the facts of the case, rather than a diagnosis made by a mental health professional. There is recognition that rejection of a parent is a complex issue, and that a distinction must be made between pathological alienation and reasonable estrangement. A study of 145 Canadian alienation cases by law professor Nicholas Bala of Queen's University noted that in half of the cases, judges declined to make findings of parental alienation as the child was "understandably estranged from the rejected parent due to abuse or poor parenting.

United Kingdom
In the United Kingdom, the admissibility concerning the evaluation of PAS was rejected both in an expert review, and by the Court of Appeal.

United States
PAS has been cited as part of the child custody determination process in the United States. Based on the evaluation of PAS, courts in the US have awarded sole custody to some fathers. PAS has been challenged under the Frye test, to evaluate if it has been accepted by the scientific community. Despite Gardner claiming PAS was generally accepted by the scholarly community and passed the Frye test in two states, a 2006 analysis of court cases involving PAS and cited by Gardner concluded that these decisions did not set legal precedent, that PAS is viewed negatively in most legal scholarship, and that Gardner's writings do not support the existence of PAS. Of sixty-four precedent-bearing cases, only two decisions, both in New York State and both in criminal courts actually set precedents. Both held PAS inadmissible and one case found that PAS failed the Frye test as the appropriate professional community did not generally accept; this decision was upheld in an appellate court. Gardner listed fifty cases on his website that he claimed set precedents that made PAS admissible, but none actually did; forty six set no precedents or did not discuss admissibility and the remaining four were problematic. One case stated that PAS passed the Frye test, but the appeal did not discuss the Frye test and actually "[threw] out the words "'parental alienation syndrome'" and focused on the "willingness and ability of each parent to facilitate and encourage a close and continuing relationship between the parents and the child." In the second case the appellate court did not discuss PAS; the third case specifically chose not to discuss the admissibility of PAS and the fourth made no decision on PAS.

Philip Stahl, a child custody evaluator, states that problems described by advocates on both sides of the issue on PAS are happening, adding that during child custody hearings, courts are ruling in favor of people unfairly accused of alienation and are also ruling against people who have been alienated. He added that some evaluators do not understand alienation, and some evaluators want to apply it in every case.

Reformulations
Since Gardner proposed PAS, other researchers in the field haver suggested focussing less on diagnosing a syndrome and more on what has been described as the "alienated child", and the dynamics of the situation that have contributed to the alienation. In this view, alienation is seen as a breakdown of attachment between parent and child, and may be caused by multiple factors. The behaviors of all family members, including those of the alienated parent, may lead to the family dysfunction and rejection of a parent. The evaluation of all contributing factors and all possible remedies are recommended in evaluating cases where children has estranged from a parent.