Older Child Adoption

What is RAD?
RAD (Reactive Attachment Disorder) is a psychological and neurological (although the psychological diagnosis “bible” only calls it psychological) disorder that occurs during the first two years of life when a child does not attach and bond properly to their primary caregiver. Fundamental processes do not occur resulting in on-going rage, fear of attaching to anyone, lack of trust, an unusual effort to control everything in their lives, a lack of self worth, and an inability to fully comprehend cause and effect.

Give me some examples of how RAD develops�
A baby cries and cries and no one comes. A baby has a wet diaper, and it isn’t changed for hours. No one smiles at the baby. The baby learns to feel unworthy of love.

A baby is generally ignored and is only able to get attention through extreme misbehaviors or by being overly cute.

Because the primary parent mistreats the child, she assumes that all caregivers are inherently mean.

No one cares for the baby’s basic needs. The baby doesn’t trust anyone.

Sometimes when the baby cries she’s ignored. Sometimes when she cries, someone yells at her. Sometimes when she cries, someone gives her a bottle. Sometimes when she cries, some one smiles and rocks her. She does not learn proper cause and effect.

Why don’t I know about RAD?
The diagnosis hasn’t been used until fairly recently. Even many psychiatrists, social workers, and psychologists don’t know about it. So, it’s not surprising that the general public isn’t aware of it. Other psychological and neurological disorders are so common as to be written into movie and TV scripts. Think of Rain Man and autism. Other disorders such as Obsessive Compulsive Disorder, Attention Deficit Disorder, and others have become a common part of our general awareness. RAD will, but it’s still new.

I think I’ve heard of RAD�but aren’t they supposed to be kids who burn down houses, kill pets, and are unable to attach to their parents?
When RAD was first diagnosed, the cases that were identified and treated were the extreme ones. Now, there’s a realization that RAD, like most illnesses and diagnosis’s, has varying degrees of severity.

Hannah does not fall into that extreme category. Her behaviors are most often directed at me and include rages, an under-developed understanding of cause and effect, an insatiable need to be in control, and low self esteem. She does show some minor RAD behaviors toward all of you, but you don’t yet identify them as RAD.

Who gets RAD? Is it just adopted kids, or post institutionalized children�?
Any child who lives through separation, neglect, or multiple caregivers in the first two years of their life can suffer from RAD. It can even develop in-utero.

Isn’t PTSD something prisoners of war, or veterans get?
Post Traumatic Stress Disorder (previously called “shell shock”) can affect anyone going through severe events–things that threaten their life or their physical well-being. It can be a single incident i.e. being rescued from a burning building, an earthquake, being shot at; or from multiple incidents i.e. domestic violence, or being repeatedly abused or neglected. The results can include intrusive memories of those past events, horrifying dreams of those events, intense anger when confronted with situations similar to those past events, and a continued state of hyper-vigilence.

I JUST DON’T UNDERSTAND�

How can she have RAD? It’s always seemed like you two have had such a loving, affectionate relationship.
We do, but from within her, it could be better�stronger. It’s as if she has a hole in her heart that right now she won’t let me fill. As she heals, the bond will be even tighter. And, remember, since her RAD is on the mild side, her affection toward me is much, much stronger than a child with severe RAD. Our therapist describes it by saying that Hannah is as attached to me as she probably ever has been to anyone. And that her violence toward me is, in part, her way to fight that attachment, since in her early years, attachments just brought pain.

Isn’t she just being a kid�my child does that too�
Several things differentiate Hannah’s behaviors from your child. Your child might yell and kick the floor for half an hour in an attempt to annoy you when you tell your child she can’t get a new Nintendo game. Hannah screams, and attempts (and often succeeds) to bite me, kick me, hit me, for hours on end, with an intent to inflict harm and abuse, because I asked her to wipe the table.

The other difference is the reason for her misbehaviors. Your child might occasionally forget to do something they’re supposed to do. Or they might be testing the limits through the normal developmental process. Hannah, and all children with RAD, “forget” things over and over, and misbehave in an attempt to control their world, engage you, and generally make you miserable.

Aren’t you attributing normal childhood behavior to her background?

No. As I mentioned previously, her behaviors are not “normal.” They are more intense, more pervasive, and done for different reasons.

You just need to set firm limits as a parent.
Ha! In fact, I’m a true “mean mama!” I’m very firm. I’m very explicit with my expectations. And I always give consequences when rules are broken, or behavior is unacceptable.

This is one of the on-going issues in families who have children with RAD. Normal parenting techniques and behavior modifications, and consequences like time-outs, don’t work with RAD children.

Being reasonable and explaining why things should or shouldn’t be done, doesn’t work, because children with RAD aren’t reasonable. They are doing the behavior intentionally, often in an effort to engage you, thus controlling their world. Secondly, they have a mis-connect about cause and effect. It’s as if their cause and effect development is stuck at one or two years old. Thirdly, things like time out merely reinforce their lack of self worth i.e., “I’m being sent away from the people who are supposed to care about me�AGAIN.”

Why don’t I see her horrible behavior?
Some children with RAD, the more severe cases, are manipulative and out-of-control in all areas of their lives. With Hannah’s less severe RAD, it’s mostly limited to her behavior at home. Also, the therapist says that because of my firm parenting style, and my attachment-aware parenting techniques, Hannah “shows” well, and in fact, may have already done some limited healing.

At her age, surely Hannah can learn how to control her emotions. She just has to be taught.
With a “normal” child, this would be true. But, on some issues, Hannah’s development is stuck at a much younger age than she is. Her brain needs to be “re-wired,” and re-taught. Also, considering that her RAD is tied in with PTDS, you wouldn’t say to a Vietnam vet who has PTDS flashbacks, “Just stop that, you’re old enough to know better.”

Why are you so strict with her?
RAD behavior is often an effort to feel safe. But in a perverse way, what they’re trying to do is prove that no one is strong enough to be in control of them. They make efforts over and over to prove that you can’t control them, which then reinforces their fear that no one is strong enough to keep them safe. At the same time, they can be very manipulative, in extremely subtle ways.

I’m strict for three main reasons. The primary one is to reinforce to Hannah that I am strong enough to be in control (of her behaviors and her manipulations), and to be her parent. Secondly, because her cause and effect “mechanism” needs work, I need to repeatedly re-enforce that wrong choices result in consequences. Thirdly, her behaviors can escalate very quickly, so I don’t let anything slip past.

What triggered this recent escalation in her behaviors?
We may never know, but several things may have contributed… We moved in September. Even though she says she’s glad to be here, major moves in her past have always been extremely traumatic. I think this move may have triggered some PTSD flashbacks and insecurities. Also, I traveled twice in March for business, after not having traveled since September. That also may have contributed to her RAD and PTSD issues.

TREATMENT AND HEALING

Why did it take you so long to find the right therapist and get a diagnosis?
On one hand, it’s because, our previous two therapists were unfamiliar with and/or untrained in attachment and attachment therapy. And, for a long time, while I knew that Hannah had attachment issues, I didn’t realize it was RAD.

In my search to find a therapist after Hannah’s escalation in rages, one therapist I spoke with (who has some basic awareness and knowledge of RAD) said, “I think you need to talk to a therapist who can diagnose and treat RAD.” She was right.

Can’t she just take some medication to calm her down?
Depending on the outcome of the RAD and PTSD therapy, this may be something I consider. At the moment, however, I’m certain that the rages are tied to her RAD and PTSD and I feel confident that the treatment plan will re-connect her thought processes and overcome her poor behaviors. If, in the future, the therapist and I think there are some additional neurological issues, then I’ll get Hannah a psychiatric and/or neurological exam to evaluate that possibility.

Just let her stay with us for a few days. It will give both of you a break.
For a while, I can’t do that unless you’ve learned how to parent her this new way. Staying with someone who doesn’t follow my approach results in two outcomes. One, she is given too much freedom and feels that the adults she’s with are not keeping her safe. And, two, she concurrently thinks, “Hey, this is fun! These people don’t catch on to me like my mom does. What a pain to think I have to live with someone who expects me to be so totally responsible for my choices, and who expects me to work so hard to get better�”

From my perspective, it’s as if I found out my child had diabetes and was following a strict plan of proper eating, daily exercise, and twice daily injections to help her be healthy. I wouldn’t send her to stay with you unless you knew, understood, and were willing to give her what she needed to be safe and healthy.

If any of you want to learn the special parenting approaches, let me know and I’ll give you some reading materials and videos. Otherwise, I’ll take a rain check and let Hannah come stay with you after she has healed.

What is therapeutic respite care and how will you find it?
There are a couple people in western North Carolina who are trained in providing RAD parenting approaches during respite. I’ll develop contact with them and use them to give me a break from this very intense parenting, and at the same time, keep the structure the same around Hannah as it is when I’m parenting her.

How do you feel about the RAD and PTSD diagnosis?
Good�overwhelmed�bad�concerned�pleased�. Good because now I have a plan. Overwhelmed because this type of parenting is very challenging and I�m still learning how to do it right. Bad because it means the bond between Hannah and me is not quite as tight as I thought it was. Pleased because I know it’s treatable, and also because our therapist is super wonderful!

What is included in her treatment plan?
There are several parts as of now. These may shift and change as we continue to work with the therapist and she gets to know us better. Right now it includes: fine tuning my therapeutic parenting approach, weekly therapy sessions, and getting occasional RAD respite care. We’re also discussing an “intensive” which would be where Hannah and I go to an attachment treatment center for a week or two.

How long will it take?
As with any treatment plan, it’s hard to be precise. Maybe 10 – 12 months, with some dramatic improvements in the first few months, and more improvements following an intensive therapy session.

In the end, will Hannah be over all of this, or will there be lingering affects?
Generally, with proper treatment, and assuming that Hannah’s RAD and PTSD are as mild as they seem to be, she should be able to fully recover and function as well as the rest of us do. Although, I’m not sure any one fully “gets over” what she suffered in the first six years of her life�

What is the end result for RAD kids if they don�t get therapy?
As they get older, without treatment, their effort to control their lives intensifies, and the level of their violence increases. Treatment before the age of 12 has extremely high success rates. After that, the positive outcomes decrease. Some older children who do not receive treatment early enough, or who get improper treatment, end up in residential treatment centers because their parents are unable to care for such violent and manipulative children in their home. I’m very happy we’re treating this when we are, with exactly the right therapist.

Some days, don’t you just feel like sending her back?

Never. Not even deep down. Well, not anymore than the rest of you want to send your child off to live at the North Pole on some days!

Since most of you have not adopted a child, you don’t realize that love has NOTHING to do with biology. I know you THINK that love has to do with the sperm of the father�carrying the child in your womb�the family genes�and so forth, but, it’s not true.

Love comes from acting like a parent, from taking care of your child, from loving your child, and from committing to your child. Hannah is my daughter. Forever. If she had MS, I’d keep her. If she had an accident and ended up in a wheel chair, I’d keep her. Just like you’d keep and love your child. I’m no different and my love is no different.