RAD, DTD – What’s all the controversy about?

Tweets. Facebook messages. Verbal knockouts. One too many times, I’ve been told reactive attachment disorder (RAD)—the result of a child’s early trauma—isn’t a “real” diagnosis. When parents like me hear that our child’s diagnosis is fake, bogus, or phony, it’s like a kick in the stomach. We feel invalidated, misunderstood, hurt, angry, and frustrated.

I’ve even had more than one mental health professional question my son’s diagnosis of RAD. I’m not sure if this stems from a lack of education, of effort, or of something else. Here is what I, and other parents raising children like my son, know for certainwe know RAD is “real” because we’re living with it.

Parents know firsthand the heartbreak and frustration of raising a child who cannot receive or return our love…and what that looks like in the privacy of our own homes.

A new diagnoses for early trauma

To complicate matters, there is another diagnosis outside of RAD to explain the effects of early trauma. Many clinicians are advocating for the elimination of the RAD diagnosis altogether in lieu of developmental trauma disorder (DTD).

The term DTD was coined by Dr. Bessel van der Kolk who I recently heard speak at the 2018 ATTACh conference. Over the three days of that conference, I had the opportunity to learn more about the DTD diagnosis and the controversy attached from leading researchers and clinicians and I walked away with a new perspective…

Here’s what I heard:

  • We don’t like the label “RAD,” but we totally get it. We understand the extreme behaviors and challenges parents are facing on a daily basis.

  • We want to partner with parents because we believe healthy relationships with adoptive parents are the key to healing for these kids.

  • We know it is very difficult to find and access effective treatments for the impacts of early trauma. We’re advocating every day for adoptive families and focusing our research on meaningful treatments for trauma.

As I absorbed more about the DTD diagnosis, I realized parents and professionals are talking past each other on this issue. These professionals aren’t denying our experiences. They’re questioning how we categorize, label, and communicate about it.

Here is what I, and other parents raising children like my son, know for certain—we know RAD is “real” because we’re living with it. Click To Tweet

What can we agree upon?

  1. Attachment is only one of the ways early childhood trauma impacts kids. We already know this as parents. Our kids have learning disabilities, cognitive issues, developmental delays, emotional problems, as well as attachment issues. In fact, most of our kids have an alphabet soup of diagnoses to cover all their symptoms.

  2. Having a correct diagnosis is important. Children with early childhood trauma are often misdiagnosed and therefore don’t receive treatment. Furthermore, the RAD diagnosis is only the attachment piece of the puzzle. There are a number of diagnoses frequently given to victims of early childhood trauma including PTSD, conduct disorder, ADHD, and RAD. No one disorder covers the complexity of the issues our children face.

  3. Regardless of what the diagnosis is called, parents just want help. We’re desperate for treatments that work, therapists who understand, schools where our kids can be successful, more awareness in our communities, and strategies to better parent our children. We want our children to heal and thrive.

What’s in a name?

The Diagnostic and Statistical Manual of Mental Disorders (DSM) is the guide mental health professionals use to diagnose mental disorders. It’s used by providers to submit insurance reimbursement claims. RAD was added to the DSM as a diagnosis in the 1980s. Three decades ago is a long time! Neuroscience has made huge advances and it’s time for the DSM to catch up.

Here are definitions of the RAD and DTD diagnoses in a nutshell:

RAD is caused by childhood neglect or abuse which leads to a child not forming a healthy emotional attachments with their caregivers. As a result they struggle to form meaningful attachments leading to a variety of behavioral symptoms.

DTD is caused by childhood exposure to trauma. As a result they may be dysregulated, have attachment issues, behavioral issues, cognitive problems, and poor self esteem. In addition, they may have functional impairments in these areas: Educational, Familial, Peer, Legal, Vocational. (footnote)

As you can see, the DTD diagnosis brings the impacts of childhood trauma under one umbrella. It enables mental health professionals to take a holistic approach to our children instead of piecemeal treatments.

Experts petitioned the American Psychiatric Association (APA) to have the DTD diagnosis added to the latest version of the DSM. The request was denied. One cannot help but wonder the impact the health insurance industry had this decision. In fact, Bessel van der Kolk made this point at the ATTACh conference, urging mental health professionals and parents to become politically active around this issue.

While the APA rejected the diagnosis in this latest version of the DSM, leading researchers and experts have embraced the DTD diagnosis. For example, the Institute for Attachment and Childhood Development is not waiting for the inclusion of DTD into the DSM in order to properly acknowledge it. 

When mental health and other professionals frown at the RAD diagnosis, they’re not invalidating our very real experiences. On the contrary, they’re recognizing that the current diagnoses, including RAD, don’t adequately describe the severe and devastating impact trauma has had on our children. They’re advocating for more research, treatments, and funding for our kids.

This mom’s resolution of the diagnoses for trauma

Until DTD is added to the DSM and/or covered by health insurance, to embrace the diagnosis still poses issues for parents. Treatment and care for children with early trauma backgrounds is expensive. The DTD diagnosis doesn’t currently qualify for insurance reimbursements. So, for now, I’m hanging onto my son’s RAD diagnosis. For better or worse, that’s how our healthcare system works.

When mental health and other professionals frown at the RAD diagnosis, they’re not invalidating our very real experiences…they’re advocating for more research, treatments, and funding for our kids.

However, I’m thrilled the mental health community is recognizing the devastating scope of impact early childhood trauma has on our children. I’m optimistic about the promising advances in neuroscience that are leading to new treatments. The DTD diagnosis is a major step forward in helping children like mine, who have suffered early childhood trauma, to heal and thrive.

Footnote: http://www.traumacenter.org/products/pdf_files/preprint_dev_trauma_disorder.

Originally posted by IACD here.