I’m in Atlanta at the Navigating RAD 22 conference with RAD Advocates this weekend. For those of you who couldn’t make it, this is your place for the highlights from the amazing speakers!
Co-existing Disorders with RAD and their Effective Medical Treatment
Dr. John F. Alston, MD
Highlights & Takeaways
- The fatal flaw in the overall treatment of RAD is with psychiatric interventions and medications.
- The most common co-morbidity in children with RAD is childhood bipolar but it is often misdiagnosed as other disorders including PTSD.
- There is a high likelihood kids with RAD have an inherited mental health disorder.
- Normal biological parents do not create abusive circumstances for their children. Most abusive biological parents abuse methamphetamines, are ages 18-25, and they don’t want to stop. Up to 70% of people with substance abuse have coexisting mental illness. Up to 70% of people with bipolar disorder abuse substances.
- Bipolar is an inherited mood disorder that affects 3-5% of the population. It is the most likely inherited disorder children with RAD have. They also may have antisocial personality disorder, borderline personality disorder, or paranoid schizophrenia (very rare).
- If your RAD kid has coexisting childhood bipolar, antidepressants will have an adverse effect. Kids with childhood bipolar often get misdiagnosed with PTSD. A key indicator of misdiagnosis is a child who truly has PTSD should be overly compliant not defiant. Kids are prescribed antidepressants for PTSD. However, when the PTSD is a misdiagnosis and the child has bipolar, the antidepressants will accentuate rapid cycling (according to 20 of 21 studies)
- Stimulants will have an adverse effect on your RAD kid. Kids with bipolar often get misdiagnosed with ADHD and prescribed stimulants. Probably no more than 10% of kids with RAD also have ADHD. Stimulants will exacerbate the RAD symptoms and even for a correct ADHD should be the last not first prescribed medication.
- Mood stabilizing medications work very well for RAD kids. The most often prescribed mood stabilizers are Depakote and Lithium which are effective, but can cause massive even life-threatening side effects. In Dr. Alston’s practice he looked to these as much safer alternatives: Lamictal (10% skin rash side effect, slow to take effect). Trileptal which is not FDA approved as a mood stabilizer.
- Atypical antipsychotic medications work very well for RAD kids but need to be given in adequate doses. Many clinicians give sub-therapeutic dosages and then discontinue usage when it doesn’t work. Also parents tend to ask for the lowest effective dose assuming the dose can be the minimum. Many RAD kids with bipolar are moderately to substantially mentally ill and need substantially higher dosages to get and stay better.
- Medications, potentially lifelong, are an opportunity for our children to have a full, functioning life. This is because medications treat the genetic root cause of the illness. Appropriate medications and dosages help dysregulated and behaviorally disturbed kids feel better about themselves, help them think more clearly, and help them to be more likely to coexist peacefully in their families. Medications help everybody – the child, the family, and the community.
Dr. John F. Alston, MD is a child, adolescent, family, and adult psychiatrist. He has a significant national reputation within the attachment community. He has evaluated and treated over 3,000 patients with disruptive behavioral disorders associated with early life abuse and neglect. Dr. Alston has published several articles in medical journals and a book chapter emphasizing the co-existence of childhood mood disorders, especially bipolar disorder with reactive attachment disorder.