Category: About RAD

What is Reactive Attachment Disorder (RAD)?

Also published on The Mighty

I visualize my son’s mental disorder, Reactive Attachment Disorder (RAD), as a tug-of-war. If I tell him to wear blue socks, he’ll wear white. If I make his favorite sandwich, he’ll toss it in the trash and tell his teacher I didn’t send him with lunch. If I ask him to write his spelling words three times, he won’t even pick up his pencil. And there’s no negotiation. If I compromise and ask him to write them only once, he’ll still refuse.

No matter how inconsequential or mundane the issue is, my son treats everything as though it’s a tug of war, and the stakes couldn’t be higher. For him it’s a life-or-death battle. He must win at all costs – no matter how long it takes, and despite any consequences he’s given or any rewards he’s promised.

Kids with RAD have an indefatigable need to control the people and situations around them because they only feel safe when they prove to themselves they are in control. To understand this, we must go back to the underlying causes of the disorder.

What causes RAD?

RAD is caused by adverse childhood experiences (also called ACES) that occur during the first five years of a child’s life. This is when their rapidly developing brain is most vulnerable.

In my son’s case, he was neglected before we adopted him out of foster care at the age four. Other ACES include witnessing domestic violence, having a substance addicted parent, and losing a primary caregiver.

These experiences can cause “developmental trauma,” a term coined by leading trauma expert and researcher Bessel van der Kolk. Depending on the timing, duration, and severity of the adversity, a child can be affected in two key ways.

  1. Stuck in chronic survival mode. The fight-flight-freeze is not meant to be our “normal.” Its purpose is to kick in to keep us safe from danger. When kids are chronically abused and neglected, their brains are chronically bathed in adrenaline. As a result, they may begin to default to fight-fight-freeze even in minimally threatening situations. These kids can be hypervigilant and seem to overreact.
  2. Interrupted brain development. Our brain develops sequentially beginning with the primitive brain which controls our basic functions including our breathing and heart rate. The limbic brain comes next and regulates behavior, emotions, and attachment. The cortical brain – where critical, abstract, and cause-and-effect thinking live – comes online last. When kids experience chronic trauma, their brain may not develop properly. These kids can be dysregulated and lack high-level thinking skills.

The impact of developmental trauma is on a spectrum with a variety of symptoms and severity. This is closely related to stage of the child’s brain development at the time the trauma occurred. Unfortunately, there is no single diagnosis that covers all the symptoms of developmental trauma. Children are often given multiple diagnoses including Attention Deficit Hyperactive Disorder (ADHD), Post Traumatic Stress Disorder (PTSD), and RAD.

What is RAD?

RAD is a diagnosis given to children who have experienced chronic developmental trauma before the age of five and did not form at healthy attachment to a primary caregiver, usually their mother. They grow up without an inherent sense of being safe and loved. Instead their psyche internalizes the message they must take care of themselves because no one else will.

The world feels alarmingly unsafe and unpredictable – and that’s why they lock into a tug-of-war with their primary caregiver. Remember too, these children may be “stuck” in survival mode. They may literally perceive an innocuous situation as threatening and kick into fight-flight-freeze mode. Their higher-level brain functions like cause-and-effect thinking may be underdeveloped. This is why they cannot be reasoned with or talked down.

How to end the tug of war

As a parent, the constant tug-of-war, is exhausting, frustrating, and discouraging. Our impulse is often to tug our side of the rope even harder – to teach our child who is boss. We dole out consequences and insist on compliance. They need to learn to respect authority and obey, right? It’s parenting 101.

But traditional parenting backfires spectacularly with kids diagnosed with RAD. They dig in their heels and tighten their grip on their side of the rope. It will inevitably exacerbate the situation and strain the relationship with our child.

It may seem counterintuitive, but to help our child drop his side of the rope, we must first drop ours. This is accomplished by employing therapeutic parenting strategies that prioritize relationship building and focus on the communication and the needs behind the behavior.

Let’s look at how therapeutic parenting can transform the tug-of-war with my son.

  1. When I tell him to wear blue socks, he’ll insist on wearing white. It doesn’t really matter what color socks he wears. I decide to let him make these types of choices whenever possible which enables him to enjoy some sense of control.
  2. He’ll toss his lunch in the trash and tell his teacher I didn’t send one. Perhaps he’s lining up a backup food source because he’s unconsciously afraid I’ll stop feeding him one day. By providing consistent nurturing over time, this need – thus this behavior – will diminish.
  3. Instead of writing his spelling words, he’ll stare at his pencil. I can make this a non-issue by leaving it to his teacher to follow up. If necessary, I can pursue a 504 plan or Individual Education Plan (IEP) to ensure the accommodations he needs to be successful.

And with that, I’ve dropped my side of the rope. We are no longer locked in a tug-of-war.

Of course, it’s easier said than done and takes great patience and perseverance. RAD is a very challenging disorder to manage and there are no quick and easy fixes. A good starting point is recognizing the underlying causes and educating yourself on the therapeutic parenting approach.

RAD Symptoms – which are most common?

Parents of kids diagnosed with Reactive Attachment Disorder (RAD) are all too familiar with the symptoms. Anecdotally we often list food hoarding, violent outbursts, crazy lying, to name a few. However, there is little research on just how common each of these symptoms are.

The symptoms of RAD fall into three general categories – physical aggression, relational difficulties, and survival based behaviors. This is not surprising given the diagnostic criteria for RAD in the DSM 5. Kids with RAD have experienced chronic neglect or abuse before the age of 5 and did not form a nurturing bond with a primary caregiver.

But which symptoms are most common? To explore this further we collected data on 277 children and analyzed the results of the 236 who have been formally diagnosed with RAD.

The most common symptoms

Based on the survey results these are the most common symptoms for kids diagnosed with RAD.

  • “Crazy Lying” ….89%
  • Superficially charming …..89%
  • Damaging property …..86%
  • Poor boundaries …..85%
  • Stealing ….79%
  • Gorging/Grazing …..77%
  • Violent Outbursts ….77%

Crazy lying is the most common symptom, as many parents of kids diagnosed with RAD might have guessed. This can be as benign – though frustrating – as a kid claiming they had pizza for dinner when they had chicken. Unfortunately, it can also be dangerous. One survey respondents says her 9-year-old son has made continuous false allegations of abuse, to the point she and her husband are now now facing criminal charges. 

Being superficially charming is also a well known hallmark of the RAD diagnosis. One mom says, “I wish our child would treat the family as well as she treats strangers. They think she’s inspirational and cannot understand why she’s currently living in a treatment center.”

While it is disheartening to see these symptoms so common – over 3/4 of kids – it can be reassuring for parents to know they aren’t alone.

Aggressive symptoms

Developmental trauma can result in impaired brain development, depending on the time the trauma occurred. Many of these children have poor impulse control and are disregulated. In addition, chronic abuse they may have heightened their fight-flight response that activates in even minimally threatening situations. This can underpin many aggressive behaviors.

Out of the children studied, 94% exhibit some form of aggression. Here are the detailed results.

Damaging property86%
Violent outbursts77%
Physical aggression to mother71%
Physical aggression to siblings66%
Physical aggression to pets46%
Weaponizing bodily fluids39%
Physical aggression to others37%
Physical aggression to father26%

Worth noting:

  • The most common physical aggression is towards the child’s mother. This is expected because these children see their mother as the nurturing enemy. One mom says, “I survive by being numb to everything. I’m a shell of the person I once was, having no life or spark left in me. I honestly can’t think of one thing I enjoy doing anymore.”
  • The second most common physical aggression is towards siblings. They are often the overlooked victims of the disorder.

See also the results of my survey results on I-CPV (Intentional Child on Parent Violence).

Social Relational symptoms

Children diagnosed with RAD did not form a nurturing bond with a primary caregiver – typically a mother figure. As a result they struggle to know how to form attachments with others. They are often obsessed with their need for control – to combat what feels like an unsafe and unpredictable world – and view relationships as a means to an end.

Out of the children studied, 98% exhibit some form of social relational symptoms. Here are the detailed results.

Crazy lying89%
Superficially charming89%
Lack of boundaries85%
Inappropriate affection65%

Worth noting:

  • These children often have underdeveloped high-level brain functions. Their cause-and-effect thinking, for example, may be impaired or not “on-line.” This likely plays into the “crazy” lying symptomology.
  • These children have an innate sense of insecurity. They are afraid of authentic relationships and don’t know how to attach. They also may view relationships as a means to an end because their basic need to survive trump all.

These types of symptoms can be extremely challenging for the whole family. One parent says, “This has almost ruined our lives.  Our whole family has to go into therapy because of our son.  If it weren’t for the grace of God, we wouldn’t have a family.”

Survival symptoms

Kids with RAD have been neglected and abused. They may have cried in their crib when their belly hurt. Sometimes they were fed, but often they were hit or cried themselves to sleep – still hungry. For a young child who cannot process this, their body absorbs the trauma. They unconsciously learn that the world is unsafe and unpredictable and often their behaviors seem survival based.

Out of the children studied, 98% exhibit some form of survival based behaviors. Here are the detailed results.

Stealing79%
Gorging/Binging/Grazing77%
Potty Issues64%
Food hoarding57%

Worth noting:

  • Kids often hoard even when given free access to food. This behavior is often driven by unconscious food insecurity. Understanding this can help parents better address the behavior.
  • Potty issues may be developmental delays or due to neglect and abuse. Abuse and neglect can cause brain injury that results in developmental delays, and, for example, late potty training. Kids may also choose not to use the toilet because of PTSD type symptoms from abuse.

If you’re a mental health professional reading these survey results, please know how desperately these children need affordable, accessible, effective treatments. Many therapists disregard parents reports of these symptoms because they seem too extreme. These results prove they are not.

If you are a parent, I highly recommend The A-Z of Therapeutic Parenting. It’s an excellent practical resource. Check out my review here.

Do these results jibe with your own experience? Drop a note in the comments to let me know.

An Introduction to Developmental Trauma

Also published by The Mighty (upcoming)

Nearly half of America’s children are exposed to one or more adverse childhood experiences (ACES). ACES include being neglected or abused, witnessing domestic violence, having a substance addicted or incarcerated family member, and being forcibly separated from a primary caregiver.

Children with a single ACE often have positive long-term outcomes. However, as ACES begin piling up, they can have very serious long-term impacts. This is most common among kids who have spent time in foster care and in high-risk families.

Chronic ACES that occur before a child reaches the age of five can cause “developmental trauma,” a term coined by leading expert and researcher Bessel van der Kolk.

Trauma and Brain Development

Developmental Psychopathy, the study of how trauma impacts the development of the mind and brain, is an emerging field. What we do know is the impact of trauma depends on what stage of brain development the child is in when they experience the trauma.

For example, if a child experiences chronic trauma at six months this is the peak of primitive brain development. Limbic brain development is underway and the cortical brain is in the beginning stages. Chronic abuse or neglect at this time has the potential to affect the primitive brain functions including coordination and arousal.

In addition, because the brain develops like sequential building blocks, any impairment of the primitive brain may cause the limbic and cortical brain to not develop normally. In this way, trauma can cause a devastating domino effect.

It’s important to understand developmental trauma is a brain injury. It’s caused by chronic trauma endured in the first five years of life when the developing brain is most vulnerable.

Diagnosing the effects of Developmental Trauma

Unfortunately, there’s no single diagnosis in the DSM-5 (the manual used by clinicians to diagnose mental illness) that covers all the symptoms of developmental trauma. For this reason, kids are often given several different, seemingly unrelated diagnoses.

A few of the most common are:

Attention Deficit Disorder (ADHD)
• Post-Traumatic Stress Disorder (PTSD)
• Reactive Attachment Disorder (RAD)
• Sensory Processing Disorder
• Anxiety disorders
• Learning Disabilities
• Developmental Delays
• Oppositional Defiant Disorder (ODD)

Visualize each of these diagnosis as their own umbrella with the associated symptoms beneath. Kids with developmental trauma are often balancing two, three, or more of these umbrellas. It’s not uncommon for a child to be diagnosed with ADHD, PTSD, RAD, and ODD – or any number of other combinations.

Unfortunately, this diagnostic method is a disservice to children who have developmental trauma.

Let’s take ADHD as an example. The ADHD diagnosis is for kids who have persistent symptoms of inattentiveness, hyperactivity, impulsivity that manifest in more than one domain, for example both school and home. ADHD is caused by a, often hereditary, chemical imbalance. Stimulant medications work because they increase certain chemicals in the brain.

Kids with developmental trauma may also be inattentive, hyperactive, and impulsive. However, the symptoms are not caused by a chemical imbalance as they are with ADHD. They are caused by underdeveloped and impaired brain functions or an over-sensitive fight-flight-freeze response. Stimulant medications can exacerbate other symptoms of developmental trauma.

Unfortunately, ADHD is not the only insufficient diagnosis commonly given to kids with developmental trauma. In many cases this can result in a child receiving ineffective treatment. Worse still, these diagnoses may mask the real issue and it will go untreated.

Developmental Trauma Disorder

To better serve children with developmental trauma, Kolk has proposed adding a new diagnosis to the DSM called Developmental Trauma Disorder (DTD). The new diagnostic criteria requires exposure to chronic trauma before the age of 5. This diagnosis would fully encompass the symptoms of developmental trauma bringing them under one umbrella.

The DTD diagnosis would enable clinicians to more accurately diagnose developmental trauma. In addition, comprehensive treatments for DTD could be developed. This an area of neuroscience Dr. Bruce Perry is pioneering with his Neuro Sequential Model of Therapeutics. His approach includes mapping of underdeveloped brain functionality and a process to stimulate healing in the order of natural brain development.

Largely due to political and financial forces, the DTD diagnosis was not included in the latest version of the DSM. Advocates are working to have it included in the next revision which is several years away. In the meantime, parents must know how to successfully navigate the current diagnoses to get their child proper treatment.

Getting your child the best care

Because DTD is not in the DSM, it is not an official diagnosis and not covered by health insurance. Until this changes your child will be given other diagnoses to fully describe his or her symptoms.

Here’s what you can do to ensure the best treatment:

  1. Early intervention is key so seek professional help as soon as you recognize there may be a problem or become aware of your child’s trauma history.
  2. Go ahead and accept the alphabet soup of diagnoses. These are essential to get health insurance coverage for the very expensive treatments and therapies your child may need.
  3. Get a psychological evaluation from a psychiatrist. If you know your child has a history of trauma, don’t settle for an ADHD diagnosis from your pediatrician. Ask for a referral to get a full evaluation.
  4. See a psychiatrist for medication management. For your convenience, most pediatricians will continue refilling prescriptions once the patient is stabilized. However, get started on the right foot with a psychiatrist.
  5. Seek out therapists and other practitioners who have experience working with traumatized children.

As your child’s primary advocate, it’s critical for you to keep the entire team focused on the trauma underlying his or her symptoms. Learn all you can about developmental trauma and keep it at the forefront when you discuss your child’s treatment plan with mental health professionals, educators, therapists, and pediatricians. These steps will ensure your child gets the best treatment available.

Parents of kids with RAD: 10 Unfortunate truths you must know

Parents of kids who have severe Reactive Attachment Disorder (RAD) often feel as if they are on the verge of a nervous breakdown. They are afraid – perhaps even terrified – of their children. They literally wonder how they’ll make it through the next day. Some are suicidal. Many are depressed, fearful, and unable to cope. Too many parents, years after their child is grown and gone, deeply regret sacrificing their other children, their marriages, and their mental health and wellbeing. 

I’ve been there.

This is straightforward advice, one parent to another that you’re not going to find anywhere else. It’s specifically for parents of children who are dangerous and violent and does not necessarily apply to children with mild or moderate RAD symptoms.

Let’s strip away the platitudes and talk about surviving. Here’s my unfiltered, pragmatic RAD-parent-to-RAD-parent advice: 

1. If your child has been diagnosed with RAD and is exhibiting extreme behaviors that you can’t safely deal with on your own, get your child into treatment as soon as possible.

Do whatever it takes. Go to the mental health ER every single time your child’s behavior is dangerous to himself and others – even if it’s every week or every other day. Your insurance company will be most likely to fund the treatment your child needs if they understand the gravity of the situation. When they are made aware of your child’s needs by regular ER visits made when your child needs intervention, they will be more likely to approve the needed treatment. 

2. If your child is violent towards you (Child on Parent Violence – CPV), you may need to press criminal charges.

Child-on-Parent Violence is quite common in homes where a child suffers from RAD. Yes, the justice system is unlikely to do them any good. But it may be the only option to keep you safe. Don’t put your safety in jeopardy by waiting too long.

3. Don’t beat yourself up for not having natural affection towards your child.

You have been the victim of trauma akin to domestic violence and no one believes a victim should naturally feel affection toward her abuser. It’s hard for us to think of children – even young grade school aged children – in these harsh terms, but it’s the reality. 

4. Be prepared for false allegations.

CPS will take seriously even the most absurd claims – despite witnesses and video footage – and you absolutely can lose ALL your children during these investigations. If the allegations are substantiated you can lose your children forever.  If your child has started making false allegations against you, consider this a huge warning – act fast to get help. 

5. Enjoy your summer break and let siblings enjoy it too.

If that means setting your child with RAD up with a TV and game system, do it. What good are parenting ideals if you sacrifice siblings to reach them? Someday you’ll look back on these years and be amazed at how you managed day to day. Be pragmatic and don’t lose yourself in a losing battle.

6. Your children are being exposed to domestic violence.

Exposure to hours of screaming, explosive rages, and physical attacks is harmful to siblings. They are being forced to live in a state of hyper-vigilance that can cause anxiety, depression, PTSD, and so much more. It would be considered child abuse or neglect for a mother to allow their children to be exposed to similar behavior spousal domestic abuse. Find a way to protect and provide time to talk with a therapist for siblings – they have rights too, and you have an obligation to them too. 

7. Some children with RAD abuse their siblings. 

They may bully younger siblings or abuse them physically, emotionally, or sexually. This is something you must keep a very close eye on. Remember children with RAD are often extremely manipulative and this can enable them to abuse their siblings right under your nose.

8. Realize that someday you may have to choose between protecting your non-RAD children and keeping your child who is exhibiting extreme, dangerous RAD behaviors at home. 

This may mean putting your child in residential programs that seem to be little more than “holding cells.” It may mean filing criminal charges against them. These are heartbreaking choices no parent should have to make, but they may be coming your way. Start mentally preparing yourself now.

9. If it is necessary for your child to receive help in a residential treatment facility, understand that the experience may aggravate your child’s behavior, possibly making it worse. 

Yes, in residential treatment facilities your child will be exposed to children with worse behaviors, and many of the “treatments” will empower your child to continue with his behaviors. Despite this, these facilities are sometimes the best, the necessary choice when you need to protect the child from himself and to keep siblings safe.

10. Your child’s therapist and treatment team are very likely to turn on you. 

As the parent, you are an easy target for therapists, and much easier to focus on than RAD. Also, providers need to show positive outcomes to continue receiving funding and some will skew the truth to do it. Always remember that this is your child’s team, not yours.

Adapted from: Reactive Attachment Disorder (RAD): The Essential Guide for Parents

The ugly truth about trauma

Warning: Graphic image

Because trauma from early childhood neglect and abuse is invisible to the untrained eye, we tend to imagine our children having only bruised and bleeding hearts.

In reality, some of our children have huge gaping trauma wounds. The gash is infected and oozing puss. It smells. It’s sticky and messy. No vital organ or system in our child’s body is safe from its insidious spread. As a result, our children can’t sleep or eat. They can’t learn. They don’t play nicely with others. Sometimes they spend days – years – delirious with fever and pain.

I’m sorry if this is disturbing, but that’s the point I’m making about trauma.

Our kids don’t know how to treat their own trauma gashes, but they’re afraid to let us help. They want us to just leave it alone and let it get better by itself. But trauma gashes, left to their own, can become life threatening or leave a mangled, ugly scar.

As parents we try to treat our child’s oozing trauma gash with bandaids, ice packs, and Neosporin. Afraid and in paid, they lash out at us like wounded animals no matter how lovingly we soothe and comfort. We explain the pain is only momentary, that we’re just trying to help the wound heal, but they fight to keep us far away.

Most trauma gashes need stitches or surgery. Our kids need highly specialized treatment that, more often than not, is unaffordable or inaccessible. And so, as parents, we just do the best we can with our inadequate home first aid kit.

Bruised and broken hearts can be comforted. And even trauma gashes can heal and fade with proper treatment and time, but they always leave a scar.

Learn more here:

Understanding the impact of childhood trauma
Raising a child with developmental trauma

Developmental Trauma and Psychosis


When my son was 12 he’d “snap” into one of two personalities – a ballerina or a thug – by shaking like a wet dog. As a ballerina he’d loop his arms over his head and plie across the lawn, deftly ignoring calls to come in for shower time. His thug personality was less benign. He’d curse and swagger, punching walls and sometimes people. 

Like many moms, I fancy myself a bit of a human-lie-detector, and was pretty sure my son was faking these “personalities.” This was confirmed by the results of a neurological exam, brain scan, and full psychological evaluation. No indications of psychosis. What he had been diagnosed with, however, was Reactive Attachment Disorder (RAD), also called Developmental Trauma Disorder (DTD). 

This left me wondering if there is a link between DTD and psychosis, and what parents can do to get their child the best possible treatment.

Is there a correlation between DTD and psychosis?

Up to 3.5% of the general population experiences psychosis. Psychotic symptoms most commonly include: 

  • Visual hallucinations – seeing things that aren’t there.
  • Auditory hallucinations – hearing things that aren’t there.
  • Sensory hallucinations – feeling things that aren’t there.
  • Delusions – beliefs that are not true and are irrational.

DTD is a brain injury caused by early childhood trauma (and RAD is just one related diagnosis). DTD can have wide ranging symptoms with varying severity depending on the stage of brain development the child was in when the trauma occurred. Symptoms can include attention deficits, poor impulse control, developmental delays, underdeveloped cause-and-effect thinking, aggression, and more. 

Psychosis, however, is not a symptom of DTD.

Though psychosis is not a symptom of their developmental trauma, some children with DTD do report hearing voices, seeing “beings,” or seem delusional. To delve deeper, I conducted a survey on this topic. Out of 184 parents, over 1/3 said their child reports symptoms of psychosis. 

(March 2019)

This is a significant number and a concern for many families. Since psychosis is not a symptom of DTD, if your child has reported any of these concerning symptoms the first step is understanding the possible causes. 

Potential causes of “psychotic” symptoms

1. The psychotic symptoms may be made up.

When a person fakes psychotic symptoms it is called malingering psychosis. Manipulation and lying are common behaviors of children diagnosed with DTD. These strategies are often used to gain a sense of control in what feels like an unsafe and unpredictable world. This was the case with my son. 

Tracy, another mom, says her son faked multiple personalities and was even diagnosed at one point with dissociative identity disorder (DID). After professional psychological evaluations, the clinician identified it as malingering psychosis. “He knew exactly what he was doing,” she says. 

Qualified psychologists are equipped to discern between malingering and true psychotic symptoms. Don’t rely on your own gut feelings. It’s always best to get a professional evaluation. In addition, if your child is faking symptoms they need treatment for the underlying reasons for this behavior.

For help with malingering psychosis, find a therapist who has extensive experience working with adopted or foster kids who have developmental trauma.

2. The psychotic symptoms may be a drug side effect. 

Children with DTD are commonly diagnosed with RAD, PTSD, ADHD, ODD, and more. They are frequently on a cocktail of serious medications, some of which may have psychosis as a potential side effect. 

Jessica’s son saw “little goblin creatures” when he was taking medications. “The last time, he said a naked man woke him up and told him to go outside,” she says. “Praise God he didn’t listen! That was a scary time.”

Psychotic symptoms may be a side effect of a drug, the result of drug interactions, or due to abruptly stopping or inconsistently taking the medication. Remember too, illicit drug use like LSD can cause psychotic symptoms. While appropriate medications have been helpful for many children it can takes some time to find the right combination.

For the best treatment insist on seeing a psychiatrist for medication management.

3. The psychotic symptoms may indicate a co-morbid disorder.

Disorders including schizophrenia, schizoaffective disorder, and bipolar can cause psychotic symptoms. These can be particularly difficult to diagnose in children because adoptive parents don’t have knowledge of hereditary mental illnesses that may run in the family. 

Furthermore, developmental trauma paired with a co-morbid disorder with psychotic symptoms can be a dangerous combination. “Developmental trauma disorder alone does not deem a child dangerous,” says Forrest Lien, Director of the Institute for Attachment and Child Development. “Furthermore, not all children with DTD have a mental illness. Yet, some do. Children with complex developmental trauma often feel angry and can lack empathy. When you combine a child who feels slighted and vengeful with [for example] a misdiagnosed or poorly-treated severe bipolar disorder with psychotic features, it can be dangerous.”

Angela, says her daughter “creates her own ‘truths’ or ‘realities.’ “At 11 and 12 I would hear her having long talks with herself but I never knew if she was putting on an act or if it is real…” This is a dilemma for parents because what seems like delusions may be immature thinking caused by the DTD.

For correct diagnoses, a professional evaluation is essential. 

Don’t panic – but do get professional help.

If your child is reporting psychotic symptoms, don’t panic – but do get professional help. Whether your child has malingering psychosis, is suffering a drug side effect, or has a co-morbid disorder they are signaling for help. With proper treatment and early intervention these children can grow and thrive.

Understanding the long-term impact of early childhood trauma

When Amias was born, I was totally and immediately infatuated with him. I breast-fed and co-slept. I almost never used a stroller or carrier – he was always in my arms. At his slightest whimper, I was there. When he was a toddler, Amias hated the bright Florida sunshine in his eyes. He would hold up a palm to shield his face as he rode in his car seat. When I hung a shade from the car window with suction cups, Amias knew for sure his mom would always take care of him, even if it meant “moving” the sun for him.

My adopted daughter Kayla didn’t grow up in this type of loving environment.

As a baby and toddler, Kayla would cry and scream to get someone’s attention when she was wet or hungry. Sometimes she was cared for. Sometimes she was ignored. Many times, she fell asleep still wet and hungry – having finally exhausted herself.

When we adopted Kayla out of foster care at three-years-old, she would scream for hours – literally hours – for seemingly no reason at all, no matter what we did in an attempt to comfort her. It was so severe a neighbor once pounded on our door and threatened to call the police and report us for child abuse. I really couldn’t blame him. I’d never known a child to scream for so long and for no reason.

Of course, though, there was a reason. We just didn’t know it back then.

Due to trauma during her early development, the lens Kayla viewed the world through was warped. It made even loving caregivers seem unsafe. Situations and people all appeared unpredictable. Kayla likely had no conscious awareness of this and she certainly could not verbalize it.

The Impact of Trauma

Leading trauma expert Bessel van der Kolk explains in his book The Body Keeps The Score that, “Trauma results in a fundamental reorganization of the way the mind and brain manage perceptions.” Because a young child’s brain is vulnerable, chronic abuse and neglect during the earliest years changes the way the brain normally develops–the root cause of developmental trauma disorder (DTD).

DTD can have a wide range of negative effects of varying severity. For Kayla it has caused a math learning disability, relational and attachment struggles, attention deficits, poor impulse control and more. These are daunting challenges in themselves but, remember, her view of reality is distorted which further compounds these issues.

To put this in context, consider for a moment how your worldview – optimistic, pessimistic, faith-based, etc. – impacts everything you do. For better or worse, we all filter our experiences though the lens of our worldview.

Amias and Kayla are only three-months apart in age, but their lenses are completely different because of their differing early childhood experiences. Kayla is far more prone than Amias to being anxious in new situations, to thwarting close relationships, and to misreading people and their intentions.

Due to the differences in their early childhood experiences and development, Kayla faces far more obstacles than her brother.

For many children like Kayla, developmental trauma can be a powerful determinative factor that dramatically impacts the quality of their relationships, their education and vocation, and mental and physical health. They have a higher risk for substance abuse, problems in school and incarceration.

Because Kayla was born into a different environment, she is at a disadvantage compared to her brother.

Healing the Impact of Early Trauma

Over time, a healthy attachment with a consistent caregiver like an adoptive parent can help alter the lens through which a child with DTD views the world. Unfortunately, it’s not as simple as changing out a pair of busted up, twisted, kid-sized sunglasses for a pair of top-of-the-line Ray Bans. If only it were as simple. You can think of the lens formed by developmental trauma as melted into a child’s cornea – that’s how deeply imbedded it is into the core of who they are.

“DTD falls on a spectrum. Some kids have more struggles than others. No matter the severity, however, the adults who raise them require extensive support of varying levels,” said the Institute for Attachment and Child Development Executive Director Forrest Lien. “Too often, however, caregivers are blamed and shamed rather than supported. This lack of support often leads to a variety of problems, including divorce and adoption disruption. Effective early intervention is vital for these families.”

For children on the moderate to severe end of the developmental trauma spectrum, highly specialized treatment is required to heal. For kids who are on the milder side of the spectrum, like my daughter Kayla, families can often find success through outpatient treatment, obtaining 504s/IEPs and implementing therapeutic parenting strategies.

Kayla has been with us for over a decade now and we’ve fought for support along the journey. Although her world will always be distorted to some extent by her trauma lens, she’s thriving despite her challenges. My hope is that someday Kayla will be secure enough in our relationship to know I’ll always move the sun and moon for her too.

2/3 of kids with RAD are first misdiagnosed with ADHD

It’s not ADHD!

Our recent Facebook poll showed that 67% of children first misdiagnosed with Reactive Attachment Disorder (RAD) and other developmental trauma diagnoses were first diagnosed with ADHD.

Survey by @RaisingDevon, March 2019

6 in 10 kids are being misdiagnosed with ADHD instead of RAD or other developmental trauma related disorders. Here’s what it matters:

  • Stimulant medications typically given for ADHD can exacerbate other symptoms the child is experiencing.
  • A misdiagnosis like this can cause significant delays in the child getting the treatment they need.

Keep in mind, kids with developmental trauma may have attention deficits and other symptoms of ADHD: inattentiveness, hyperactivity, impulsivity. However, the ADHD diagnosis doesn’t correctly point to the cause of those symptoms – the trauma. ADHD is a chemical imbalance often successfully addressed with stimulant medications. These same symptoms from developmental trauma are caused by a brain injury and stimulant medications can exacerbate other symptoms of developmental trauma. 

Here’s what parents are saying about how the misdiagnosis of ADHD impacted their child and family.

Our sons ADHD medicine amped him up causing extreme violent rages. He was arrested 3 times and faced felony assault charges from these rages. It wasnt until I was able to get a doctor to listen to me that he started to get better. His ADHD diagnosis and treatment made life hell at times. He is much better now and while we still have struggles, no one ends up arrested in the process.

S.H.

I parented my child so incorrectly..,we lost so many years. Letting go of the guilt was hard, so trust me I understand!

Katie

We went in completely unprepared for RAD [because of the initial ADHD misdiagnosis]. And it delayed getting a [correct] diagnosis and treatment by several years.

Jesi

We lost three precious years chasing the wrong problem.

Emily

Wrong medication for years, delayed us understanding how to cope with him. Still many professionals dont use the RAD diagnoses and always think ADHD when he can sit still and read for hours on end!

Katalina

Too many stimulants which caused aggression and chaos at home and in school. Terrible situation which makes me angry and bitter.

Karen

It’s how they minimized the problem, only mildly medicated him, and turned all the blame on us, because we apparently couldn’t manage basic behavior management. Mind you, this was social services AND a children’s hospital after an 11 day stay. Nor was it the last time. Still happening, only now he’s self-medicating with street drugs…

Sarah

Why kids with developmental trauma get diagnosed with ADHD

  • RAD and ADHD have many overlapping symptoms. With developmental trauma, kids can be hyperactive, have attention deficits, and other ADHD-type symptoms.
  • Most kids are getting this early misdiagnosis from pediatricians who are very familiar the ADHD diagnosis, but not as well versed in RAD or developmental trauma.
  • ADHD is a go-to diagnosis for kids who are struggling with hyperactivity and inattention school. It only requires diagnosis from a pediatrician and there are a number of medications that can be easily prescribed.

The difference between ADHD and RAD

While RAD and ADHD have overlapping symptoms, skilled clinicians can differentiate between the two. In a 2010 study by the University of Glasgow, researchers found these core items that point to a RAD diagnoses vs. ADHD.

Disinhibited items

  • Does s/he preferentially seek comfort from strangers over those s/he is close to?
  • Is s/he overly friendly with strangers?
  • If you are in a new place, does X tend to wander away from you?
  • How cuddly is s/he with people s/he does not know well?
  • Does s/he ask very personal questions of strangers?

Inhibited Items

  • Does s/he often stand or sit as if frozen?
  • Is s/he a jumpy child?
  • Is s/he wary or watchful even in the absence of literal threat?
  • When you have been separated for a while (e.g. after an overnight apart), is it difficult to tell whether s/he will be friendly or unfriendly?)

While not all children with RAD will exhibit all these symptoms, they are not symptoms of ADHD. Asking these diagnostic questions can enable clinicians to differentiate between the two disorders.

Full information on this research study can be found here:

How to get the right diagnosis

It’s critical that a child gets the correct diagnosis so they can receive the treatment and medications they need without delay. Here are some steps you can take to ensure this happens for your child.

  1. Inform your pediatrician (and any other clinicians) about developmental trauma your child may have suffered. Be sure to use the term “developmental trauma” and that you are concerned your child’s brain development may have been impaired.
  2. Ask your pediatrician for a referral to a psychologist for a full psychological evaluation. A referral may be necessary for your health insurance and also enable you to get into see a psychologist sooner. If the pediatrician suggests trying ADHD medications first, remind him/her of your child’s background and respectfully insist on the referral.
  3. Be cautious about accepting prescriptions for stimulants for ADHD. See a psychiatrist for medication recommendations. Once your chid is stable on mediations usually a pediatrician will take over dispersing them for your convenience.

Thank you for understanding developmental trauma disorder when no one else did

One of the challenges of raising a child with developmental trauma disorder is how many professionals do not truly understand the disorder. However, I know one social worker who “gets it”—and had the fortune to work with her.

Natasha was the first professional who understood my family was in crisis. She understood that my son Devon has an irrational need to control people and situations. Due to his early trauma, it is how he copes. She was able to look beyond his superficial charm to identify the underlying issues.

One Saturday, Natasha showed up in her pink pajamas while my son was raging (she also taught me to use the word “rage” instead of tantrum to effectively communicate the severity of my son’s behaviors to mental health professionals). She couldn’t stop his rage anymore than I could. But she sat with me. Sometimes that’s all I needed. Natasha breathed new hope into our family and perked up the wilted and drooping mother inside me.

In honor of Social Worker Month, this is my thank you to the social workers who have touched the lives of families like mine in positive ways. If you’re a parent who hasn’t been fortunate enough to work with a wonderful social worker, I hope you will find a “Natasha” for your family.

Thank you to the social workers like Natasha (above) who make a difference for kiddos with developmental trauma and their families

Dear Social Worker, 

Raising a child with developmental trauma has been difficult, sometimes devastating. I feel like the parade of professionals—teachers, therapists, doctors, social workers, specialists—just don’t “get it”. I’m so lonely. I’m desperate for help but it seems like I’m constantly hitting a wall. I’ve been put down, unheard and misunderstood.

But you were different. You made a real difference in our lives.

Thank you for hearing me.

You really listened as I poured out my sadness, frustration and exhaustion. You didn’t judge. You didn’t offer platitudes. You were trained on complex developmental trauma and understood how complicated these situations can be. For once, I felt understood.

Thank you for believing me. 

You didn’t dismiss my concerns as over-reactive or over-sensitive. You understood that my child is charming with you because it’s his way to gain control and feel safe. I sometimes feel like I am going crazy because he acts so differently with me. You made me feel validated. 

Thank you for partnering with me. 

You collaborated and communicated with me. Together we were able to come up with the best solutions for our family and for my child. You understood that children with developmental trauma often triangulate the adults around them. You believed that by helping me—the whole family—you were helping my child. You were right.

Thank you for showing up. 

You answered my emergency calls and texts. You stayed late when there was a problem. You walked through my front door and told me to take a break—often my first in the day—while you pulled out a board game to play with the kids. 

Thank you for trying to help. 

You were creative and resourceful. Developmental trauma is difficult to treat but you taught me about therapeutic parenting. Not everything worked but some things did. You gave me renewed hope with each new approach you suggested. 

Thank you for not giving up on me. 

You never gave up on me even when I gave up on myself. Parents like myself get PSTD from the stress. So often I wanted to curl up in a ball but then you came knocking at my door with kind words, a big smile and practical help.

I know you are overworked and underpaid. You watch TV at night surrounded by stacks of paperwork. Emergency calls interrupt your weekends and evenings. You eat on the run and drink lukewarm coffee. But, you still remember the name of every child you work with—their siblings and friends’ names too.

You have touched my family and helped us grow and heal. I am deeply grateful and wish all families had an amazing social worker like you on their team.

Sincerely,

Keri

Originally published by The Institute for Attachment and Child Development.

Childhood Trauma Leads to Brains Wired for Fear

This story was produced by Side Effects Public Mediaa news collaborative covering public health.

Negative childhood experiences can set our brains to constantly feel danger and fear says psychiatrist and traumatic stress expert Bessel van der Kolk. He’s the author of the recently published book, The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma

A  report by the University of San Diego School of Law found that about 686,000 children were victims of abuse and neglect in 2013. Traumatic childhood events can lead to mental health and behavioral problems later in life, explains psychiatrist Bessel van der Kolk, author of the recently published book, The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma

Related: How two professors are helping children cope with violence

Children’s brains are literally shaped by traumatic experiences, which can lead to problems with anger, addiction, and even criminal activity in adulthood, says van der Kolk. Side Effects contributing producer Barbara Lewis spoke with him about his book. 

Barbara Lewis: Can psychologically traumatic events change the physical structure of the brain?

Dr. Bessel van der Kolk: Yes, they can change the connections and activations in the brain. They shape the brain.

The human brain is a social organ that is shaped by experience, and that is shaped in order to respond to the experience that you’re having. So particularly earlier in life, if you’re in a constant state of terror; your brain is shaped to be on alert for danger, and to try to make those terrible feelings go away. 

The brain gets very confused. And that leads to problems with excessive anger, excessive shutting down, and doing things like taking drugs to make yourself feel better. These things are almost always the result of having a brain that is set to feel in danger and fear. 

As you grow up an get a more stable brain, these early traumatic events can still cause changes that make you hyper-alert to danger, and hypo-alert to the pleasures of everyday life. 

BL: So are you saying that a child’s brain is much more malleable than an adult brain?

BK: A child’s brain is virtually nonexistent. It’s being shaped by experience. So yes, it’s extremely malleable.

BL: What is the mechanism by which traumatic events change the brain?

BK: The brain is formed by feedback from the environment. It’s a profoundly relational part of our body.

In a healthy developmental environment, your brain gets to feel a sense of pleasure, engagement, and exploration. Your brain opens up to learn, to see things, to accumulate information, to form friendships. When you’re traumatized you’re afraid of what you’re feeling, because your feeling is always terror, or fear or helplessness. I think these body-based techniques help you to feel what’s happening in your body, and to breathe into it and not run away from it. So you learn to befriend your experience. 

But if you’re in an orphanage for example, and you’re not touched or seen, whole parts of your brain barely develop; and so you become an adult who is out of it, who cannot connect with other people, who cannot feel a sense of self, a sense of pleasure. If you run into nothing but danger and fear, your brain gets stuck on just protecting itself from danger and fear. 

Related: Some Early Childhood Experiences Shape Adult Life, But Which Ones? 

BL: Does trauma have a very different effect on children compared to adults?

BK: Yes, because of developmental issues. If you’re an adult and life’s been good to you, and then something bad happens, that sort of injures a little piece of the whole structure. But toxic stress in childhood from abandonment or chronic violence has pervasive effects on the capacity to pay attention, to learn, to see where other people are coming from, and it really creates havoc with the whole social environment.

And it leads to criminality, and drug addiction, and chronic illness, and people going to prison, and repetition of the trauma on the next generation. 

BL: Are there effective solutions to childhood trauma?

BK: It is difficult to deal with but not impossible. 

One thing we can do – which is not all that well explored because there hasn’t been that much funding for it – is neurofeedback, where you can actually help people to rewire the wiring of their brain structures.

Another method is putting people into safe environments and helping them to create a sense of safety inside themselves. And for that you can go to simple things like holding and rocking.

We just did a study on yoga for people with PTSD. We found that yoga was more effective than any medicine that people have studied up to now. That doesn’t mean that yoga cures it, but yoga makes a substantial difference in the right direction.

Trauma-Informed Care: School Counselors Take On At-Home Trauma In The Classroom.

BL: What is it about yoga that helps?

BK: It’s about becoming safe to feel what you feel. When you’re traumatized you’re afraid of what you’re feeling, because your feeling is always terror, or fear or helplessness.  I think these body-based techniques help you to feel what’s happening in your body, and to breathe into it and not run away from it. So you learn to befriend your experience. 

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.

Don’t miss out on this post: Raising a Child with Developmental Trauma

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.

What can we agree upon?

  1. 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.
  2. 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
  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.

What is Conduct Disorder?

I stand in the bathroom stall of the courthouse, texting a friend. “I can’t do this,” I write and lean my head against the cold partition of the stall.

“You’ve got this,” she replies. “Breathe, Honey.”

I hear the restroom door open and a singsong voice I recognize as my daughter, Debbie, quietly calls my name. I quickly pull my feet up, trying to be invisible. “I know you’re in here, you stupid bitch. Come out, come out, where ever you are.”

My breath halts and my pulse pounds in my ears. Be still, be quiet, I think. Maybe she will go away.

Footsteps approach as door after door of the stalls bang open. I quake in fear as the steps come nearer until I see her shoes in front of my door. 

“You can’t hide forever,” Deb says in a lilting, singsong voice. She quickly tells me how plans to murder me and what she will do with my body before setting it and my home on fire. She reminds me that she has had months to perfect her plan, while in juvenile detention, without my interference. 

I don’t respond.

Tiring of her game, Deb’s voice acquires the hard edge I’ve come to associate with rage. “Get out here, you bitch. I hate you. I want to see you scream as you die. Your precious boy will die, you will all die.” I cower behind the door as her diatribe continues; the words increasingly vulgar.

Suddenly the door into the hall opens and a new voice speaks. “Deb, are you in here?”

I hear Deb whisper, “Shit.” Then she begins to sob. 

“Baby, what’s wrong? What happened?” I recognize the newcomer as Deb’s caseworker.

Still sobbing, Deb says, “I saw Mommy come in here. I just wanted a hug. She hates me.” She wails and sobs as though her world has just ended. “Why doesn’t she love me, Miss C?” 

Debbie is only 14. Debbie has Conduct Disorder.

What is Conduct Disorder?

The DSM-5 (the manual used by mental health professionals to make diagnoses) defines Conduct Disorder (CD) as “a repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated.”

Children with Conduct Disorder (CD) may exhibit behaviors such as:

  • bullying, threatening, or intimidating others
  • initiates physical or verbal altercations
  • physically or verbally cruel to others
  • physically cruel to animals
  • steals
  • forces someone into sexual activity or is sexually aggressive
  • frequently lies
  • deliberately sets fires or destroys property
  • lack of empathy
  • lack of remorse
  • grandiose thinking
  • highly manipulative
  • rages (or “tantrums”) lasting 25 minutes or more
  • inability to learn from mistakes
  • lacks critical thinking skills/has difficulties understanding abstracts
  • shallow affect
  • superficial charm/has a public and private demeanor
  • lack of fear

Recent scientific studies indicate CD is in part due to abnormal brain activity, as well as an under development of the amygdala and prefrontal cortex. The amygdala is known to be responsible for controlling aggression as well as the perception of emotions. The prefrontal cortex handles executive functions such as controlling short-sighted or reflexive behaviors in order to plan long-term goals, make informed decisions, and exhibit self-control.

But what does all of this really mean?

In simple terms it means that the child with Conduct Disorder has a brain that is structurally different from that of a neuro-typical child. Because of this difference, the child with CD does not respond to rules, discipline, and societal norms the way a typical child does.

Conduct Disorder is evidenced by some, or all, of the behaviors listed above. The spectrum of behaviors is wide and varies between mild to severe. The tendency to lie, manipulate, and gaslight are strong and seemingly innate behaviors.

Standard parenting techniques are not effective. Discipline, rewards for good behavior, star charts, and other techniques fall short of managing behaviors long- term. Conduct Disorder transcends race, ethnicity, environment, location, and socioeconomic backgrounds. Unlike attachment disorders CD is not always due to trauma, abuse, or neglect. However, many children diagnosed with Reactive Attachment Disorder (RAD) at younger ages are ultimately diagnosed with CD as teenagers. CD can manifest at 2 years old or 15 years old, and any age in between.

There are an estimated 7 million children in the U.S. alone with Conduct Disorder. This translates into approximately 1 in 10 children affected.

Love does not cure Conduct Disorder (CD), nor does being a model family. – Karen Huff, Compass for Conduct Disorder. Find support, community and resources @CompassforCD Click To Tweet

For families affected by CD, it can mean very little in terms of treatment. Children with Conduct Disorder do not respond well to traditional talk therapy. In general, these children will use the counselor to further manipulate caregivers. Some go so far as to employ triangulation, in which the counselor becomes the unwitting accomplice of the child to further demoralize caregivers. Medication cannot relieve the symptoms of CD but it may be prescribed for co-morbid diagnoses such as ADHD.

At present there are very few viable inpatient treatment centers for children with Conduct Disorder. Many programs state that CD is treated at their facility, however most apply standard practices toward the treatment of other mental illnesses to CD. This is highly inappropriate and may lead to further issues for both the child and family living with CD.

Often, families feel vilified and become isolated due to the harsh judgment they face. Family and friends lack understanding of what is happening and drift away, unable to provide support for something they seldom witness. Parents beg doctors and mental health professionals for help, only to be mocked and treated with derision. The community, hearing of the child’s disrespect and abusive nature when the police are called, make assumptions about the parents: too lenient, too strict, not enough activities, too many activities, set boundaries, spank him/her, it’s all because of poor parenting, they say. All this does it further isolate families who are living in a constant war zone, created by someone they love and for whom they are legally responsible. Love does not cure Conduct Disorder (CD), nor does being a model family.

If there are no treatment options available, what can be done?

Fortunately, CD is being researched more in recent years. Unfortunately for those living with CD, viable treatment options are still years in the making. The founders of Compass for Conduct Disorder realized the need for community support programs, resources for parents/caregivers, and early childhood detection and intervention.

Compass for Conduct Disorder is a nonprofit organization whose goal is to provide resources, services, and hope for those living with CD. In addition to a parent/caregiver support group, Compass also provides an information and awareness group, parent advocacy, crisis buddies, the Compass Peer Network for professionals to exchange information relating to CD, and an awareness raising campaign. In the planning stages is the Compass Child and Family Support Center, which will be geared toward children ages 2 to 5 showing early signs of Conduct Disorder, and their families.

If you have a child with Conduct Disorder, Compass for Conduct Disorder is a place to find support, resources, and community.

Website: www.compassforcd.org
Facebook: @CompassforCD
Twitter: @CompassforCD
Compass Cares: A Conduct Disorder Support Community
Compass for CD Information and Awareness


Karen Huff is the mother of four children, one of whom has Conduct Disorder.

She is the President for Compass for Conduct Disorder and an admin for the Compass Cares support group, as well as for the Compass for CD Information and Awareness group. 

Connect with her on Facebook and Twitter.