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

Christmas Gift List for kids in Residential Treatment Facilities (RTFs)

It can be challenging to Christmas shop for kids who are living in residential treatment facilities (PRTFs, RTFs, or group homes). There are almost always restrictive rules about personal items along with special rules for Christmas gifts. For example, in most facilities electronics, candy, and hardback books are not allowed.

So what can you give your child for Christmas? Below is a list curated from parents who have successfully navigated the holiday season while their child is living in an RTF.

But first, here are some tips.

  • Gifts deemed inappropriate or against policy will likely be thrown away and not returned to you.
  • Most facilities do not allow wrapped gifts because they need to approve the items.
  • Often gifts must be dropped off on a specific day.
  • You may not be allowed to open Christmas gifts with your child. If this is important to you, ask their therapist about doing so during a family therapy session or home visit.
  • Kids in higher level facilities aren’t allowed to have “dangerous” item which may include shoe laces, belts, hard back books, calendars with staples, etc.
  • Ask the facility if your child will be getting additional gifts from local charities or the facility. As you shop, it can be helpful to know if you are supplementing gifts or supplying all your child’s gifts.
  • Plan for the gifts you buy to be lost or destroyed. Shop at Walmart and don’t give expensive gifts. Label what you can with your child’s name.
  • To successfully navigate Christmas gift giving with the least amount of frustration and waste, email your child’s therapist your planned gift list ahead of time for approval.

Christmas Gift List
(For kids in RTF)

  • Clothes
  • Pillow
  • Stuffed animal
  • Pajamas
  • Markers and coloring books
  • Dot to Dot books
  • Playing cards
  • Family Pictures
  • Art Supplies
  • Basket ball
  • Soccer ball
  • Foot ball
  • Journal
  • Hygiene supplies
  • Hair bands
  • Stickers
  • Pillow case
  • Picture book of “happy” memories
  • Paperback books
  • Crayons
  • Teddy bear
  • Gloves
  • Hat
  • Shoes
  • Puzzles
  • Funky Socks
  • Magic 8 Ball
  • Comic books
  • MP3 Player/iPod Shuffle with no internet access
  • Stationary
  • Legos
  • Crazy Aaron’s thinking Putty
  • Blanket – burrito etc
  • Posters
  • Calendar (no staples)

Please let me know your additional ideas so I can add to this list!

A few thoughts about realistic expectations…

Kids with developmental trauma, especially those diagnosed with Reactive Attachment Disorder (RAD) are likely to turn any situation into a power struggle, including their Christmas gifts.

Even if you give them a gift they’ve been asking for – that you know they’ll love – you can expect them to:

  • Tell the therapist they know you aren’t planning to give them any gifts because you don’t love them.
  • Complain to staff about the gifts they do get, and say they don’t like them.
  • Destroy the gifts even if they love them and desperately wanted them.

It may feel personal, but it’s simply how your child relates to the world because of the lasting effects of early childhood neglect and abuse. Unfortunately, you may end up feeling manipulated, lied about, coerced, and judged. It can be tempting to withhold gifts because of these behaviors or because your child is not cooperating with treatment, but that’s not a good strategy.

First, keep in mind that it will be very difficult to execute. Staff will likely compensate by giving your child extra gifts creating an opportunity for triangulation.

Additionally, your child’s therapist will almost certainly see your lack of gifts as a sign you are a cold, and unloving parent – and the focus of your child’s treatment will be side tracked.

Most importantly, your child will internalize feelings of rejection and this will not be a learning lesson no matter how well-intentioned you are. Jessie Hogsett, who was diagnosed with RAD as a child, reminds us that our child’s actions aren’t necessarily reflective of what’s going on inside. He says “I remember being in an RTF during Christmas. So lonely. And I felt totally unwanted. Horrible times. A gift would have made me feel wanted, special, and thought about.”

So, plop on your Christmas hat, sip a peppermint latte, and go shopping.

A Dad’s Struggle Accepting Reactive Attachment Disorder Diagnosis

Learn about a Dad’s struggle with awareness and acceptance of a Reactive Attachment Disorder (RAD) diagnosis and helpful tips to overcome the challenge of accepting related Developmental Trauma Disorders.

click here to learn more about Christine Hartmann…

Joker: A warning we should heed

At my teenaged kids’ insistence, I took them to watch Joker in the theater, expecting a typical action-packed, comic book movie – not a genre I typically enjoy. Instead, I sat in the darkness, stunned to near-tears by it’s devastating portrayal of how early childhood trauma and untreated mental illness can spiral into tragedy. 

The poignant film explores the backstory of comic book villain Joker: a man named Arthur Fleck who has a disturbing past and a troubling present. It is a compelling and nuanced portrayal of untreated trauma and mental illness. 

Joker is incredibly violent and disturbing, certainly earning its R-rating, but at the same time reflects a reality we are already seeing in our society today. Early childhood trauma is at epidemic levels. Our mental health system is in disarray. We aren’t meeting the needs of the vulnerable around us and sometimes violence and tragedy are the price we pay as a society. 

There’s a huge amount of controversy swirling around the film and it’s portrayal of mental illness. After watching the movie, I believe the real controversy we should be focused on is why we don’t have affordable, accessible, effective treatment for mental illness and early childhood trauma!

*** Spoilers Below ***

In the film, Joker, we meet Arthur Fleck shortly after he’s been discharged from a mental health institution. He’s receiving mediocre city mental health services, living in poverty, and attempting to build a semblance of a life for himself.

While the film does not specify all of Arthur’s diagnoses, his symptoms include hallucinations, paranoia, delusions, and feelings of despair, loneliness, and worthlessness. Arthur’s one obvious diagnosis, Pseudobulbar Affect (PBA), fits of uncontrollable laughter, results in severe bullying. We also learn Arthur was abused and neglected by his mother during early childhood. This included severe head trauma as well as psychological and emotional abuse. Arthur has never been able to access the treatment he needs to manage his condition, much less heal, or thrive. He’s completely lacking social skills, unable to hold down a job despite his best efforts, and even with medication, unable to feel happy or optimistic.

Unfortunately, Arthur is not simply a far-fetched character. We have “Arthurs” living and breathing all around us – in our daycare centers, classrooms, workplaces, and neighborhoods. Early childhood trauma is a hidden epidemic affecting millions of people. While victims of early childhood trauma and/or people who have mental illnesses aren’t necessarily violent, the combination of untreated trauma and mental illness with psychosis can be dangerous. Furthermore, high-risk children are not receiving effective treatments in residential treatment facilities. They are aging out ill-equipped to function in the adult world and at high risk of criminal behavior and incarceration. Like Arthur, most of these individuals want to be happy. They want to have good lives. However, we, as a society, fail them by not providing effective, affordable, accessible treatments for trauma and mental illness. Like Arthur, these people struggle to navigate even the basics of life.

Arthur, though teetering like a wobbling house of cards, is trying to build a life for himself. He’s trying to find some happiness. But it’s obvious to the viewer that he simple doesn’t have the resources or skills to do so. And so begins Arthur’s devastating spiral that should be a warning for us all. 

  1. Arthur loses his services (therapy, medications, etc) due to city financial cuts.
  2. He’s fired from the job he loves – sure he made a mistake, but he’s given no mercy or compassion.
  3. He follows his dream to be a comedian, and falls flat. He’s mocked mercilessly.
  4. He’s physically assaulted for laughing (his Pseudobulbar Affect) and in self-defense shoots and kills two men on a train. In a panic, he kills another.
  5. He’s cruelly rejected by the man he believes to be his birth father.
  6. He learns his mother abused him as a child and anger that has been festering in his unconscious for decades surfaces.

The spiral tightens. Arthur is drawn to the rioters who praise him as a vigilante for the killing on the train (which was in fact, self-defense). He becomes more violent and murders several people. In his mind, his path has become inevitable as all other doors – all other options – have slammed closed in his face. 

Does this not reflect the crumbling path of so many young people in our society today? People who struggle on the edge of society: to hold down a jobs, to form relationships, to find their next meal, or place to sleep. This instability is the fate of so many people who have experienced early childhood trauma and/or are mentally ill because they are unable to access effective treatment and services. Is it any wonder that they are hopeless, desperate, and caught in a downward spiral? Is it any surprise that some end up engaging in criminal behavior? That some act out violently?

Towards the end of the movie, Arthur has fully transformed into the Joker. Wearing chalky make-up and a sardonic smile, he sits on a talk show stage and casually confesses to the train murders, Before shooting the talk show host point-blank in the face, Joker says, “I’ve got nothing to lose. Society has abandoned me.” And we can’t disagree: He has got nothing to lose. Society has abandoned him.

It only takes thumbing through the headlines to know that far too many of our most vulnerable have been abandoned by society and with nothing to lose have picked up guns and lashed out violently too. Read more about one recent incident here. This will continue until we prioritize affordable, accessible, effective treatment for early childhood trauma and mental illness.

NOTE: In case it wasn’t clear in this post, I am not saying that mental illness or childhood trauma lead to violent behaviors. What I am saying is that untreated mental illness and untreated childhood trauma can put people on a dangerous spiral.

Online support groups for parents of kids with trauma

Are you parenting a child who came to you from hard places? If your child is suffering from the effects of early childhood trauma, also called adverse childhood experiences (ACEs), they may have extreme behaviors that seem impossible to manage.

Unfortunately, you may not fit into typical parenting support groups. Your child’s behaviors and emotions may be so extreme that other parents can’t relate. As their parenting-101 and common sense advice falls flat and over time, their lack of understanding can feel an awful lot like blame.

You may be feeling:

Developmental trauma (often diagnosed as Reactive Attachment Disorder) is a very serious disorder that requires specialized and specific treatment. You’re unlikely to find the support you need in typical mommy-and-me, ADHD, or other types of parenting support groups. The approaches to those parents use may not be effective with your child.

First, know you are not alone. There are thousands of us going through the same things. It’s just difficult to find each other and connect for support.

So where can you find the support and community you so desperately need? One fantastic option is a private online support group. Here are the two I like to recommend, and am most active in. (Tell them Raising Devon sent you!)

These groups are for parents and caregivers only and have strict confidentiality rules. They are a great place to ask for advice, vent, and feel understood.

You don’t have to do this alone!

Don’t miss out on these resources as well:

Post-Adoption Support
Recommended Books
Mental Health
Trauma
Blogs to Follow
Handouts
Quotes and Shareables

The Special Needs of Adopted Children

Whether you are religious or not, this list from Sherrie Eldridge is a powerful tool. She’s included Bible verses for those who would like them.

EMOTIONAL NEEDS

  • I need help in recognizing my adoption loss and grieving it. (Ecclesiastes 1:18)
  • I need to be assured that my birth parents’ decision not to parent me had nothing to do with anything defective in me. (Proverbs 34:5)
  • I need help in learning to deal with my fears of rejection–to learn that absence doesn’t mean abandonment, nor a closed door that I have done something wrong. (Genesis 50:20)
  • I need permission to express all my adoption feelings and fantasies. (Psalm 62.8)

EDUCATIONAL NEEDS

  • I need to be taught that adoption is both wonderful and painful, presenting lifelong challenges for everyone involved. (Ezekiel 17:10a, Romans 11:24)
  • I need to know my adoption story first, then my birth story and birth family. (Isaiah 43:26)
  • I need to be taught healthy ways for getting my special needs met. (Philippians 4:12)
  • I need to be prepared for hurtful things others may say about adoption and about me as an adoptee. (John 1:11)

VALIDATION NEEDS

  • I need validation of my dual-heritage (biological and adoptive). (Psalm 139:16b)
  • I need to be assured often that I am welcome and worthy. (Isaiah 43:4, Zephaniah 3:17)
  • I need to be reminded often by my adoptive parents that they delight in my biological differences and appreciate my birth family’s unique contribution to our family through me. (Proverbs 23:10)

PARENTAL NEEDS

  • I need parents who are skillful at meeting their own emotional needs so that I can grow up with healthy role models and be free to focus on my development, rather than taking care of them. (II Corinthians 12:15)
  • I need parents who are willing to put aside preconceived notions about adoption and be educated about the realities of adoption and the special needs adoptive families face. (Proverbs 23:12, Proverbs 3: 13-14, Proverbs 3:5-6)
  • I need my adoptive and birth parents to have a non-competitive attitude. Without this, I will struggle with loyalty issues. (Psalm 127:3)

RELATIONAL NEEDS

  • I need friendships with other adoptees. (Ecclesiastes 4:12)
  • I need to taught that there is a time to consider searching for my birth family, and a time to give up searching. (Ecclesiastes 3:4)
  • I need to be reminded that if I am rejected by my birth family, the rejection is symptomatic of their dysfunction, not mine. (John 1:11)

SPIRITUAL NEEDS

  • I need to be taught that my life narrative began before I was born and that my life is not a mistake. (Jeremiah 1:5a, Ephesians 1:11)
  • I need to be taught in this broken, hurting world, loving families are formed through adoption as well as birth. (Psalm 68:6)
  • I need to be taught that I have intrinsic, immutable value as a human being.
  • I need to be taught that any two people can make love but only God can create life. He created my life and I’m not a mistake.  (John 1:3)

This list is reprinted with permission from: Copyright, 1999, Sherrie Eldridge, Random House Publishers-TWENTY THINGS ADOPTED KIDS WISH THEIR ADOPTIVE PARENTS KNEW.

Video: Early Childhood Trauma – we need treatments now!

Learn more

Aging out of RTF and into the real world: A dangerous proposition

Raising a child with Developmental Trauma

Immigration isn’t the only “system” that’s harmful to children

Why adoption stories aren’t fairy tales

It takes a village

NEW video teaches kids about trauma and the brain

I am so excited to share this exciting new resource with you! The Brain Game is a new psycho-educational, 20-minute video, It’s designed to teach children about how trauma may have impacted their brain and what they can do about it. It was created by Family Futures, an adoption support agency based in London.

The Brain Game is designed around video game imagery and vernacular children are familiar and comfortable with. This is effective because each “level” is first played on easy mode. This sets the stage for what healthy and normal is. Then the level is replayed on hard mode and kids learn how trauma can make things more difficult for them.

Here’s the introduction to The Brain Game which will give you a good idea of the look, feel, and accessibility for children.

01: Intro

Here’s a sneak peek at the other 4 levels of The Brain Game.

02: THE WOMB
Kids learn how substance abuse, nutrition, and their parents’ stress can impact the ability of their brain to develop properly even before they are born.
03: BIRTH
Kids learn the potential impact of being sent to ICU, being born dependent on alcohol or having an inhospitable environment as an infant.
04: BRAIN BUILDER
Kids learn about the primitive, feeling, and thinking brains and how early traumas can cause “big” feelings. The also learn about fight-flight-freeze responses.
05: HOW WE CAN HELP
Kids learn that their brain is like “plastic.” It can change and grow and overcome many of their early traumas.

Why do I like The Brain Game?

  1. It reinforces the idea that children cannot control the trauma they’ve gone through.
  2. It acknowledges the unfortunate reality that kids may be stuck playing life on hard mode.
  3. It offers hope by showing how kids can help themselves change and live happier lives.

How you can use this resource

Parents – The Brain Game is a wonderful way to help children who have experienced trauma understand what’s going on with their mind and body. It’s also a valuable tool for siblings to foster an empathetic and supportive family environment.

Groups – The Brain Game can be watched with small groups of children and used for discussion. And don’t overlook it’s value for adults either. Trauma is a complicated and emotionally charged topic and many adults will learn from this video.

Therapists – The Brain Game is an excellent tool for therapists to use with children who have experienced trauma. It will be an effective discussion starter and a good way to get parents and children on the same page.

This resource is not useful for kids only!
The paradigm shift to trauma informed is a tricky one and this video can be eye opening for adults as well.

Details

Where to buy: Online via Family Futures (be sure to tell them I sent you!)
Length: 19 minutes
Format: MP4 download

Developmental Trauma and Psychosis


When my son Devon 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 Devon 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 Devon 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.

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

What is Reactive Attachment Disorder (RAD)?

Also published on The Mighty (upcoming)

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 and abused 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.