Be sure to follow The Adoption and Fostering Podcast for more great content and information around adoption and foster care. http://www.alcoates.co.uk/p/the-adoption-fostering-podcast.html
2022 IndieReader Discovery Award Winner
16th National Indie Excellence Award Winner
Available in paperback, ebook, and Audiobook.
The gripping and heart wrenching true story of a desperate mother who must grapple with impossible choices as her young son becomes too dangerous to live at home but is only growing bigger, stronger, and more violent while in treatment.
When Keri and her husband adopt Devon, he has concerning behaviors, but she’s confident all he needs is the love of a “forever family.” Devon’s hidden history of early childhood trauma quickly takes center stage when Devon throws screaming fits, yanks his bedroom door off its hinges, chases his classmates with a knife, and pushes his younger brother down the stairs and viciously karate-chops him in the throat. When Devon is admitted to a psychiatric residential treatment facility at age 10 and is diagnosed with Reactive Attachment Disorder (RAD), Keri is faced with an impossible choice—Devon is too dangerous to live at home, but he’s not getting better in treatment. Keri must race against time to find help for Devon and keep her other children safe, as he grows bigger, stronger, and more violent.
Based on a shocking true story, this reads-like-fiction memoir exposes the dysfunctions of the child welfare and mental health systems and how they fail kids with RAD and their families.
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.
- 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.
- 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.
- 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.
- 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.
- 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.
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.
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.
|Physical aggression to mother||71%|
|Physical aggression to siblings||66%|
|Physical aggression to pets||46%|
|Weaponizing bodily fluids||39%|
|Physical aggression to others||37%|
|Physical aggression to father||26%|
- 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.
|Lack of boundaries||85%|
- 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.”
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.
- 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.
My teenaged son called this evening to explain that he’d cursed his teacher out and thrown his desk across the classroom. He was upset because he’d lost his school issued Chrome book because he’d taken it home (not allowed, and not his first time) and had pornography on it. I listened patiently without judgement. He explained how his elopement from school ended in an entanglement in a pricker bush and contact with a concrete culvert which scratched up his arms and legs. He was covered with bloody scratches and scrapes. I expressed empathy as I sipped my coffee. I offered encouragement when he said he was going to try to earn back the Chromebook and even said I’d talk to the school to ask for a clear plan to work towards that goal. I told him I was proud of this choice to make tomorrow a new day.
Today I was a therapeutic parent superstar and here’s why:
- My son is living in a group home
- My son has lived out of our home for several years and I have had time to heal
- I have had treatment and therapy for my PTSD
- I have educated myself on therapeutic parenting
- I have educated myself on early childhood trauma and Reactive Attachment Disorder
- I have surrounded myself with a supportive community of parents
Had this situation happened when my son was still living at home, I would have gone nuts. I would have been throwing out consequences and yelling. My anxiety would have been through the roof. I would have been angry, embarrassed, frustrated, and overwhelmed.
Back when my son was living at home, our family was in crisis. The situation had grown toxic. It took several years of his being in treatment programs, and my being in therapy and educating myself, to begin to find a positive way forward.
Unfortunately, this is not uncommon. Adoptive and foster parents aren’t prepared for the early childhood trauma most kids coming into our families have experienced. We usually reach a crisis point before we learn about therapeutic parenting. By that time, we’ve become desperate and demoralized. Our mental and physical health is so degraded that we are barely surviving. Our kids are out of control. Our life is out of control. We can’t even manage to brush our hair in the morning much less use a calm and kind voice after our child spits in our face.
No doubt, our children need us to be that calm and steady, therapeutic parent, but at that point, we simply don’t have the capacity to do it. And given the our current relationship with our kids, it’s likely we aren’t even the best person to do it. Though few dare tell the shameful truth – we likely have come to a point where we really don’t like our kid. It’s a struggle to be nice to them. It’s difficult to not feel adversarial towards them. If we’re really being honest, some days we’re as out of control as our kids.
Unfortunately, few therapists understand this. They usually underestimate our child’s extreme behaviors and the level of crisis our family is in. They assume we have the ability to parent therapeutically and shame us if we don’t. For our families to heal and thrive, this is something that must be recognized and addressed.
The only clinician I know who is talking about this and teaching other clinicians about this is Forrest Lien of Lifespan Trauma Consulting. (If you are a parent, please follow him on social media to support his efforts on our behalf.)
Families in crisis do not have the capacity to parent therapeutically. This is why we must:
1) Get help to families before they are in crisis (this means pre-adoption training and post-adoption support),
2) Support parents and families in a holistic way. Help us get to a place where we can parent therapeutically.
3) Surround families who are in crisis with supports. Stop shaming us for being broken and demoralized. Give us a hand up.
Parents must be healthy and educated to parent therapeutically.
A note about therapeutic parenting:
There are no perfect treatments for developmental trauma. My son hasn’t been able to access the highly specialized treatment he needs. My response to his phone call today doesn’t solve the problem – I realize that. However, consequences, though perhaps “deserved” won’t work, and will only further escalate my son. What I must do is choose the response that is most likely to move the ball forward. My goal is for him to remain in school and to not get kicked out of the group home. My goal is to de-escalate the situation. I highly recommend A to Z Therapeutic Parenting for practical information on therapeutic parenting.
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 that I 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. However, always keep in mind that only conversations with your attorney (and sometimes your therapist) are legally privileged).
You don’t have to do this alone!
If you are struggling to parent a child with Reactive Attachment Disorder (RAD), this is the resource you need.
No platitudes or false hopes here, only practical suggestions that actually work!
- Understand developmental trauma and Reactive Attachment Disorder (RAD)
- Learn tips and tricks to help you to navigate “the system”
- Get resource recommendations that will provide a way forward
Adopting or fostering a child with Reactive Attachment Disorder (RAD) is beyond challenging.They may have violent outbursts, engage in outlandish lying, steal, play with feces, and hoard food. With histories of early childhood trauma, kids with RAD too often break even the most loving of caregivers. Many parents of these children feel utterly isolated as family, friends, and professionals minimize the struggles.
Reactive Attachment Disorder (RAD) – The Essential Guide for Parents comes from a parent who’s in the trenches with you. Keri has lived the journey of raising a son with RAD and has navigated the mental health system for over a decade.
“It’s like living in a prison. We can’t go anywhere. All doors are locked. Alarms everywhere. We can’t have friends over. Stuff goes missing. We’ve all had black eyes, split lips and bite marks…we’re the ones who suffer.” – Grace, 14, on living with a sibling with reactive attachment disorder.
Grace’s experience is not uncommon for siblings of children who fall on the moderate to severe range of reactive attachment disorder (RAD). The dysregulation and other challenges of RAD restrict family activities, cause stress and chaos, and require a disproportionate amount of parental attention and energy.
Siblings are too often the overlooked victims of the disorder.
I initially thought that adopting another child would enrich the lives of my other kids. I certainly never imagined that it’d be a traumatizing situation. For years, my children were routinely exposed to scary outbursts and stressful conflicts. They were humiliated and embarrassed at school – especially after their brother who has RAD punched a teacher in the stomach. They missed out on sleepovers, birthday parties, and were late to basketball and soccer practices. Doing my best in the moment – surviving – I didn’t realize how difficult things were for them until much too late. They had internalized fear, anxiety, and anger.
Doing my best in the moment – surviving – I didn’t realize how difficult things were for them until much too late. It was only later that I realized how traumatized siblings internalize fear, anxiety, and anger.
The struggles and emotions of brothers and sisters of children with RAD—siblings like Grace—can best be understood through their own words. I put up a post on two online Facebook support groups to gather those sentiments. In those posts, I requested parents to ask their children what it’s like having a sibling with RAD. I’ve included their responses throughout this article and only edited their comments for grammar.
Living in Fear
Many siblings are trapped in a perpetual state of anxiety and vigilance, fearful for their own safety and the safety of their parents. They’re often targeted with physical aggression and witness terrifying situations.
Here’s what siblings are saying:
“I can feel her getting all angry and I get worried and feel a little sick in my stomach. When she gets really bad and is yelling and screaming and hitting you [mom] I feel upset that I can’t stop her, that I can’t protect you from her.” – Chad, 10
“Mommy, I am scared. She hurts me.” – Susie, 6
“Is the door locked?” – Jake, 15, sleeping on his parent’s bedroom floor with his 10 and 12-year-old brothers.
“I’m scared she’s going to do something to me. But I won’t let her know I’m scared.” – Mia, 11
“I wish she could live somewhere else. I don’t like her anymore. She’s never nice.” – Ava, 4, whispered to her mother afraid her sister with RAD would overhear and retaliate.
“No, Sis!” – Emma, 2, screamed in a nightmare after watching her 12-year-old sibling with RAD physically attack her mother.
“Why is she always so mean to me? She’s always hateful and yelling at me.” – Ashley, 10. A middle child, Ashley also has a brother with RAD. Of him she says, “He lies to get me in trouble. He hits me and threatens to kill me and swears at me.”
What you can do
Put alarms on sibling’s doors to help them feel safe. Give them the option of sleeping on a daybed in your bedroom. Make a concerted effort to minimize their exposure to violence and danger with an escape plan out of escalating situations. This may mean calling grandma to be picked up, going outside to play or another option that works best for your family.
For many siblings, family life can be highly dysfunctional and confusing. This can lead to a warped view of normal family relationships with devastating, lifelong impacts. Siblings often struggle to differentiate the person from the disorder and come to hate their brother or sister who has RAD.
Here’s what siblings are saying:
“She always says she’s sorry and goes right back to being so happy when I’m still hurt. I can’t trust her anymore because she always says she won’t do it again and then usually does in the very same day.” – Beth, 10
“I never want children of my own. What if something goes wrong and they end up like her? I just couldn’t handle raising a child like that!” – Marie, 29
“Mom, does he have to come home? You are so much nicer when he is gone.” – Brandon, 12
“Sometimes I feel like no one can see me because my mom and dad give [my sister with RAD] constant attention.” – Honor, 6, who after having to help out with her RAD sister says she never wants to have children.
“It breaks my heart to hear my baby sister say she hates me and is going to kill me tonight! It’s not fair.” – Samantha, 15, said weeping.
“They’re always mad, sad, and don’t like their mom or dad, and lie all the time.” – Addison, 10, on why all siblings are bad.
“Don’t you get it? She is a horrible person.” – Kayla, 12, when she found her mom sobbing over something her sister with RAD said.
What you can do
Let siblings be honest about their feelings and don’t minimize their experiences. Find a good therapist who can help them process and gain some perspective. An outside person, like a therapist, can help them develop empathy and compassion while maintaining healthy boundaries.
Many people think that time apart is counterintuitive in helping a child with RAD and their family heal and attach. Yet, it’s quite the opposite with the right model.
Losing their childhood
Siblings don’t live the carefree lives of others. They miss basketball practice and piano lessons when their sibling flips into a rage. They aren’t able to go on family vacations and outings are often cut short. Their treasures and toys are broken. Their allowance is stolen. For them, growing up can be less than ideal and full of heartache and challenges.
Here’s what siblings are saying:
“I’m only 10-years-old! I’m too little to have to deal with this stuff!” – Ethan, 10, once a happy-go-lucky boy who is in therapy.
“It was depressing and exhausting. I was never allowed to have fun.” – Michael, 10, who has been in therapy for the last two years.
“It feels like living in a minefield. Looks peaceful and nice one minute, war zone the next.” Jeffrey, 8
“I never get to have friends over and I missed my best friend’s birthday party. I already had a present and had to give it to her at school on Monday.” – Abby, 11
“They have no idea what it’s been like!” Skylar, 8, cried after neighborhood kids blamed her when her sister with RAD, 11, was removed from the home. Her sister was removed because she was planning to murder Skylar and her family.
“I can’t wait to move out.” – Hunter, 17. When Hunter’s sister Ava, 10, also traumatized by their sibling with RAD heard this she said, “You can’t leave me here with her!”
“Sometimes it feels like it will never end.” – Emma, 15, who has started cutting to “release” the pain, is severely depressed, and has lost 40 pounds in the last year after witnessing the tantrums, explosions, anger, aggression, violence, and threats of a sibling with RAD.
Siblings don’t live the carefree lives of others. They miss basketball practice and piano lessons when their sibling flips into a rage. They aren’t able to go on family vacations and outings are often cut short…For them, growing up can be less than ideal and full of heartache and challenges.
What you can do
Enlist family and friends to help siblings with rides to practice, science fair projects, and other important activities. When accomodations cannot be made, acknowledge your child’s feelings and validate them. Enroll them in camps. Let them stay with grandma or auntie for long vacations to get a break and enjoy their childhood.
Many parents, myself included, are so consumed with the minute-by-minute challenges of raising a child with RAD that they underestimate, or don’t fully recognize, the impact on siblings. It was only after my son was admitted to a residential treatment facility that I began to fully understand how his disorder had impacted my other children. To this day my youngest son who lived in fear of his brother for the first five years of his life is highly anxious and at age 11 is afraid to sleep alone. I often wish for a do-over.
When assessing treatment options for your child with RAD, be mindful of the needs of siblings. Many people think that time apart is counterintuitive in helping a child with RAD and their family heal and attach. Yet, it’s quite the opposite. “Time apart allows the parents and other children to heal from their own trauma while, at the same time, kids with RAD learn how to attach and to live in a family,” said Executive Director Forrest Lien. “When the children return to their own families after the Institute, everyone is stronger. They can live together safely. We’re strengthening families so they don’t fall apart forever.”
Don’t make the mistake of imagining siblings are coping and doing okay. Don’t, like me, realize only once the damage has been done. There are no perfect answers, but understanding how RAD impacts siblings is a good starting place. Don’t let them be collateral damage.
Don’t miss these posts:
Some names have been changed to protect the privacy of these children.
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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:
- 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.
- 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.
- 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.
- 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.
- 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 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.
It’s the million-dollar question. How do we manage the behavior of children with RAD?
Therapeutic approaches can seem scarily permissive. Meanwhile, traditional parenting approaches backfire spectacularly.
At the root, most behaviors children with RAD engage in are intended for self-preservation – by sabotaging relationships and controlling their environments. It’s unlikely, however, that they’re introspective enough to be consciously doing this. These underlying motivations are etched like scars on their psyche.
Most likely, the in-your-face motivations of these kids are far more concrete. For example, our kids may be arguing incessantly because:
- it’s a habit like biting their nails or spinning a pencil
- they want to test our boundaries to see how flexible the rules are
- they don’t really care about anyone else’s feelings or needs
- they love to push our buttons and get a reaction
When we’re in the trenches trying to manage these behaviors it’s sometimes difficult to embrace therapeutic parenting approaches because they seem to discount these in-your-face motivations entirely. Instead, they focus completely on the underlying, unconscious motivations.
Yes, in the real-world of RAD parenting, we know the in-your-face motivations are every bit as real as the unconscious, underlying motivations. In fact, they’re what make the behaviors so painful to deal with emotionally. As a result, parents often focus on the in-your-face motivations and find themselves angry, frustrated, and easily triggered.
Let’s consider that in many children, both sets of motivations co-exist.
My child is arguing just because they enjoy pushing my buttons. It gives them a feeling of control which they unconsciously crave because they intrinsically believe the world is unsafe.
When we look at the motivations for the behavior more holistically like this we are able to have greater empathy, more patience, and find energy to invest in long-term approaches. Below are some resources I’ve found useful for specific strategies and approaches. Please be sure to comment and share what’s working for you.
The A-Z of Therapeutic Parenting
Sara Naish’s book “The A-Z of Therapeutic Parenting” it a balanced approach that’s both therapeutic and practical. She covers behaviors from Absconding to ZZZZ (sleep issues) and everything in between. For each behavior she helps us understand the broad range of reasons why a child might be doing it. She also provides strategies to prevent the behavior, to manage it in the moment, and to address it after the fact. These suggestions are refreshingly practical and obviously written by someone who has been in the trenches themselves. Read my full review or pick up a copy here: The A-Z of Therapeutic Parenting.
How-to blog post
Check out this excellent post on how to discipline a child with RAD. This is one of the most complicated topics related to RAD. Most ‘discipline’ is ineffective and it can be quite risky.
Annie watched in horror as Charlie, red-faced with rage, snatched a picture frame off a wall and slammed it against the bedpost. The glass shattered. He picked up a long shard and brandished it like a dagger. Stalking towards Annie, he growled, “I’m gonna kill you.”
This type of abusive behavior in relationships is far too common. 29% of women and 10% of men in the US will experience domestic violence in their lifetimes. Child protective services investigates more than three million reports of abuse and neglect annually. However, Charlie and Annie’s altercation isn’t included in either of these statistics.
That’s because Charlie is a 13-year-old boy. And Annie is his mother.
What the parents living next door may be hiding
Like Annie, I’m the mother of a son who acts out. Both our boys are products of the foster care system, adopted as toddlers, and who are diagnosed with Reactive Attachment Disorder (RAD) and Conduct Disorder (CD), serious behavioral disorders. They have both received medication and thousands of hours of treatment, but nothing has helped.
When Annie and I tell friends, family, and mental health professionals about our sons’ behaviors, we are met with disdain and disbelief. In the same way many sex abuse victims are treated, parents like us are blamed and shamed into silence. We have been forced underground, into private Facebook groups where we find non-judgemental support from thousands of other parents in similar situations.
Four years ago, Lillyth Quillan founded the online parent support group, Parents of Children with Conduct Disorder. She says, “More than 1,000 families have come together to share their stories; to know they are not alone. They are emotionally raw and shredded to the marrow at how they’ve been treated and not believed by close friends and family.”
How many families this affects
The general public assumes these situations, where children are violent towards their parents, are isolated to a handful of sensationalized episodes of Dr. Phil.
This is simply not the case.
While the anecdotal evidence of children with serious disorders abusing their parents is abundant, quantitative data is desperately lacking. This is why I recently surveyed more than 200 parents of children diagnosed with, among other behavioral disorders, RAD and CD. This type of informal survey is an invaluable way to begin to understand the scope of the problem.
According to my survey, Are You In An Abusive Relationship? more than 90% of the respondents are in chronically abusive relationships – and the abuser is their child.
- 93% say their child threatens them, other family members, or pets with physical violence.
- 65% say their child grabs, hits, kicks, or otherwise physically assaults them.
- 71% say their child hides their behavior from others and blames them for their outbursts.
These aren’t merely numbers; each one is a tragic story. Here are just a few of the examples shared anonymously by survey respondents:
“My son purposely hurts the cat to get my attention.”Anonymous parents
“My daughter attacked me with a steak knife.”
“My son choked me and broke my wrist.”
These findings show that it is alarmingly common for children with serious behavioral disorders to abuse their parents.
When children abuse their parents
Intentional Child to Parent Violence (I-CPV) is deliberate, harmful behavior by a child to cause a parent physical or psychological distress. These are purposeful behaviors intended to gain control over, and instill fear in, parents. I-CPV takes many different forms and varies in severity. It is often chronic and usually directed at the child’s mother figure. 
One surveyed mom has a moon-shaped scar on her forehead from her 14-year-old daughter grabbing her by her hair and slamming her face onto the stove. Another mom says her son tried to push her down the stairs and makes homicidal threats towards her.
Parents like these sustain physical injuries and may develop mental health disorders including PTSD. They are isolated from friends and family. Their marriages can become irreparably damaged. They frequently lose jobs and friends. Other children in the home suffer secondary, if not primary trauma.
Without highly specialized treatment, the child perpetrating the abuse will not get better. Far too often, it becomes necessary to have them institutionalized, or end up incarcerated, for the safety of their siblings, parents, and themselves.
Hypervigilance – and fear – are common for parents in these situations. One mom describes how, “Before my son was taken to the hospital, then jail, and then a treatment center, I had to sleep with my door locked and a chair jammed under the knob because he knows how to pick locks.” She suffers with PTSD after years of chronic abuse.
Why children abuse their parents
While there is no one clear “cause” leading to antisocial behaviors like I-CPV, there are a number of underlying factors to consider. Perhaps the most significant is “developmental trauma,” a term coined by leading expert, Dr. Bessel van der Kolk, MD. When a child is chronically neglected or abused at a young age, their brain development may be impacted, causing long-term issues sometimes including physical aggression. This is called Developmental Trauma Disorder (DTD) and is commonly diagnosed as CD or RAD.
While developmental trauma can explain much of RAD, not all children who are violent towards their parents have a trauma background. Some children from nurturing families are diagnosed with CD. Psychologist Stanton E. Samenow, PhD specializes in working with juvenile offenders and says early identification of emerging antisocial behaviors is key. He points to a study that found “aggression at age 8 is the best predictor of aggression at age 19, irrespective of IQ, social class or parents’ aggressiveness.”  He believes, regardless of environment and parenting, children become antisocial by choosing the bad behaviors that eventually become an entrenched pattern.
As a parent, I don’t believe these are mutually exclusive views and find both to be informative. My son has a history of developmental trauma. As a result he struggles with impulsivity, attachment, and cause-and-effect thinking. At the same time, his behavior is not involuntary. He is making a choice when he acts aggressively and knows right from wrong.
Why families can’t get help
Even once parents understand the complexity and seriousness of the abuse taking place, there is nowhere to turn for help. Unfortunately, the systems designed to protect victims of other types of abuse don’t have a mandate to protect the victims of I-CPV.
Most domestic violence shelters are for intimate partners, and, for example, offer no help to a mother whose son or daughter beats her. Advice commonly given to victims of domestic violence simply doesn’t work. Take for example the following from the online article, “What to Do if You Are in an Abusive Relationship“:
1. Talk with someone you trust
Parents are rarely believed by friends, family, teachers, and mental health professionals. Instead, they’re blamed for their child’s misbehavior and labeled bad parents. One mom says, “My son can be incredibly sweet and charming when he wants to be. My friends, his teachers – my own mother – don’t believe my 9-year-old son is dangerous because he’s so good at hiding his behavior.”
2. Call the police if you are in immediate danger
Parents receive little assistance from police, especially if their child is under the age of 16. They also hesitate to press charges knowing incarceration is not the “treatment” their child needs. One mother called 911 after her son beat her. The officer said to her son, “It’s okay, Buddy, you’re not in trouble. Let’s talk.” The next time her son beat her, she ended up in urgent care.
3. Make a plan to go to a safe place such as a shelter
Despite their child’s abusive behaviors, parents are still legally and morally responsible for them. Even if parents want to seek safety, their hands are tied. “If I were treated this way by a man,” says one mother, “I would have left long ago. But because this is my daughter, my options are limited.”
Unfortunately there are no good solutions for these parents, and no quick and easy cures for their children. Few therapists and mental health professionals are equipped to offer the highly specialized treatment needed. While there are promising advances in neuroscience, emerging treatments are not accessible for most families. They’re expensive, rarely covered by health insurance, and unavailable in most areas.
Out of all the families she’s worked with, Quillian says only one family has ever received appropriate treatment. “One. One family experiencing what I believe to be the absolute bare minimum of care. One.”
What needs to change
I-CPV isn’t merely talk-show fodder. It’s happening behind closed doors in your neighborhood. It’s happening in Annie’s home. It’s happening in mine.Intentional Child on Parent Violence (I-CPV) isn't merely talk-show fodder. It's happening behind closed doors in your neighborhood. These parents need support and viable treatment options for their kids. Click To Tweet
While the US lags behind, there appears to be growing awareness of I-CPV in the UK where a new domestic abuse bill includes I-CPV. US citizens can support these families by asking their legislators to draft similar legislation which would not only provide legal remedies, but more importantly, facilitate funding for research, prevention and treatment.
We need viable treatment options for our children, as well as resources to combat the violence and destruction we face in our daily lives,. We need help and the support of our communities. That begins with a national dialogue about I-CPV and viable treatment options for serious behavioral disorders.
Parents deserve the same support and understanding that all victims of abuse deserve. Until then, they will suffer physical and psychological harm while their child faces a lifetime of relational, educational, financial, and legal struggles.