Category: Parenting a child with RAD

RAD Symptoms – which are most common?

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

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

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

The most common symptoms

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

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

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

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

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

Aggressive symptoms

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

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

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

Worth noting:

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

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

Social Relational symptoms

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

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

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

Worth noting:

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

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

Survival symptoms

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

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

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

Worth noting:

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

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

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

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

When suicidal ideations may not be serious

I opened the closet door to find my son Devon squatting in the shadowy darkness with a belt looped loosely around his neck. He was 9. Confident that he wasn’t actually trying to hurt himself, and was only trying to get attention, I hid my fear. I knew if I showed my alarm, he’d be more likely to do it again. And again.

“Stop being silly,” I said in as carefree of a tone as I could manage. I took the belt, which wasn’t even buckled, from him. Unfortunately, in spite of my nonplussed response, his behavior escalated until I had no choice but to bring him to the mental health emergency room.

The intake nurse explained to me that he was experiencing “suicidal ideations,” that is thoughts or plans to commit suicide. “But he’s not actually thinking of harming himself,” I insisted, surprised by her diagnosis. “He wouldn’t even know how to kill himself with a belt. He’s only nine.”

Looking down her nose at me, the nurse said, “We don’t really know that, do we?”


It’s a complicated scenario faced by many parents of children with reactive attachment disorder (RAD) – kids like Devon who are sometimes willing to up the ante sky-high, even threatening self-harm and suicide. This is because kids who have RAD are desperate to control the people and situations around them. While there are certainly some who are suicidal, it’s not uncommon for kids with RAD to use these behaviors as a coping mechanism, with no genuine intention of harming themselves. And, the payoff can be huge. They avoid consequences, side-step difficult conversations, garner sympathy and attention, and gain control of virtually any situation.

My son, now 16, routinely threatens to kill himself over the smallest of triggers – breakfast cereal he doesn’t like, being told no, having to wait his turn. He’s attempted to slit his wrists with paper cuts, tried to hang himself using a belt on a closet rod, and tried to strangle himself with his shirt. Perhaps the scariest incident was when he climbed to the top of the rail of a second floor stairwell at school and threatened to jump. During the subsequent suicide assessments, Devon always admits he was bored, mad, or frustrated – not actually wanting to kill or hurt himself. Therapists, nurses, and social workers who have witnessed these incidents agree they are motivated by a desire for attention or a desire for control. We also all agree that the attempts are inherently dangerous, regardless of his motivation.

But why?

In some cases, his behavior is deliberate and calculated. Other times, it’s caused by dysregulation, lack of cause-and-effect thinking, and poor impulse control. In these situations, it has been helpful to me to remember that my child’s innate need to control situations and people is borne of childhood trauma. I am better able to respond from a place of empathy when I keep in mind the neglect or abuse that has causes my child to go to such desperate lengths.

Though the initial incidents of suicidal ideation are alarming, parents of kids with RAD can become weary and calloused over time. Click To Tweet

What to do

Though the initial incidents of suicidal ideation are alarming, parents of kids with RAD can become weary and calloused over time. It is, after all, counterintuitive to give credence to threats that seem designed to manipulate or control, but these behaviors are simply too serious to ever be minimized or ignored. Even if you’re 1000% certain your child has no intention to kill himself, you must take suicidal ideations seriously every time, and here’s why:

    • You may be misinterpreting the situation and they may really desire to harm themselves.

    • They can accidentally hurt themselves, even if that’s not their intention.

    • These behaviors are clearly indicative of an underlying problem that needs to be addressed.

If your child is having suicidal ideations here are some steps you can take to keep them safe and find a way forward.

Plan Ahead
    1. Create a detailed safety plan

    2. Know what mental health resources are available in your area including contact information, hours, and crisis services offered.

    3. Be vigilant. What this looks like in your home will be unique to your situation, but it may include locking away knives, removing belts, or installing collapsing closet rods.

In the Moment
    1. De-escalate the situation at all costs in order to stop your child from endangering themselves.

    2. Lower your expectations – now’s not the time to quibble about tone of voice, cursing, and other unacceptable behaviors. Your only goal is to keep your child safe.

    3. Seek emergency help by calling a crisis team or taking your child to the mental health emergency room. In some cases, you can schedule an emergency session with an outpatient therapist.

After the fact
    1. Follow-through with recommendations for therapy, medication management, and other services.

    2. Identify and address underlying triggers.

    3. Update your safety plan based on the latest episode.

When our children use suicidal ideations to manipulate and control situations it can be tiresome and frustrating. It’s easy to begin reacting to these behaviors like we do any other attention-seeking behavior. But, with suicidal ideation the risks are simply too high. Always take them seriously and make safety your priority.

What it’s like being the sibling of a child with RAD

“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.

Internalizing dysfunction

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.

Collateral damage

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:

What to consider before you adopt

How moms of kids with RAD get PTSD

Some names have been changed to protect the privacy of these children.

Disclaimer: As an Amazon Affiliate I earn referral fees when you use my links.

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

How to Discipline a Child with Reactive Attachment Disorder (RAD)

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.

I’ve had therapists tell me that my son has no control over his behaviors – as if they’re as involuntary as a sneeze. I sure know that’s not the case. Click To Tweet

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.

For example,

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.

Recommended Resources


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 Discipline a Child with Reactive Attachment Disorder-2

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.

How to Discipline a Child with Reactive Attachment Disorder – Every Star Is Different

5 creative ways to foster attachment

Kayla “then”

When Kayla was a newly adopted toddler I’d rub my face against her pudgy cheek as I tucked her in for the night. “Look at that,” I’d exclaim. “A freckle just jumped off my face onto yours!” She’d giggle and ask me to count her freckles.

Like most kids that come from hard places, Kayla struggles with attachment. Kids who have experienced early childhood trauma often don’t form a strong bond with a primary caregiver as an infant. As a result, they may unconsciously fear the closeness of relationships and thwart attachment. They also don’t have the context of a healthy mother-child bond from which to understand other relationships. As a result they don’t naturally form healthy relationships with family, friends, romantic partners, teachers, co-workers, and others. 

Kayla “now”

Kayla is now a persnickety 16-year-old, but I sometimes still “rub freckles” onto her face, much to her fake chagrin. While attachment isn’t easy for her, our relationship is very close and a source of safety and comfort for her. One way our bond solidified was through our silly – and simple – nightly freckle ritual. Our kids needs are challenging and complex and we need to find creative ways to reach them and help them learn healthy attachment.


Every child and parent are different, but here are five creative attachment ideas that have worked for other families. 

  1. Taking mommy-and-me swimming lessons with younger children can be a great, natural way to facilitate physical contact. Over time a child will learn to feel secure in the safety of his or her parent’s arms. (Of course, take into consideration if your child is fearful of water or swimming before trying this.)
  2. Braiding hair, painting toe nails, and foot massages are another way to encourage gentle, loving physical touch. These activities can facilitate hours of easy conversation and connection. Gentle face massages can also be a calming bedtime ritual.
  3. Sharing a secret with your child is a way to connect in a special way. It doesn’t have to be anything big – a childhood memory, a favorite snack, or secret wish. Once you’ve shared your secret, your child might just want to share one of their own. Be sure to respect and cherish it.
  4. Sharing a sleeping space, a staple of attachment parenting, can be accomplished with older children by allowing them to sleep in your room or laying with them until they fall asleep. This can provide a tremendous amount of comfort to a young, traumatized child.
  5. Cooking and baking together is a tactile and practical way to spend quality bonding time with your children. For kids with food issues, this can also be a way to give them a sense of control over an area of their life that may seem erratic and unpredictable. (See below for our family’s chocolate chip cookie recipe.)

Don’t forget to reciprocate. Let your child brush your hair and paint your nails too. Accept their special gifts and secrets, no matter how trivial they may seem. Attachment is a two-way process and you must be as fully engaged as you want them to be.


As promised, here’s my family’s cakey chocolate chip cookie recipe passed down from my kids’ great-great-grandmother. Enjoy!

Adoption: How not to be like a frog boiling in a pot

Adoption can be a lot like the Frog Boiling in a Pot metaphor. We jump in heart-first and are deliriously happy to have finally made it through the long, emotional, and expensive adoption process. We relax back to enjoy our new family without realizing there’s a fire beneath the pot we’ve leapt into. As the water gradually warms around us and we adjust and acclimate.

Tantrums evolve into rages.
Late potty training graduates to poop smearing.
And squabbles escalate into fist fights.

Meanwhile we’re unaware of how serious the situation is becoming. By the time we realize the danger, the water is already boiling.

Due to our child’s early trauma,
we’re often jumping into a heating pot.

Unfortunately, many children who are adopted have gone through early childhood traumas which can result in a myriad of issues: severe behaviors, sensory processing issues, attention deficits, learning disabilities, attachment challenges, and more. Early intervention is key, but often the gradual worsening of the symptoms makes it difficult to recognize when to get help. As a result, our kids don’t get the early interventions they need which is a delay that has significant impacts on their prognosis as well as the family’s health.

When I adopted my son at the age of 3, there were plenty of warning signs that we needed professional help – at least in hindsight. As things grew gradually worse over the years, I didn’t realize how serious the situation was. When had he gone from toddler tantrums to chasing siblings with a baseball bat? When had he begun to weaponize urination when he was mad? Sometimes, when we are living in these types of situations we are much like the frog in the pot – we don’t realize what’s happening because we are acclimating to it bit by bit. In my case, it took a scary incident for me to recognize the danger and act.

We have dreams and high hopes wrapped up in adoption that make it hard to admit we need help. That’s why it’s so important to understand that, for kids with severe trauma, love alone is not enough. To heal and thrive these children need highly specialized services and, even so, may continue to struggle at some level throughout their whole life.

For the best prognosis, early intervention for childhood trauma is key. This is why every adoptive (and pre-adoptive) parent must know the warning signs and where to find help.

The warning signs

In our pre-adoption classes we learn some behaviors are “normal” for kids who have been in the system. This includes issues related to food, potty training, aggression, hygiene, attachment, and learning. What we often don’t understand is that adverse childhood experiences (ACES) affect each child differently and some children have such severe symptoms they cannot be managed by parents – especially when there are other children in the home. You must know the warning signs.

Here’s what you need to look for:

  • Behaviors are creating a safety issue for the child, their siblings, or parents.
  • Over time you do not see any improvements; only a worsening of symptoms.
  • The child is unable to successfully function in school, daycare, or other settings.
  • They are perpetually “in punishment” at home.
  • You are being triggered and feeling depression, anxiety, anger, or other PTSD symptoms.
  • Your child’s tantrums are lasting hours and/or are violent.
  • You dislike your child and begin to dread spending time with them.
  • There is not a growing attachment between you and your child.

If you’re unsure, remember, it’s always better to reach out for help early than to wait too long. Waiting is not simply wasted time. It exacerbates your child’s condition and can damage their relationship with you and other family members.

Getting help

Even more challenging than recognizing you need professional help, is finding it. Children who have been traumatized in foster care or orphanages need more than “trauma informed” resources. They need help from individuals who are experienced working with this specific population of children and their families. If you begin to work with a pediatrician, therapist, or other professional who “doesn’t get it,” don’t stick around. Though well-meaning, those without this specialized background can make things worse.

Children who have been traumatized in foster care or orphanages need more than #traumainformed resources. They need help from professionals who are experienced working with this specific population of children and their families. via… Click To Tweet

Here’s what you need to know:

  • Your child needs a comprehensive psychological evaluation for the most accurate diagnosis (ask your pediatrician for a referral).
  • As soon as your child begins to experience learning or behavioral problems at school ask for a 504 or IEP evaluation.
  • Look for therapy services that are for the whole family:
    • Outpatient FAMILY therapy (not individual)
    • In-home FAMILY treatment
  • Know where your local mental health hospital is (google “Mental Health Emergency Care” for your city).
  • Contact the police department ahead of time and ask how to reach the CIT (Crisis Intervention Team) should you require law enforcement help.
  • If you adopted from foster care, contact your agency about respite, medicaid coverage, and other services.
  • Join online support groups to network with other parents and find the best local resources. These are my favorite groups and the ones I’m most actively involved with:

Remember, even in the most severe cases, with early interventions and specialized treatment, there IS hope for kids who have experienced early childhood trauma. Here’s one story where early interventions saved a family.

You’re angry…I totally get it

Our homes are in utter disarray: broken toys and torn books, holes in the walls, heirlooms at the bottom of the trash can. We’re spit on, yelled at, hit, kicked, and sometimes worse. We endure hours of screaming and mayhem Every. Single. Day. We beg for help, but get criticized instead. We deal with crazy lying, poop smearing, and food hoarding. At night we sob into our pillow feeling as though we can’t bear another day. We are demoralized, frustrated, beaten down – and yes, we are angry.

People looking in from the outside have unrealistic expectations of parents who are struggling to raise kids who have developmental trauma. They seem to believe we should have an infinite well of patience, kindness, and energy. But that’s simply not reasonable or realistic. When our children flip out, they’re not the only ones who go into fight-flight-freeze mode. We do too. It’s a natural response to being physically and psychologically attacked. 

Of course, this may not happen to most parents, but that’s because their children have tantrums not rages. Picture the most calm, serene mother you know from church, the playground, or your child’s school. Know this – she too is only human. If she was struggling with what you are, she also would be on the very edge of sanity. Eventually she also would become angry too. It’s only normal.

As a fellow parent of a child diagnosed with Reactive Attachment Disorder (RAD), I completely understand your anger. However, after years of healing, I also have the benefit of hindsight. And here’s what I’ve learned: While anger is a natural response, it doesn’t serve you or your child well. And here’s why…

Your child feeds off your anger

Your child is likely unconsciously acting out of early hurts. They may have spent their formative years perpetual fight-flight-freeze mode and, as a result, thrive on the adrenaline rush of chaos. They crave control over a world they unconsciously perceive as unsafe and unpredictable. Knowing they can push your buttons gives them reassurance of their power. When anger rolls off you in waves, it bolsters the waves their anger has been building. Feeding off one another you can end up with a tsunami. 

It’s counterproductive with teachers, therapists, and others

It can be easy to let our anger fly at teachers, therapist, other parents – all the people who don’t understand and, as a result, make things worse. While this can be momentarily cathartic and feel well deserved, it ultimately does not serve us well. This is just the excuse these people need to label us as unreasonable and out of control. It also reinforces the perception that our child is merely the victim of bad parenting. Ultimately, angry outbursts undermine our credibility and it can be almost impossible to turn back that tide. 

It’s unhealthy for you

Prolonged anger can be deeply harmful to your psychological, spiritual, and physical health. Your blood pressure spikes, you over eat and can’t sleep properly. You may develop chronic health conditions or mental health problems. Anger can cause you to accidentally rear-end another car. You lose your ability to be rational. When you are already carrying such a heavy load, these health issues can be catastrophic and have long-term and lasting effects.

How to stop being angry

It’s not easy and there are no quick fixes. After all, you are living in a highly stressful environment with extreme challenges and relentless demands on you. This is why you must look for realistic ways to begin to reign in your emotions and feel good about small wins.

Here are some ways to begin: 

  • Recognize your triggers and avoid them. Just like our children, we have our triggers and we can cope by avoiding or minimizing them. For example, maybe you’re triggered more easily when you’re hot, tired, and running late. Keep a snack in your purse and simplify your calendar as much as you can. If it sets you on edge when your child slams their bedroom door, install a slow-close hinge or strategically pad the door frame.
  • Build your resilience. If you’ve been at this a while, you know it’s unlikely you’ll be able to change your child’s behavior – especially in the short term. What you can do is build your own resilience so you can tolerate more. For example, if your air conditioner is constantly breaking that extra heat may be stoking the fire within you. Repairing your air conditioner can be a pragmatic way to make it easier to cope. 
  • Understand why your child acts the way they do. You can build greater empathy and patience by learning about developmental trauma and reactive attachment disorder. By understanding why your child behaves the way they do, you can often blunt your anger with compassion and you’re better equipped to grab for your therapeutic parenting tool box
  • Seek treatment for your own mental health. It’s common for parents of children with extreme behaviors to develop PTSD. Find a therapist who can help you through this difficult time, even using tele-conferencing if that’s a way to squeeze it in. Also, consider asking your primary care doctor about options for anxiety and depression medications to help take the edge off. 
  • Take care of yourself. Easier said than done right? Girls night out, date nights, and Zumba classes may be completely out of reach.However, you can use aroma therapy, DVR your favorite shows, and fill your social media feeds with encouragement. My favorite self-care is a chair massage at the mall (20 min, no appt necessary) and a non-fat Starbucks latte pre-ordered on my app and picked up through the drive through.
  • Consider residential treatment for your child. It’s an unfortunate reality, but for some families a residential treatment facility (RTF) may be the best option. Consider RTF if your child is unsafe towards themselves or other children in the home. Remember, if you are at your breaking point, you are no longer able to effectively parent and RTF may give you some breathing space to recharge and heal. 

None of these suggestions are quick fixes or silver bullets. What they are is a way forward. This isn’t something you are going to resolve overnight. When trying to get your emotions, and especially anger, back under control it’s important to realize even small incremental improvements are a huge win. Do it for your family. Do it for yourself. 


10 Survival Strategies for Summer

As school winds down, many families look forward to beach vacations, summer camps and lazy days. They break out the backyard sprinkler, sunblock and barbecue grill. But parents of children with developmental trauma disorder (DTD), like myself, often dread the long summer days which are anything but relaxing and enjoyable. 

Our kids will sabotage fun activities and have behavioral and emotional meltdowns on a regular basis. They’re likely to disrupt anticipated family vacations with rages and extreme behaviors. And it’s a waste of money to enroll our children in summer camps they’ll only get kicked out of. 

There’s no use sugar coating it—summer is going to be challenging for our families. But there is hope. 

Here are 10 strategies to help you survive summer (and maybe sneak in some relaxation time too):

1. Have realistic expectations.

We often view summer as an opportunity to focus on getting our child’s negative behavior under control. It’s important (for both you and your children) to be realistic, however. Maybe simply getting through the summer is a huge accomplishment. Plan activities your child enjoys and that you feel good about—playing basketball, riding bikes, maybe watching cartoons at times if you need a break. Remember, a daily tug-of-war is not a way forward.

2. Pick your battles.

For summer success, go back to the basics with family rules and chores. Don’t wait for your children to wear you down. Instead, make conscious, up-front decisions you can own. Explain to the kids that chores and rules still need to occur during the summer. Yet, plan them in a way that doesn’t cause extra stress for you or the family. For example, neatly-made beds may make a bedroom look tidy, but is it worth 30 minutes of your day? Is it worth feeling stressed? Is it worth kick-starting adrenaline pumping through your child’s body? Decide what is and is not negotiable for you, within reason. 

3. Keep the kids busy.

Help your kids sleep better at night and get into less trouble by keeping them busy. Remember, many kids with DTD are developmentally delayed. Get creative and offer tactile activities like play dough which can be fun for kids of all ages. If your child can handle it, recreational sports, camps and trips to the playground are all great ideas. Look for opportunities in your area. For example, you could sign your older teens up for the free teen summer challenge program through the gym Planet Fitness to help build their self-esteem and get those feel-good endorphins flowing.

4. Plan ahead.

Help your kids transition from the routine of school to home by maintaining regular bedtime and mealtimes. Also, plan regular activities the whole family can look forward to and enjoy together. You don’t have to break the bank either. You could look into free summer bowling programs or outdoor concerts, for example. Go in knowing that using these outings as a reward or consequence isn’t going to work (see Why Sticker Charts (and other traditional parenting techniques) Don’t Work). Instead, view these as opportunities for your kids to get their energy out and have fun as a family.

5. Utilize local services.

If your child is on the severe end of the spectrum for DTD, you may need to access community services over the summer. If they can’t function safely at home, talk to their therapist about options like partial hospitalization or day treatment. Some communities offer local camps and programs for at-risk kids where your child will receive additional supports. If your child has an IEP, they may qualify for summer school through the district as well.

6. Have a crisis plan.

While it’s important to be optimistic, we also must be realistic. Summer is likely to be long and hard with many meltdowns along the way. Take some time to really consider what your child’s triggers are and ways to avoid them before they even begin. Also, plan practical ways to de-escalate situations. Instead of implementing consequences, focus on reintegrating them back into family activities as quickly as possible. Be sure to have a crisis plan for when your child is unsafe, including a way for siblings to remain psychologically and physically safe.

7. Keep up with therapy and medications.

Your child will have different stressors during the summer than during the school year. This is why medications and therapy cannot take a summer break. Many psychological medications cannot be stopped without adverse effects and, if they can, your child likely needs the added support of the medications as they navigate the summer. Also, keep up with your child’s therapy and treatment appointments even if the schedule is irregular.

8. Carve out time for yourself.

It’s important to balance the needs of everyone in the family— including your own. Letting your kids sleep in a bit later than normal during the summer can be one practical way to make time for yourself. If you’re a stay-at-home parent, consider having your spouse take some vacation time so you can get a break from being the primary caregiver. Spend that time out of the house relaxing and enjoying a bit of summer. Perhaps your spouse can work 4-day weeks to provide some support. In some cases, it may be worth considering a spouse taking Family Medical Leave (FMLA) to help care for the child.

9. Plan respite for siblings.

Siblings only have one childhood and deserve to enjoy their summer too. Be intentional in planning ways for them to escape toxic stress and have fun. Enroll them in overnight camps and day programs. Always try to arrange transportation with other families so your troubled child cannot sabotage their sibling’s activities with misbehavior. Consider letting siblings spend extended time away with grandparents or cousins.

10. Simplify, simplify, simplify.

You have limited ability to control your child’s behavior but you can reduce other stressors in your life. Don’t overcommit yourself to activities and find ways to simplify the mundane tasks of life. Hire a teenager to mow your lawn and bring in a maid service to clean the kitchen and bathrooms whenever possible. Have a pizza place on speed dial and buy quick-fix meals. By eliminating stressors from your life, you increase your capacity to handle stress. This is good for everyone in the family.

Your family dynamics are unique. Some of these strategies will work for you and some will not. You’ll probably be more successful with children on the mild-to-moderate end of the spectrum. Be creative and pragmatic. Hopefully these 10 summer survival strategies will spark some optimism for a more manageable and enjoyable break.

Understanding the long-term impact of early childhood trauma

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

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

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

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

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

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

The Impact of Trauma

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

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

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

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

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

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

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

Healing the Impact of Early Trauma

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

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

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

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

Raising a Child with Developmental Trauma

Published by Fostering Families Magazine (May/June 2019)

Three-year-old Devon, whose name has been changed to protect his privacy, had big, chocolate brown eyes and was eager to please. His sister Kayla, 2, was feisty, with gobs of curly hair and dimples. During our pre-adoption waiting period, Kayla screamed for hours on end, seemingly for no reason at all, and couldn’t be consoled. I found Devon elbow deep in the toilet playing with his feces. At mealtime, he’d eat fast and furious then throw up all over the table. Once, I found Kayla hiding in the pantry and clutching a jar of peanut butter.

Despite all this, my husband and I jumped heart-first into the adoption. We understood these behaviors weren’t uncommon for foster kids. We believed all Devon and Kayla needed to heal was the love of a forever family.

Unfortunately, it wasn’t so simple.

By referring to these concerning behaviors as “normal for foster kids,” it’s easy to lose sight of the why behind them. For example, Kayla was frequently left alone in her crib for hours as a baby. When she cried because she was hungry or wet, no one came. These experiences etched an innate sense of insecurity on her psyche. 

Devon lost his birth mother at 6 months when he was removed from her care and her parental rights were eventually terminated. His mind couldn’t understand, but his body absorbed the loss. 

Leading trauma expert Bessel A. van der Kolk uses the expression, “The body keeps the score,” to illustrate how the body remembers trauma with tragic, long-term impacts for kids like Kayla and Devon – even if they find a loving forever family.

What is Developmental Trauma?

Developmental trauma occurs when a child experiences chronic abuse or neglect before the age of 5. These are the years when the brain is developing rapidly and is particularly vulnerable. 

Trauma may disrupt a child’s sequential brain development, according to psychiatrist Dr. Bruce Perry. This can cause, for example, impaired cause-and-effect thinking and poor self-regulation. Their behaviors, emotions, and thinking are developmentally immature because they’re literally “stuck” at earlier developmental levels. 

Also, when a child experiences frequent activation of their fight-or-flight response due to abuse, their brains can be overexposed to the stress hormone cortisol. As a result, their fight-or-flight pathway may activate in even minimally threatening situations. Forrest Lien, executive director for the Institute for Attachment and Child Development, explains: “These children live in constant ‘survival mode’. They are hyper vigilant, do not trust others, and feel the need to control their environment at all times to feel safe. Therefore, they do not allow adults to parent them and cannot have healthy relationships.”

Devon and Kayla

Developmental trauma affects each child uniquely and its impact varies in symptoms and severity. The symptoms can include attachment difficulty, self-esteem problems, anxiety, sleeplessness and a lack of impulse control.

Kayla has overcome a math learning disability, has close friends, and is a creative and independent 15-year-old. However, the trauma symptoms haven’t disappeared entirely. She still sleeps on the floor instead of in her bed, and won’t eat in front of non-family members.

Devon, unlike his sister, falls on the moderate to severe end of the spectrum for developmental trauma. Now 17, he lives in a psychiatric treatment facility. He’s physically aggressive and has no close friendships. He has pending criminal charges for assault and is on track to turn 18 with an 8th grade education. 

Early Intervention is Key

Like many foster and adoptive parents, I was unfamiliar with developmental trauma and didn’t know the warning signs. I only realized we needed professional help when Devon, at 9, karate chopped his adoptive little brother in the throat and pushed him down the stairs. Regretfully, those early missteps and missed opportunities exacerbated his condition. 

To determine if your child needs professional intervention watch for:

  1. Behaviors that don’t respond to discipline (particularly therapeutic parenting methods)
  2. Tantrums that last far past the terrible twos and threes
  3. Persistent struggles severe enough to interfere with home life, school, or friendships
  4. Feeling frightened for the safety of the child, yourself, or other children in the home

Trust your instincts and err on the side of caution. There’s no harm in getting a professional evaluation, while the cost of not getting help early can be devastating. If you delay, your child may turn to unhealthy coping mechanisms including drugs, promiscuity, and self-harming.

Untreated developmental trauma can result in behaviors that cause kids to be expelled from school, institutionalized, or face criminal charges. Other siblings in the home are at high risk for primary and secondary trauma. Parents, especially mothers, may develop PTSD

This doesn’t have to happen. Your child’s future isn’t yet written. Early intervention can change their trajectory academically, vocationally, legally and relationally.

How to get help

The best place to start is with your child’s pediatrician – but be wary of the ADHD diagnosis they might dole out at first. While developmental trauma may cause attention deficits and poor impulse control, an ADHD diagnosis doesn’t tell the full story. Also, the stimulant medications prescribed for ADHD can exacerbate symptoms. Instead, ask for a referral to a psychiatrist for a comprehensive psychological evaluation and diagnosis.

Developmental trauma doesn’t currently map to any single diagnoses. As a result, your child will likely be given multiple diagnoses to fully cover their symptoms. These may include:

  • Post Traumatic Stress Disorder (PTSD)
  • Anxiety Disorder
  • Reactive Attachment Disorder (RAD)
  • Oppositional Defiant Disorder (OD)
  • Sensory Processing Disorder
  • Developmental Delays
  • Learning Disabilities 

For a child with developmental trauma, these diagnoses are interconnected and need to be addressed in the context of the underlying trauma. For example, PTSD-like symptoms caused by developmental trauma requires different treatment than PTSD caused by combat according to Dr. van der Kolk. 

This is why it’s critical to engage clinicians who have experience working with traumatized children, foster kids, and adopted kids. Work with a psychiatrist to explore medication choices. Get an Individualized Education Plan (IEP) in place at school to ensure your child receives the services and supports to be successful.

Unfortunately, there are no quick or easy fixes to developmental trauma, but there is hope with early intervention. 

Love is critical, but it’s not enough

Devon with adoptive brother Amias

Raising a child with developmental trauma can be incredibly difficult and isolating. The more you understand your child’s trauma history, and learn about the science of trauma and therapeutic parenting, the better equipped you will be to help your child heal. Join a local or online parents support group (I recommend, The Underground World of RAD or Attach Families Support Group), prioritize your self-care, and consider seeing a therapist if you begin to feel overwhelmed.

“Love and time will not erase the effects of early trauma,” says Lien. “The best first step is to secure the child in a healthy family but that is only the beginning.”

Children who have experienced developmental trauma desperately need the love of a forever family, but love alone isn’t enough. Get professional help early, before the behaviors and emotions grow too big and overwhelming.

"Love and time will not erase the effects of early trauma. The best first step is to secure the child in a healthy family but that is only the beginning.” – Forrest Lien, executive director @InstituteAttach Click To Tweet

RTF: A bad option, that’s sometimes the best option

My son Devon was 10-years-old when I dropped him off at a residential treatment facility (RTF) for the first time. I knew almost instantly it wasn’t going to work. They didn’t believe in consequences. School work was optional. With unlimited dessert and no rules, it was more like a summer camp than a program for kids with severe behavioral problems.

I called my sister for advice and my words came out with a sob, “He’s going to get worse here.”

“Without hesitation, my sister said, “You have to get him out of your house. Nothing else matters right now.”

“But he’ll see this as a reward.”

“I don’t care if it’s Disney World. We’ll deal with that later. Leave him,” she said. 

And I did.

Devon’s behavior had been growing increasingly unmanageable and dangerous over the previous 18 months. He was having violent outburst every day and the stress level in our house was toxic for everyone. My youngest son, who was 4, was especially frightened and would tremble with fear when he sensed Devon’s anger mounting. I was suffering from PTSD—even though I didn’t realize it at the time.

I’d been trying to get help for Devon for years. We’d tried outpatient therapy, intensive in-home therapy and partial hospitalization. He wasn’t getting better and I had no idea how to help him. I only knew what I was doing wasn’t working. 

As I’d predicted, Devon’s behaviors did become dramatically worse from the RTF. However, my sister had recognized what I could not – it was still the best option available to us. Unfortunately, if you’ve exhausted outpatient options and your child is becoming unsafe, it may be your only option too. 

Why RTFs don’t work

While an RTF may be the best – or only – option available, it’s important to have realistic expectations. These facilities are rarely effective for kids with developmental trauma disorder. In fact, they can exacerbate the symptoms, and here’s why:

1. The treatment is not specialized for developmental trauma. Your child will be placed with kids who have a variety of issues including anxiety disorders, eating disorders and PTSD. The coping skills they will learn – like taking deep breaths, playing with a stress ball and counting to ten – are not enough to heal the brain injury caused by developmental trauma.

2. The workers are under-trained, overworked and underpaid. Your child will work with a licensed clinician for therapy. Yet, the general supervision is typically provided by workers who have a high school diploma and on-the-job training. Our kids are very challenging to deal and the chronic understaffing and inadequate training results in inconsistent quality of care.

3. The staffing structure lends itself to triangulation. Because workers are rotated (and have high turnover) they are easily triangulated – especially against the therapist and parents. Unfortunately, your child is likely to gain a sense of control by behaving this way – a feeling they unconsciously crave – and will continue even when it sabotages their treatment.

4. The kids become institutionalized. In these facilities, your child will be exposed to and influenced by kids with sexualized behaviors, horrific language and physical violence. They’ll quickly learn the ropes and how to work the system to their advantage, for example, by making false allegations to retaliate against staff or peers. This is knowledge they’ll ultimately use to manipulate the staff and you as well.

RTFs are intended to teach your child how to cope and let them “practice” good behavior for when they return home. Yet, the artificial environment and behavior-based modification techniques do not help them to truly heal. 

“Kids with DTD learn to work within the external structure of residential treatment facilities. It doesn’t get internalized for them though,” said Institute for Attachment and Child Development Executive Director Forrest Lien. “Ultimately, most kids go back into their families and fall apart. Sadly, it’s oftentimes the only option for parents.” 

Sadly, unless you are able to send your child to a program that is highly specialized for developmental trauma, your child is unlikely to get better. 

When to consider an RTF anyway

Parents who are considering sending their children to an RTF often ask for my advice. It is a very personal decision and every child and family is different. However, the following are a few words of hard-earned wisdom I often share. 

1. Consider an RTF if your child is unsafe to himself or others. Remember to consider not only the physical, but also psychological well-being, of other children in the home.

2. Consider an RTF if you are at your breaking point. You cannot help your child when you are unstable yourself. An RTF may be the breather you need to regain perspective.

3. Consider an RTF if your child  engages in unlawful behavior. An RTF is likely a better option that juvenile detention where your child will get a criminal record and receive little treatment.

The decision to send your child to an RTF should be a last resort but you may be at that point now. You alone are not able to heal developmental trauma any more than you can set your child’s arm or cure his leukemia. The best you can do is access the best possible treatments available and support and love your child through the process. 

For us, an RTF was the best choice because Devon had become unsafe to himself and his siblings. And after years of giving it my all, I had nothing left to give. He’s now 17 and in his ninth RTF. It’s not the forever family I’d hoped for and not what any parents wants. Yet, it is often the best of the limited choices families like mine have. It is the best choice for us. And while my son doesn’t live at home, he’ll always be a part of our family.

First published by Institute for Attachment and Child Development.