Category: Parenting a child with RAD

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

It’s not ADHD!

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

Survey by @RaisingDevon, March 2019

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

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

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

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

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

S.H.

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

Katie

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

Jesi

We lost three precious years chasing the wrong problem.

Emily

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

Katalina

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

Karen

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

Sarah

Why kids with developmental trauma get diagnosed with ADHD

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

The difference between ADHD and RAD

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

Disinhibited items

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

Inhibited Items

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

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

Full information on this research study can be found here:

How to get the right diagnosis

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

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

You need a safety plan

If you’re raising a child with RAD you almost certainly need a safety plan.

Our children’s dangerous behaviors can include suicidal ideation, self- harming, violent outbursts, serious property damage, and physical aggression towards others (especially siblings).

This is shared from a blog post by Renae and Jason who are grappling with their daughter’s violent episodes.

This story could be mine, and probably yours too:

It was a Monday when everything came to a head.  Sunshine couldn’t be reasoned with.  She was not functioning.  What would normally be a calm exchange of words turned violent.  Sunshine started to throw any items she could get her hands on.  She even threw a dining room chair, almost breaking a window.  And then she verbally threatened to kill me with a knife.

That’s when I knew, my dear sweet Sunshine was horribly manic.  She had become a danger to herself and to others.  The medicine had been working more than we knew.  We were in trouble.  I had to initiate our safety plan.

They also share these important steps of their safety plan:

1. Immediately remove others from harm’s way
2. Stop the child from endangering herself or others
3. Call and report
4. Lower expectations
5. Follow through with recommendations made by doctors and specialists

Renae and Jason say their daughter “had become a danger to herself and others.” If you reach this point, it’s always time to get help. Also, be sure to tell mental health professionals this – “My child is a danger to themselves and others” are ‘magic words’ that will help you get your child the acute care they need. (See my post on why I use the word “rage” and not “tantrum” for the same reason.

'My child is a danger to themselves and others' are 'magic words' that will help you get your child the acute care they need. Click To Tweet

Read more details on Renae and Jason’s safety plan in the full post here: A Safety Plan for Mental Health Emergencies 

What steps do you take to keep your family safe in a crisis?

When a mom struggles to love her child

Originally published by the Institute for Child Development.

Carol was bitter and angry—on edge. Shortly after we met through a mutual friend, she told me about her three adopted sons. She adored her youngest son. The older two were regularly suspended from elementary school, lied incessantly, and threw screaming fits daily. They teased and bullied her 10-year-old daughter.

Her husband Ted listened to us and nodded patronizingly, as if Carol was exaggerating or over-sensitive. He sighed and said that he had told her how to fix the issues but she wouldn’t listen to him. Like my son, Carol’s boys were good in front of their dad. And, like my husband, Ted just didn’t get it.

I know Carol’s desperation well because I lived it myself for years. I told Carol and Ted about adopting siblings Devon and Kayla from foster care. Devon’s behaviors had grown so extreme and dangerous he was now living in a residential treatment facility. He was ten. “I’ll do whatever it takes to keep him there,” I told them. That’s how bad life had been with Devon at home.

I confessed that, although I feel a strong sense of responsibility for Devon, I don’t love him.

Carol burst into tears. I struggled to make out her words through her gasping and sobbing. She said that she didn’t love her two boys and she’d never been able to say it out loud. It was a dark secret she kept, afraid of what others would think.

I’d kept the very same secret as Carol for years, smothered beneath a plastered smile. Love came surely and steadily with Kayla. But it never did with Devon. I was sure something was wrong with me and was driven nearly mad in my quest to love him. I struggled to bond with this little boy who spit in my face, kicked and hit me, threw objects at me, destroyed my home, dismantled my marriage, and tormented my other children.

People understand why a woman wouldn’t love an abusive husband or partner. But this is a child.

We don’t like to admit that even a young child can perpetrate domestic violence. In fact, well-meaning family, friends, and professionals insist that all these children need is love from a “forever family.” With these platitudes condemning us, adoptive mothers struggle to find help.

Carol and I kept what was happening in our homes a secret. Here’s why—

  • We didn’t realize we were being abused. We refused to believe it’s happening because child on parent violence is taboo in our society.
  • We felt responsible. We believed our children would behave differently if only we could be better mothers.
  • We believed things can change. We kept trying to fix it, holding onto hope that we can keep our adoption dreams alive.
  • We feared how others would react. We worried about letting down family and friends who have supported our foster care or international orphan adoptions.

It took years to get help for myself and Devon. Eventually, I learned he had gone through early childhood trauma and he was diagnosed with reactive attachment disorder (RAD). While not all children with RAD are violent, some can be.

In my own therapy, I was diagnosed with post-traumatic stress disorder (PTSD) from the relentless stress of raising a child with RAD.

I came to understand that my emotions of anger, frustration, exhaustion, and bitterness were normal. My therapist helped me see that feeling love for a person abusing me–even a child–was not natural, normal, or healthy. It’s unfair to expect adoptive mothers to love children with these extreme behaviors and issues. Faking-it-until-you-make it in front of friends, family, and professionals is not the answer. “It’s unreasonable to force a parent to bond with a child whose behaviors have led to his or her PTSD,” said Institute for Attachment and Child Development Executive Director Forrest Lien. “The whole family needs healing in order to foster parent-child attachments.” These mothers need compassion, understanding, and support rather than shame and guilt.

The whole family needs healing in order to foster parent-child attachments. These mothers need compassion, understanding, and support rather than shame and guilt. Click To Tweet

With the proper support and therapy there is hope for healing. There are treatments for kids with RAD that can help them learn to have healthy relationships. Their adoptive families can come to embrace and genuinely care for them. Keeping our uncomfortable, but true, feelings a secret makes it harder, if not impossible, to get the help we need.

For the sake of Carol, and countless other moms who have been shamed into the shadows, I choose to be a silence breaker. I’m not proud that I don’t love my son in that emotional way, but I’m no longer ashamed.

6 Steps to protect yourself from false allegations

Published by Institute for Attachment & Child Development

A sweet little kindergartener, with a Blues Clues backpack and big brown eyes, Devon went to school every morning with a hungry belly. At least that’s what he told the bus driver, his teacher, and the cafeteria ladies. When I got the call from his school, I was positively indignant. Not only did Devon eat breakfast every day, but he usually had seconds.

Within a few years, Devon’s lies had become dangerously calculated deceptions. “I’m gonna hurt myself and tell them you did it. They’ll arrest you,” he’d say cooly, before punching himself in the jaw. Other times he’d twist the tee-shirt he was wearing round-and-round, cinching it against his neck until it left a puffy, red ligature mark. He’d accuse me of strangling him.

Unfortunately, many children with reactive attachment disorder are capable of false allegations. “Due to early trauma, children with reactive attachment disorder feel safe when they can control their environments and push away people who try to get close to them,” said Institute for Attachment and Child Development Executive Director Forrest Lien. “False allegations are one way for them to achieve both.”

Even if we understand the diagnoses and social histories that prompt our children’s false allegations, however, being lied about can be infuriating and hurtful.

A child’s allegations, however outrageous or unlikely, will be investigated. This unwarranted disruption and family upheaval is collateral damage, necessary to make sure children who really are abused get the justice and safety they deserve. “By law, police officers or child protective service workers investigate all allegations of child abuse, as they should. Child abuse allegations need to be taken seriously,” says Institute for Attachment and Child Development Executive Director Forrest Lien. “On the other hand, it’s also harmful for children to falsely accuse adults of abuse charges.” The consequences of false allegations can be devastating if our children, master manipulators, manage to convince a guidance counselor, therapist, or police officer they’re telling the truth. Parents can unjustly face jail time and lose their children without reason.

Here are 6 steps you can take to protect yourself and your family if your child makes false allegations against you:

1. Keep a daily log. I use small notebooks that fit easily in my purse and document conversations with social workers and teachers, write notes after therapy appointments, and record details of any behavioral incidents. I also write down what my son eats for breakfast, what activities we do, and what time he goes to bed. The key is to be consistent and document even the mundane. Your log will be much less credible if you only log when an incident occurs.

2. Gather documentation. To establish a pattern of behavior, keep school disciplinary records, ask people to follow up on calls with an email, and, if your child is admitted to a treatment program, request their records when they are discharged. These documents may have mistakes or minimize your child’s behaviors so comb through them and request any corrections. Discuss false allegations with your child’s therapist. Your child may admit the truth to them and this can be documented.

3. Don’t lose your cool, or your credibility. When a therapist, teacher, or others bring an allegation to your attention, listen. Breathe. Keep the frustrated tone out of your voice,  don’t jump to defend yourself and never exaggerate. Sometimes you’re going to find yourself in a she said–he said and your credibility will be everything. A non-defensive response might sound like: “Gosh, I fed Devon eggs and toast this morning, but thanks for letting me know that he told you he hadn’t eaten. If he ever does miss breakfast, I’ll be sure to email you so we’ll be on the same page.”

4. Use video/audio recordings (sparingly). This is a tricky one that can backfire. First, remember that your words and actions on any recording will be judged, probably more harshly than your child’s. Second, you may be accused of provoking your child by recording them, especially if they scream at you to stop. In a few instances, I’ve been successful flipping my cell phone recorder on without my son seeing it. Give that a try.

5. Don’t go it alone. If things are spinning out of control, call a family member or friend to come over to act as a witness. Sometimes you may have to resort to desperate measures. For example, my son currently lives in a group home and I’ve refused to have visitations with him unless we are in a room with cameras and a staff member. We’ve had to cancel and reschedule visits because of this, but I cannot risk being alone with him.

6. Have a backup plan. Have a contingency plan so your other children do not end up in foster care if social workers remove them during an investigation of a false allegation. My sister and her husband have agreed to take my children if this should ever happen to me. It’s a worse case scenario, but you need to be prepared with a plan.

Though my son has hurled devastating false allegations against me, I’ve been able to avoid the worst potential outcomes by being proactive and meticulous about documentation. It’s extremely sad that I’ve had to do so. Yet, it’s a devastating reality that many parents of children with reactive attachment disorder must face to save their families.

Here’s a great resource with advice and information: Responding to Investigations Manual

3 Reasons Traditional Parenting Doesn’t Work With Kids From Trauma.

For years I pulled out my hair not understanding why my parenting strategy was working with my birth and other adopted children, but not with my son, Devon. NOTHING worked. Learning that traditional parenting methods don’t work with kids who have a trauma background was a milestone for us, something I wish I’d know much earlier than I did.  How to work with these kids is counter intuitive. Check out this great post by adoptive parent Mike Berry

via 3 Reasons Traditional Parenting Doesn’t Work With Kids From Trauma. | Confessions of an Adoptive Parent