What is Conduct Disorder?

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

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

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

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

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

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

I don’t respond.

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

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

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

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

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

Debbie is only 14. Debbie has Conduct Disorder.

What is Conduct Disorder?

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

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

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

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

But what does all of this really mean?

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

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

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

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

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

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

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

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

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

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

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

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


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

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

Connect with her on Facebook and Twitter.


Tips to work with your child’s school (includes free teacher handout)

I can’t tell you how many days I’ve navigated through carline with a drink holder full of steaming hot cups of coffee. Every school year I’d learn how my kid’s teachers took their coffee. On my way to drop the kids off at school in the mornings, I’d pick up a coffee for myself and one more to go. Especially when they were in elementary school, the kids loved their teacher’s reaction to the nice, fresh cup of coffee – and I loved the good will it built. In fact, when I found a teacher to be particularly challenging to work with, I’d throw in a muffin or cookie. That’s right – kill them with kindness and generosity and 9 times out of 10 it paid off in spades.

Working with teachers and school staff can be challenging for any parent, but more so for parents of children with special needs. Parent’s of kids with Developmental Trauma and/or RAD struggle even more because of the nature of these diagnoses. Few schools are truly trauma informed and our children are often adept at triangulating adults.

I have five children and we’ve got 504s and IEPs. We’ve navigated suspensions and expulsions. We’ve been to alternative schools and been in co-taught classrooms. Below is my hard-earned advice for how to navigate the system successfully.

Behind the scenes

Like any “system” we work with as parents, it’s important to pull back the curtain and understand how that system works and recognize its dysfunctions. Many of us have become so frustrated with a teacher, school administrator, or principal that we blow our top. We feel justified because they are being so unreasonable, causing our child undue hardship, or simply aren’t acting fairly. Unfortunately, our strongly worded emails and outbursts can have long-reaching negative impacts on our child’s school experience.

  • Teachers and school staff talk. Teachers and administrators talk about students, and even more often about their “cranky,” “unreasonable,” “mean” parents. The 6th grade English teacher vents her frustration to the 6th grade history and science teachers. The 8th grade teachers give the high school teachers and administration a heads up. If you are perceived as a difficult parent to deal with – everyone knows.
  • Parents are labeled and handled. Administrators and teachers will make a determination about what kind of parent you are based on even one interaction. While this may not be fair, it’s simply the reality. They’ll often meet ahead of time to strategize how to “handle” you in meetings and conferences which can lead to the incredibly frustration realization it’s the one of you against all of them. And once you’ve been labeled – it sticks
  • You won’t win (at least in the long-term). Sometimes a “strongly worded email” or conference can seem to be effective. But it’s important to realize your child will be in school for 13 years. Winning one battle at all costs can have serious long-term impacts. Once the school labels you as a “problem parent’ they’ll strategize how to best handle you in the future. A nasty email may win the battle – it won’t win the war.

While we all wish this wasn’t true, it’s human nature. For the sake of our children, we must understand the reality and become pragmatic. At least that’s been my strategy and more often than not it’s been successful.

Start off on the right foot

It’s so important to start the new school year in good faith and without a chip on your shoulder. Instead of assuming your child’s teacher is “going to be a problem,” start out by believing they’re going to be a partner. This means seeing the classroom through their eyes and empathizing with their needs. I have several teachers in my family and know it is a hard, often thankless job. Many teachers spend weekends and evenings grading papers and pay for supplies out of their own pockets. Most go into the job because it’s their passion, but can become discouraged and burnt out .

  • Be polite and act in good faith. A little genuine kindness and please and thank you can go a long way – especially with teachers who are overworked. Look for opportunities to compliment your child’s teacher. If called for, apologize and seek to make amends.
  • Be reasonable and solution oriented. It’s so important to recognize and respect the limitations of schools and teachers. Don’t lock yourself into one solution. Be an active listener and go into every meeting with a spirit of collaboration and mutual support.
  • Be ‘that’ parent. Reach out to your teacher in practical ways. Be the parent who they can count on as volunteer. Send in extra supplies when they’re requested – and when they aren’t. For example, all teachers always need extra pencils, tissues, and hand sanitizer.

Let’s not forget that as parents we find it incredibly challenging to care for our child, especially when their behaviors are extreme. Imagine a teacher trying to do that while teaching a full classroom of children. A bit of empathy and consideration can go far.

Work within the system

Fighting the system for reforms is a noble cause and one we all must support. However, the strategy for personal success is almost always learning how to work within the system. Thankfully, there are standard, legal processes to insure your child receives the educational supports they need and are entitled to. It can be a long process to obtain a 504 or IEP (Individual Education Plan), but well worth it because they are comprehensive plans with legal requirements. There are also many free or low-cost parenting advocates who are trained to assist parents in negotiations with their schools and setting up of 504s and IEPs.

  • 504s A 504 is a detailed plan for how the school will remove learning barriers for students with disabilities. Most commonly these include accommodations (how a student learns) like extended time for testing or priority seating. A 504 is easier to get than an IEP and usually the best stepping stone to an IEP.
  • IEPs An IEP is a legal agreement for a student to receive special education services. The IEP agreement can include both accommodations (how a student learns) and modifications (what a student learns). For example, it may include pull out educational services or classes co-taught by a traditional teacher and a special education teacher. An IEP requires an evaluation. Typically diagnoses like ADHD or RAD can qualify a student.

Resources

Be sure to check out this excellent resources on the ins and outs of navigating special education services for your child. From Emotions to Advocacy

Here’s a handout you are welcome to reproduce or email to your child’s teacher: Remember, approach is everything. You don’t want to come across like a patient being wheeled into surgery while handing the surgeon a diagram of the heart. Just offer this handout to teachers and school staff as “helpful information about my child’s diagnoses,” I find it’s always best delivered with a cup of coffee!

Here’s a social media shareable:

As parents of children with special needs, we’ve all had that sick feeling when we realize teachers and school staff have circled the wagons – and it’s “us” against “them.” Use the strategies in this article to make sure you are part of the team and that everyone – teachers, school counselors, principals, and you as the parent – are linking arms and circling your child with the supports they need.

NEW video teaches kids about trauma and the brain

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

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

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

01: Intro

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

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

Why do I like The Brain Game?

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

How you can use this resource

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

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

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

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

Details

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

How to Start a Local Support Group

Parenting a child with developmental trauma and Reactive Attachment Disorder (RAD) is extremely isolating and difficult. As parents, we simply don’t fit into the typical parenting support groups. We need our own “extreme parenting” support groups which are hard to find. Finding community and support are key to our own mental wellness and providing the best care we can to our children.

If you’re considering starting your own local group, here are some tips to help you get started.

Keep it simple

  • Create a “come as you are” atmosphere with no strings or commitments. Some parents may only come once or may not be able to attend regularly. Make sure people know it’s okay to show up in their sweats, for just an hour, or only once every few months. This is the flexibility acceptance parents desperately need.
  • Don’t overcommit yourself as the leader. Start with scheduling single events or a monthly meetings rather than weekly meetings. Most parents of kids with trauma simply won’t have time to attend more frequently and as a leader it’s important to not overcommit.

Make it comfortable

  • Select a meeting place where people will feel comfortable to share. While meeting in a coffee shop can be convenient, remember how sensitive your discussions will be. Try to meet in a home, a church conference room, or private room at a local coffee shop.
  • Limit attendees to parents only. Having social workers, therapists and other professionals changes the tone and will make parents hesitant to share transparently.
  • Set ground rules ahead of time and repeat them at every meeting. Two important ones to include are:
    • Confidentiality – What’s shared in the meeting, stays in the meeting
    • Judgement-free – Parents need to be able to share their anger, frustration, sadness, and guilt without being judged.
    • Limited advice – It’s great to provide each other with ideas and resources, but the focus of your group should be to provide encouragement and a place to be heard.

Pick a format that works

Owl timer from Amazon
  • Organic Sharing. Parents are desperate to be heard and know they aren’t alone. A wonderful way to do this is to allow people to share their stories and updates on their lives. If you choose this format here are a few things to consider.
    • Make sure everyone has a chance to share. You can do this without seeming insensitive by using a fun timer – perhaps a 5 minutes – for each person.
    • Consider a talking stick for discussions to prevent interruptions and rabbit trails.
  • Book studies. Picking a practical book to read and discuss can be an excellent way to facilitate a support group meeting. Here are a few to consider:
  • Expert presentations, videos, local events, etc…. There are all sorts of possibilities, so be creative and engage your attendees for ideas.

Find parents to invite

If you’re just getting started you may not know other parents to invite. Rest assured, there are many parents in the same position as you are – and most also feel completely alone. Here’s some ways to connect:

  • Join online support groups and write a post asking who else is in your city. The two groups I like to recommend and am most active in are Attach Families Support Group and The Underground World of RAD
  • Provide information about your group to providers you work with: therapists, exceptional children teachers, pediatricians, the agency you foster/adopted through, and others.
  • Attach Families is working to create an international directory of support groups. Here’s a flyer you can reproduce to handout and please be sure to let them know about your group.

Remember, small is good – a turn out of 3-4 parents is a wonderful start. If your group becomes large – regularly more than 10 people – consider breaking into two groups by geography or date/time.

A few thoughts on logistics

  • Use an RSVP system like the free version of SignUp Genius. This can be helpful because it’s easily shared on social media.
  • Start a Facebook Group to communicate with local parents about your group and share information on other local events and resources.
  • Use name tags and provide light snacks and drinks. Be sure to have a couple boxes of tissues on hand.
  • If you are a leader and need advice on handling specific situations please reach out to Attach Families.

I’d love to support you too! If you’d like copies of my book Reactive Attachment Disorder: The Essential Guide for Parents to provide free of charge to members of your support group please contact me.

An Introduction to Developmental Trauma

Also published by The Mighty (upcoming)

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

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

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

Trauma and Brain Development

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

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

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

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

Diagnosing the effects of Developmental Trauma

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

A few of the most common are:

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

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

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

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

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

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

Developmental Trauma Disorder

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

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

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

Getting your child the best care

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

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

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

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

What is Reactive Attachment Disorder (RAD)?

Also published on The Mighty (upcoming)

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

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

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

What causes RAD?

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

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

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

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

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

What is RAD?

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

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

How to end the tug of war

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

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

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

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

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

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

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

Understanding the long-term impact of early childhood trauma

Published by IACD here.

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.

Kayla, age 3.

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 will 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.

Documentary exploring the school-to-prison pipeline

The PBS documentary, The Kids We Lose, explores how discipline techniques in schools feed the school-to-prison pipeline. It effectively argues for ending punitive practices in schools, but where are the viable and realistic solutions?

One strength of the film is showing how incredibly serious (and dangerous) these behaviors can be. However, it focuses on ADHD, Dyslexia, and Autism as the underlying causes. It’s important to note that the most significant underlying cause of these school behaviors is complex trauma – with nearly half of Americas children suffering at least one adverse experience hurting kids are in every classroom.

One of the highlights of the film is Dylan, an adult man now reflecting on his behaviors as a school aged child. His problems began in 6th grade when didn’t want to do what he was told to do. “I wanted to do things my way,” he says. When discussing his interactions with law enforcement in high school, Dylan says he was rebelling and acting out because he was unhappy. However, the experts on the film don’t address this type of willful behavior. In fact, they specifically say the kids have the motivation, but not the skills to succeed.

While it’s frowned up on in our society to say – some of our kids do have serious, willful behaviors. These children likely also have emotional issues, are disregulated, and may be hyperactive. They may lack the skills they need to succeed. They may also lack motivation and be willful in their behaviors. To find real solutions that work we have to start looking at children’s needs more holistically and realistically. When we deny a child’s control over their behaviors we steal their agency and cripple their chances of sucess in the future.

Photo Credit: The Kids We Lose, PBS

My thoughts…

Teachers need to teach

The film does a great job of showing just how serious and dangerous kids’ behaviors can be. However, it seems to unfairly put the onus on teachers with a focus on the need for teacher training so they can mitigate and manage the behaviors. In my opinion, behavior management (at this level) is not a teacher responsibility. We need support staff that will allow teachers to teach.

Restrains aren’t therapeutic, but we need an alternative

The film effectively shows how shocking and disturbing physical restraints can be. It goes on to explain that restraints are not therapeutic or educational – and therefore have no place in schools. However, the film doesn’t offer an alternative solution. There are cases where a child is completely out of control and unsafe to themselves and others. If we are do do away with physical restrains we must have a realistic acute solution – while continuing to provide long term treatment.

Teachers and peers matter too

It’s often forgotten that these types of extreme behavioral problems create a toxic environment for teachers and peers who are entitled to a healthy environment. The producer argues, “Instead of kids being taught to behave in school they are removed from school.” While this is a valid point, we must consider the needs of everyone – the struggling child, other students, teachers, and support staff.

It’s complicated

Photo Credit: The Kids We Lose, PBS

When my son Devon was in 5th grade he didn’t want to come inside after recess. All the other students were lined up at the door waiting as teachers called for Devon to come. He finally walked over with a large rock in his hand. He slammed the rock into a window and it shattered. Then Devon walked down the line of his peers punching them. When his teacher rushed over to stop him, he punched her in the stomach.

Here’s what I know:

  • Devon’s behavior clearly signaled mental health issues that needed treatment.
  • Physically restraining Devon wasn’t therapeutic or educational, but absolutely necessary.
  • Devon’s teacher had a right to work in a safe and healthy environment.
  • Devon’s behavior was traumatic and disruptive to other students.

These are complicated situations and we will not solve them by painting with a broad brush or focusing on only one prong. To find real solutions for behaviorally challenging students we must be willing to honestly define the problem(s), view the child holistically, and balance their needs along with the needs of others.

The Kids We Lose is a thought provoking film worth your time to watch. After you view it please leave me a comment to let me know what you think.

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 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.

A to Z of Therapeutic Parenting

The a-z Of Therapeutic Parenting, Sarah Naish

My Rating: 5/5

We can’t always be therapeutic, no matter how hard we try, but we just need to be as therapeutic as we can, whenever we can. After all, we are only human!

– Sarah naish, adoptive parent and author

The a-z Of Therapeutic Parenting has real strategies and solutions for kids with developmental trauma. Enough said. Seriously, for most adoptive parents I could end my review here. That’s how incredibly rare it is to find practical strategies that make sense.

But let me explain more… Sarah Naish is the adoptive parent of 5 children and fostered for years. She speaks from experience and that’s clear. Her book isn’t full of platitudes or theory. It’s practical which is what parents like myself are desperate for.

The book begins with general information on developmental trauma and strategic approaches. This is well written and helpful in making the paradigm shift from traditional parenting to therapeutic parenting. However, what makes this a 5-coffee review is PART 2: A-Z OF BEHAVIORS AND CHALLENGES WITH SOLUTIONS which is an indexed guide of behaviors with strategies to address each of them.

Each behavior (Lying, Food Issues, Brushing Teeth, Charming, and so many more!) has its own entry. Let’s take “Lying” as an example since that’s a hard one to deal with. Here’s a taste:

  • WHAT IT LOOKS LIKE– This section includes descriptions of how the behavior may manifest in your home. The entry for lying includes: blatant lying, habitual lying for not reason, stalwart sticking to the lie…
  • WHY IT MIGHT HAPPEN – This is one of the best parts of each entry because it’s honest. It doesn’t assume all kids have exactly the same motive. Instead it allows for the fact that some kids may be more willful than others. The entry for lying includes: avoiding shame, lack of cause-and-effect thinking, dysregulation, momentary hatred of parent…
  • REALITY CHECK – Here’s where all adoptive and foster parents can connect. Naish gets personal and doesn’t gloss over how these behaviors can drive parents crazy. We’re only human after all! The entry for lying includes: the struggle parents feel over letting a child ‘get away’ with lying and the frustration we feel…
  • USEFUL STRATEGIES – This is the information we are desperate for. The entry for lying has 6 bullet pointed suggestions to try. They’re not all going to work for every child – and because Naish is a fellow parent – she gets that. The strategies are varied, practical, realistic, and useful. I won’t give them away. Go pick up a copy of the book

My Bottom Line
The a-z Of Therapeutic Parenting is practical and comprehensive help for foster and adoptive parents who are looking for parenting strategies. It’s obviously written from the trenches, not the desk of an academic. I can’t recommend this book enough- in fact, I’d add a dollop of whipped cream to my 5-coffee rating if I could!

Consider too joining the Therapeutic Parenting facebook group founded by author Sarah Naish. Be sure to let them know you heard about them from @RasingDevon.


The Body Keeps the Score

The Body Keeps The Score , Bessell van der Kolk, MD

My Rating: 5/5

Being traumatized means continuing to organize your life as if the trauma were still going on—unchanged and immutable—as every new encounter or event is contaminated by the past.

– Bessell Van Der Kolk, MD.

The Body Keeps The Score reveals the mysteries of brain development – and disruption.

Leading trauma expert Bessel Van Der Kolk, MD expertly guides the average reader through the complex world of neuroscience. The book documents his journey which begins by working with adults suffering from PTSD to recognizing the need for a Developmental Trauma Disorder diagnosis for children who have been chronically abused and neglected.

This book will provide an interesting and enlightening background on the science of trauma. It’s not a how-to, although Dr. Kolk does offer some insight into treatments he’s found useful including yoga. While Dr. Kolk is a highly technical, leading expert he’s repackaged this information in a way that can be easily understood by lay parents.

If you need help with the paradigm shift from traditional parenting to therapeutic parenting, this book may help.

It’s a long book but it’s well worth your time. I fit it into my busy mom schedule by listening on Audible!

My Bottom Line
The Body Keeps The Score is a thought provoking, comprehensive exploration of how our children’s behaviors may be linked to brain development that was disrupted due to trauma. It’s an important read for adoptive and foster parents who want to understand how trauma has affected their kids and catch the vision for therapeutic parenting.