Tag: Adoption

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Parents in crisis can’t parent therapeutically – so stop expecting us to.

My teenaged son called this evening to explain that he’d cursed his teacher out and thrown his desk across the classroom. He was upset because he’d lost his school issued Chrome book because he’d taken it home (not allowed, and not his first time) and had pornography on it. I listened patiently without judgement. He explained how his elopement from school ended in an entanglement in a pricker bush and contact with a concrete culvert which scratched up his arms and legs. He was covered with bloody scratches and scrapes. I expressed empathy as I sipped my coffee. I offered encouragement when he said he was going to try to earn back the Chromebook and even said I’d talk to the school to ask for a clear plan to work towards that goal. I told him I was proud of this choice to make tomorrow a new day.

Today I was a therapeutic parent superstar and here’s why:

Had this situation happened when my son was still living at home, I would have gone nuts. I would have been throwing out consequences and yelling. My anxiety would have been through the roof. I would have been angry, embarrassed, frustrated, and overwhelmed.

Back when my son was living at home, our family was in crisis. The situation had grown toxic. It took several years of his being in treatment programs, and my being in therapy and educating myself, to begin to find a positive way forward.

Unfortunately, this is not uncommon. Adoptive and foster parents aren’t prepared for the early childhood trauma most kids coming into our families have experienced. We usually reach a crisis point before we learn about therapeutic parenting. By that time, we’ve become desperate and demoralized. Our mental and physical health is so degraded that we are barely surviving. Our kids are out of control. Our life is out of control. We can’t even manage to brush our hair in the morning much less use a calm and kind voice after our child spits in our face.

No doubt, our children need us to be that calm and steady, therapeutic parent, but at that point, we simply don’t have the capacity to do it. And given the our current relationship with our kids, it’s likely we aren’t even the best person to do it. Though few dare tell the shameful truth – we likely have come to a point where we really don’t like our kid. It’s a struggle to be nice to them. It’s difficult to not feel adversarial towards them. If we’re really being honest, some days we’re as out of control as our kids.

Unfortunately, few therapists understand this. They usually underestimate our child’s extreme behaviors and the level of crisis our family is in. They assume we have the ability to parent therapeutically and shame us if we don’t. For our families to heal and thrive, this is something that must be recognized and addressed.

The only clinician I know who is talking about this and teaching other clinicians about this is Forrest Lien of Lifespan Trauma Consulting. (If you are a parent, please follow him on social media to support his efforts on our behalf.)

Families in crisis do not have the capacity to parent therapeutically. This is why we must:

1) Get help to families before they are in crisis (this means pre-adoption training and post-adoption support),

2) Support parents and families in a holistic way. Help us get to a place where we can parent therapeutically.

3) Surround families who are in crisis with supports. Stop shaming us for being broken and demoralized. Give us a hand up.

Parents must be healthy and educated to parent therapeutically.

A note about therapeutic parenting:

There are no perfect treatments for developmental trauma. My son hasn’t been able to access the highly specialized treatment he needs. My response to his phone call today doesn’t solve the problem – I realize that. However, consequences, though perhaps “deserved” won’t work, and will only further escalate my son. What I must do is choose the response that is most likely to move the ball forward. My goal is for him to remain in school and to not get kicked out of the group home. My goal is to de-escalate the situation. I highly recommend A to Z Therapeutic Parenting for practical information on therapeutic parenting.

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

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.

How to discipline a child with Reactive Attachment Disorder – Part II

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

Resources

The Special Needs of Adopted Children – Bible Verses

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

EMOTIONAL NEEDS

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

EDUCATIONAL NEEDS

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

VALIDATION NEEDS

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

PARENTAL NEEDS

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

RELATIONAL NEEDS

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

SPIRITUAL NEEDS

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

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

In the News, We need to do better

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

In recent months, the stories of migrant children separated from their parents at the border have tugged at our hearts. The news media is rightly exposing how early childhood trauma – such as separation from a mother – can cause lifelong, negative impact.

The issue of childhood trauma may only recently have become front page news with the crisis at the border, but it’s all too familiar for adoptive and foster families. Reactive attachment disorder (RAD), rare among the general population, is most prevalent among adopted and foster children. Due to early childhood trauma, they are often unable to form meaningful attachments to caregivers and may exhibit extremely challenging behaviors.

Instead of enjoying playful childhoods, these children struggle to cope with everyday life. As a result, some are unable to earn a high school diploma and too often get tangled up in the criminal justice system. Disorders like RAD, that are caused by early childhood trauma, are literally stealing away our children’s future.

In advocating for children we must cast a wide net

Regardless of our politics, we can advocate together on behalf of innocent children. Let’s consider that immigration isn’t the only “system” that’s harmful to children. The foster care, adoption, and criminal justice systems are also dysfunctional with misguided policies that traumatize and retraumatize our children. The impact of this trauma is staggering, life-altering, and devastating.

Here are just a few of the ways it happens:

  • Some vulnerable kids are overlooked by “the system” and left in abusive and neglectful situations.
  • Some kids are unable to be placed in a permanent family because “the system” makes repeated, misguided attempts at reunification.
  • Some kids are unnecessarily removed from their caregivers and processed into “the system.”

Sadly, “the system,” intended to protect our vulnerable children is broken.  

These children, with trauma scars indelibly etched on their psyche, need specialized treatment to heal and thrive. Few get it. The mental health community is woefully unprepared to recognize and treat RAD. Where treatments are available, most families cannot afford them. As a result these damaged children grow into unstable and unhappy adults.

We can do better

Let’s join together for all children – migrant children, foster kids, and adopted children – who are so often collateral damage of policies not focused on their best interest and well-being. There is power in our collective outcry. It’s time to leverage our collective outrage and advocate for reform of “the system” and for meaningful treatments and resources to treat trauma-caused disorders like RAD.

Image: A boy and father from Honduras are taken into custody by U.S. Border Patrol agents near the U.S.-Mexico Border on June 12, 2018, near Mission, Texas. via @Huffington Post

RAD and related diagnoses

Why adoption stories aren’t fairy tales

Adoption finalization is a reason to celebrate. Parents have filled out mountains of paperwork, waited months or years and shed many tears to get to that moment. They wear matching tee-shirts, eat way too much cake and splash photos all over social media. Adoption day is so momentous that it feels like a “happily ever after” in itself. After friends and family return home and the frosting is wiped clean, some adoptive families are left with a much different “ever after” than anticipated. They can struggle immensely feel completely alone. 

When you support adoptive families, you support children from hard places and all the generations to come.  Click To Tweet

While a friend, family member or professional can support an adoptive family in multiple ways, one simple task is most important—to understand that adoption stories aren’t fairy tales. And the path to happily ever after can be extremely difficult to find for kids with developmental trauma. Once a person understands this reality, they can offer more effective support to an adoptive family over time.

Unfortunately, the judge’s pen isn’t a magic wand for kids who come from hard places. “While many people think that love or ‘good parenting’ will make up for the early trauma a child experienced, it’s just not that simple,” said Executive Director Forrest Lien. “Families of kids with developmental trauma need extensive support and specialized services.” 

Without early and effective intervention, many adopted children from hard places continue to struggle academically and socially[i]—even in stable, loving families. They’re at increased risk for substance abuse and criminal conduct and at higher risk for mental health issues.[ii]

When adopted kids struggle, it’s easy for those around them—family, friends, community—to point the finger at adoptive parents. They’re quick to blame the adoptive parents for not getting help for their child. Or they criticize the child for willfully squandering the opportunities given to them.  

“While many people think that love or ‘good parenting’ will make up for the early trauma a child experienced, it’s just not that simple,” said Executive Director Forrest Lien. “Families of kids with developmental trauma need extensive support and specialized services.”

But an adoptive parent cannot serve as a hero or the villain in combating the effects of a child’s early trauma. And the child cannot simply “get over” developmental trauma. 

Adoption is better likened to the nostalgic “make your own adventure books” where readers make choices that lead to different endings. But depending on their geographical location, proximity to specialized therapists, level of trauma their child experienced early on, financial situation, insurance provider, etc., adoptive parents don’t have many viable good options from which to choose. 

Make Your Own Adoption Adventure: Story of Bobbi

To begin to understand the reality for many adoptive families, take a walk through their unfortunate “adventures”—

Chapter 1

Bobbi, age 7, squirrels food away under her pillow and gets into fights at school. Her parents notice these behaviors aren’t getting better. Bobbi needs to see a therapist who has experience working with adopted kids with developmental trauma. This would put her on the path to happily ever after. However, this is unlikely to be a choice available to Bobbi and her family. Here’s why:

 No matter the path chosen, most parents unwittingly go it alone.  They often hope traditional parenting methods will eventually work. Or they find a therapist who lacks specialized training in developmental trauma. Either way, matters get worse with time.

Chapter 2

By the time Bobbi is a teenager, her behavior is increasingly risky. She’s experimenting with drugs, partying and sexting. At this point, Bobbi needs to go to a specialized in-patient treatment program for her safety and the safety of others. This would put her on the path to happily ever after. However, this is unlikely to be a choice available to her and her family. Here’s why: 

  • Most residential programs mix together kids with a variety of conditions instead of offering specialized treatment for developmental trauma.
  • Many families cannot afford the out-of-pocket costs left over after the limited insurance coverage provided. 

Chapter 3

Unfortunately, many children like Bobbi grow up in institutions where they do not get better. Others get tangled up with the juvenile justice system. By then, choices are even more limited as early intervention is key for optimal healing.  

Why the good options are limited

Developmental trauma can have far reaching and severe impacts. Kids may suffer from attention deficits, developmental delays, behavioral problems and more. Because developmental trauma is a disorder stemming from brain impact during critical developmental stages, there are no shortcuts to happily-ever-after—no quick fixes or easy solutions. Even well-informed adoptive parents and early intervention by qualified clinicians is not always enough. However, proper and early interventions definitely offers hope.

Here’s how that can happen:

  1.  Adoptive parents must be given comprehensive training on developmental trauma and therapeutic parenting. They need support to parent their child and to recognize when they need professional help. 
  2. Adopted children must have access to effective, specialized mental health services. This treatment needs to be accessible and affordable.

It’s both shockingly simple and profoundly tragic. Parent training and specialized mental health services are just common sense. Yet, far too many adoptive families are headed down a rocky and difficult path due to lack of these two basics. 

Although the path toward “happilly-ever-after” isn’t as simple as one would hope, friends, family and professionals can at least try to understand the journey. And they can advocate and educate on behalf of these families. 

The Institute for Attachment and Child Development and I invite you to choose your own adventure in creative ways to support and advocate on behalf of the adoptive families. It’s time for communities to join together to make sure our vulnerable children have every possible resource to reach their happily ever after. Because when you support adoptive families, you support children from hard places and the generations that follow.

Originally published by the Institute for Attachment and Child Development..

[i]https://ifstudies.org/blog/the-paradox-of-adoption/
[ii]https://www.childwelfare.gov/topics/can/impact/long-term-consequences-of-child-abuse-and-neglect/crime/

Book Reviews

RAD and Developmental Trauma in Fiction

These popular novels are twisty, psychological thrillers with surprise endings. They each feature a child with developmental trauma and/or RAD. Some details are true-to-life while others are just fiction…

Defending Jacob

Andy, a district attorney, believes his son Jacob, diagnosed with RAD, is innocent of the murder he’s been accused of. Andy puts all his efforts into Jacob’s defense despite mounting evidence against him. But is Andy really innocent?

The Foster Child

Psychologist, Imogen, refuses to believe her new patient 11-year-old foster child Ellie, is dangerous. She’s determined to protect Ellie from the distrustful and cruel adults and children around her. But is she the one who needs protecting?

Baby Teeth

Hanna is a difficult, non-verbal child whose mother is chronically ill. She’s adored by her dad, but mistrusted by her mother, Suzette. After Hanna breaks her silence with whispers threats, bad things begin to happen. Is Hanna really dangerous?

What’s just fiction…and what’s not.

*** WARNING! SPOILERS BELOW ***

When 14-year-old Jacob is accused of murdering a classmate it seems impossible – especially to his father, Andy, who is the local district attorney. Jacob is evaluated by a psychiatrist who diagnoses him with Reactive Attachment Disorder (RAD). The psychiatrist tells the family it is “unusual” for a kid to develop RAD without experiencing any abuse, neglect, or trauma. As the investigation gets underway, Jacob’s mother Laurie begins to question his innocence.
Jacob is ultimately exonerated of the murder. A few months later, however, his girlfriend mysteriously disappears. Andy again defends Jacob vigorously and will not consider the possibly he’s capable of these crimes. However, the truth dawns on Laurie as incriminating evidence mounts. Laurie is deeply conflicted by fear, guilt, shame, love, and desperation. To atone for herself, and to save Jacob from himself, Laurie purposely crashes her minivan into a concrete barrier, killing Jacob instantly.

What’s just fiction – It’s impossible to have with RAD without an underlying trauma per the DSM-IV diagnostic criteria. The author could have incorporated one of the causes of RAD in a “typical” biological families into his plot. Also, it’s unlikely for a child with RAD to be homicidal, as Jacob is, unless he has other serious co-morbid mental illnesses.

And what’s not – The story effectively portrays the common RAD symptoms of extreme manipulation and how father’s often do not “get it.” Also, the conflicted feelings of the mother are realistic and true-to-life. While her ultimate actions are unthinkable – real-life mothers of children with RAD may understand her desperation.

Read Defending Jacob

Ellie, an 11-year-old foster child, the only survivor of a house fire that took her entire family. She’s a child with a trauma background, but is now in a nice foster home. Unfortunately, she’s facing bullying from peers and dislike from teachers. Idealistic child therapist Imogen immediately lays blame on those around Ellie and is certain they are projecting their distain onto her. Wanting to shield Ellie from the unfair treatment of others, Imogen oversteps boundaries in the therapeutic relationship.

All too coincidental “accidents” happen around Ellie. For example, her foster brother teases her at dinner then wakes up and his mouth is super glued shut. Imogen is the only one who believes Ellie is the victim, not the perpetrator. In an unexpected twist, it turns out Ellie’s foster sister, resentful of foster children coming in and out of the home, is to blame for many of the problems. However, in the final scene we find Ellie flicking a lighter and contemplating her future. We realize she murdered her family and was complicit in what happened in the foster home.

What’s just fiction – While these situations can be difficult for siblings, the foster sister’s actions seem highly unusual and unlikely. Also, the book portrays many of Ellie’s responses as involuntary which is not always the case for children with developmental trauma. They can be angry and act out quite willfully.

And what’s not – While Ellie’s behaviors may seem over-the-top, unfortunately, they are all to familiar to parents of kids with RAD. The story also effectively captures how a therapist can be manipulated and mislead in these situations complex situations.

Read The Foster Child

Hanna is a difficult, non-verbal, 7-year-old. Her mother, Suzette, has a debilitating medical condition that has left her distant. While Hanna is not formally diagnosed with RAD, the hallmarks are there and likely a result of having an unavailable primary caregiver. Hanna is highly intelligent, but has angry outbursts and is kicked out of kindergarten. Suzette must homeschool Hanna who grows increasingly defiant, rebellious and resentful towards her. Meanwhile, Hanna is charming and loving with her father, Alex. He sees only an obedient, clever child. Hanna’s first words are whispered threats towards Suzette. And as Hanna begins to target her mother with physical violence, Suzette grows increasingly fearful.

It’s only after the situation has grown frighteningly dangerous that Alex happens to witness Hanna’s violent behavior for himself and understands there is a problem. Husband and wife work together to send Hanna to a residential treatment facility and they quickly accept the reality that she will live there indefinitely. In a sinister final twist, Hanna realizes what she must do. She must follow the rules at the facility so she can go home, get rid of her mom, and have her father all to herself.

What’s just fiction – The ease at which the family finds residential treatment for Hanna, and how quickly they accept her need for long-term care does not mirror the reality of most real-life families in this situation.

And what’s not – Most children with RAD target their mother, as Hanna does. They also hide their behavior well from their father and this can cause serious marital discord. While Hanna’s behaviors seem too extreme to be believable, parents of kids with RAD know they are in fact not that far fetched.

Read Baby Teeth

Resources

Resources shared at the 2019 REFRESH conference!
DTD and RAD Guide for TeachersDownload
How parents get PTSDDownload
Self-care guideDownload
What to do when CPS knocks on the doorDownload
Most Popular, Parenting advice

5 lessons I wish I’d known when I first adopted a child with developmental trauma

My husband and I adopted Devon out of foster care when he was 3. Devon has complex developmental trauma disorder (DTD, commonly diagnosed as reactive attachment disorder). This often occurs when a child experiences chronic abuse or neglect early on and results in disrupted brain development. Adoptive parents like myself aren’t given a how-to manual for raising kids with a history of trauma. I very quickly found myself drowning with no life boat in sight.

This is why I’ve been working on telling my story through a memoir. I hope to educate others about the challenges parents like myself face and to raise awareness about the lack of treatment. Throughout the writing process, I relived painful memories. I grappled with guilt and many regrets. As they say, hindsight is 20/20 and I’ve learned a great deal through reflecting on my own story.

Here are 5 lessons I wish I learned earlier in the journey of raising Devon:
1. I should have given up and gotten help earlier.

For years, I tried to parent Devon on my own. But no matter how hard I tried, nothing worked. Unfortunately, those failures and missteps weren’t merely wasted time. They exacerbated my son’s condition, derailed our relationship and led to a decline in my own mental health. Meanwhile, my other children were living in a home that was highly volatile and unhealthy, causing them secondary trauma.

I often wonder how things might be different if I’d gotten help in the years before Devon was 10-years-old. Don’t get me wrong, writing my memoir also solidified my belief that most professionals aren’t versed in developmental trauma and few treatments are available. However, perhaps with support, my family could have avoided some of our darkest moments. Maybe Devon would have better coping skills and a brighter future. Unfortunately, I didn’t know the warning signs and had no idea where to find help.

2. I was worse off than I knew.

I stopped taking phone calls and opening my mail. My hair was falling out. I knew I was overwhelmed, frustrated, and depressed but didn’t realize I was suffering from post-traumatic stress disorder from the ongoing stress (see How Parents of Children with Reactive Attachment Disorder Develop Post-Traumatic Stress Disorder). I was hanging onto the very edge of sanity by my chipped fingernails. Raising a child with a trauma background took its toll emotionally, physically, and spirituality. It irreparably damaged my marriage and relationships with family and friends.

When writing my memoir, I was shocked to realize just how difficult things were. I saw that there was a gradual shift from manageable to completely out of control. For example, at the time, I didn’t recognize when my son’s tantrums shifted to rages. My mental health was declining more than I realized and did not begin to improve until I started seeing a therapist and went on antidepressants. In retrospect, I realize I should have started taking care of myself far earlier than I did.

3. I could only change myself.

At the time, I was so sure I could “fix” Devon – but I was wrong. Early trauma can tamper brain development and requires specialized treatment. It’s like having a child with leukemia – you can feed them organic chicken soup, tuck them in with warm blankets and curl up beside them to read stories – but, you can’t treat the disease. For that, children need professional treatment. “Many people mistake children with DTD as typical kids going through a tough time or phase. They think love and structure will make all the difference. Unfortunately, it’s often not that simple,” said Institute for Attachment and Child Development Executive Director Forrest Lien. “DTD is a disorder of the brain, not a developmental stage that they outgrow with time or ‘good parenting’. Parents can’t heal them through love alone. They need effective professional help.”

I very nearly had a nervous breakdown before acknowledging what was beyond my control and identifying what I could change. The parenting challenges I was facing were difficult enough without having marital issues, an air conditioner on the fritz and the stress of a difficult boss. What I could do was improve my ability to cope and my capacity as a caretaker by addressing these things. To survive, I had to find ways to raise my own resilience by decreasing or eliminating other stressors in my life.

4. Burning bridges with clinicians is a bad idea.

Some mental health professionals say the hallmark of a kid with RAD is a “pissed off mom”. That was me. As a result, my son’s therapists pinned me as unreasonable, uncaring and angry. I thought they’d give me the benefit of the doubt and assume the best about me. I was wrong. I spent two years torching bridges before I realized the value of building partnerships, even with professionals with whom I disagreed.

I started making progress in getting my son better treatment when I began to hold my cards close to the vest. I forced myself to listen then respond calmly and reasonably. Why is this important? Some of those professionals became my best allies when I needed referrals for treatment, favors called in to get Devon into new placements and back-up documentation when he made false allegations.

5. My family really didn’t get it.

When my father read a draft of my memoir, he found it so painful he had to take breaks from reading. My mother, after reading it, apologized for not understanding and being more supportive. It took my parents walking in my shoes, through the pages of my memoir, to truly grasp how difficult my life was. For some reason, I’d always felt their minimization of my challenges raising Devon was in part willful – as if they just didn’t want to believe it.

I now realize, they truly didn’t “get” it. That makes sense. If my life were a movie, I’d be the first to say the script was over the top and totally unrealistic. Before I adopted, I never imagined a child could have behaviors as extreme and unrelenting as my son does. It’s easy to become defensive with family and friends, but, in retrospect, I wish I’d done more to help educate them about developmental trauma disorder and reactive attachment disorder with movies like The Boarder and through other online resources.

Learning from our stories

It’s hard – impossible – to see the big picture when you’re just trying to stay afloat while parenting a child with developmental trauma. We’re often so caught up in our day-to-day moments, we don’t have time to reflect. We then fail to take a strategic approach to parenting. I wish I’d had the opportunity to benefit from the stories of others instead of learning the hard way.

I encourage parents of children with a trauma background to join online communities like Attach Families Support Group and The Underground World of RAD. We can all learn from each other’s experiences and support one another along the way.

First published by IACD.

In the News, We need to do better

The making of a murderer?

Our Failed Solutions for Seriously Ill Foster Youths (published by The Chronicle of Social Change)

Justin Taylor Bean, removed from his abusive birth parents as a toddler, spent the next two decades in psychiatric hospitals and more than 40 residential facilities.

Over the years, his physical and verbal aggression increased despite treatment and medication. Then, at the age of 22, Justin strangled to death a fellow group home resident.

During his sentencing last month, District Attorney Laura Thomas argued almost sympathetically that Justin “did not have a chance — it was all over for him at age 2.” She then asked that he be sentenced to a life behind bars, which he was.

“There’s not a miraculous cure,” Thomas said. “The public needs to be protected from him forever.”

Many will be outraged by this story, but few will understand how something like this happens. After all, all the warning signs were there. Doesn’t that mean this could have been prevented?

Sadly, it’s not that simple.

More than a million children each year experience early childhood trauma, most often due to abuse and neglect. “Developmental trauma,” a term coined by leading expert Dr. Bessel van der Kolk, affects a child’s brain development. The impact can be devastating, including severe attachment and behavioral issues. These traumatized children need comprehensive, specialized professional intervention and treatment – treatment that’s expensive and not available in most areas.

Unfortunately, I know all too well just how true this is. My adopted son, Devon, has also attempted to seriously harm fellow residents in group homes – more than once. Like Justin, Devon has a diagnosis of reactive attachment disorder and has a similar treatment history. My son could easily have killed someone, he’s just been small enough that staff can control him.

He’s received medication and thousands of hours of therapy. He’s only become more violent and dangerous. Unable to safely live at home, he’s been in and out of psychiatric residential treatment facilities for years. All I can do is helplessly watch as he careens toward adulthood, an angry and violent young man.

What’s clear from Devon and Justin’s stories is that our mental health system does not yet know how to effectively treat children with the most severe developmental trauma. Residential treatment facilities, often the only available choice, are virtual incubators for violence, and many children leave more dangerous than they went in. And far too many end up institutionalized or incarcerated.

As a society, we take these already broken and vulnerable children, and like a gruesome medieval torture press, crush their hope for a good future. We perpetuate their trauma by piling on with broken systems that exacerbate the very problems they try to address: foster care, family court, health care, mental health services and juvenile justice, to name a few.

Further, our communities don’t understand developmental trauma and underestimate its impact. And so, schools, unwitting parents, therapists and social groups pile on too. Under this pressing weight, what hope is there for these children?

The vast majority of people with mental health disorders do not go on to commit murder. But given our apathetic and broken mental health system, developmental trauma can be its own life sentence for youth in the child welfare system. It negatively affects all areas of life – relational, legal, educational and financial. A few victims, like Justin, go on to commit violent crimes.

How many lives have to be destroyed? Isn’t it time to recognize developmental trauma as the unsolved challenge it is, and prioritize funding research, prevention and treatment? Until we do, too many broken children will continue to grow into broken adults and we will continue to see tragedies like the murder committed by Justin.

We need to do better

When pigs fly: the day my son’s therapist apologized…

Today my son’s therapist apologized to me. (Go ahead, take a moment to pick yourself up off the floor, then keep reading…) If you’re the parent of a child diagnosed with reactive attachment disorder (RAD) you know just how significant this is. 

As parents of children with developmental trauma, one of our biggest pain points is dealing with therapists who don’t “get it.” They blame us, are manipulated by our kids, and offer our families little practical help. At best they’re ineffective, at worst they cause enormous damage.

My son’s current therapist, we’ll call her Amy, has made the classic blunders we’re all so familiar with.

      • She tells my son all he really needs is my love, excusing him from responsibility.
      • She praises his cunning circumvention of rules as “trying really, really hard.”
      • She disagrees with me openly and emphatically in front of my son.
      • She makes me the “bad guy” in therapy sessions.
      • She prioritizes her relationship with my son over mine.

Can I get a show of hands? I sure know most of us are struggling with these very same issues.

But today something unexpected happened. I confronted Amy and she acknowledged she could have handled things better and apologized. We then worked together to come up with a reasonable path forward. I very nearly fell off my chair.

In retrospect, here are a few things that may have contributed to this success:

  1. I was confident, not defensive. When we act defensively, therapists are quick to write us off as unreasonable, close minded and pissed off. It’s important to be in a place where we know our rights and can speak as confidently and unemotionally as we might in a business presentation.
  2. I didn’t get personal. We’ve all been offended and hurt by therapists and it’s easy to become wrapped up in those feelings. But when we do, our confrontation goes off the rails. In the end, the conversation shouldn’t be about our feelings at all. It should be about the needs of our child.
  3. I focused on my child. Don’t talk about what the therapist has done to you, or how they have made you feel. Keep the focus on what’s best for your child. My child needs to be safe. My child needs to build a strong secure relationship with me. These are specific things you and the therapist can agree on.
  4. I was specific and kept it simple. If you walk into these conversation with a laundry list of problems, it’s far too easy to get lost in the weeds. Pick one specific issue that highlights the underlying problems to focus on. Make it specific, actionable, and simple. Pick something as objective as possible.

  5. I was reasonable. What can you expect out of a confrontation? You’re not going to change the therapist’s style or philosophy. You’re unlikely to educate them on RAD and DTD, although you might crack open the door for that. What you should be able to do, is come to an understanding and agree to some ground rules.

It sure felt good when Amy apologized to me, but that mattered far less than the action plan we put into place. With a common goal established we agreed to:

  • Meet prior to family therapy sessions to agree on how news will be delivered to my son and how to approach what will be discussed in the session.
  • If  a topic comes up that we need a sidebar on, before discussing in front of my son, I’ll use a code word and she’ll put off that topic until after we’ve had a time to talk privately.

Every therapist, family, and child is different. Some therapists are easier to work with than others and this isn’t a one-size-fits all formula for every situation. Still, I hope reflecting on my experience may provide a useful starting point as you work hard to advocate for your kids and help them get the therapy they need.

Today my son’s therapist apologized to me. If you’re the parent of a child diagnosed with reactive attachment disorder (RAD) you know just how significant that is. In fact, you might have to pick yourself up off the floor after reading that. Click To Tweet

How have you been successfully able to work with therapists?

RAD and related diagnoses

RAD, DTD – What’s all the controversy about?

Tweets. Facebook messages. Verbal knockouts. One too many times, I’ve been told reactive attachment disorder (RAD)—the result of a child’s early trauma—isn’t a “real” diagnosis. When parents like me hear that our child’s diagnosis is fake, bogus, or phony, it’s like a kick in the stomach. We feel invalidated, misunderstood, hurt, angry, and frustrated.

I’ve even had more than one mental health professional question my son’s diagnosis of RAD. I’m not sure if this stems from a lack of education, of effort, or of something else. Here is what I, and other parents raising children like my son, know for certain—we know RAD is “real” because we’re living with it.

Don’t miss out on this post: Raising a Child with Developmental Trauma

Parents know firsthand the heartbreak and frustration of raising a child who cannot receive or return our love…and what that looks like in the privacy of our own homes.

A new diagnoses for early trauma

To complicate matters, there is another diagnosis outside of RAD to explain the effects of early trauma. Many clinicians are advocating for the elimination of the RAD diagnosis altogether in lieu of developmental trauma disorder (DTD).

The term DTD was coined by Dr. Bessel van der Kolk who I recently heard speak at the 2018 ATTACh conference. Over the three days of that conference, I had the opportunity to learn more about the DTD diagnosis and the controversy attached from leading researchers and clinicians and I walked away with a new perspective…

Here’s what I heard:

  • We don’t like the label “RAD,” but we totally get it. We understand the extreme behaviors and challenges parents are facing on a daily basis.
  • We want to partner with parents because we believe healthy relationships with adoptive parents are the key to healing for these kids.
  • We know it is very difficult to find and access effective treatments for the impacts of early trauma. We’re advocating every day for adoptive families and focusing our research on meaningful treatments for trauma.

As I absorbed more about the DTD diagnosis, I realized parents and professionals are talking past each other on this issue. These professionals aren’t denying our experiences. They’re questioning how we categorize, label, and communicate about it.

What can we agree upon?

  1. Having a correct diagnosis is important. Children with early childhood trauma are often misdiagnosed and therefore don’t receive treatment. Furthermore, the RAD diagnosis is only the attachment piece of the puzzle. There are a number of diagnoses frequently given to victims of early childhood trauma including PTSD, conduct disorder, ADHD, and RAD. No one disorder covers the complexity of the issues our children face.
  2. Attachment is only one of the ways early childhood trauma impacts kids. We already know this as parents. Our kids have learning disabilities, cognitive issues, developmental delays, emotional problems, as well as attachment issues. In fact, most of our kids have an alphabet soup of diagnoses to cover all their symptoms
  3. Regardless of what the diagnosis is called, parents just want help. We’re desperate for treatments that work, therapists who understand, schools where our kids can be successful, more awareness in our communities, and strategies to better parent our children. We want our children to heal and thrive.

What’s in a name?

The Diagnostic and Statistical Manual of Mental Disorders (DSM) is the guide mental health professionals use to diagnose mental disorders. It’s used by providers to submit insurance reimbursement claims. RAD was added to the DSM as a diagnosis in the 1980s. Three decades ago is a long time! Neuroscience has made huge advances and it’s time for the DSM to catch up.

Here are definitions of the RAD and DTD diagnoses in a nutshell:

RAD is caused by childhood neglect or abuse which leads to a child not forming a healthy emotional attachments with their caregivers. As a result they struggle to form meaningful attachments leading to a variety of behavioral symptoms.

DTD is caused by childhood exposure to trauma. As a result they may be dysregulated, have attachment issues, behavioral issues, cognitive problems, and poor self esteem. In addition, they may have functional impairments in these areas: Educational, Familial, Peer, Legal, Vocational. (footnote)

As you can see, the DTD diagnosis brings the impacts of childhood trauma under one umbrella. It enables mental health professionals to take a holistic approach to our children instead of piecemeal treatments.

Experts petitioned the American Psychiatric Association (APA) to have the DTD diagnosis added to the latest version of the DSM. The request was denied. One cannot help but wonder the impact the health insurance industry had this decision. In fact, Bessel van der Kolk made this point at the ATTACh conference, urging mental health professionals and parents to become politically active around this issue.

While the APA rejected the diagnosis in this latest version of the DSM, leading researchers and experts have embraced the DTD diagnosis. For example, the Institute for Attachment and Childhood Development is not waiting for the inclusion of DTD into the DSM in order to properly acknowledge it.

When mental health and other professionals frown at the RAD diagnosis, they’re not invalidating our very real experiences. On the contrary, they’re recognizing that the current diagnoses, including RAD, don’t adequately describe the severe and devastating impact trauma has had on our children. They’re advocating for more research, treatments, and funding for our kids.

This mom’s resolution of the diagnoses for trauma

Until DTD is added to the DSM and/or covered by health insurance, to embrace the diagnosis still poses issues for parents. Treatment and care for children with early trauma backgrounds is expensive. The DTD diagnosis doesn’t currently qualify for insurance reimbursements. So, for now, I’m hanging onto my son’s RAD diagnosis. For better or worse, that’s how our healthcare system works.

When mental health and other professionals frown at the RAD diagnosis, they’re not invalidating our very real experiences…they’re advocating for more research, treatments, and funding for our kids.

However, I’m thrilled the mental health community is recognizing the devastating scope of impact early childhood trauma has on our children. I’m optimistic about the promising advances in neuroscience that are leading to new treatments. The DTD diagnosis is a major step forward in helping children like mine, who have suffered early childhood trauma, to heal and thrive.

Footnote: http://www.traumacenter.org/products/pdf_files/preprint_dev_trauma_disorder.

Originally posted by IACD.

Most Popular, Resources

What to consider before you adopt…

Two-year-old Kayla was shy with dimples that winked when she laughed. Her brother, three-year-old Devon, had curly brown hair, freckles and a quick smile. We’d long dreamed of adopting foster kids and my husband and I jumped in heart-first.

During the mandatory three-month pre-adoption waiting period, Devon and Kayla had some concerning behaviors – issues with food, problems potty training and impulse control – but foster parenting training had prepared me. I knew these were completely normal issues, nothing that couldn’t be healed with the love of a forever family.

What I didn’t know was that Devon and Kayla had experienced early childhood trauma. I discovered that they had learning disabilities, cognitive issues, attachment struggles and behavioral problems over the years. I was woefully unprepared to parent these two beautiful, hurting children.

I did the best I could raising Devon and Kayla but I have regrets in retrospect. Knowing what I do today, I would still have jumped into the adoption heart-first, but I wish I’d also had more information, been better prepared and gone in with the right mindset.

The impacts of early childhood trauma

In the United States there are over 100,000 children waiting to be adopted out of foster care (1). There are thousands more living in orphanages around the globe. Unfortunately, many of these children have histories of neglect, physical abuse, sexual abuse, emotional abuse, abandonment and more. When these experiences occur during critical time periods of development, the child’s brain development can be disrupted.

The impact of early trauma is broad and varies in severity. Renowned psychiatrist Dr. Bessel van der Kolk coined the term development trauma disorder (DTD) to describe its effects on some children. Children with DTD typically struggle to form meaningful and authentic relationships, regulate their emotions and control their impulses and aggression. Many of them have sleep issues, poor executive functioning, learning disabilities and low self-esteem. While certainly not all adopted and foster children suffer from DTD, many do.

There are no quick and easy fixes for the effects of early trauma, unfortunately. A healthy, positive attachment to a stable and consistent caregiver, however, is key to positive outcomes for these kids. Adoption is an important piece of the puzzle for many children to heal from early childhood trauma.

Here are some important ways families can prepare for adoption:

1. Learn everything you can about the impacts of early childhood trauma. Despite what people sometimes assume or want to believe, children do not simply outgrow serious impacts of trauma. “Good parenting” also does not heal the disorder. You need to educate yourself beforehand to know what to look for and who to call upon if you need assistance. One resources to get started is The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma by Bessel van der Kolk, M.D. and this set of blog posts all about trauma and the potential diagnostic outcomes.

2. Be realistic in your expectations. Traumatized children need stable love to heal but love alone cannot repair the damage of early childhood trauma and mental disorders. Many children with DTD will need life-long care and intensive mental health and educational services.

3. Consider your ability to manage difficult behaviors and challenging special needs. Every family has differing levels of resilience and abilities to take on challenges. Be realistic when considering your bandwidth. Children with DTD can actively thwart your affection and have serious behavioral problems. It’s possible your adopted child may need a stay-at-home parent. Is this something you are financially able to manage? Also consider the time requirements for tutoring, counseling, occupational therapy, and medical and psychiatric appointments.

4. Think carefully about other children in your home. Having a sibling with special needs can be both a positive and negative experience. It will undoubtedly result in your resources being stretched and shared. If your child has a history of aggression or violence, it’s best if they are the youngest child in the family. It’s almost always beneficial for children to have their own bedrooms. Siblings will need access to respite activities – camps, time away with grandparents and friends and one-on-one time with you.

5. Work closely with your adoption agency. Request a copy of all available records for the child and read them thoroughly. Insist on a full psychiatric evaluation by a mental health clinician so you can understand the challenges your child faces. If you’re adopting out of foster care, ask that your child remain qualified for Medicaid regardless of your income. Negotiate a subsidy and understand the appeal process should your financial obligations change.

6. Build a strong support system now. Lack of support is one of the greatest issues adoptive families face. Don’t assume family and friends understand the challenges of adoption and early childhood trauma. Even adoptive parents typically don’t understand the realities of raising a child with DTD until they have the experience. Provide friends, family, neighbors and educators with resources and ask them to partner with you before the child enters your home, if possible. Consider who you will be able to call on to pick up a child from school, help with dinner in a pinch and to listen without judgement when you just need a supportive ear. Reach out and join local and online support groups.

Children who have experienced early childhood trauma desperately need to be welcomed into families as part of their healing process. Click To Tweet

Children who have experienced early childhood trauma desperately need to be welcomed into families as part of their healing process. Unfortunately, too many adoptive families go in with unrealistic expectations and are unprepared for the challenges they will face. If you decide to adopt, be sure to consider the trauma history of the child and prepare yourself and your family for the challenges ahead.

Before you adoptDownload

1 – https://www.adoptuskids.org/meet-the-children/children-in-foster-care/about-the-children

Originally published by IACD