Recently I’ve seen several headlines about schools who are introducing yoga as a way to address student behaviors. The West Fargo Pioneer explains this way:
Behavior issues stem from a multitude of reasons. However, studies show that students today are more likely to experience trauma and have mental health needs, increasing the likelihood of classroom disruptions and behavioral issues.
In a classroom of 20, one or two students on average will be dealing with serious psycho-social stressors relating to poverty, domestic violence, abuse and neglect, or a psychiatric disorder, according to the Child Mind Institute.
This type of stress can shorten periods of brain development and limit brain growth in early years, making it harder for students to regulate emotions and concentrate on learning.
And while schools can’t control students’ experiences outside the classroom, they can help students learn how to cope with stress and regulate emotional outbursts. Social-emotional curriculum aims to help students recognize and deal with emotions and tackle the increased presence of stress and trauma.
It’s absolutely true that every classroom has children who have experienced trauma. Early childhood trauma is an epidemic. It’s absolutely true that these experiences affect a student’s ability to learn and cope in school. It’s also absolutely true that some students will benefit from yoga. It will help by,
Great ideas, however news articles like these give the impression that yoga is an inexpensive, quick fix for childhood trauma. For kids on the moderate to severe end of the spectrum, this simply isn’t the case.
Here’s the problem
Many kids with developmental trauma are so dysregulated they cannot follow instructions or calm themselves enough to even choose to participate in yoga. A 10-year-old who flips desks, curses at the teacher, and fights with other kids is likely not able to safely or effectively participate in yoga.
Furthermore, kids who have extreme behaviors and emotions may be extremely disruptive during yoga activities. This can cause other students to be unable to focus and benefit from the exercises. A 6-year-old who refuses to follow instructions, pesters other kids, and runs around in circles, will disrupt the entire atmosphere.
If a child has a cold, a spoonful of honey does wonders. However, that same spoonful of honey is not able to cure a child who has strep throat. Here’s the ugly truth about trauma: Some kids who have experienced trauma have needs far beyond what a spoonful of honey can heal. Without comprehensive and specialized treatments, these children are unlikely to benefit from yoga at school. They probably won’t even be able to successfully participate.
I cringe at the “yoga in school” headlines because they minimize the devastating, often debilitating, effects of trauma on our kids. Most people who read the articles, or just skim the headlines, will assume childhood trauma is easily treated.
Don’t get me wrong – I applaud schools incorporating yoga into their curriculum and behavior programs because it can be helpful to so many children. However, yoga cannot curb extreme behaviors caused developmental trauma. It is a far more complicated and challenging issue.
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
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:
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.
Visualize each of these diagnosis as their own umbrella with the associated symptoms beneath. Kids with developmental trauma are often balancing two, three, or more of these umbrellas. It’s not uncommon for a child to be diagnosed with ADHD, PTSD, RAD, and ODD – or any number of other combinations.
Unfortunately, this diagnostic method is a disservice to children who have developmental trauma.
Let’s take ADHD as an example. The ADHD diagnosis is for kids who have persistent symptoms of inattentiveness, hyperactivity, impulsivity that manifest in more than one domain, for example both school and home. ADHD is caused by a, often hereditary, chemical imbalance. Stimulant medications work because they increase certain chemicals in the brain.
Kids with developmental trauma may also be inattentive, hyperactive, and impulsive. However, the symptoms are not caused by a chemical imbalance as they are with ADHD. They are caused by underdeveloped and impaired brain functions or an over-sensitive fight-flight-freeze response. Stimulant medications can exacerbate other symptoms of developmental trauma.
Unfortunately, ADHD is not the only insufficient diagnosis commonly given to kids with developmental trauma. In many cases this can result in a child receiving ineffective treatment. Worse still, these diagnoses may mask the real issue and it will go untreated.
Developmental Trauma Disorder
To better serve children with developmental trauma, Kolk has proposed adding a new diagnosis to the DSM called Developmental Trauma Disorder (DTD). The new diagnostic criteria requires exposure to chronic trauma before the age of 5. This diagnosis would fully encompass the symptoms of developmental trauma bringing them under one umbrella.
The DTD diagnosis would enable clinicians to more accurately diagnose developmental trauma. In addition, comprehensive treatments for DTD could be developed. This an area of neuroscience Dr. Bruce Perry is pioneering with his Neuro Sequential Model of Therapeutics. His approach includes mapping of underdeveloped brain functionality and a process to stimulate healing in the order of natural brain development.
Largely due to political and financial forces, the DTD diagnosis was not included in the latest version of the DSM. Advocates are working to have it included in the next revision which is several years away. In the meantime, parents must know how to successfully navigate the current diagnoses to get their child proper treatment.
Getting your child the best care
Because DTD is not in the DSM, it is not an official diagnosis and not covered by health insurance. Until this changes your child will be given other diagnoses to fully describe his or her symptoms.
Here’s what you can do to ensure the best treatment:
Early intervention is key so seek professional help as soon as you recognize there may be a problem or become aware of your child’s trauma history.
Go ahead and accept the alphabet soup of diagnoses. These are essential to get health insurance coverage for the very expensive treatments and therapies your child may need.
Get a psychological evaluation from a psychiatrist. If you know your child has a history of trauma, don’t settle for an ADHD diagnosis from your pediatrician. Ask for a referral to get a full evaluation.
See a psychiatrist for medication management. For your convenience, most pediatricians will continue refilling prescriptions once the patient is stabilized. However, get started on the right foot with a psychiatrist.
Seek out therapists and other practitioners who have experience working with traumatized children.
As your child’s primary advocate, it’s critical for you to keep the entire team focused on the trauma underlying his or her symptoms. Learn all you can about developmental trauma and keep it at the forefront when you discuss your child’s treatment plan with mental health professionals, educators, therapists, and pediatricians. These steps will ensure your child gets the best treatment available.
When Amias was born, I was totally and immediately infatuated with him. I breast-fed and co-slept. I almost never used a stroller or carrier – he was always in my arms. At his slightest whimper, I was there. When he was a toddler, Amias hated the bright Florida sunshine in his eyes. He would hold up a palm to shield his face as he rode in his car seat. When I hung a shade from the car window with suction cups, Amias knew for sure his mom would always take care of him, even if it meant “moving” the sun for him.
My adopted daughter Kayla didn’t grow up in this type of loving environment.
As a baby and toddler, Kayla would cry and scream to get someone’s attention when she was wet or hungry. Sometimes she was cared for. Sometimes she was ignored. Many times, she fell asleep still wet and hungry – having finally exhausted herself.
When we adopted Kayla out of foster care at three-years-old, she would scream for hours – literally hours – for seemingly no reason at all, no matter what we did in an attempt to comfort her. It was so severe a neighbor once pounded on our door and threatened to call the police and report us for child abuse. I really couldn’t blame him. I’d never known a child to scream for so long and for no reason.
Of course, though, there was a reason. We just didn’t know it back then.
Due to trauma during her early development, the lens Kayla viewed the world through was warped. It made even loving caregivers seem unsafe. Situations and people all appeared unpredictable. Kayla likely had no conscious awareness of this and she certainly could not verbalize it.
The Impact of Trauma
Leading trauma expert Bessel van der Kolk explains in his book The Body Keeps The Score that, “Trauma results in a fundamental reorganization of the way the mind and brain manage perceptions.” Because a young child’s brain is vulnerable, chronic abuse and neglect during the earliest years changes the way the brain normally develops–the root cause of developmental trauma disorder (DTD).
DTD can have a wide range of negative effects of varying severity. For Kayla it has caused a math learning disability, relational and attachment struggles, attention deficits, poor impulse control and more. These are daunting challenges in themselves but, remember, her view of reality is distorted which further compounds these issues.
To put this in context, consider for a moment how your worldview – optimistic, pessimistic, faith-based, etc. – impacts everything you do. For better or worse, we all filter our experiences though the lens of our worldview.
Amias and Kayla are only three-months apart in age, but their lenses are completely different because of their differing early childhood experiences. Kayla is far more prone than Amias to being anxious in new situations, to thwarting close relationships, and to misreading people and their intentions.
Due to the differences in their early childhood experiences and development, Kayla faces far more obstacles than her brother.
For many children like Kayla, developmental trauma can be a powerful determinative factor that dramatically impacts the quality of their relationships, their education and vocation, and mental and physical health. They have a higher risk for substance abuse, problems in school and incarceration.
Because Kayla was born into a different environment, she is at a disadvantage compared to her brother.
Healing the Impact of Early Trauma
Over time, a healthy attachment with a consistent caregiver like an adoptive parent can help alter the lens through which a child with DTD views the world. Unfortunately, it’s not as simple as changing out a pair of busted up, twisted, kid-sized sunglasses for a pair of top-of-the-line Ray Bans. If only it were as simple. You can think of the lens formed by developmental trauma as melted into a child’s cornea – that’s how deeply imbedded it is into the core of who they are.
“DTD falls on a spectrum. Some kids have more struggles than others. No matter the severity, however, the adults who raise them require extensive support of varying levels,” said the Institute for Attachment and Child Development Executive Director Forrest Lien. “Too often, however, caregivers are blamed and shamed rather than supported. This lack of support often leads to a variety of problems, including divorce and adoption disruption. Effective early intervention is vital for these families.”
For children on the moderate to severe end of the developmental trauma spectrum, highly specialized treatment is required to heal. For kids who are on the milder side of the spectrum, like my daughter Kayla, families can often find success through outpatient treatment, obtaining 504s/IEPs and implementing therapeutic parenting strategies.
Kayla has been with us for over a decade now and we’ve fought for support along the journey. Although her world will always be distorted to some extent by her trauma lens, she’s thriving despite her challenges. My hope is that someday Kayla will be secure enough in our relationship to know I’ll always move the sun and moon for her too.
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.”
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:
Behaviors that don’t respond to discipline (particularly therapeutic parenting methods)
Tantrums that last far past the terrible twos and threes
Persistent struggles severe enough to interfere with home life, school, or friendships
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)
Reactive Attachment Disorder (RAD)
Oppositional Defiant Disorder (OD)
Sensory Processing Disorder
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
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.
Our recent Facebook poll showed up to 95% of adoptive parents are not sufficiently trained on developmental trauma and the related diagnoses including Reactive Attachment Disorder (RAD).
While adoptive parents don’t understand the scope and magnitude of developmental trauma, they do do expect children coming out of foster care to have some issues. Among the adoptive and fostering communities, these are considered “normal for foster kids”:
These issues are indeed common among foster kids, but normalizing them is a problem.
Because parents are told these behaviors are normal, and will diminish once the kids are safe in their “forever home,” they don’t raise the alarm bells they should. We often lose sight of the fact these behaviors are usually symptoms of neglect or abuse.
All children adopted out of foster care or international orphanges have, by definition, experienced one or more adverse childhood experience (ACES). ACES are traumas including being separated from a caregiver, physical abuse, neglect, and more. Unfortunately, most adopted children have more than one ACE which can cause developmental trauma when experienced by a child before the age of 5. During those formative years, their brains are rapidly developing and so particularly vulnerable.
YET only 5% of adoptive parents are trained to recognize the signs of developmental trauma and get help for their child.
This is a staggering lack of pre-adoptive training considering the high likelihood (as high as 50%) their child will have developmental trauma.
Here’s what parents are saying about the lack of pre-adoption training
In foster parenting training we were told about RAD but that it was so rate that it was not worth much discussions as we would likely never see it in our home.”
We knew RAD was a likely thing when we started fostering, not because our agency bothered to tell us, but based on our own research.
We knew and were trained and immediately sought help through a therapist we were already using. It didn’t change a thing though. She still tried to have me killed this past November. All the resources, professionals, etc didn’t make it any better.
I recognized something was wrong on day 2. It took me 10 months of researching to find what it was.
Yes I knew, but NO I was completely unprepared for the extent to which the challenges would be.
We adopted 15 years ago and were told nothing and knew nothing about RAD. I should add that I am a medical professional and was never taught anything about this.
We were not taught about it. In fact we were not even told he had been diagnosed with it. Of course we were told that he had had Leukemia and would need follow ups.
Love alone is not enough
While few pre-adoptive parents are trained on developmental trauma and RAD, they are consistently told “these kids only need the “love of a forever family” to heal and thrive.” While it’s true they need love in a forever family, love alone is not enough.
Just as love cannot heal a broken arm, strep throat, or leukemia – love alone cannot heal developmental trauma. Developmental trauma is a brain injury that requires highly specialized treatment.
Without adequate training, parents are unprepared to recognize the symptoms and get the early intervention these children so desperately need. Sadly, far too many families are already in crisis before they get professional help. In some cases the children end up institutionalized or incarcerated. Other families are forced to trade custody for mental health care. Some adoptions fall apart.
These are preventable tragedies, in many cases, if only pre-adoptive parents were trained and prepared.
What parents need in pre-adoptive training
For adoptive children to thrive, our pre-adoptive training (often called MAPP classes) must be reformed. The information needn’t be told in a way that scares away prospective adoptive families. But it does need to be comprehensive and allow each family to honestly evaluate their ability to care for a child from hard places. It also needs to equip parents to recognize when they need professional help and to know how to get it.
Prospective adoptive parents ned to walk away from training with:
A comprehensive understanding of developmental trauma – the science of trauma, the risk factors, and potential impacts to the child.
A familiarity with the hallmark symptoms of Reactive Attachment Disorder (RAD).
Practical training on the how-to of therapeutic parenting.
A full understanding of the warning signs that a child needs professional help.
Guidance for how and where to find help.
Parents must understand that they are not able to heal developmental trauma on their own. Let’s give them the information, community supports, and mental health resources they need to successfully help their child heal and thrive.
If you’re an adoptive parent who wasn’t provided with training on this important topic, here are some resources to check out. More resources are listed on our Resources for Parents page.
Our recent Facebook poll showed that 67% of children first misdiagnosed with RAD (and other developmental trauma diagnoses) were first diagnosed with ADHD.
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.
I parented my child so incorrectly..,we lost so many years. Letting go of the guilt was hard, so trust me I understand!
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.
We lost three precious years chasing the wrong problem.
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!
Too many stimulants which caused aggression and chaos at home and in school. Terrible situation which makes me angry and bitter.
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…
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.
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?
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.
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.
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.
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.
One of the challenges of raising a child with developmental trauma disorder is how many professionals do not truly understand the disorder. However, I know one social worker who “gets it”—and had the fortune to work with her.
Natasha was the first professional who understood my family was in crisis. She understood that my son Devon has an irrational need to control people and situations. Due to his early trauma, it is how he copes. She was able to look beyond his superficial charm to identify the underlying issues.
One Saturday, Natasha showed up in her pink pajamas while my son was raging (she also taught me to use the word “rage” instead of tantrum to effectively communicate the severity of my son’s behaviors to mental health professionals). She couldn’t stop his rage anymore than I could. But she sat with me. Sometimes that’s all I needed. Natasha breathed new hope into our family and perked up the wilted and drooping mother inside me.
In honor of Social Worker Month, this is my thank you to the social workers who have touched the lives of families like mine in positive ways. If you’re a parent who hasn’t been fortunate enough to work with a wonderful social worker, I hope you will find a “Natasha” for your family.
Thank you to the social workers like Natasha (above) who make a difference for kiddos with developmental trauma and their families
Dear Social Worker,
Raising a child with developmental trauma has been difficult, sometimes devastating. I feel like the parade of professionals—teachers, therapists, doctors, social workers, specialists—just don’t “get it”. I’m so lonely. I’m desperate for help but it seems like I’m constantly hitting a wall. I’ve been put down, unheard and misunderstood.
But you were different. You made a real difference in our lives.
Thank you for hearing me.
You really listened as I poured out my sadness, frustration and exhaustion. You didn’t judge. You didn’t offer platitudes. You were trained on complex developmental trauma and understood how complicated these situations can be. For once, I felt understood.
You collaborated and communicated with me. Together we were able to come up with the best solutions for our family and for my child. You understood that children with developmental trauma often triangulate the adults around them. You believed that by helping me—the whole family—you were helping my child. You were right.
Thank you for showing up.
You answered my emergency calls and texts. You stayed late when there was a problem. You walked through my front door and told me to take a break—often my first in the day—while you pulled out a board game to play with the kids.
Thank you for trying to help.
You were creative and resourceful. Developmental trauma is difficult to treat but you taught me about therapeutic parenting. Not everything worked but some things did. You gave me renewed hope with each new approach you suggested.
Thank you for not giving up on me.
You never gave up on me even when I gave up on myself. Parents like myself get PSTD from the stress. So often I wanted to curl up in a ball but then you came knocking at my door with kind words, a big smile and practical help.
I know you are overworked and underpaid. You watch TV at night surrounded by stacks of paperwork. Emergency calls interrupt your weekends and evenings. You eat on the run and drink lukewarm coffee. But, you still remember the name of every child you work with—their siblings and friends’ names too.
You have touched my family and helped us grow and heal. I am deeply grateful and wish all families had an amazing social worker like you on their team.
Originally published by The Institute for Attachment and Child Development here.
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…
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?
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?
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.
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.
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.
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.
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 Boarders 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’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.
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.
[bctt tweet=”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.” username=”RaisingDevon”]
What can we agree upon?
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.
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
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.
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.