Tag: DTD

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
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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

What we might learn from another tragic story of mental health help given too late, too little

Caleb, 11, was thin with blond hair, glasses, and a big smile where crooked teeth jockeyed for space. He and his brother, Elijah, were adopted by Martin and Dena Lishing when Elijah was a toddler and Caleb was a baby. Their young birth mother struggled from addiction.

Born a preemie at 24-weeks-old and weighing only 1 pound, Caleb beat the odds. His 5th grade teachers remember him as shy, inquisitive and loving. He wore cowboy boots to school every day. He was fascinated by all things Titanic. A classmate says, “He was really funny. He always had jokes and puns to tell.”

It was a warm, overcast evening on April 23, 2018–Caleb was asleep in his bed. An adult babysitter was in a nearby room. Meanwhile, 13-year-old Elijah dismantled their grandfather’s locked gun cabinet to access a .357 Magnum. Caleb was sleeping on his stomach when Elijah shot him in the back, killing him.

This tragedy was the first murder in the small, sleepy town of Streetsboro, Ohio in 20 years. But it wasn’t the first time police were called to the Lishing home on Alden Drive.

Mental health interventions, too late

Over the years, the family had attempted – unsuccessfully – to get mental health treatment for Elijah although details are not public. Reports indicated Elijah tried to commit suicide twice. In 2017, Elijah was charged with indecent exposure on the school bus. In 2018, his stepmother called police because he became “unruly.” When he told officers he was thinking of harming himself, they transported him to a local behavioral health center for evaluation.

Only four days later, Elijah shot and killed his little brother Caleb. Police have not disclosed Elijah’s motive but say it was premeditated.

Psychologist Dr. Amy Thomas testified at the sentencing hearing that Elijah suffered early childhood abuse. Elijah claims, in addition to neglect from his birth mother, he was subsequently abused in the Lishing home. He details harsh punishments from a young age and says his adopted mother was more devoted to premature Caleb than to him. The Lishing couple also divorced several years after the adoption.

Thomas diagnosed him with reactive attachment disorder (RAD), also called developmental trauma disorder (DTD). This often occurs when a child experiences chronic abuse or neglect before the age of 5. A child with DTD has disrupted brain development and, if not provided early and highly-specialized intervention, can suffer long-term and devastating impacts. They have difficulty forming healthy attachments with caregivers and others which can lead to familial, social, educational and legal issues. Dr. Thomas also diagnosed Elijah with post-traumatic stress disorder and conduct disorder, both common diagnoses for children with DTD.

Elijah’s situation is even more complex than DTD alone, however. Dr. Thomas testified that Elijah also suffers from paranoia and stated that a previous clinician had diagnosed him with schizophrenia. Reflecting on the time of the murder, Elijah told the court, “I was living inside my head, unable to determine the difference between imagination and reality.” This points to serious mental illness in addition to complex DTD.

The worrisome correlation of complex developmental trauma and mental illness

Dr. John Alston, psychiatrist for the Institute for Attachment and Child Development, found a strong correlation between complex DTD and co-morbid mental illness. In his studies, Dr. Alston recognized that adults who abuse or neglect their children often do so as a result of a mental illness. Thus, their children may suffer the unfortunate combination of both the nature (genetics) and nurture (attachment) consequences.

And when children with complex DTD inherit a mental illness, it is often in a profound way according to Dr. Alston. He gives the analogy of more commonly-known childhood health issues. “You never hear of symptoms of childhood diabetes in a mild form, you never hear of childhood asthma in a mild form. They are always inherited in a severe or profound form and therefore the earlier the onset, the more severe the disorder, the more intensive the treatment needs to be,” said Dr. Alston. “It is exactly the same when we are talking about mental health disorders.”

Elijah told the court, “I was living inside my head, unable to determine the difference between imagination and reality.” This points to serious mental illness in addition to complex DTD.

Forrest Lien, Director of the Institute for Attachment and Child Development, is adamant that not all children with developmental trauma are dangerous. Rather, it is often the unfortunate combination of specific and severe disorders. “Developmental trauma disorder alone does not deem a child dangerous. Furthermore, not all children with DTD have a mental illness. Yet, some do,” Lien says. “Children with complex developmental trauma often feel angry and can lack empathy. When you combine a child who feels slighted and vengeful with a misdiagnosed or poorly-treated severe bipolar disorder with psychotic features, it can be dangerous.”

Neuroscience is an emerging science and this link between early trauma and mental illness is not well known. However, given the potential for sometimes dangerous antisocial behavior, it is critical that clinicians still give careful consideration to these correlations. It is vital, Dr. Alston says, to differentiate the impact of severe trauma from potential mental illness symptoms in order to properly diagnose and treat the whole child. 

The case for better mental health support

Unfortunately, Elijah’s developmental trauma and co-morbid disorders were not accurately diagnosed until after he was incarcerated—not in time to prevent this horrific incident. He did not receive appropriate treatment and the costs to his family and himself have been enormous.

Martin and Dena are heartbroken having suffered the loss of their children. Innocent 11-year-old Caleb’s life has been cut short. And they must now grapple with the incarceration of their other son.

“When you combine a child who feels vengeful and slighted with a misdiagnosed or poorly-treated severe bipolar disorder or schizophrenia with psychotic audio and visual hallucinations, it can be dangerous,” said Institute for Attachment and Child Developmental Executive Director Forrest Lien.

Elijah, now 13, is a convicted murderer facing a lifetime of struggles. He has been sentenced to juvenile detention until he turns 21 and at that time his case will be reevaluated with the potential for adult detention time. According to the Record Courier, “Judge Robert Berger said that despite abuse the boy suffered as a child, it did not excuse shooting and killing his brother.”

Perhaps with earlier diagnosis and interventions, Elijah wouldn’t be sitting in a prison cell today. Caleb might be running around the playground instead of being memorialized by the Titanic-shaped play fort the community is erecting in his memory.

Published originally by IACD. Updated 1/28/2019 after sentencing.

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, Tips to navigate "the System"

What to do when child protective services investigates…

An interview with Diane L. Redleaf, a family defense pioneer

Nationally-known leaders have called Diane L. Redleaf the “conscience of the child welfare system,” the driving force behind creating a “better, fairer child welfare system” and “the people’s lawyer.” Diane has played a leading role in hundreds of important cases on behalf of families, with over 60 published court opinions. She has also led legislative efforts that have benefited millions of children and families.  Her litigation and legislative advocacy has created due process remedies for wrongly accused family members and created social service and housing support models for families throughout the United States.

Child protective services (CPS) plays a vital role in keeping kids safe. For this reason, CPS investigators often err on the side of caution to ensure children aren’t exposed to harmful situations. Even when allegations are false, caregivers can face lengthy investigations. This unwarranted disruption and family upheaval is collateral damage, necessary to make sure children who really are abused get the justice and safety they deserve. 

For many parents of children with complex developmental trauma disorder (typically diagnosed as reactive attachment disorder or RAD) these interactions with child protective services are an unfortunate and challenging reality.

To legally advance the false allegations of a child with DTD is an unrecognized, innocent and unintended form of further harm to that child.

Children with RAD may make false allegations in their desperate attempt to control the people and situations around them. The resulting investigations disrupt the family, are tremendously stressful and in rare cases the outcome can be devastating.

Innocent parents and caregivers are often frightened and lack the resources and knowledge to defend themselves and protect the interest of their children. I recently had the opportunity to speak with Diane Redleaf, a leading civil rights lawyer for families in the child welfare system. She has extensive experience defending and advocating for parents who face false allegations of child abuse and neglect. She’s the founder of the Ascend Justice (formerly, Family Defense Center) where she served for many years as the Executive Director/Legal Director. With over 60 published court opinions, she’s played a leading role in hundreds of important cases and policy change efforts on behalf of families. Today she’s an advocate for families through her private legal practice Family Defense Consulting.

In our interview, I asked Diane how falsely accused parents and caregivers can successfully navigate the child protection system. While this cannot substitute for legal advice or address individual circumstances, I’m excited to share her invaluable guidance and tips.       

Keri: Kids like mine, who have RAD, sometimes make false allegations of abuse. As parents we’re afraid CPS investigations will be unfair and that we’ll lose our kids. Does that really happen? Are our fears justified?

Diane: It is a justified fear. You may assume the system will protect your rights and that justice will be done. That’s not always the case. There is a tendency to reinterpret everything as the parent’s fault. It may not happen the first time, but if the child makes allegations over and over, it’s possible they will finally get to an investigator who believes them.

Keri: CPS once knocked on my door at 1 a.m. because my son made a false allegation of abuse. What do you recommend a parent do in this situation?

Diane: Certainly be polite. In general, I never recommend you invite them in if you’re the only person around. You need a third party present. This will help ensure the investigator does not misrepresent what you say to them. You might suggest going into the office to discuss the situation at another time.

Keri: How can we protect ourselves during an investigative interview as parents? Is it a good idea to ask to record the interview?

Diane: In some states it’s perfectly permissible to record the interview, but that can get the investigators’ back up. Definitely have a third party present and keep your own notes. Put everything in writing.

You also need to be prepared for commonly asked questions. You can find a list in the Responding to Investigations manual found on the Family Defense Center website. For example, investigators will ask if you use drugs, have a domestic violence problem or have a history of mental health treatment yourself. If your answers to these questions could be problematic, you need to have thought through your responses because the information you give likely will be used against you. You don’t want to be provocative but you have the right to say, “Thank you very much, but I’m declining to answer any further questions.”

Keri: What if CPS wants to talk to our kids? Can they interview them without permission at school or similar locations?

Diane: It’s such a basic question but there isn’t a clear answer as a matter of law. They shouldn’t be able to speak to a child at school without the parent’s permission, especially if it’s not an emergency. They cannot speak to a child in the home without parental consent unless they have a court order or a dire (life-threatening) emergency. Children also have the right to not talk to investigators but of course they get intimidated easily. This is why it’s important to try to set up the interview in a therapeutic setting, especially if the child has a mental health issue. This will help make sure false statements aren’t repeated unchecked, that the situation doesn’t escalate unnecessarily and that the child doesn’t feel uncomfortable.

Keri: Many parents like myself keep daily documentation of our children’s behaviors. Some parents also use security cameras. Are those good strategies?

Diane: In general, keeping as much documentation as possible in terms of a diary is a very good idea. It’s really important for people to educate and work with their service providers. A lot of times they are your best allies. If there’s a history of false allegations, you need the service providers to document it. Having that documentation readily available will disarm the investigators because they’ll realize they may not have a strong case to go forward with.

Using security cameras depends on personal judgement and may sometimes be helpful. But I worry that cameras can be a double-edged sword—they may not show the full incident for example, or they may be used to show the parent was unreasonable even if all the parent is doing is defending herself. Video footage is more open to interpretation than parents may realize. And at the same time, video can capture the real out-of-control behavior of the child in a way that is otherwise hard to describe in words.

Keri: These investigations can be extremely frustrating and sometimes we get angry about how we’re being treated. Is it safe to vent on social media?

Diane: It’s a bad idea. I understand why parents do it but Facebook creates a written record. You worry that those communications will go straight to the state’s attorney or the judge who is going to interpret the child’s behavior as the result of the parent having a temper. It may not happen very often, but if a prosecutor wanted to access those communications, they absolutely could. And if they wanted to use them against the parent in court they almost certainly could. Remember only communications with your lawyer, and in some cases a therapist, are truly confidential.

Keri: So, what can we do if we feel the investigator or agency is targeting us or treating us unprofessionally?

Diane: You begin by going up the chain of command to register your concerns about how the matter is being treated. Start with the supervisor and go all the way up the line to the director. Unfortunately in some states you won’t get anywhere with that. At some point going to a legislator might be a good idea. If your concerns are legitimate, legislators can intervene and get a bad situation addressed. If there is an ombudsperson or inspector general in the agency then a call to them can be a good idea too.

Keri: When do we need a lawyer?

Diane: If you get the sense there is the possibility of legal action or you need advice on how to answer potentially problematic questions then getting legal counsel is a good idea. There are cases that get closed as unfounded right away. In those cases, getting a lawyer isn’t necessarily a good use of your funds and may make things worse. Unfortunately, you may be viewed as having something to hide if you get a lawyer. The investigators are often not sophisticated enough to understand that you can be innocent and still need or want a lawyer.

Keri: What type of lawyer handles these types of cases?

Diane: One of the reasons I founded the Family Defense Center in 2005 is that so many families truly didn’t know where to go or how to find help. The situation is better now than in 2005 — there is a much more organized family defense bar nationally and there are even well-coordinated networks of family defense attorneys in some states (Colorado, Illinois, Michigan, North Carolina and Washington state are the ones I know the most about). However, in many places, it is still extremely hard to find a knowledgeable and affordable lawyer. Lawyers who aren’t well versed in this area will oftentimes advise families to go along with what child protective services is asking. I don’t necessarily give that advice because I’m trying to protect people. Even unaffordable lawyers may not be knowledgeable so it is especially important to ask questions about the lawyer’s child protection defense experience. Lawyers who have represented families with mental health issues often have the experience needed for these cases so that can be a good place to start.  

 Keri: One of our big fears is that we’ll lose our children during an investigation. In my case, I’ve pre-arranged for my sister to take them. What can parents do proactively to ensure their children won’t go into foster care?

Diane: Exactly what you are suggesting is a good idea. Also, short term guardianships are a legal protection that can be developed as a plan. If it happens that the kids get taken, it’s really important for support people and family to go to court. Judges often see families who show up to court alone with no support or people willing to be a resource for the family. A big group of supporters showing up to court creates a whole different dynamic.

Keri: I understand you have a very limited practice these days and are focusing your efforts on advocacy. Are there other resources you can recommend to families?

Diane: When I was with the Family Defense Center I wrote the manual, “Responding to Investigations” which is posted on their website. It is used by both parents and lawyers who want to understand the questions and concerns that arise during a child protection investigation.

Keri: I’m really excited about your recent book, They Took the Kids Last Night: How the Child Protection System Puts Families at Risk. Tell me more.

Diane: The book is about how the system is not adequately protecting parents in wrongful allegation cases. I cover several cases where there is a medical misdiagnosis of abuse, usually with very young children who cannot say what happened. I focused on these types of cases in particular because they make it easy for the average person to understand how things could go wrong and the dynamics of these situations. I use these cases as a vehicle to talk about the challenges families face in proceedings where the presumption of innocence is not honored in practice. I discuss in detail what family defense is all about and make recommendations for some fundamental changes in the system to protect children by protecting their families. (Find more information about Diane’s book and request a discount code on her website here.)

The information in this article is intended to provide general guidance for “wrongly accused” parents who are involved in child protective investigations. It does not constitute specific legal advice.

Interview first published by IACD.

What to do when CPS knocks on the doorDownload