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We need to do better

Understanding the long-term effects of Reactive Attachment Disorder

J.D. spent his teenage years growing up in a residential treatment facilities. He celebrated his 18th birthday by walking out through those doors – free to make his own decisions and live life his way. Within days, J.D. was causing a public disturbance. Police were called. They told him to put his hands in the air. He laughed. He mimed a gun with his fingers. The officers open fire.

J.D. fell to the ground – dead.

For those of us who’s kids have spent years in residential treatment facilities (RTFs) – growing only more dangerous and violent – this story strikes like a death bell in our chest.

My son Devon has been bounced trampoline-style from facility to facility since he was 10. He’s been in these facilities because he cannot live safely at home. He poses a threat to himself and to his younger siblings. However, instead of getting better in these therapeutic settings, his behavior has become worse. 

Because of the polices of these facilities, Devon has committed assaults and serious vandalism with no consequences. 

  • He’s created thousands of dollars of property damage –  no consequence.
  • He’s made false allegations of abuse – no consequence. 
  • He broke a woman’s thumb – no consequence.
  • He stabbed a kid in the back with a pencil – no consequence.
  • He punched a girl in the back of the head – no consequence.

Unfortunately, this is how treatment facilities work. The underlying idea is if you consequence kids, that’s all you’ll ever do and they won’t be able to receive therapy. This is true, but on the flip side, what if the “therapy” the kid is receiving in leu of consequences does not help? What have they learned?

My son will turn 18 in a handful of months. He’s itching to leave and at one-minute past midnight he’ll bolt. He won’t have a high school diploma or have any job skills. Worse, he won’t understand that there are consequences in the real world. He’s come to believe that, with a bit of fast talking, he can turn any situation into a ‘therapeutic incident’ and deflect consequences. 

I’m sure that’s what J.D. thought too – before he was shot and killed by police. He expected them to beg him to calm down, offer him coping skills, and at worse drop him to the ground in a physical restraint. I have no doubt that J.D. did not understand the danger of his behavior.

For the safety of our kids, who will someday age-out of residential treatment and into the real world we must find a balance. I don’t pretend to know the answer and there are no quick and easy solutions to this problem. But here’s what I do know: Our kids must have effective treatment AND understand that their choices have consequences. 

My kids’ pediatrician told me this story. He personally knew this young man and the incident happened several years ago. 

We need to do better

RTF: A bad option, that’s sometimes the best option

My son Devon was 10-years-old when I dropped him off at a residential treatment facility (RTF) for the first time. I knew almost instantly it wasn’t going to work. They didn’t believe in consequences. School work was optional. With unlimited dessert and no rules, it was more like a summer camp than a program for kids with severe behavioral problems.

I called my sister for advice and my words came out with a sob, “He’s going to get worse here.”

“Without hesitation, my sister said, “You have to get him out of your house. Nothing else matters right now.”

“But he’ll see this as a reward.”

“I don’t care if it’s Disney World. We’ll deal with that later. Leave him,” she said. 

And I did.

Devon’s behavior had been growing increasingly unmanageable and dangerous over the previous 18 months. He was having violent outburst every day and the stress level in our house was toxic for everyone. My youngest son, who was 4, was especially frightened and would tremble with fear when he sensed Devon’s anger mounting. I was suffering from PTSD—even though I didn’t realize it at the time.

I’d been trying to get help for Devon for years. We’d tried outpatient therapy, intensive in-home therapy and partial hospitalization. He wasn’t getting better and I had no idea how to help him. I only knew what I was doing wasn’t working. 

As I’d predicted, Devon’s behaviors did become dramatically worse from the RTF. However, my sister had recognized what I could not – it was still the best option available to us. Unfortunately, if you’ve exhausted outpatient options and your child is becoming unsafe, it may be your only option too. 

Why RTFs don’t work

While an RTF may be the best – or only – option available, it’s important to have realistic expectations. These facilities are rarely effective for kids with developmental trauma disorder. In fact, they can exacerbate the symptoms, and here’s why:

1. The treatment is not specialized for developmental trauma. Your child will be placed with kids who have a variety of issues including anxiety disorders, eating disorders and PTSD. The coping skills they will learn – like taking deep breaths, playing with a stress ball and counting to ten – are not enough to heal the brain injury caused by developmental trauma.

2. The workers are under-trained, overworked and underpaid. Your child will work with a licensed clinician for therapy. Yet, the general supervision is typically provided by workers who have a high school diploma and on-the-job training. Our kids are very challenging to deal and the chronic understaffing and inadequate training results in inconsistent quality of care.

3. The staffing structure lends itself to triangulation. Because workers are rotated (and have high turnover) they are easily triangulated – especially against the therapist and parents. Unfortunately, your child is likely to gain a sense of control by behaving this way – a feeling they unconsciously crave – and will continue even when it sabotages their treatment.

4. The kids become institutionalized. In these facilities, your child will be exposed to and influenced by kids with sexualized behaviors, horrific language and physical violence. They’ll quickly learn the ropes and how to work the system to their advantage, for example, by making false allegations to retaliate against staff or peers. This is knowledge they’ll ultimately use to manipulate the staff and you as well.

RTFs are intended to teach your child how to cope and let them “practice” good behavior for when they return home. Yet, the artificial environment and behavior-based modification techniques do not help them to truly heal. 

“Kids with DTD learn to work within the external structure of residential treatment facilities. It doesn’t get internalized for them though,” said Institute for Attachment and Child Development Executive Director Forrest Lien. “Ultimately, most kids go back into their families and fall apart. Sadly, it’s oftentimes the only option for parents.” 

Sadly, unless you are able to send your child to a program that is highly specialized for developmental trauma, your child is unlikely to get better. 

When to consider an RTF anyway

Parents who are considering sending their children to an RTF often ask for my advice. It is a very personal decision and every child and family is different. However, the following are a few words of hard-earned wisdom I often share. 

1. Consider an RTF if your child is unsafe to himself or others. Remember to consider not only the physical, but also psychological well-being, of other children in the home.

2. Consider an RTF if you are at your breaking point. You cannot help your child when you are unstable yourself. An RTF may be the breather you need to regain perspective.

3. Consider an RTF if your child  engages in unlawful behavior. An RTF is likely a better option that juvenile detention where your child will get a criminal record and receive little treatment.

The decision to send your child to an RTF should be a last resort but you may be at that point now. You alone are not able to heal developmental trauma any more than you can set your child’s arm or cure his leukemia. The best you can do is access the best possible treatments available and support and love your child through the process. 

For us, an RTF was the best choice because Devon had become unsafe to himself and his siblings. And after years of giving it my all, I had nothing left to give. He’s now 17 and in his ninth RTF. It’s not the forever family I’d hoped for and not what any parents wants. Yet, it is often the best of the limited choices families like mine have. It is the best choice for us. And while my son doesn’t live at home, he’ll always be a part of our family.

Here’s some information about Best Choice Admissions that may be able to help with finding placements.

RAD and related diagnoses

Why adoption stories aren’t fairy tales

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

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

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

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

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

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

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

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

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

Make Your Own Adoption Adventure: Story of Bobbi

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

Chapter 1

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

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

Chapter 2

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

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

Chapter 3

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

Why the good options are limited

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

Here’s how that can happen:

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

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

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

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

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

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

We need to do better

What I Wish People Knew About These Popular Social Media Quotes…

Everyday I see quotes like these on social media:

Behavior is not a kid being bad, it’s a form of communication.

My behavior is a symptom of my trauma, not willful non-compliance.

These types of sentiments garner thousands of likes, shares, and re-tweets. But for families like mine, they simply don’t ring true.

My son, Devon, has been diagnosed with Reactive Attachment Disorder (RAD), a result of early childhood trauma. My husband and I adopted him out of foster care when he was 4 and prior to that he was neglected and did not form a close attachment with a caregiver. This is called “developmental trauma,” a term coined by leading expert Bessel van der Kolk.

Kids who experience chronic neglect and abuse may begin to default to fight-or-flight mode in even minimally threatening situations. Developmental trauma can also disrupt the brain’s development causing impaired or under developed cortical brain functions including cause-and-effect thinking and abstract thinking. RAD is a common diagnoses for these kids.

I liken RAD to a tug-of-war. For example, Devon will become belligerent over anything from what color socks he’ll wear to if he’ll use a seat belt. His screaming fits last for hours – literally hours – and often include property damage and dangerous physical aggression. Devon treats every situation as though it’s life-or-death, in a desperate attempt to control the people and situations around him.

Are Devon’s extreme behaviors related to his developmental trauma? Of course. He’s driven by the unconscious trauma scars etched on his psyche.

His behavior IS communication.

His behavior IS a symptom of his trauma.

That doesn’t mean his behavior isn’t also willful.

Devon makes a choice when he refuses to buckle his seatbelt. He chooses to tip desks over in his classroom. He chooses to break windows and chase his siblings with a baseball bat.

Certainly, there are some disorders where symptoms are involuntary such as schizophrenia and alzheimer’s. However, RAD is a behavioral disorder. Control and anger issues are symptoms of this disorder.

Kids with RAD can be both unconsciously motivated by underlying trauma scars and willful. These two things can and do coexist. In fact, this is what makes parenting a child diagnosed with RAD so challenging.

Our child enjoys pushing our buttons because it gives them a feeling of control, which they unconsciously crave. That’s the underlying motivation and the pay off, but that doesn’t negate the child’s role in making a choice to engage in certain behaviors.

The idea that a person has no control over their behaviors is not healthy for anyone. I refuse to take away my son’s agency. If he has no control over his behaviors. then he has no hope for a better life and no hope for the future.

As a parent in the trenches, here’s my take on the social media quotes I listed above:

  • I recognize my son’s behavior is a symptom of his trauma, but also as willful non-compliance.
  • I listen to the communication behind my son’s behavior, but I also tell him his behavior is bad.

As I like to tell my son, a sneeze is involuntary – stabbing someone with a pencil is not.

Let’s acknowledge that our children’s mental health is complex and nuanced. Let’s stop painting with such a broad brush. Causes behind our children’s behaviors aren’t always simple enough to be encapsulated in a snappy social media quote.

Most Popular, We need to do better

95% of adoptive parents jump in heart-first, but unprepared

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).

Survey by @RaisingDevon March 2019

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”:

  • Food issues
  • Potty Issues
  • Attention deficits
  • Difficulty accepting affection
  • Difficulty attaching
  • Sleep disturbances
  • Separation anxiety
  • Poor hygiene
  • Physical aggression

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.

According to one study documented in The British Journal of Psychiatry, nearly 50% of children from deprived backgrounds (and from foster care) may meet the diagnostic criteria for Reactive Attachment Disorder (RAD).

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.”

Micci

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.

Adrienne

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.

Christina

I recognized something was wrong on day 2. It took me 10 months of researching to find what it was.

Julia

Yes I knew, but NO I was completely unprepared for the extent to which the challenges would be.

Laura

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.

Nancy

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.

Beth

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.

Resources

If you’re an adoptive parent who wasn’t provided with training on this important topic, here are some resources to check out.

Support Groups

(Let them know @RaisingDevon sent you!)


Most Popular, RAD and related diagnoses, Tips to navigate "the System"

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

It’s not ADHD!

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

Survey by @RaisingDevon, March 2019

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

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

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

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

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

S.H.

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

Katie

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

Jesi

We lost three precious years chasing the wrong problem.

Emily

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

Katalina

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

Karen

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

Sarah

Why kids with developmental trauma get diagnosed with ADHD

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

The difference between ADHD and RAD

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

Disinhibited items

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

Inhibited Items

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

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

Full information on this research study can be found here:

How to get the right diagnosis

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

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

A to Z of Therapeutic Parenting

The a-z Of Therapeutic Parenting, Sarah Naish

My Rating: 5/5

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

– Sarah naish, adoptive parent and author

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

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

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

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

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

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

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

We need to do better

It takes a village

My son Devon has a long track-record of making false allegations against staff at treatment facilities where he’s a patient. “I’m afraid Devon might make up a story about me too,” I recently told his therapist Cathy. “If CPS got involved, I could lose my other kids during the investigation…” In my mind I imagined my youngest son being dragged off to foster care even for one night. It’s a mom’s worst nightmare.

Cathy stammered a response, apparently incredulous I believed my son capable of such a thing. 

When Cathy and I spoke the following week, she’d already discussed the issue with Devon. “I explained to him exactly why you’re so concerned about false allegations.You could be arrested. You could lose your other kids. False allegations could ruin your life,” Cathy said, recalling her words to Devon. She continued, “When I explained this to Devon, he was so upset. Now that he knows how serious this is, you have nothing to worry about.” 

I was dumbfounded. I felt as though Cathy had handed my son the user’s manual for a weapon of mass destruction. And our family was the potential target. Telling Devon just how powerful false allegations are was extremely risky. It gave Devon all the more reason to do so. 

Unfortunately, Cathy was unfamiliar with the nuances of developmental trauma disorder—a result of Devon’s early childhood neglect and abuse. Because Devon lacks an innate sense of security, he can be very manipulative in an attempt to control his environment. “When children’s brains are impacted by trauma during early development, they live in a fight/flight ‘survival mode’, do not trust others and rely entirely upon themselves,” said Institute for Attachment and Child Development Executive Director Forrest Lien. “They will go to great lengths to push others away—especially primary caregivers—to feel safe. Sometimes, that includes false allegations.”

When “help” isn’t helpful

Those on the “other side” of developmental trauma disorder—adults living outside of the child’s home—may want to help the child and family but lack the insight to do so. With DTD, there is often more happening than meets the eye. If therapists, educators, police officers, and other professionals aren’t familiar with the nuances of developmental trauma, their interventions sometimes make already volatile situations worse. This is why parents like myself can seem defensive, inflexible and frustrated. We desperately need support from community resources. Yet, we’re also desperately afraid they’ll exacerbate our child’s condition, damage our hard-won and tenuous attachment with our child or put our family in danger. 

Here are some real-life examples of misunderstandings about developmental trauma that have had a harmful impact on families:

Tom’s Story

Ms. Linda, the school cafeteria worker, was charmed by 6-year-old Tom. He told her stories about how his mom mistreated and didn’t feed him. Ms. Linda always had a cookie or treat for Tom. She even told him that some kids get ‘re-adopted’ if their family isn’t a good fit. In fact, she said, she’d love to adopt a little boy just like him. That afternoon, Billy went home and demanded his mother let him be “re-adopted.”

Things to consider from the “other side”—

Kids with developmental trauma can be superficially charming. Again, it is often a learned survival strategy because they unconsciously feel unsafe in the world. By having this “secret” with Ms. Linda, Tom was bonding with her instead of his mom. Instead of encouraging Tom to build healthy relationships within his new family, she gave him an easy out. Mom needed Ms. Linda to contact her about the situation so they could get on the same page and partner together in Tom’s best interest. 

Janey’s Story

Janey had a bad month. She’d been in a fight and had run away. She’d broken her bedroom window. She’d been suspended from school. During therapy Janey, her mom, and the therapist set some goals for Janey to work on. Then, just as the session was ending, the therapist smiled maternally at Janey. “Look at her, mom,” she prompted. “She just needs love. That’s all this is about. A little girl who needs her mom to love her.” Janey’s behavior did not improve during the following month.

Things to consider from “the other side”—

Kids with developmental trauma need clear and consistent parenting in order to thrive. While Janey certainly needed her mom’s love, that should not be used to excuse her from accountability for her actions. This is not a mindset that will be helpful to Janey in the long run. Unfortunately, Mom walked away from this session feeling blamed and beaten down. And Janey had no motivation to work toward more effective strategies. Mom needed the therapist to do attachment work but also to hold Janey accountable for her actions. 

Nate’s Story

Nate, 13, was enraged and lunged at his mom with a shard of glass. She called the police. By the time the officer arrived, Nate was calm and sitting in a recliner as though nothing had happened. The officer looked between hysterical mother and serene son and made a snap judgement. “This seems like a ‘parenting problem’,” he said. He then reassured Nate not to worry and that he couldn’t be arrested for anything at his age. The next time Nate acted up, he told his mother there was nothing she could do to stop him—the policeman said so.

Things to consider from “the other side”—

Kids with developmental trauma may escalate until they reach a hard limit. Without limits, they may continue to behave violently and endanger themselves or others in their family. Mom needed the officer to speak with her privately to understand the full story and to express any concerns he may have out of earshot of Nate. Even if the officer was not going to make an arrest, Mom needed him to speak sternly to Nate so he’d understand how serious his actions were. 

Unfortunately, in these examples, well-meaning professionals made the situation worse. They inadvertently derailed treatment, disrupted attachment work, caused confusion and stoked deep resentments and hurts. In some cases, they put the children and families they were trying to help in greater danger. 

Ways professionals can best support children with DTD and their families

The best ways to help children who have developmental trauma can feel counterintuitive and, therefore, requires more than common sense. If you’re a mental health professional, educator, police officer or other community resource, please educate yourself on developmental trauma and therapeutic interventions so you can help families like mine.

Here are some good things to know as a professional working with children and families—

  1. Realize things may not be as they appear. Pause to consider that there may be complex, nuanced mental health issues involved.
  2. Consider that parents’ concerns and fears may be justified – that we may not be overreacting. Our children may be dangerous even at startlingly young ages, particularly if they have a co-morbid mental disorder.
  3. Realize children with developmental trauma may act very differently in front of you than how they behave behind closed doors with their parents. The situations you encounter are likely far more complicated than an innocent misunderstanding.
  4. Discuss your concerns frankly with parents, but always privately. Partner with us—out of earshot of our children—to resolve and manage the situation and present a unified front.
  5. Refer us to local crisis services and community resources. We often don’t know where to turn for help but are eager to follow-through on any recommendations for services that can be helpful for our child and family.
  6. As a clinician, feel comfortable referring clients with developmental trauma elsewhere if appropriate. If you do not specialize in developmental trauma, it is vital to know your limitations. Do your best to connect families with therapists who specialize in the disorder.

We desperately need the community to rally around our families and provide support. To successfully help our children heal, we need to partner with trauma-informed therapists, educators, and law enforcement officers. If our children, who come from hard places, are to thrive and live happy, well-adjusted lives, it’s going to take a village. 

If our children, who come from hard places, are to thrive and live happy, well-adjusted lives, it’s going to take a village.  Click To Tweet

Some names and identifying details have been changed to protect the privacy of those involved and all stories are being told with permission.

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

In the News, We need to do better

When Insurers Deny Mental Health Coverage, Families In Crisis Struggle Even More

By Christine Herman

When Matthew Timion needed to get his son treatment for mental illness, he did not anticipate it would be so hard to get the insurance company to pay for it.

Timion adopted his son out of foster care when he was 3. He says the trauma and neglect his son experienced in his early childhood led to mental health issues later in life.

At age 10, Timion’s son began to act out aggressively and threaten violence. At one point, Timion was bringing his son to an inpatient psychiatric hospital in the Chicago area every few weeks.

At times, the insurance company and the hospital staff disagreed over whether treatment was necessary.

“He was cutting himself and he’s hearing voices and he is threatening to run away and kill me,” Timion says. “The insurance company says, ‘Well, he hasn’t done that in three or four days now, he’s good to go home.’ And the hospital said, ‘No, he has to stay.’”

Timion filed multiple appeals and won. But months later, when his son needed even more costly residential treatment, Timion almost relinquished parental custody to force the state to step in and pay for treatment he couldn’t afford.

But data from Illinois shows not all parents can navigate insurance for their children like Timion. Dozens of children a year enter state custody when parents run out of options for getting them the mental health care they need. Fundamentally this issue of who pays for mental health treatment comes down to a law that requires insurance companies to cover mental health care at the same level as other medical conditions.

The Complicated Battle for Coverage

To get an insurance company to pay for a claim they’ve denied, patients can file an appeal. But if the internal reviewer—a medical doctor employed by the insurance company—agrees the treatment isn’t needed, the patient has to pay the bill.

When this happened to Timion, he appealed to the state agency that regulates insurers. The case was reviewed by a psychiatrist, who determined Timion’s son needed to be at the hospital, and the insurance company, Blue Cross Blue Shield of Illinois, must pay for it.

“So in our case it worked out,” Timion says. “Most people don’t have the tenacity to go through this process,” especially if they’re in the middle of a crisis with their child.”

A 2015 survey from the National Alliance on Mental Illness suggests Timion’s experience is not unique.

NAMI asked consumers across the country about their experience with private insurers, and found that people seeking coverage for mental health services report being denied at a rate double those wanting coverage for other medical services.

Blue Cross Blue Shield of Illinois declined an interview but sent a statement saying the level of care they cover for group, individual and family health insurance policies is based on medical necessity, which includes looking at national guidelines and the needs of individual members. For members who receive health coverage through a government-sponsored program, BCBSIL says coverage is determined by the state or the Centers for Medicare and Medicaid Services.

Locked Out: Listen to the episode of The Workaround related to this story

Laws On The Books

Ten years ago, Congress enacted the Mental Health Parity and Addiction Equity Act. It requires most insurance companies to cover mental illness on par with other medical issues.

But the law doesn’t require insurers to cover all mental health treatments. Rather, they must demonstrate they cover mental and physical health equally.

David Lloyd, national senior policy adviser for the mental health advocacy group the Kennedy Forum, says insurance companies have made some progress toward compliance with parity laws. They no longer charge higher deductibles or have stricter limits on mental health services. But potential violations include denying coverage they deem unnecessary.

John Foley, CEO of Benefit Consulting Group in Northbrook, Ill., says during a time of rising health care costs, insurers don’t want to spend money on expensive treatments that aren’t absolutely needed.

Foley says hypothetically, if an insurance company is asked to pay for a mental health treatment that will cost $600,000, they want to know: “Is there another way to treat this, to handle it for $75,000 and get the same outcome?”

Part of the challenge is that what’s medically necessary is sometimes up for debate, says Foley. If someone breaks a bone, they need a cast. But with issues pertaining to mental health, it’s not always as clear-cut.

Foley says there are also financial incentives on both sides: Providers make more money on expensive treatments, while insurers save money by denying that same care.

“Providers are not angels and neither are the payers. I just want to make that clear,” Foley says. “Neither side is, shall we say, virtuous.”

Stepping Up Enforcement

Advocates say regulators need to step up and do a better job enforcing existing laws so that the burden doesn’t fall to patients in crisis—or their families—to battle insurers when mental health coverage gets denied.

In recent years, state and federal regulators have taken steps to improve compliance with parity laws.

A 2014 investigation led by New York Attorney General Eric Schneiderman uncovered numerous parity violations by private insurers, resulting in settlements that forced the companies to return millions of dollars to consumers. In 2014 and again in 2017, the state of California fined Kaiser Permanente for failing to provide members with timely access to mental health care.

In Illinois, where Timion is, Governor Bruce Rauner recently signed into law a measure advocates say will enable greater enforcement of parity laws by increasing transparency and accountability for health plans.

Lloyd says Illinois now has the strictest mental health parity laws in the country, and he hopes other states will follow suit.

The Price Of Coverage Denial

Mental health coverage denials can have dire consequences on families.

When Timion’s son was hospitalized again at age 13, doctors said it wasn’t safe for him to return home. He needed to go to a residential treatment center to receive 24/7 care, which can cost up to $200,000 a year.

Timion’s insurance company said they would cover one month. But many facilities won’t accept a patient without proof of payment for at least six months, which Timion did not have.

While his son remained at the psychiatric hospital, Timion says he spent eight hours a day for more than a month on the phone with his insurance company, state agencies, even lawmakers, trying to figure out how to pay for residential treatment.

Thanks to a family connection with a mental health facility nearby, Timion moved his son from the hospital into residential treatment. The month covered by his insurance company ran out, but he convinced the child welfare agency to cover treatment until a state grant would kick in to pay for the remainder of his son’s treatment.

“Mental health care is not treated the same way as cancer or anything else,” Timion says. “So people have to go through these ridiculous hoops” to get treatments covered.

The Kennedy Forum’s David Lloyd says Timion’s story is an example of why it’s in states’ best interests to ensure parity laws are enforced.

“Costs are going to be picked up by taxpayers in one way or another,” he says.

A Father’s Worry

Timion’s son is now 15 and just moved home to Illinois after a year-and-a-half at another residential facility in Missouri.

His son is doing much better, Timion says, but there’s still a long road ahead.

“Parenting never stops,” Timion says. “In his case, it’s just a lot harder.”

He worries about parents who aren’t able to access mental health treatment for their child.

“Most of the parents I talk to, they’re looking at their kids ending up in jail soon, or dead,” Timions says. “That’s just how bad the behaviors are getting.”

This story is part of a podcast from Side Effects Public Media called The Workaround. You can listen and subscribe to the show here.

Christine Herman is a recipient of the 2018-2019 Rosalynn Carter Fellowships for Mental Health Journalism. Follow her on Twitter: @CTHerman

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.