Tag: RAD

How to Start a Local Support Group

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

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

Keep it simple

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

Make it comfortable

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

Pick a format that works

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

Find parents to invite

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

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

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

A few thoughts on logistics

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

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

Raising a Child with Developmental Trauma

Published by Fostering Families Magazine (May/June 2019)

Three-year-old Devon, whose name has been changed to protect his privacy, had big, chocolate brown eyes and was eager to please. His sister Kayla, 2, was feisty, with gobs of curly hair and dimples. During our pre-adoption waiting period, Kayla screamed for hours on end, seemingly for no reason at all, and couldn’t be consoled. I found Devon elbow deep in the toilet playing with his feces. At mealtime, he’d eat fast and furious then throw up all over the table. Once, I found Kayla hiding in the pantry and clutching a jar of peanut butter.

Despite all this, my husband and I jumped heart-first into the adoption. We understood these behaviors weren’t uncommon for foster kids. We believed all Devon and Kayla needed to heal was the love of a forever family.

Unfortunately, it wasn’t so simple.

By referring to these concerning behaviors as “normal for foster kids,” it’s easy to lose sight of the why behind them. For example, Kayla was frequently left alone in her crib for hours as a baby. When she cried because she was hungry or wet, no one came. These experiences etched an innate sense of insecurity on her psyche. 

Devon lost his birth mother at 6 months when he was removed from her care and her parental rights were eventually terminated. His mind couldn’t understand, but his body absorbed the loss. 

Leading trauma expert Bessel A. van der Kolk uses the expression, “The body keeps the score,” to illustrate how the body remembers trauma with tragic, long-term impacts for kids like Kayla and Devon – even if they find a loving forever family.

What is Developmental Trauma?

Developmental trauma occurs when a child experiences chronic abuse or neglect before the age of 5. These are the years when the brain is developing rapidly and is particularly vulnerable. 

Trauma may disrupt a child’s sequential brain development, according to psychiatrist Dr. Bruce Perry. This can cause, for example, impaired cause-and-effect thinking and poor self-regulation. Their behaviors, emotions, and thinking are developmentally immature because they’re literally “stuck” at earlier developmental levels. 

Also, when a child experiences frequent activation of their fight-or-flight response due to abuse, their brains can be overexposed to the stress hormone cortisol. As a result, their fight-or-flight pathway may activate in even minimally threatening situations. Forrest Lien, executive director for the Institute for Attachment and Child Development, explains: “These children live in constant ‘survival mode’. They are hyper vigilant, do not trust others, and feel the need to control their environment at all times to feel safe. Therefore, they do not allow adults to parent them and cannot have healthy relationships.”

Devon and Kayla

Developmental trauma affects each child uniquely and its impact varies in symptoms and severity. The symptoms can include attachment difficulty, self-esteem problems, anxiety, sleeplessness and a lack of impulse control.

Kayla has overcome a math learning disability, has close friends, and is a creative and independent 15-year-old. However, the trauma symptoms haven’t disappeared entirely. She still sleeps on the floor instead of in her bed, and won’t eat in front of non-family members.

Devon, unlike his sister, falls on the moderate to severe end of the spectrum for developmental trauma. Now 17, he lives in a psychiatric treatment facility. He’s physically aggressive and has no close friendships. He has pending criminal charges for assault and is on track to turn 18 with an 8th grade education. 

Early Intervention is Key

Like many foster and adoptive parents, I was unfamiliar with developmental trauma and didn’t know the warning signs. I only realized we needed professional help when Devon, at 9, karate chopped his adoptive little brother in the throat and pushed him down the stairs. Regretfully, those early missteps and missed opportunities exacerbated his condition. 

To determine if your child needs professional intervention watch for:

  1. Behaviors that don’t respond to discipline (particularly therapeutic parenting methods)
  2. Tantrums that last far past the terrible twos and threes
  3. Persistent struggles severe enough to interfere with home life, school, or friendships
  4. Feeling frightened for the safety of the child, yourself, or other children in the home

Trust your instincts and err on the side of caution. There’s no harm in getting a professional evaluation, while the cost of not getting help early can be devastating. If you delay, your child may turn to unhealthy coping mechanisms including drugs, promiscuity, and self-harming.

Untreated developmental trauma can result in behaviors that cause kids to be expelled from school, institutionalized, or face criminal charges. Other siblings in the home are at high risk for primary and secondary trauma. Parents, especially mothers, may develop PTSD

This doesn’t have to happen. Your child’s future isn’t yet written. Early intervention can change their trajectory academically, vocationally, legally and relationally.

How to get help

The best place to start is with your child’s pediatrician – but be wary of the ADHD diagnosis they might dole out at first. While developmental trauma may cause attention deficits and poor impulse control, an ADHD diagnosis doesn’t tell the full story. Also, the stimulant medications prescribed for ADHD can exacerbate symptoms. Instead, ask for a referral to a psychiatrist for a comprehensive psychological evaluation and diagnosis.

Developmental trauma doesn’t currently map to any single diagnoses. As a result, your child will likely be given multiple diagnoses to fully cover their symptoms. These may include:

  • Post Traumatic Stress Disorder (PTSD)
  • Anxiety Disorder
  • Reactive Attachment Disorder (RAD)
  • Oppositional Defiant Disorder (OD)
  • Sensory Processing Disorder
  • Developmental Delays
  • Learning Disabilities 

For a child with developmental trauma, these diagnoses are interconnected and need to be addressed in the context of the underlying trauma. For example, PTSD-like symptoms caused by developmental trauma requires different treatment than PTSD caused by combat according to Dr. van der Kolk. 

This is why it’s critical to engage clinicians who have experience working with traumatized children, foster kids, and adopted kids. Work with a psychiatrist to explore medication choices. Get an Individualized Education Plan (IEP) in place at school to ensure your child receives the services and supports to be successful.

Unfortunately, there are no quick or easy fixes to developmental trauma, but there is hope with early intervention. 

Love is critical, but it’s not enough

Devon with adoptive brother Amias

Raising a child with developmental trauma can be incredibly difficult and isolating. The more you understand your child’s trauma history, and learn about the science of trauma and therapeutic parenting, the better equipped you will be to help your child heal. Join a local or online parents support group (I recommend, The Underground World of RAD or Attach Families Support Group), prioritize your self-care, and consider seeing a therapist if you begin to feel overwhelmed.

“Love and time will not erase the effects of early trauma,” says Lien. “The best first step is to secure the child in a healthy family but that is only the beginning.”

Children who have experienced developmental trauma desperately need the love of a forever family, but love alone isn’t enough. Get professional help early, before the behaviors and emotions grow too big and overwhelming.

"Love and time will not erase the effects of early trauma. The best first step is to secure the child in a healthy family but that is only the beginning.” – Forrest Lien, executive director @InstituteAttach Click To Tweet

Surviving and thriving with RAD: In his own words

Jessie Hogsett was diagnosed with RAD at the age of 12 and grew up acting out of the hurt and trauma of his early childhood. Not only has he survived and thrived a childhood of horrific abuse and neglect, but he’s gone on to work in a treatment facility for troubled kids. Today he has a beautiful wife, five children, and a successful career.

Jessie understands the struggles of a child diagnosed with RAD in a way a parent alone never can.

His book, Detached: Surviving Reactive Attachment Disorder is an invaluable window into the psyche of a child struggling to overcome developmental trauma. His advice comes from personal experience and is invaluable to parents and clinicians alike.

Here’s a few gems of wisdom from Jessie:

  • You can’t walk forward if you keep looking backward. Keep helping your RAD child concentrate on the now and the near future. Keep reminding him he can do absolutely nothing about the past. Keep telling him he can do everything about the present and future though.
  • Tell him that taking responsibility for his actions makes him really powerful. After all, if he can create problems, then he can also create solutions. His choices determine success or failure. Blaming someone else for his problems saps his power because he has little or no control over other people. Tell him he can have a terrific future but it’s all up to him.
  • Drive him around to see the nicest house in the neighborhood. Tell him when he’s older, if he works hard, he could be living in that house, in that neighborhood, and enjoying a good life. tell him you can picture him growing up and living there surrounded by his own happy family.
  • Tell your child that you love him all the time. Even though love alone will never be enough to “cure” a RAD child, instilling in his mind every day that he is loved, will, over time, let him realize that someone does care for him. Keep telling him this even when you don’t get any response back and even if it seems he isn’t listening. He probably is.
  • Seek out comedies on TV, DVDs, and at the movies. Laughter alleviates stress and is clearly good for both body and soul.
  • When your child raises his voice to you, lower your voice. Speak to him in a calm reassuring “your behavior doesn’t phase me” tone of voice. He wants to hear what you are saying because he wants that attention. In order for him to hear you, he will have to lower his voice.
  • To build trust, tell the child the time frame in which you’ll be completing whatever you promised him you’ll do. Give yourself more than ample time so you can always do it within that time period.
  • Teach him step-by-step how to succeed at tasks. Write down the steps for him using numbers 1, 2, 3, etc.

These unconventional, practical suggestions are only a fraction of the 144 ideas included in Detached: Surviving Reactive Attachment Disorder.

Jessie is a huge asset to the parenting community and I’m looking forward to interviewing him soon. If there’s a specific question you’d like me to ask Jessie, please drop it in the comments.

Be sure to follow Jessie on social media for news and updates on his new upcoming book!

Find Jessie on Instagram or Facebook

Documentary exploring the school-to-prison pipeline

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

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

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

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

Photo Credit: The Kids We Lose, PBS

My thoughts…

Teachers need to teach

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

Restrains aren’t therapeutic, but we need an alternative

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

Teachers and peers matter too

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

It’s complicated

Photo Credit: The Kids We Lose, PBS

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

Here’s what I know:

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

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

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

Aging out of RTF into the real world – a dangerous proposition

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. 

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

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

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

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

In advocating for children we must cast a wide net

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

Here are just a few of the ways it happens:

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

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

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

We can do better

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

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

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.

First published by Institute for Attachment and Child Development.

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/

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.

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!)


For a determined would-be school shooter, there’s always a way – until we address the underlying causes

 Only a few days ago, I had the opportunity to plant a gun in a school.

The doors were unlocked. There was no security guard. No office staff was signing visitors in. No one was monitoring the surveillance cameras.

It was Saturday morning, and I was attending my son’s recreational basketball game at a local public middle school. The school was wide open. I could have easily walked in with a duffle bag slung over my shoulder, an AR-15 and ammo hidden inside. If I was a student, I could have stashed the weapon in my locker, but the heap of lost and found items would make a good hiding place too. And just that easily, I would have secreted away a weapon for easy access.

There’s always a way to get a weapon into a school. More than once I thought about this as I watched students at my daughter’s charter school pass through metal detectors. They pulled three-ring binders, laptops, cell phones – anything with metal – from their bookbags and passed them around the detector. But couldn’t a pistol be hidden in a binder and pass into the school undetected?

As controversy swirls around efforts to keep guns out of schools –school officers, armed teachers, wanding, metal detectors – we must remember these steps alone cannot protect against every determined and resourceful would-be school shooter. It’s not enough to try to stop violent plans already in the execution stage. Instead, we must understand what leads young people to act violently and implement comprehensive, proactive measures to address the underlying causes.

It's not enough to try to stop violent plans already in the execution stage. Instead, we must understand what leads young people to act violently and implement comprehensive, proactive measures to address the underlying causes. Click To Tweet

Dr. Terry Levy of Evergreen Psychotherapy Center co-authored “Kids Who Kill: Attachment Disorder, Antisocial Personality, and Violence” in the aftermath of the Columbine school shooting. In it, he pointed to evidence of the relationship between early childhood trauma and violence.

Research has shown elevated cortisol levels caused by early childhood trauma,  typically chronic abuse and neglect, can impact a young child’s brain development. As a result, they may struggle with emotional regulation, linking cause-and-effect, abstract thinking, and other high-level brain functions. Not all, but some of these children may become aggressive and violent.

The correlation between early childhood trauma and violence is frightening given the number of students at risk. According to the Child and Adolescent Mental Health Initiative at Johns Hopkins, almost half of all children have experienced at least one type of childhood trauma. As a result, a staggering number of students walk into our schools every day with a festering wound borne of childhood trauma. Most often, the wound is unrecognized and untreated. At best, we might slap on a band aid, but rarely do we treat the underlying trauma.

We’ve known about the link between childhood trauma and violence for 20 years, yet little has changed. Our society does not recognize the devastating impact of childhood trauma on it’s victims or the collateral damage on our community as a whole. We do not prioritize funding for research needed for prevention and meaningful treatments. And as a result, our communities continue to face acts of violence from young people.

Just last month we learned about four North Carolina (my home state) middle school students who were planning a Columbine style attack on their school. This was thwarted, but you can be sure many other future attacks will not be stopped in time. For a determined would-be school shooter, there’s always a way.

Childhood trauma is an epidemic in our society and without treatment, children will not heal and will have little hope for a happy and productive future. For some, their trauma wound will grow so unbearably painful they’ll lash out violently. No metal detector, locked door, gun sniffing dog, or wand will stop them.

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.