Tag: Reactive Attachment Disorder

The Secret Next Door (Child on Parent Violence)

Annie watched in horror as Charlie, red-faced with rage, snatched a picture frame off a wall and slammed it against the bedpost. The glass shattered. He picked up a long shard and brandished it like a dagger. Stalking towards Annie, he growled, “I’m gonna kill you.”

This type of abusive behavior in relationships is far too common. 29% of women and 10% of men in the US will experience domestic violence in their lifetimes. Child protective services investigates more than three million reports of abuse and neglect annually. However, Charlie and Annie’s altercation isn’t included in either of these statistics.

That’s because Charlie is a 13-year-old boy. And Annie is his mother.

What the parents living next door may be hiding

Like Annie, I’m the mother of a son who acts out. Both our boys are products of the foster care system, adopted as toddlers, and who are diagnosed with Reactive Attachment Disorder (RAD) and Conduct Disorder (CD), serious behavioral disorders. They have both received medication and thousands of hours of treatment, but nothing has helped.

When Annie and I tell friends, family, and mental health professionals about our sons’ behaviors, we are met with disdain and disbelief. In the same way many sex abuse victims are treated, parents like us are blamed and shamed into silence. We have been forced underground, into private Facebook groups where we find non-judgemental support from thousands of other parents in similar situations.

Four years ago, Lillyth Quillan founded the online parent support group, Parents of Children with Conduct Disorder. She says, “More than 1,000 families have come together to share their stories; to know they are not alone. They are emotionally raw and shredded to the marrow at how they’ve been treated and not believed by close friends and family.”

How many families this affects

The general public assumes these situations, where children are violent towards their parents, are isolated to a handful of sensationalized episodes of Dr. Phil.

This is simply not the case.

While the anecdotal evidence of children with serious disorders abusing their parents is abundant, quantitative data is desperately lacking. This is why I recently surveyed more than 200 parents of children diagnosed with, among other behavioral disorders, RAD and CD. This type of informal survey is an invaluable way to begin to understand the scope of the problem.

According to my survey, Are You In An Abusive Relationship? more than 90% of the respondents are in chronically abusive relationships – and the abuser is their child.

  • 93% say their child threatens them, other family members, or pets with physical violence.
  • 65% say their child grabs, hits, kicks, or otherwise physically assaults them.
  • 71% say their child hides their behavior from others and blames them for their outbursts.

These aren’t merely numbers; each one is a tragic story. Here are just a few of the examples shared anonymously by survey respondents:

“My son purposely hurts the cat to get my attention.”
“My daughter attacked me with a steak knife.”
“My son choked me and broke my wrist.”

Anonymous parents

These findings show that it is alarmingly common for children with serious behavioral disorders to abuse their parents.

When children abuse their parents

Intentional Child to Parent Violence (I-CPV) is deliberate, harmful behavior by a child to cause a parent physical or psychological distress. These are purposeful behaviors intended to gain control over, and instill fear in, parents. I-CPV takes many different forms and varies in severity. It is often chronic and usually directed at the child’s mother figure. [1]

One surveyed mom has a moon-shaped scar on her forehead from her 14-year-old daughter grabbing her by her hair and slamming her face onto the stove. Another mom says her son tried to push her down the stairs and makes homicidal threats towards her.

Parents like these sustain physical injuries and may develop mental health disorders including PTSD. They are isolated from friends and family. Their marriages can become irreparably damaged. They frequently lose jobs and friends. Other children in the home suffer secondary, if not primary trauma.

Without highly specialized treatment, the child perpetrating the abuse will not get better. Far too often, it becomes necessary to have them institutionalized, or end up incarcerated, for the safety of their siblings, parents, and themselves.

Hypervigilance – and fear – are common for parents in these situations. One mom describes how, “Before my son was taken to the hospital, then jail, and then a treatment center, I had to sleep with my door locked and a chair jammed under the knob because he knows how to pick locks.” She suffers with PTSD after years of chronic abuse.

Why children abuse their parents

While there is no one clear “cause” leading to antisocial behaviors like I-CPV, there are a number of underlying factors to consider. Perhaps the most significant is “developmental trauma,” a term coined by leading expert, Dr. Bessel van der Kolk, MD. When a child is chronically neglected or abused at a young age, their brain development may be impacted, causing long-term issues sometimes including physical aggression. This is called Developmental Trauma Disorder (DTD) and is commonly diagnosed as CD or RAD.

While developmental trauma can explain much of RAD, not all children who are violent towards their parents have a trauma background. Some children from nurturing families are diagnosed with CD. Psychologist Stanton E. Samenow, PhD specializes in working with juvenile offenders and says early identification of emerging antisocial behaviors is key. He points to a study that found “aggression at age 8 is the best predictor of aggression at age 19, irrespective of IQ, social class or parents’ aggressiveness.” [2] He believes, regardless of environment and parenting, children become antisocial by choosing the bad behaviors that eventually become an entrenched pattern.

As a parent, I don’t believe these are mutually exclusive views and find both to be informative. My son has a history of developmental trauma. As a result he struggles with impulsivity, attachment, and cause-and-effect thinking. At the same time, his behavior is not involuntary. He is making a choice when he acts aggressively and knows right from wrong.

Why families can’t get help

Even once parents understand the complexity and seriousness of the abuse taking place, there is nowhere to turn for help. Unfortunately, the systems designed to protect victims of other types of abuse don’t have a mandate to protect the victims of I-CPV.

Most domestic violence shelters are for intimate partners, and, for example, offer no help to a mother whose son or daughter beats her. Advice commonly given to victims of domestic violence simply doesn’t work. Take for example the following from the online article, “What to Do if You Are in an Abusive Relationship“:

1. Talk with someone you trust
Parents are rarely believed by friends, family, teachers, and mental health professionals. Instead, they’re blamed for their child’s misbehavior and labeled bad parents. One mom says, “My son can be incredibly sweet and charming when he wants to be. My friends, his teachers – my own mother – don’t believe my 9-year-old son is dangerous because he’s so good at hiding his behavior.”

2. Call the police if you are in immediate danger
Parents receive little assistance from police, especially if their child is under the age of 16. They also hesitate to press charges knowing incarceration is not the “treatment” their child needs. One mother called 911 after her son beat her. The officer said to her son, “It’s okay, Buddy, you’re not in trouble. Let’s talk.” The next time her son beat her, she ended up in urgent care.

3. Make a plan to go to a safe place such as a shelter
Despite their child’s abusive behaviors, parents are still legally and morally responsible for them. Even if parents want to seek safety, their hands are tied. “If I were treated this way by a man,” says one mother, “I would have left long ago. But because this is my daughter, my options are limited.”

Unfortunately there are no good solutions for these parents, and no quick and easy cures for their children. Few therapists and mental health professionals are equipped to offer the highly specialized treatment needed. While there are promising advances in neuroscience, emerging treatments are not accessible for most families. They’re expensive, rarely covered by health insurance, and unavailable in most areas.

Out of all the families she’s worked with, Quillian says only one family has ever received appropriate treatment. “One. One family experiencing what I believe to be the absolute bare minimum of care. One.”

What needs to change

I-CPV isn’t merely talk-show fodder. It’s happening behind closed doors in your neighborhood. It’s happening in Annie’s home. It’s happening in mine.

While the US lags behind, there appears to be growing awareness of I-CPV in the UK where a new domestic abuse bill includes I-CPV. US citizens can support these families by asking their legislators to draft similar legislation which would not only provide legal remedies, but more importantly, facilitate funding for research, prevention and treatment.

We need viable treatment options for our children, as well as resources to combat the violence and destruction we face in our daily lives,. We need help and the support of our communities. That begins with a national dialogue about I-CPV and viable treatment options for serious behavioral disorders.

Parents deserve the same support and understanding that all victims of abuse deserve. Until then, they will suffer physical and psychological harm while their child faces a lifetime of relational, educational, financial, and legal struggles.

A Dad’s Struggle Accepting Reactive Attachment Disorder Diagnosis

Learn about a Dad’s struggle with awareness and acceptance of a Reactive Attachment Disorder (RAD) diagnosis and helpful tips to overcome the challenge of accepting related Developmental Trauma Disorders.

click here to learn more about Christine Hartmann…

Online support groups for parents of kids with trauma

Are you parenting a child who came to you from hard places? If your child is suffering from the effects of early childhood trauma, also called adverse childhood experiences (ACEs), they may have extreme behaviors that seem impossible to manage.

Unfortunately, you may not fit into typical parenting support groups. Your child’s behaviors and emotions may be so extreme that other parents can’t relate. As their parenting-101 and common sense advice falls flat and over time, their lack of understanding can feel an awful lot like blame.

You may be feeling:

Developmental trauma (often diagnosed as Reactive Attachment Disorder) is a very serious disorder that requires specialized and specific treatment. You’re unlikely to find the support you need in typical mommy-and-me, ADHD, or other types of parenting support groups. The approaches to those parents use may not be effective with your child.

First, know you are not alone. There are thousands of us going through the same things. It’s just difficult to find each other and connect for support.

So where can you find the support and community you so desperately need? One fantastic option is a private online support group. Here are the two I like to recommend, and am most active in. (Tell them Raising Devon sent you!)

Attach Families Support Group
Underground World of RAD
Christian RAD Support Group

These groups are for parents and caregivers only and have strict confidentiality rules. They are a great place to ask for advice, vent, and feel understood.

You don’t have to do this alone!

Don’t miss out on these resources as well:

Post-Adoption Support
Recommended Books
Mental Health
Trauma
Blogs to Follow
Handouts
Quotes and Shareables

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.
Parent Support Group FlyerDownload

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.

What is Reactive Attachment Disorder (RAD)?

Also published on The Mighty (upcoming)

I visualize my son’s mental disorder, Reactive Attachment Disorder (RAD), as a tug-of-war. If I tell him to wear blue socks, he’ll wear white. If I make his favorite sandwich, he’ll toss it in the trash and tell his teacher I didn’t send him with lunch. If I ask him to write his spelling words three times, he won’t even pick up his pencil. And there’s no negotiation. If I compromise and ask him to write them only once, he’ll still refuse.

No matter how inconsequential or mundane the issue is, my son treats everything as though it’s a tug of war, and the stakes couldn’t be higher. For him it’s a life-or-death battle. He must win at all costs – no matter how long it takes, and despite any consequences he’s given or any rewards he’s promised.

Kids with RAD have an indefatigable need to control the people and situations around them because they only feel safe when they prove to themselves they are in control. To understand this, we must go back to the underlying causes of the disorder.

What causes RAD?

RAD is caused by adverse childhood experiences (also called ACES) that occur during the first five years of a child’s life. This is when their rapidly developing brain is most vulnerable.

In my son’s case, he was neglected and abused before we adopted him out of foster care at the age four. Other ACES include witnessing domestic violence, having a substance addicted parent, and losing a primary caregiver.

These experiences can cause “developmental trauma,” a term coined by leading trauma expert and researcher Bessel van der Kolk. Depending on the timing, duration, and severity of the adversity, a child can be affected in two key ways.

  1. Stuck in chronic survival mode. The fight-flight-freeze is not meant to be our “normal.” Its purpose is to kick in to keep us safe from danger. When kids are chronically abused and neglected, their brains are chronically bathed in adrenaline. As a result, they may begin to default to fight-fight-freeze even in minimally threatening situations. These kids can be hypervigilant and seem to overreact.
  2. Interrupted brain development. Our brain develops sequentially beginning with the primitive brain which controls our basic functions including our breathing and heart rate. The limbic brain comes next and regulates behavior, emotions, and attachment. The cortical brain – where critical, abstract, and cause-and-effect thinking live – comes online last. When kids experience chronic trauma, their brain may not develop properly. These kids can be dysregulated and lack high-level thinking skills.

The impact of developmental trauma is on a spectrum with a variety of symptoms and severity. This is closely related to stage of the child’s brain development at the time the trauma occurred. Unfortunately, there is no single diagnosis that covers all the symptoms of developmental trauma. Children are often given multiple diagnoses including Attention Deficit Hyperactive Disorder (ADHD), Post Traumatic Stress Disorder (PTSD), and RAD.

What is RAD?

RAD is a diagnosis given to children who have experienced chronic developmental trauma before the age of five and did not form at healthy attachment to a primary caregiver, usually their mother. They grow up without an inherent sense of being safe and loved. Instead their psyche internalizes the message they must take care of themselves because no one else will.

The world feels alarmingly unsafe and unpredictable – and that’s why they lock into a tug-of-war with their primary caregiver. Remember too, these children may be “stuck” in survival mode. They may literally perceive an innocuous situation as threatening and kick into fight-flight-freeze mode. Their higher-level brain functions like cause-and-effect thinking may be underdeveloped. This is why they cannot be reasoned with or talked down.

How to end the tug of war

As a parent, the constant tug-of-war, is exhausting, frustrating, and discouraging. Our impulse is often to tug our side of the rope even harder – to teach our child who is boss. We dole out consequences and insist on compliance. They need to learn to respect authority and obey, right? It’s parenting 101.

But traditional parenting backfires spectacularly with kids diagnosed with RAD. They dig in their heels and tighten their grip on their side of the rope. It will inevitably exacerbate the situation and strain the relationship with our child.

It may seem counterintuitive, but to help our child drop his side of the rope, we must first drop ours. This is accomplished by employing therapeutic parenting strategies that prioritize relationship building and focus on the communication and the needs behind the behavior.

Let’s look at how therapeutic parenting can transform the tug-of-war with my son.

  1. When I tell him to wear blue socks, he’ll insist on wearing white. It doesn’t really matter what color socks he wears. I decide to let him make these types of choices whenever possible which enables him to enjoy some sense of control.
  2. He’ll toss his lunch in the trash and tell his teacher I didn’t send one. Perhaps he’s lining up a backup food source because he’s unconsciously afraid I’ll stop feeding him one day. By providing consistent nurturing over time, this need – thus this behavior – will diminish.
  3. Instead of writing his spelling words, he’ll stare at his pencil. I can make this a non-issue by leaving it to his teacher to follow up. If necessary, I can pursue a 504 plan or Individual Education Plan (IEP) to ensure the accommodations he needs to be successful.

And with that, I’ve dropped my side of the rope. We are no longer locked in a tug-of-war.

Of course, it’s easier said than done and takes great patience and perseverance. RAD is a very challenging disorder to manage and there are no quick and easy fixes. A good starting point is recognizing the underlying causes and educating yourself on the therapeutic parenting approach.

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 will turn 18 with an 8th grade education. 

Early Intervention is Key

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

To determine if your child needs professional intervention watch for:

  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.

Navigating Reactive Attachment Disorder – And Succeeding!

Guest post by Gina Heumann

We knew something was off right away.

We had just traveled 2700 miles to pick up our second child in Guatemala – our second adoption from the same country. Our first baby, Landrey, was incredibly easy, so much so that my friends called him “The Stepford Child”. We were convinced his awesome behavior was due to our stellar parenting, so we assumed that new baby Maddox would be just as easy.

Ha!

We didn’t know the signs to look for back then and had never heard of attachment disorders. We chose Guatemala because we could get babies as young as 4 months, and assumed if there were any issues before we picked him up, we would be able to fix them with love and attention. Boy, were we mistaken!

From the beginning, Maddox was a fussy baby. He didn’t make eye contact and didn’t smile easily. In fact, we discovered as he got a little older that the only way to get a picture of him smiling was to have someone chase him while another person set up the camera and tried to capture him as he was running past.

He didn’t sleep. It seemed the planets had to align in order to get him down, and my husband spent several hours every night putting him to bed. For years. He awoke at least 4-5 times a night until he was eleven.

Even at 6 months old, the kid was DIVING across the table to grab our food. It was then (and after meeting his completely detached former foster mom) that I started to suspect he was neglected before we adopted him.

As he grew older, we started to experience intense meltdowns. Like REALLY intense. He could scream for four hours over something as silly as asking us to play a song again – on the radio. If we were unable to fulfill his requests, he would scream. And scream. And scream. And then throw things – whatever was within arms length, and when I figured out to keep items out of reach, he’d take off his shoes and throw them. As time went on, he would destroy property – TVs, computers, lamps, car windshields, you name it. If we put him in timeout in his room, he would throw the lamp, the table, even take pictures off the wall and smash them so that the floor was covered in glass. He’d throw things at me, punch holes in the door, pull my hair. At one point, he punched me in the face. At 3am. While I was sleeping. Because I took away his video games eight hours earlier.

We were at a loss. We tried therapy. In the beginning, they assumed it was a parenting issue and offered us behavioral charts, marbles, stickers. You know, the techniques that work for “regular” kids. All of them worked on my first son. NONE of them worked on Maddox.

Over time, we tried other types of therapy: individual therapy, group therapy, family therapy, in-home therapy (which is really weird – a therapist comes to your home and tries to be invisible while you go about your business and pretend he’s not there… then he interferes as necessary. So uncomfortable!) We took parenting classes. We tried homeopathy, neurofeedback, nutritionists, and even the Brain Balance program. 

He was eventually kicked out of school, sent in handcuffs to the Juvenile Assessment Center, appeared in court, and had to serve a summer of community service at the ripe old age of 12. That felt like rock bottom to me. 

I have never felt so helpless and alone in my whole life. Strangers in the grocery store witnessing a public meltdown would assume I was a terrible parent. Most of the time I could tell by the looks on their faces, but on rare occasions, they’d tell me right to my face. “You should be embarrassed. You’re failing as a mother”, said one lovely woman who was “only trying to help.” UGH.

Not until we identified a proper diagnosis 10 years in were we able to find an expert in Reactive Attachment Disorder. With this doctor’s help, we were finally able to find some peace for our family. We did a family intensive therapy that lasted two solid weeks, four hours a day, with four therapists, and all four of us. This experience was hard… probably the most intense and soul-searching thing I’ve ever done, but over time, we realized that this therapeutic effort was the greatest money we’ve ever spent on our family.

We also found Maddox a school that was designed for kids with social, behavioral and academic challenges. The environment offered incredibly small class sizes, experiential learning, meditation and yoga, a social worker on staff who met with them every day, and even a weekly visit from the school therapy dog.

That was three years ago. Today, Maddox is doing amazing. He’s finishing up his freshman year at the public high school, which he chose primarily because he wanted to be in a marching band. Music has been great for him, and he’s now a member of six different bands both at his school and in the metro area. He is playing both the tuba and the bass trombone. Smallest kid, biggest instrument. He loves it!

We haven’t seen a violent incident in over two years and he’s incredibly mellow now. His grades have improved. He has a group of friends. He even has a girlfriend, who he’s been meeting at the mall or the library for almost a year. Life is good.

I’m so proud to have a success story to share. Our journey wasn’t easy, and I wouldn’t wish RAD on my worst enemy, but I’m happy to say that we never quit searching for answers and trying new alternatives. I love this kid with all my heart. And love never quits.

Gina Heumann is the author of the upcoming book, Love Never Quits – Surviving & Thriving After Infertility, Adoption, and Reactive Attachment Disorder, which is due to be released in the summer of 2019. Find her at www.ginaheumann.com or on Facebook and Instagram @loveneverquits.

Book Review: The Boy Who Built a Wall Around Himself

If your child has attachment issues, The Boy who Build a Wall Around Himself is the perfect book to cuddle up with. This lovely story by Ali Redford, an adoptive parent, gently describes the emotional wall some children build to protect themselves and keep safe after experiencing early childhood trauma. On one side of this “wall” is the caregiver, and on the other side the child.

The beautiful illustrations in this book will help even young children begin to reflect on how this “wall” is negatively affecting their lives, by keeping them from getting support and having fun with people who care for them.

This book will not only be thought provoking for children, but also paradigm shifting for caregivers. It’s a gentle reminder that our children’s behaviors are deeply rooted in trauma. Their unwillingness to attach to us is out of fear and the need to control everything around them because they view the world as an unsafe and uncaring place.

When I read this book I thought of my daughter Kayla. We adopted her out of foster care at the age of three and she’d been neglected. The she came to us, she spent hours screaming and could never get enough to eat. No doubt her needs had not been met up to that point and she was desperately trying to survive. She’s healed over the years, but the scars of early childhood trauma are forever etched on her core.

Kayla is now 15, but still my sweet baby girl. So I recently read her The Boy who Build a Wall Around Himself substituting “girl” for the word “boy.” It was a truly touching moment for us even though she’s a teenager and it’s a picture book. Always keep in mind that for traumatized kids, connecting at an earlier emotional level can be a powerful way to rebuild those connections they may have missed.

If you pick up this book and read it with your child please be sure to come back and share about the experience in the comments. I’m looking forward to hearing about your beautiful moments.

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. 

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 here.

[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/

California Looks To Lead Nation In Unraveling Childhood Trauma

Anna Maria Barry-Jester

Imagine identifying a toxin so potent it could rewire a child’s brain and erode his immune system. A substance that, in high doses, tripled the risk of heart disease and lung cancer and reduced life expectancy by 20 years.

And then realizing that tens of millions of American children had been exposed.

Dr. Nadine Burke Harris, California’s newly appointed surgeon general, will tell you this is not a hypothetical scenario. She is a leading voice in a movement trying to transform our understanding of how the traumatic experiences that affect so many American children can trigger serious physical and mental illness.

The movement draws on decades of research that has found that children who endure sustained stresses in their day-to-day lives — think sexual abuse, emotional neglect, a mother’s mental illness, a father’s alcoholism — undergo biochemical changes to their brains and bodies that can dramatically increase their risk of developing serious health problems, including heart disease, lung cancer, asthma and depression.

“[Nadine] has probably single-handedly done more to elevate this issue than anyone else,” said Dr. Mona Hanna-Attisha, the pediatrician known for documenting the rise in children’s blood lead levels in Flint, Mich., after the city switched its water supply.

With Burke Harris’ selection as the state’s first surgeon general, California is poised to become a vanguard for the nation in embracing the research that traces adverse childhood experiences, or ACEs, to the later onset of physical and mental illness. In pockets across the country, it’s increasingly common for schools and correctional systems to train staff on how academic and behavioral problems can be rooted in childhood trauma. Burke Harris envisions a statewide approach whereby screening for traumatic stress is as routine for pediatricians as screening for hearing or vision, and children with high ACEs scores have access to services that can build resilience and help their young bodies reset and thrive.

As California’s surgeon general, she will have a powerful bully pulpit — and the firm backing of a new administration with deep pockets. In his first weeks in office, newly elected Gov. Gavin Newsom has made clear he intends to devote significant resources to early childhood development. He has named several recognized experts in child welfare, along with Burke Harris, to top posts, and is promoting child-centric policies that include extended family leave for new parents, home nursing visits for new families and universal preschool. In his first state budget proposal, released last month, Newsom called out ACEs by name and committed $105 million to boost trauma and developmental screenings for children.

“It should be no surprise to anyone that I’m going to be focusing on ACEs and toxic stress,” Burke Harris said in a phone interview just days into the new job. “I think my selection is a reflection of where that issue fits in the administration’s priorities.”

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A Game-Changing Study

Adversity is the sort of thing we intuitively understand, at least to some extent. Having a parent who struggles with addiction or mental illness is hard on kids, as is growing up in a neighborhood marked by poverty, gun violence or drug abuse.

A 1990s study laid the groundwork, however, for an understanding of adversity that suggests it poses a pervasive threat to public health.

During interviews with patients at a Kaiser Permanente obesity clinic in Southern California, Dr. Vince Felitti was shocked at how many said they had been sexually abused as children. He wondered if the experiences could be connected. (Kaiser Health News, which produces California Healthline, is not affiliated with Kaiser Permanente.)

As head of the Department of Preventive Medicine at Kaiser Permanente in San Diego, he had access to a huge pool of patients to try to find out. Together with the Centers for Disease Control and Prevention, he surveyed more than 17,000 adult patients about 10 areas of childhood adversity. Among them: Did a parent or other adult in your household physically abuse you? Emotionally abuse you? Sexually abuse you? Go to prison? Was your mother regularly hit? Did you often go hungry? Were your parents divorced? The researchers scored each patient, assigning a point for each yes, and matched up the responses with patients’ medical records.

What they found was striking. Almost two-thirds of participants reported experiencing at least one kind of adversity, and 13 percent — about 1 in 8 — said they had experienced four or more. Those who reported experiencing high doses of trauma as children were far more likely to have serious health problems as adults, including heart disease, stroke, cancer and diabetes. And the higher their ACEs score, the worse their health was likely to be.

This extended to mental health, as well: Adults who reported experiencing four or more ACEs were 4.6 times as likely to have clinical depression and 12 times as likely to have attempted suicide.

In the 20 years since, scientists have built on the research, replicating the findings and digging into the “why.” In the simplest terms, traumatic events trigger surges in cortisol, the “stress” hormone. When those surges go unchecked for sustained periods, they can disrupt a child’s brain development, damage the cardiovascular system and cause chronic inflammation that messes with the body’s immune system.

And where children really get into trouble is when they also are missing the best-known antidote to adversity: a nurturing and trustworthy caregiver. Without that positive stimulation, children can end up with an overdeveloped threat response and a diminished ability to control impulses or make good decisions. Children with high ACEs scores are more likely to develop attention deficit hyperactivity disorder, known as ADHD, and cognitive impairments that can make school a struggle. They are more likely to grow into adults who drink to excess, are violent or are victims of violence.

The research is compelling, because it has the potential to explain so many intractable health problems. What if some portion of Generation ADHD really has PTSD? What if obesity and hypertension are disorders with roots in childhood experiences, and not just what we eat for dinner?

‘What Happens To You Matters’

Until now, Burke Harris’ professional epicenter has been Bayview-Hunters Point in San Francisco. It’s a vibrant community with a history of activism, but also deeply impoverished, and blighted by pollution and violence. It was there that Burke Harris, at her pediatric clinic, noticed that many of her young patients with serious medical conditions also had experienced profound trauma. And patients who had experienced serious adversity were 32 times more likely to be diagnosed with learning and behavioral problems than kids who had not.

When a colleague introduced her to the ACEs study, she saw her patients written between its lines. Though these problems might be concentrated in Bayview, they certainly weren’t confined there. This was a health crisis transcending race, class and ZIP code.

In the years since, Burke Harris has worked to advance ACEs science though her work at the clinic and her nonprofit research institute, the Center for Youth Wellness. She regularly travels the country to train fellow pediatricians in trauma screening and treatment. She has written an acclaimed book on the issue, “The Deepest Well,” and her TED talk on the topic has been viewed nearly 5 million times online.

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Now, she’ll be directing her singular focus back on California.

She plans to start with a statewide tour to hear from doctors and other health leaders about barriers to increasing pediatric screening and care. She’ll also be talking about the science of ACEs. “It’s Public Health 101 that raising awareness is a critical form of primary prevention,” she said.

But even with the funding included in Newsom’s budget, there are challenges to standardizing trauma screening. For one: In medicine, it’s common practice that you screen only for what you can treat. Many doctors — even those persuaded by research on adversity — have raised concerns about the lack of established protocols for treating childhood trauma. What can a pediatrician, with her 15-minute time slots and extensive to-do list, do about the ills of an absent parent, or a neighborhood riddled with gun violence?

In general, experts working on the issue say a critical ingredient in helping kids heal is ensuring they find and develop healthy relationships.

“All of us want to feel seen, heard, understood and supported,” said Alicia Lieberman, a researcher at the University of California-San Francisco who specializes in early childhood trauma. Involving parents is an essential aspect of treatment, particularly because so many have experienced trauma themselves. “It has to start with an acknowledgment that what happens to you matters.”

Researchers have found early success in seemingly simple interventions: Therapists coaching parents by filming and playing back positive interactions with their child. Therapists working with teachers on how to support their students. Key to success, said Pat Levitt, chief scientific officer at Children’s Hospital Los Angeles, are quality programs that start early and recognize the role of relationships.

At her clinic, Burke Harris coordinates with a team that wraps a child in care, treating mind and body. When a patient scores high on the adversity scale, she can send them down the hall to a therapist; connect them with classes on meditation, nutrition and exercise; involve the family in counseling; and aggressively monitor for and treat any physical manifestations.

Most clinics aren’t set up for this staff-intensive approach.

Dr. Andria Ruth, a pediatrician with the Santa Barbara Neighborhood Clinics in California, is among those researching how to “treat” adversity within a more traditional doctor’s office. Her research team is randomly assigning patients who screen positive for trauma into one of three groups. One group is assigned a navigator who connects the family to services for basic needs, such as food and housing. A second group also sees a behavioral health therapist at their child wellness visits. The third group receives both those services, and gets home family visits from therapists.

Ruth has a healthy skepticism about what’s possible, but she and her colleagues are convinced childhood trauma does pose a potent health threat: None of them felt comfortable including a control group that wouldn’t receive any services.

In the big picture, these experts say, addressing the fallout of traumatic stress will require a broader paradigm shift, to a system that recognizes that bad behavior can be a physical symptom rather than a moral failing. Gov. Newsom has signaled a move in that direction: In January, he said he would transfer the Division of Juvenile Justice out of the Department of Corrections, which runs the state’s prison system, and into the Health and Human Services Agency.

Garnering that kind of official backing is a powerful boost, said Jason Gortney, director of innovation at the Children’s Home Society of Washington, that state’s oldest and largest nonprofit dedicated to child welfare. His organization has lots of programs with promising results, he said, but connecting them to state agencies that aren’t used to working together is a challenge.

With Burke Harris crusading from the surgeon general post, Gortney said, he and fellow advocates across the country are hoping California can provide a beacon.

“Maybe California can show some of the other states how to do this,” he said.

This story first published on California Healthline, a service of the California Health Care Foundation.

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 Devon, 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.

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.

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.