I opened the closet door to find my son Devon squatting in the shadowy darkness with a belt looped loosely around his neck. He was 9. Confident that he wasn’t actually trying to hurt himself, and was only trying to get attention, I hid my fear. I knew if I showed my alarm, he’d be more likely to do it again. And again.
“Stop being silly,” I said in as carefree of a tone as I could manage. I took the belt, which wasn’t even buckled, from him. Unfortunately, in spite of my nonplussed response, his behavior escalated until I had no choice but to bring him to the mental health emergency room.
The intake nurse explained to me that he was experiencing “suicidal ideations,” that is thoughts or plans to commit suicide. “But he’s not actually thinking of harming himself,” I insisted, surprised by her diagnosis. “He wouldn’t even know how to kill himself with a belt. He’s only nine.”
Looking down her nose at me, the nurse said, “We don’t really know that, do we?”
It’s a complicated scenario faced by many parents of children with reactive attachment disorder (RAD) – kids like Devon who are sometimes willing to up the ante sky-high, even threatening self-harm and suicide. This is because kids who have RAD are desperate to control the people and situations around them. While there are certainly some who are suicidal, it’s not uncommon for kids with RAD to use these behaviors as a coping mechanism, with no genuine intention of harming themselves. And, the payoff can be huge. They avoid consequences, side-step difficult conversations, garner sympathy and attention, and gain control of virtually any situation.
My son, now 16, routinely threatens to kill himself over the smallest of triggers – breakfast cereal he doesn’t like, being told no, having to wait his turn. He’s attempted to slit his wrists with paper cuts, tried to hang himself using a belt on a closet rod, and tried to strangle himself with his shirt. Perhaps the scariest incident was when he climbed to the top of the rail of a second floor stairwell at school and threatened to jump. During the subsequent suicide assessments, Devon always admits he was bored, mad, or frustrated – not actually wanting to kill or hurt himself. Therapists, nurses, and social workers who have witnessed these incidents agree they are motivated by a desire for attention or a desire for control. We also all agree that the attempts are inherently dangerous, regardless of his motivation.
But why?
In some cases, his behavior is deliberate and calculated. Other times, it’s caused by dysregulation, lack of cause-and-effect thinking, and poor impulse control. In these situations, it has been helpful to me to remember that my child’s innate need to control situations and people is borne of childhood trauma. I am better able to respond from a place of empathy when I keep in mind the neglect or abuse that has causes my child to go to such desperate lengths.
Though the initial incidents of suicidal ideation are alarming, parents of kids with RAD can become weary and calloused over time. It is, after all, counterintuitive to give credence to threats that seem designed to manipulate or control, but these behaviors are simply too serious to ever be minimized or ignored. Even if you’re 1000% certain your child has no intention to kill himself, you must take suicidal ideations seriously every time, and here’s why:
You may be misinterpreting the situation and they may really desire to harm themselves.
They can accidentally hurt themselves, even if that’s not their intention.
These behaviors are clearly indicative of an underlying problem that needs to be addressed.
If your child is having suicidal ideations here are some steps you can take to keep them safe and find a way forward.
Know what mental health resources are available in your area including contact information, hours, and crisis services offered.
Be vigilant. What this looks like in your home will be unique to your situation, but it may include locking away knives, removing belts, or installing collapsing closet rods.
In the Moment
De-escalate the situation at all costs in order to stop your child from endangering themselves.
Lower your expectations – now’s not the time to quibble about tone of voice, cursing, and other unacceptable behaviors. Your only goal is to keep your child safe.
Seek emergency help by calling a crisis team or taking your child to the mental health emergency room. In some cases, you can schedule an emergency session with an outpatient therapist.
After the fact
Follow-through with recommendations for therapy, medication management, and other services.
Identify and address underlying triggers.
Update your safety plan based on the latest episode.
When our children use suicidal ideations to manipulate and control situations it can be tiresome and frustrating. It’s easy to begin reacting to these behaviors like we do any other attention-seeking behavior. But, with suicidal ideation the risks are simply too high. Always take them seriously and make safety your priority.
It’s the million-dollar question. How do we manage the behavior of children with RAD?
Therapeutic approaches can seem scarily permissive. Meanwhile, traditional parenting approaches backfire spectacularly.
At the root, most behaviors children with RAD engage in are intended for self-preservation – by sabotaging relationships and controlling their environments. It’s unlikely, however, that they’re introspective enough to be consciously doing this. These underlying motivations are etched like scars on their psyche.
Most likely, the in-your-face motivations of these kids are far more concrete. For example, our kids may be arguing incessantly because:
it’s a habit like biting their nails or spinning a pencil
they want to test our boundaries to see how flexible the rules are
they don’t really care about anyone else’s feelings or needs
Yes, in the real-world of RAD parenting, we know the in-your-face motivations are every bit as real as the unconscious, underlying motivations. In fact, they’re what make the behaviors so painful to deal with emotionally. As a result, parents often focus on the in-your-face motivations and find themselves angry, frustrated, and easily triggered.
Let’s consider that in many children, both sets of motivations co-exist.
For example,
My child is arguing just because they enjoy pushing my buttons. It gives them a feeling of control which they unconsciously crave because they intrinsically believe the world is unsafe.
When we look at the motivations for the behavior more holistically like this we are able to have greater empathy, more patience, and find energy to invest in long-term approaches. Below are some resources I’ve found useful for specific strategies and approaches. Please be sure to comment and share what’s working for you.
Sara Naish’s book “The A-Z of Therapeutic Parenting” it a balanced approach that’s both therapeutic and practical. She covers behaviors from Absconding to ZZZZ (sleep issues) and everything in between. For each behavior she helps us understand the broad range of reasons why a child might be doing it. She also provides strategies to prevent the behavior, to manage it in the moment, and to address it after the fact. These suggestions are refreshingly practical and obviously written by someone who has been in the trenches themselves. Read my full review or pick up a copy here: The A-Z of Therapeutic Parenting.
How-to blog post
Check out this excellent post on how to discipline a child with RAD. This is one of the most complicated topics related to RAD. Most ‘discipline’ is ineffective and it can be quite risky.
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.”
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.
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.
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.
This HBO documentary explores the struggle of three moms who are trying to find mental health services for their aggressive sons.
A Dangerous Son tells the story of families with sons who have disorders that lead to explosive, violent behaviors. These kids are a danger to their families and themselves – but there are few options for mental health services. The documentary doesn’t go into the diagnoses of the children but does mention the autism spectrum, intellectual disability, and schizoaffective disorder.
While our children may have different diagnoses, the issues are the same for every parent struggling with a child who has violent behaviors. The themes are eerily familiar:
The documentary is headlined by Liza Long who wrote the viral blog post, “I am Adam Lanza’s Mother,” in the aftermath of the Sandy Hook school shooting. If you haven’t read it, here’s an excerpt:
I live with a son who is mentally ill. I love my son. But he terrifies me…In the wake of another horrific national tragedy [Sandy Hook], it’s easy to talk about guns. But it’s time to talk about mental illness.
The lack of mental health treatment for kids with a propensity for violence is a national tragedy. It’s impacted Liza Long’s family and my own. And in some cases it spills out into our schools and communities. A Dangerous Son is a well made, compelling documentary that helps raise awareness around the difficulties of parenting a child who has violent behavior and the struggle to find help.
Have you seen it? Drop a comment below to share your thoughts.
Under my desk is an antique iron. It has been there since the day my mother hid it from my teenage son. That day, attempts to get him up had repeatedly failed. He was hungry but refused to eat, he became increasingly volatile until eventually he threatened to hurl the iron at my head.
I’d had enough objects thrown at me in the past to not take any chances. I ran out of the house and for the first time called the police. While I waited for them, my son punched through a window, the resulting cut narrowly missing his artery.
Many, though not all, of the perpetrators have experienced childhood traumas such as physical or emotional abuse,and unstable families, with violent, absent or alcoholic parents or siblings, for example. And most have experienced significant losses.
For example, the defendant in the case of the Parkland, Fla., shooting last year had lost his adopted mother to complications from the flu just a couple of months before the school attack. His adopted father had died when he was a little boy.
Caleb, 11, was thin with blond hair, glasses, and a big smile where crooked teeth jockeyed for space. He and his brother, Elijah, were adopted by Martin and Dena Lishing when Elijah was a toddler and Caleb was a baby. Their young birth mother struggled from addiction.
Born a preemie at 24-weeks-old and weighing only 1 pound, Caleb beat the odds. His 5th grade teachers remember him as shy, inquisitive and loving. He wore cowboy boots to school every day. He was fascinated by all things Titanic. A classmate says, “He was really funny. He always had jokes and puns to tell.”
It was a warm, overcast evening on April 23, 2018–Caleb was asleep in his bed. An adult babysitter was in a nearby room. Meanwhile, 13-year-old Elijah dismantled their grandfather’s locked gun cabinet to access a .357 Magnum. Caleb was sleeping on his stomach when Elijah shot him in the back, killing him.
This tragedy was the first murder in the small, sleepy town of Streetsboro, Ohio in 20 years. But it wasn’t the first time police were called to the Lishing home on Alden Drive.
Mental health interventions, too late
Over the years, the family had attempted – unsuccessfully – to get mental health treatment for Elijah although details are not public. Reports indicated Elijah tried to commit suicide twice. In 2017, Elijah was charged with indecent exposure on the school bus. In 2018, his stepmother called police because he became “unruly.” When he told officers he was thinking of harming himself, they transported him to a local behavioral health center for evaluation.
Only four days later, Elijah shot and killed his little brother Caleb. Police have not disclosed Elijah’s motive but say it was premeditated.
Psychologist Dr. Amy Thomas testified at the sentencing hearing that Elijah suffered early childhood abuse. Elijah claims, in addition to neglect from his birth mother, he was subsequently abused in the Lishing home. He details harsh punishments from a young age and says his adopted mother was more devoted to premature Caleb than to him. The Lishing couple also divorced several years after the adoption.
Thomas diagnosed him with reactive attachment disorder (RAD), also called developmental trauma disorder (DTD). This often occurs when a child experiences chronic abuse or neglect before the age of 5. A child with DTD has disrupted brain development and, if not provided early and highly-specialized intervention, can suffer long-term and devastating impacts. They have difficulty forming healthy attachments with caregivers and others which can lead to familial, social, educational and legal issues. Dr. Thomas also diagnosed Elijah with post-traumatic stress disorder and conduct disorder, both common diagnoses for children with DTD.
Elijah’s situation is even more complex than DTD alone, however. Dr. Thomas testified that Elijah also suffers from paranoia and stated that a previous clinician had diagnosed him with schizophrenia. Reflecting on the time of the murder, Elijah told the court, “I was living inside my head, unable to determine the difference between imagination and reality.” This points to serious mental illness in addition to complex DTD.
The worrisome correlation of complex developmental trauma and mental illness
Dr. John Alston, psychiatrist for the Institute for Attachment and Child Development, found a strong correlation between complex DTD and co-morbid mental illness. In his studies, Dr. Alston recognized that adults who abuse or neglect their children often do so as a result of a mental illness. Thus, their children may suffer the unfortunate combination of both the nature (genetics) and nurture (attachment) consequences.
And when children with complex DTD inherit a mental illness, it is often in a profound way according to Dr. Alston. He gives the analogy of more commonly-known childhood health issues. “You never hear of symptoms of childhood diabetes in a mild form, you never hear of childhood asthma in a mild form. They are always inherited in a severe or profound form and therefore the earlier the onset, the more severe the disorder, the more intensive the treatment needs to be,” said Dr. Alston. “It is exactly the same when we are talking about mental health disorders.”
Elijah told the court, “I was living inside my head, unable to determine the difference between imagination and reality.” This points to serious mental illness in addition to complex DTD.
Forrest Lien, Director of the Institute for Attachment and Child Development, is adamant that not all children with developmental trauma are dangerous. Rather, it is often the unfortunate combination of specific and severe disorders. “Developmental trauma disorder alone does not deem a child dangerous. Furthermore, not all children with DTD have a mental illness. Yet, some do,” Lien says. “Children with complex developmental trauma often feel angry and can lack empathy. When you combine a child who feels slighted and vengeful with a misdiagnosed or poorly-treated severe bipolar disorder with psychotic features, it can be dangerous.”
Neuroscience is an emerging science and this link between early trauma and mental illness is not well known. However, given the potential for sometimes dangerous antisocial behavior, it is critical that clinicians still give careful consideration to these correlations. It is vital, Dr. Alston says, to differentiate the impact of severe trauma from potential mental illness symptoms in order to properly diagnose and treat the whole child.
The case for better mental health support
Unfortunately, Elijah’s developmental trauma and co-morbid disorders were not accurately diagnosed until after he was incarcerated—not in time to prevent this horrific incident. He did not receive appropriate treatment and the costs to his family and himself have been enormous.
Martin and Dena are heartbroken having suffered the loss of their children. Innocent 11-year-old Caleb’s life has been cut short. And they must now grapple with the incarceration of their other son.
“When you combine a child who feels vengeful and slighted with a misdiagnosed or poorly-treated severe bipolar disorder or schizophrenia with psychotic audio and visual hallucinations, it can be dangerous,” said Institute for Attachment and Child Developmental Executive Director Forrest Lien.
Elijah, now 13, is a convicted murderer facing a lifetime of struggles. He has been sentenced to juvenile detention until he turns 21 and at that time his case will be reevaluated with the potential for adult detention time. According to the Record Courier, “Judge Robert Berger said that despite abuse the boy suffered as a child, it did not excuse shooting and killing his brother.”
Perhaps with earlier diagnosis and interventions, Elijah wouldn’t be sitting in a prison cell today. Caleb might be running around the playground instead of being memorialized by the Titanic-shaped play fort the community is erecting in his memory.
Published originally by IACD. Updated 1/28/2019 after sentencing.
Justin Taylor Bean, removed from his abusive birth parents as a toddler, spent the next two decades in psychiatric hospitals and more than 40 residential facilities.
Over the years, his physical and verbal aggression increased despite treatment and medication. Then, at the age of 22, Justin strangled to death a fellow group home resident.
During his sentencing last month, District Attorney Laura Thomas argued almost sympathetically that Justin “did not have a chance — it was all over for him at age 2.” She then asked that he be sentenced to a life behind bars, which he was.
“There’s not a miraculous cure,” Thomas said. “The public needs to be protected from him forever.”
Many will be outraged by this story, but few will understand how something like this happens. After all, all the warning signs were there. Doesn’t that mean this could have been prevented?
Sadly, it’s not that simple.
More than a million children each year experience early childhood trauma, most often due to abuse and neglect. “Developmental trauma,” a term coined by leading expert Dr. Bessel van der Kolk, affects a child’s brain development. The impact can be devastating, including severe attachment and behavioral issues. These traumatized children need comprehensive, specialized professional intervention and treatment – treatment that’s expensive and not available in most areas.
Unfortunately, I know all too well just how true this is. My adopted son, Devon, has also attempted to seriously harm fellow residents in group homes – more than once. Like Justin, Devon has a diagnosis of reactive attachment disorder and has a similar treatment history. My son could easily have killed someone, he’s just been small enough that staff can control him.
He’s received medication and thousands of hours of therapy. He’s only become more violent and dangerous. Unable to safely live at home, he’s been in and out of psychiatric residential treatment facilities for years. All I can do is helplessly watch as he careens toward adulthood, an angry and violent young man.
What’s clear from Devon and Justin’s stories is that our mental health system does not yet know how to effectively treat children with the most severe developmental trauma. Residential treatment facilities, often the only available choice, are virtual incubators for violence, and many children leave more dangerous than they went in. And far too many end up institutionalized or incarcerated.
As a society, we take these already broken and vulnerable children, and like a gruesome medieval torture press, crush their hope for a good future. We perpetuate their trauma by piling on with broken systems that exacerbate the very problems they try to address: foster care, family court, health care, mental health services and juvenile justice, to name a few.
Further, our communities don’t understand developmental trauma and underestimate its impact. And so, schools, unwitting parents, therapists and social groups pile on too. Under this pressing weight, what hope is there for these children?
The vast majority of people with mental health disorders do not go on to commit murder. But given our apathetic and broken mental health system, developmental trauma can be its own life sentence for youth in the child welfare system. It negatively affects all areas of life – relational, legal, educational and financial. A few victims, like Justin, go on to commit violent crimes.
How many lives have to be destroyed? Isn’t it time to recognize developmental trauma as the unsolved challenge it is, and prioritize funding research, prevention and treatment? Until we do, too many broken children will continue to grow into broken adults and we will continue to see tragedies like the murder committed by Justin.
When Toni and Jim Hoy adopted their son Daniel as a toddler, they did not plan to give him back to the state of Illinois 10 years later.
“Danny was this cute, lovable little blonde-haired, blue-eyed baby,” Jim said. There were times Daniel would reach over, put his hands on Toni’s face and squish her cheeks.
“And he would go, ‘You pretty mom,’” Toni said. “Oh my gosh, he just melted my heart when he would say these very loving, endearing things to me.”
But as Daniel grew older, he began to show signs of serious mental illness that manifested in violent outbursts. When his parents exhausted all other options, they decided to relinquish custody to the state to get Daniel the treatment he needed.
“To this day it’s the most gut-wrenching thing I’ve ever had to do in my life,” Jim said. “But it was the only way we figured we could keep the family safe.”
Across the U.S., children encounter many barriers to mental health treatment, including a shortage of psychiatric beds and coverage denials from insurance companies. In a desperate attempt to get their child treatment, some parents have discovered a last resort workaround: they trade custody for treatment.
Known as a psychiatric lockout, a parent brings a child to a hospital and refuses to pick them up. The child then enters foster care, and the state is obligated to pay for their care.
This happened to Daniel in 2008, and has happened to thousands of other children before him, according to a report from the Government Accountability Office.
Today, despite a 2015 Illinois law that states families should never have to trade custody for mental health treatment, at least four children a month enter state custody this way, according to data obtained by Side Effects.
Out of options
Daniel grew up as the youngest of four children in Ingleside, just north of Chicago. As a baby, he’d been severely neglected — starving and left for dead — and the early trauma Daniel experienced affected his brain development.
At around age 10, his post-traumatic stress disorder manifested in violent outbursts.
“You could almost tell the stories that would describe him like a monster,” Toni said.
“He held knives to people’s throats. He tried putting his fingers and his tongue in the light sockets. He broke almost every door in the house.”
In the car, there were times when he’d reach over and grab the wheel while Toni was driving to try and force the car into oncoming traffic. Other times, he would lash out at his siblings.
“At the same time, he’s a little boy,” she said. “He didn’t want to be that way. He didn’t like being that way.”
Despite Toni and Jim’s efforts to help their son with therapy, the violence escalated. Daniel was hospitalized almost a dozen times over a period of two years.
His doctors said he needed more intensive mental health services than he could get while living at home. He needed 24/7 residential treatment, but both Daniel’s private health insurance, and the secondary Medicaid coverage he received as an adoptee, denied coverage.
So the Hoys applied for a state grant meant for children with severe emotional disorders. They also asked for help from Daniel’s school district, which is supposed to cover a portion of the costs when students need residential care. They were denied both.
“We were told we had to pay out of pocket for it,” Toni said. The treatment could cost up to $150,000 a year, and that was money they didn’t have.
Then, during Daniel’s 11th hospitalization, the Illinois Department of Children and Family Services, or DCFS, gave the Hoys an ultimatum.
“[They] basically said, ‘If you bring him home, we’re going to charge you with child endangerment for failure to protect your other kids,’” Toni said. “‘And if you leave him at the hospital, we’ll charge you with neglect.’”
Out of options, the Hoys chose the latter option as a last-ditch workaround to get treatment.
Once the DCFS steps in to take custody, the agency will place the child in residential treatment and pay for it, said attorney Robert Farley, Jr., who is based in Naperville.
“So you get residential services, but then you’ve given up custody of your child,” he said. “Which is, you know, barbaric. You have to give up your child to get something necessary.”
The Hoys were investigated by DCFS and charged with neglect. They appealed in court and the charge was later amended to a “no-fault dependency,” meaning the child entered state custody at no fault of the parents.
Losing custody meant Toni and Jim could visit Daniel and maintain contact with him, but they could not make decisions regarding his care.
Toni spent months reading up on federal Medicaid law and she learned the state-federal health insurance program is supposed to cover all medically necessary treatments for eligible children.
The Hoys hired a lawyer, and two years after giving Daniel up, they sued the state.
Less than a year later, in 2011, they settled out of court, regained custody of Daniel, who was 15, and got the funding for his care.
Around the same time, Farley decided to take on the lack of access to mental health care on behalf of all Medicaid-eligible children in the state. He filed a class-action lawsuit, claiming Illinois illegally withheld services from children with severe mental health disorders.
“There [are] great federal laws,” Farley said. “But someone’s not out there enforcing them.”
In the lawsuit, Farley cited the state’s own data that shows 18,000 children in Illinois have a severe emotional or behavioral disorder, yet only about 200 of them receive intensive mental health treatment.
In a settlement in January, a judge ruled the state must make reforms to comply with Medicaid law. The state has until October to come up with a plan to ensure all Medicaid-eligible children in the state have access to in-home and community-based mental health services.
A law that didn’t fix the problem
While these legal battles were taking place, lawmakers began their own work to ensure parents no longer have to give up custody to get their children access to mental health services.
In Illinois, six state agencies interact with at-risk children in some form. But Democratic state Rep. Sara Feigenholtz said they operate in silos, which causes many children to slip through the cracks and end up in state custody.
“It’s almost like these there’s a vacuum, and the kids are just being sucked into DCFS,” she said.
Feigenholtz worked to get a bill passed in 2014. The Custody Relinquishment Prevention Act, which became law in 2015, orders those six agencies to work together to help families that are considering a lockout to find care for their child and keep them out of state custody.
So the agencies developed a program together that launched in 2017 — years after the deadline set by the law. It aims to connect children to services.
But Feigenholtz said the fact lockouts still happen shows a lack of commitment on behalf of the agencies.
“I think the question is: Shouldn’t government be stepping in and doing their job? And they’re not,” she said. “We just want them to do their job.”
B.J. Walker, head of DCFS, said the reasons lockouts happen are complex. “If law could fix problems, we’d have a different world,” she said.
Walker said many children in need of residential treatment for mental illness have such severe or unique conditions that it can be a struggle to find a facility that’s willing and able to take them.
Even for families that get state funding to pay for the care, families Side Effects Public Media spoke to said the waiting lists can run six months or longer. When parents are unable to arrange a placement, the child may enter state custody, and as ProPublica Illinois reports, they could languish for months in emergency rooms that are ill-equipped to provide long-term care. Some out-of-state facilities are not willing to accept Illinois children, citing concerns over severe delays in payments that stem from a recent two-year budget crisis in Illinois.
The program to prevent lockouts requires families take children home from the hospital after medical providers have done everything they can. But many parents say it’s not an option for them because their child remains too violent for home.
For these reasons, children continue to enter state custody as a final effort by their families to help them.
A spokesman for DCFS said in an email that, when the agency gets blamed for this problem, it’s like when a pitcher comes in at the end of a losing game to save the day and gets tagged with the loss.
What it will take to prevent lockouts
Lockouts can happen anywhere, but Heather O’Donnell, a lawyer with a Chicago-based mental health treatment provider, Thresholds, said the situation is particularly bad in Illinois.
She said a big part of the problem is that society sweeps mental health conditions under the rug until there’s a crisis.
“We don’t have a very good system in Illinois for children or adolescent or young adults with significant mental health conditions,” O’Donnell said. “What Illinois needs to put into place is a system that helps these families early on so that these kids never get hospitalized.”
That’s what the state is trying to fix now.
The consent decree issued as part of the class-action lawsuit settlement requires the state to propose a plan by October to ensure all Medicaid-eligible children in the state have access to mental health services in their communities, with changes slated to begin in 2019. Farley estimates the changes will cost the state several hundred thousand dollars, based on what it cost other states like Massachusetts to implement similar reforms.
The difference treatment and family can make
Daniel Hoy is now 23 and has been out of residential treatment — and stable — for five years. He has a 2-year-old daughter, works nights for a shipping company in Rantoul, in central Illinois, where he recently moved to be closer to his parents.
Daniel said treatment was tough, and he would not have gotten better without his parents’ love and support.
“Sometimes it’s so hard to do it for yourself,” he said. “It almost helps to know that I’m doing it for myself, but I’m also doing it for my family and for our relationship.”
Toni’s thankful that despite losing Daniel while trying to help him, they ultimately made it through intact. She’s in touch with other families that have gone through lockouts too and most, she said, are not as lucky.
That’s why Toni said she will continue to speak out about this issue. “Kids do need services,” she said. “But they also need the support of their families. And when they have both, a lot of kids can be a lot more successful.”
After my son was placed in a psychiatric residential treatment facility (PRTF) I went to therapy. Something was wrong with meand I needed to fix myself before my son returned home.He was 10 and had been terrorizing our family with his violent and out of control behaviors for several years.
I was diagnosed with PTSD, but I brushed it off. How could dealing with a young child cause PTSD? Looking back I now believe I had in fact developed PTSD and it took years for me to heal.
Here are a few symptoms I experienced: hyper-vigilance, social isolation, agitation, paralyzing fear/dread, and heightened reactions
via [INFOGRAPHIC] How parents of kids with reactive attachment disorder get post-traumatic stress disorder – Institute For Attachment and Child Development
When my son, Devon, was nine he pushed his four-year-old brother down the stairs. It was one big shove that launched Brandon through the air and left him sprawled on the tile floor below. At 10, he punched his teacher and several classmates. At 11, he attacked a woman and dislocated her thumb.
Told a man had fresh dental work, Devon (for the purposes of this oped, I’ll call him Devon) promptly slugged him in the jaw. He was 12. At 13, he punched a young girl in the back of the head, unprovoked, and used his pencil to stab classmates. He still does. At 14, he grabbed a woman’s breasts and genitals threatening to rape her; using a jagged piece of plastic he stabbed a man in the cornea. At 15, he bit a man, breaking the skin and drawing blood; he did $3000 worth of property damage in mere minutes.
Devon, now 16, has verbalized detailed plans to torch the group home he lives in. He routinely threatens to kill himself, me, his siblings, his teachers, and other students.
Nikolas Cruz, the Parkland high school shooter, is a troubled kid, too. While I don’t presume to know Nikolas’ history or diagnoses, Devon and Nikolas are both teenagers, adopted males with behavioral and mental health issues. I adopted Devon from foster care in Broward County when he was four. Like Nikolas, his disturbing record of deviant behavior telegraphs worse to come.
The media is calling the Parkland massacre “preventable” and pointing to missed warning signs. But, I’ve heeded the warning signs. Devon’s received comprehensive mental health services for years. Running the gamut — outpatient therapy, day treatment, therapeutic foster care, group homes, psychiatric residential facilities, mental health hospitalizations — he’s received thousands of hours of therapy. He’s been dealt diagnoses like a hand of Go Fish and is on a cocktail of anti-psychotic drugs.
All these mental health services, like water and sunshine, have unwittingly nurtured Devon’s proclivity for violence. He’s only gotten bigger, stronger, smarter, and more dangerous. I fear he could be the next teen paraded across the headlines in handcuffs.
When Republicans call for greater access to mental health services as a remedy to school shootings, they fail to recognize the mental health system has no meaningful solutions for violent kids like Devon and Nikolas.
Take a walk. Talk to staff. Hug your pillow. These are the coping skills therapists give angry teens to reel in their extreme emotions. The absurdity comes into focus when a teen like Nikolas opens fire on hundreds of innocent victims, taking 17 lives. Would tragedy have been averted if Nikolas knew to pull off his gas mask and take some deep breaths? To put down his AR-15 and hug his pillow?
Psychiatric treatment facilities are virtual incubators for violent kids. They focus on underlying mental health issues promising the negative behaviors will diminish. In these programs, Devon has no consequences for truancy, vandalism, criminal threats, and assault. Not even a time-out. Protected from criminal charges, he’s become desensitized to his own violence and indifferent to social boundaries. It’s normalized his violent responses to even the smallest triggers: waiting his turn, a snarky look from a peer, being served breakfast he doesn’t like.
It’s unlikely Nikolas’ trajectory would have changed even if he’d received the years of intensive mental health treatment Devon has. Mental health facilities are little more than holding pens for kids who are too dangerous to live at home.
I’ve tried the system. It doesn’t work.
Funding to offer these same ineffectual services to more would-be-shooters won’t stop tragedies like the Parkland shooting, especially since Trump nixed the Obama-era regulations making it easier, not harder, for mentally ill people to buy guns. I don’t pretend to know the answers, but I do know a bad idea when I see one: giving these kids access to guns. If we’re not going to do something as basic as keeping deadly weapons out of the hands of mentally disturbed teens, what mental health interventions can possibly keep us safe?
Keri Williams, a former resident of Broward County, lives with her family in Charlotte, N.C., and is working on a memoir about raising her adopted son.
After my son was placed in a psychiatric residential treatment facility (PRTF) I went to therapy. Something was wrong with me and I needed to fix myself before my son returned home. He was 10 and had been terrorizing our family with his 