This blog is my place to vent and share resources with other parents of children of trauma. I try to be open and honest about my feelings in order to help others know they are not alone. Therapeutic parenting of adopted teenagers with RAD and other severe mental illnesses and issues (plus "neurotypical" teens) , is not easy, and there are time when I say what I feel... at the moment. We're all human!

Saturday, March 9, 2019

Continuous Traumatic Stress (CTS)


Image result for abused parent

We call ourselves Trauma Mamas (and Trauma Papas).  We live with our abusers and care for them on a daily basis. Unlike other battered women, we are not encouraged to leave. Instead, we are told we have to stay. We're told that we *should* devote all of our time and energy to our child. 
{Fighting the *shoulds* - Prioritizing Yourself, Your Family, and Your Child - In That Order!}

Our house often feels like a war zone. The stress feels like it never ends and even becomes our new normal. It affects our bodies, our minds, our relationships.

{Not coincidentally, our kids with Chronic Post-Traumatic Stress Disorder (C-PTSD) often perceive chaos as normal and their bodies can become "addicted" to the stress hormones, to such an extent that they attempt to recreate the chaos in their everyday life with us. Why Doesn't My Child Feel Safe?}


Continuous Traumatic Stress
Back in the 1980s before apartheid was abolished, mental health professionals dealing with victims of political repression in South Africa found that the usual treatment for PTSD provided little help for people living in fear that the victimization could happen again at any time. 
CTS - Not a Disorder
Many people experiencing continuous stressful environments will be formally diagnosed with C-PTSD* or DTD**. Some researchers, including Gillian Straker, suggest that continuous traumatic stress (CTS) should be seen as a separate concept instead of a disorder. 
Though many people experiencing these kinds of repeated traumas will have enough resilience to avoid developing full-blown trauma symptoms, coping with CTS often depends on how or where the trauma takes place. This includes war zones where the threat of physical attack remains very real and a state of “permanent emergency” exists. 
Soldiers,  U.N. peacekeepers, relief agency workers, people in refugee camps, and even civilians living in these war zones often experience CTS on a daily basis. 
When the Trauma Doesn't End How can people learn to live with chronic traumatic stress? by Romeo Vitelli Ph.D. Posted May 29, 2013  
I think we can safely include parents of children with severe trauma, aggression, violent tendencies, and other disorders among those dealing with CTS on a daily basis.




CTS in Parents/ Caregivers

The following article refers to this as Post-Traumatic Stress Disorder,  but I believe you'll agree that the more accurate term is Continuous Traumatic Stress. "Post" implies that the traumatic event(s) are over.
PTSD in Parents of Kids with RAD
Many foster and adoptive families of Reactive Attachment Disordered children live in a home that has become a battleground. In the beginning, the daily struggles can be expected, after all, we knew that problems would occur. Initially, stress can be so subtle that we lose sight of a war which others do not realize is occurring. We honestly believe that we can work through the problems.
Outbursts, rages, and strife become a way of life. An emotionally unhealthy way of life. We set aside our own needs and focus on the needs of our children. But what does it cost us? {Handling Rages}
In war, the battle lines are drawn; an antagonism exists between two enemies. In our homes, we are not drawing battle lines; we are not prepared for war. We are prepared for parenting. Consequently, the ongoing stress can result in disastrous affects on our well-being literally causing our emotional and physical health to deteriorate.
The primary symptoms of Post Traumatic Stress Disorder include:
  • Avoidance -- refusing to recognize the thoughts and feelings associated with the trauma, this further includes avoiding activities, individuals, and places associated with the trauma.
  • Intense distress -- when certain cues or "triggers" set off memories of the traumatic event. You may have trouble concentrating, along with feelings of irritability, and frustration over trivial events that never bothered you in the past.
  • Nightmares and flashbacks -- insomnia or oversleeping may occur. You may exhibit symptoms such as heightened alertness and startle easily.
  • A loss of interest in your life -- detaching yourself from loved ones. Losing all hope for the future and a lack of loving feelings.
Secondary symptoms of Post Traumatic Stress Disorder can include:
  • The realization that you are no longer the person you once were. Relationships have changed by alienating yourself from loved ones. Loneliness and a feeling of helplessness prevail in your daily life.
  • Depression, which can lead to a negative self-image, lowered self-esteem, along with feeling out of control of your life and environment. You may become a workaholic and physical problems may develop.
  • You become overly cautious and insecure. Angry outbursts may occur putting stress on significant relationships.

Stress - Fight-or-Flight  
Your body perceives stress like an attack (think of our ancestors being attacked by a tiger) and reacts accordingly with an instinctual fight or flight response. This feeling prompts your adrenal glands to release a surge of hormones, including adrenaline and cortisol.

To fight that "tiger," adrenaline increases your heart rate, elevates your blood pressure and boosts energy supplies. Cortisol, the primary stress hormone, increases sugars (glucose) in the bloodstream, enhances your brain's use of glucose and increases the availability of substances that repair tissues.
Image result for stress tiger
Cortisol also curbs functions that would be nonessential or detrimental in a fight-or-flight situation. It alters immune system responses and suppresses the digestive system, the reproductive system, and growth processes. This complex natural alarm system also communicates with regions of your brain that control mood, motivation, and fear.


When the natural stress response goes haywire
The body's stress-response system is usually self-limiting. Once a perceived threat has passed, hormone levels return to normal. As adrenaline and cortisol levels drop, your heart rate and blood pressure return to baseline levels and other systems resume their regular activities.

But when stressors are always present and you constantly feel under attack, that fight-or-flight reaction stays turned on.

The long-term activation of the stress-response system — and the subsequent overexposure to cortisol and other stress hormones — can disrupt almost all your body's processes. Stress Management - Mayo Clinic 

"[C]hronic stress, which is constant and persists over an extended period of time, can be debilitating and overwhelming. Chronic stress can affect both our physical and psychological well-being by causing a variety of problems including anxiety, insomnia, muscle pain, high blood pressure, and a weakened immune system. 
Research shows that stress can contribute to the development of major illnesses, such as heart disease, depression, and obesity. The consequences of chronic stress are serious." Chronic Stress- American Psychological Association

*Complex PTSD (C-PTSD)
Though CTS is not considered a disorder in itself, a new diagnosis has been suggested to take continuous traumatic stress into account:  Complex PTSD (C-PTSD).   
First proposed by Judith Herman in her 1992 book, Trauma and Recovery,  she suggested people dealing with child physical abuse,  intimate partner violence, women trapped in sexual slavery and other people experiencing long-term stress often showed symptoms very different from people experiencing single-event traumas. As a result, they can often become passive and withdrawn (due to learned helplessness), or develop highly unstable personalities. This could lead to dangerous repetitive behaviours such as becoming involved with violent partners,  repeated self-harm attempts, or chronic substance abuse. 
Though not part of the new DSM-5, suggested C-PTSD symptoms in adults include:
  •         Difficulties regulating emotions, including symptoms such as persistent sadness, suicidal thoughts, explosive anger, or covert anger
  •         Variations in consciousness, such as forgetting traumatic events (i.e., psychogenic amnesia), reliving traumatic events, or having episodes of dissociation (during which one feels detached from one's mental processes or body).
  •         Changes in self-perception, such as a chronic and pervasive sense of helplessness, shame, guilt, stigma, and a sense of being completely different from other human beings.
  •         Varied changes in the perception of the perpetrator, such as attributing total power to the perpetrator or becoming preoccupied with the relationship to the perpetrator, including a preoccupation with revenge.
  •         Alterations in relations with others, including isolation, distrust, or a repeated search for a rescuer.
  •         Loss of, or changes in, one's system of meanings, which may include a loss of sustaining faith or a sense of hopelessness and despair.
**Developmental Trauma Disorder (DTD)
Since C-PTSD does not adequately reflect the kind of developmental impact seen in children, clinicians have suggested an alternative diagnosis, Developmental Trauma Disorder (DTD).
Symptoms for children are similar but also include:
  • behavioural problems,
  • poor impulse control,
  • pathological self-soothing (through dysfunctional coping mechanism such as self-cutting), and
  • sleep problems.  
When the Trauma Doesn't End How can people learn to live with chronic traumatic stress? by Romeo Vitelli Ph.D. Posted May 29, 2013



Treatment of CTS

Living with CTS 
So what do classic PTSD symptoms such as flashbacks, nightmares, hypervigilance and the startle response mean for people who are afraid of being re-victimized? People experiencing CTS are usually more preoccupied with the possibility of future traumatic events than by what happened to them in the past. 
For them, staying vigilant is a healthy way of responding to what they must face although they need to learn to tell the difference between realistic vs. imagined threats to their safety. 
When the Trauma Doesn't End How can people learn to live with chronic traumatic stress? by Romeo Vitelli Ph.D. Posted May 29, 2013

Caregiver Fatigue/ Compassion Fatigue


The demands of caregiving can be overwhelming, especially if you feel you have little control over the situation or you’re in over your head. If the stress of caregiving is left unchecked, it can take a toll on your health, relationships, and state of mind—eventually leading to burnout.
When you’re burned out, it’s tough to do anything, let alone look after someone else. That’s why taking care of yourself isn’t a luxury—it’s a necessity.

Caregiver stress and burnout: What you need to know
Caring for a loved one can be very rewarding, but it also involves many stressors. Caregiver stress can be particularly damaging since it is typically a chronic, long-term challenge.

If you don’t get the physical and emotional support you need, the stress of caregiving leaves you vulnerable to a wide range of problems, including depression, anxiety, and burnout. And when you get to that point, both you and the people you’re caring for suffer. That’s why managing the stress levels in your life is just as important as making sure your family member gets to his doctor’s appointment or takes her medication on time.
Common signs and symptoms of caregiver burnout
  • You have much less energy than you once had
  • It seems like you catch every cold or flu that’s going around
  • You’re constantly exhausted, even after sleeping or taking a break
  • You neglect your own needs, either because you’re too busy or you don’t care anymore
  • Your life revolves around caregiving, but it gives you little satisfaction
  • You have trouble relaxing, even when help is available
  • You’re increasingly impatient and irritable with the person you’re caring for
  • You feel helpless and hopeless

Helping Ourselves - Recovering from CTS and Burnout 

There will always be times when we feel defeated. Like we just can't take one more step. We want to run away.  We want to drop kick this kid.  I have heard so many people say, "I am DONE!  I can't take anymore!"  

I have soooo felt this way myself.  First of all, remember that YOU ARE NOT ALONE!! 

But My Child Needs Me! Giving Until There's Nothing Left
By the time most women reach out, I think we have hit rock bottom. 

 Like most moms, especially moms of special-needs children, I gave and gave and gave until there was nothing left. No reserves. Nothing. I was completely empty. That's hard to come back from.
A woman on one of my support groups was talking about feeling overwhelmed to the point that she found herself having no patience for her child and yelling at him all the time.  She was no longer able to be a therapeutic parent like she used to be.  In my response to her, I realized that things really have changed for me over the years, and I don't think it's just because Bear is out of the house and Kitty is stable.  I really am in a better place emotionally.

I totally get it.  When my kids first got here, I was empathetic, calm and patient with them- maybe TOO patient.  I stuffed things down, let it roll off my back, and GAVE and GAVE and GAVE... until there was nothing left.  I was so burned out and overwhelmed that we were all miserable.  

Here are some things I did to get ME back:


I know it sounds stupid, but I needed "permission," encouragement, and constant reminders to take care of myself.

Parenting a child with attachment issues is incredibly draining and we need extra support to deal with that. But it felt so wrong to prioritize my self over the needs of everyone else.

Society tells us that as women, we should be nurturing and prioritize our family. We should always put ourself and our needs last.
People who work with our child tell us we should prioritize that child. That we should do more for the child. 

They are all WRONG! 

What you HAVE TO do is prioritize yourself over the needs of the family! 



All those well-meaning people who say you SHOULD (or should not) be doing something have no idea what living 24/7 with a child with an attachment disorder is like. 

Even those who have experience working with special needs children don't know YOUR child and how your child is with YOU - plus they work at most an 8-hour shift with your child, then they get to go home!  Also, none of them take into account your other children or your marriage, let alone your needs as the caregiver of your family.  Their priority is the one child, not your family as a whole.




I also needed "permission to prioritize myself and the rest of the family over the needs of one child. Yes, my job as a parent is to help this child, but not at the expense of my marriage and the other children. Prioritizing Yourself, Your Family, and Your Child - In That Order!

Putting Yourself First
Remember what they say when you're on an airplane that is in trouble -- put the oxygen mask on YOURSELF first.  If you are not taking care of yourself, then you can't help anyone else.  

You have to find what works for you.

This is definitely easier if you have support, but you have to prioritize your needs, even if it's just something little, like keeping the best piece of whatever you're serving for dinner for yourself. 
If you give and give and give without getting much, if anything, back, then there is nothing left for anyone!

I knew I could not help anyone on empty. I had to find ways to refill my cup before I could even think about the rest of my family. It sounded impossible. 

Self-care? Who has time for that?

The answer: Without it, you're out of time (and emotional reserves). It's the only thing you have time for until your tank is no longer empty.


BE "SELFISH"
Go out of your way to do things just for you. Things that remind you of who you are outside of being a parent. I don't mean go to the gym once a week. This is not a New Year's Resolution kind of thing. I mean put the kids to bed early every night (we called it "room time") and have some adult time. Plop the kids in front of a video with a PB&J on a paper plate and do something that fills you up. {Getting Respite, Planning a Retreat }

REFILL YOUR TANK
For me, that meant getting my Love Language needs met. I'm a "Words of Affirmation" girl. I found ways to get people to praise my work. I blogged. I mentored. I hung out with people who "got it" and were encouraging me. I tried not to expect that affirmation from my husband and children. I knew they were too overwhelmed and drained to fill my love tank. {Five Love Languages}

TAKE CARE OF YOUR BODY
I know you're going to ignore this, but GET SOME SLEEP!  DRINK LOTS OF WATER!  Eat Right.  Exercise.  All 4 are important, but they are in order of priority.  Please do everything you can to take care of yourself.  No one else can.


FYI, exercise does not have to be joining a gym or running 2 miles a day. It can be blasting your favorite tunes and dance like no one's watching, break out the hula hoop, take the dog for a walk... kids can join in if they want to.

GET SUPPORT!!
Find people who "get it."  Real life, online... just find them, and share!! Remember, "YOU ARE NOT ALONE!"

ASK FOR HELP!!!  And ACCEPT it!!  

When someone has a baby or has been hospitalized, people come over and help out.  They bring food for several days or even weeks.  They clean, go shopping, mow the yard, take care of the kids...  just because we haven't been to a hospital, doesn't mean that we aren't living like survivors of some catastrophic illness or major life event.  When people say, "Can I help?"  Say YES!  You need help.  You deserve help.  Ask for it.  Accept it.  Please!

SURROUND YOURSELF WITH PEOPLE WHO "GET IT" 
Not only avoiding toxic people as much as possible but actively surrounding myself with people who "get it." This is why I admin the group Parenting Attachment Challenged Children. It is a safe, positive place

THERAPY
Therapy - for ME!  I needed to talk to someone whose primary goal was helping ME deal with my life. I found a therapist who specialized in trauma.

MEDICATION
It is not shameful, and it doesn't have to be forever, but a LOT of therapeutic parents I know (including myself) take medication to help with the anxiety and depression that come from parenting kids with trauma/ attachment issues.

FORGIVE YOURSELF
Forgive yourself for not being the "perfect parent" (which doesn't exist!) that could heal/fix your child.  Give yourself time to grieve the child that you wanted (one who could love you back, heal with your help, be RRHAFTBALL... 

FIND TIME TO LAUGH!
Do silly, fun stuff with the kids. Do silly, fun stuff just to entertain yourself! Here're some ideas 99 Ways to Drive Your Child Sane and Brighten Up a Boring Day!

TREAT YOURSELF!

Even if it's for the most minute of successes.  Have you seen that Wendy's commercial about a little girl who lost her baseball game, but they celebrate because she didn't get hit by a ball?! 
  • I didn't smack my child when she screamed in my face for the millionth time (Get a mani/pedi - even if you do it yourself).  
  • My kids ate dinner, fast food in front of the TV counts!  (Go on an ice cream "date" with one of my healthy children).
  • No blood was spilled in the last hour! (Take a hot bath with a trashy novel and a glass of wine after the kids go to bed).
  • Behavior Bingo - Behavior Bingo is something I heard about from somewhere on the web. As a way to cope with her children's behaviors, this mom started pretending that whenever her child did something annoying (like pitch a fit, or paint with poo, or call her a $%#*... she would sometimes act really excited like she'd gotten to put a marker on her imaginary bingo board. She didn't tell her kids what she was doing or why. Every now and then she would yell out, "Bingo!" She usually thanked the child for the behavior (again without telling the child why), and rewarded herself in some way (got an ice cream or a margarita or whatever). She said it made her feel better and confused the heck out of the child(ren). lol
    Image result for adulting award 
  • ... 

CALMING/ RELAXATION TECHNIQUES

  • How to Have Good Dreams 
  • Deep breathing - slow, deep, even breaths from the diaphragm, rather than short, shallow breaths from the chest. Can try counting - especially if trying to go to sleep
- Get comfortable and relax muscles.- Inhale deeply and hold it.- Exhale and repeat.- Try adding stretching.
  • 4-7-8 Breath. I use this quick and simple breathing every night. It works!
  • EFT Emotional Freedom Techniques (aka Tapping).  This can be a full tapping routine or just something simple like a side hand chop.
  • Mantra (can be used with tapping) - Choose a positive, calming word or phrase. Repeat it over and over to yourself silently to prevent distracting thoughts from entering and calm yourself.
  • Exercises that cross the mid-brain (like Brain Gym).  Sometimes I use a tapping-type technique - like patting my left knee and then the right, over and over. I've also crossed my arms over my chest and alternately tapped the backs of my upper arms in a subtle way that others probably won't even notice.
  • EMDR is a therapy that works in similar ways (crossing the mid-brain).  
  • Exercise - Going for a walk or run, yoga, jumping on a trampoline to clear the mind and reduce stress.
  • Distraction/ Redirection - Find a different activity or something to focus on that distracts from an event that is causing stress.  Lots of ideas in this post about the Attachment Challenge.
- Read a book or magazine.- Listen to relaxing music or watch a video.- Do a crossword puzzle, or play an electronic game.- Make cookies.- Play with playdoh- Try lying down and taking a nap.- Go somewhere in your imagination.- Cocooning (create a cozy, womb-like area with books and soft toys). 

PRIORITIZE YOUR FAMILY

Prioritize Your Relationship with Your Significant Other
With any luck this person will be around long after your kids are out of the home.  Respite, date night, at least 5 minutes a day of time together where you DON'T talk about your kids.  I also found it helped to have 10 minutes a day to talk about the kids, and schedules and how your day went...

Prioritize Your Relationship with Your Other Kids
Spend extra time with your other kids.  Go on "dates" with them.  Find times to chat.  Treat them to a little extra mommy time.  The squeaky wheel gets the oil and that means often the other kids can get shoved to the side.  Plus it helps you by getting some time with your child(ren) that is capable of having a relationship with you.

My Top 10ish Things I Couldn't Do This Without

Stop Walking on Eggshells - A book that really helped me set boundaries for living with RAD/ Borderline Personality Disorder/ Older Teens

Finding the Joy 
This is one of the hardest things I've ever done and one of the most important. I wasn't ready for it until my "love tank" was a little more full. I highly recommend this post to you when you're ready!

You Have Not Failed
I did have to accept the fact that one of my children was not able to heal. While I was recovering from the PTSD caused by him living with us, I would often start feeling guilty about my failure to "fix" him. I have reread this post a thousand times to help me combat this feeling. It works for me.

Thursday, January 24, 2019

Overlapping Diagnoses in Children


Here's the link to the original document
Overlapping Behavioral Characteristics Chart
I thought this was a very interesting chart of the overlapping characteristics of the different diagnoses. We see a lot of overlap in behavioral characteristics in our children who have multiple diagnoses. 

{This chart was designed by a group with an FASD background, which is fine, and I agree that kids with FASD usually have all of those characteristics. I just disagree with the fact that they don't also have RAD checked off on most of the characteristics. I realize that how RAD affects children is different and that they may not check things off if the child only acts that way with certain adults (meaning family), but NONE of these were checked for RAD?!!! }

Comorbidity
Children with trauma issues usually have more going on than just one issue - attachment disorders, physical and sexual abuse, PTSD, RAD bipolar disorder, ADHD, FAS/FAE... caseworkers will not or cannot tell you all of what caused these issues, and often symptoms overlap and appear to be other things. For example, I don't think I've ever heard of a child with RAD that didn't also have PTSD. 
The simultaneous presence of two (or more) chronic illnesses or conditions in a patient.
"Comorbidity does not mean the simple addition of two illnesses that independently follow their usual trajectories. The simultaneous presence of two or more diseases will worsen the prognosis of all the diseases that are present, lead to an increasing number (and severity) of complications, and make the treatment of all of them more difficult and, possibly, less efficacious.
What is worse is that one of the comorbid illnesses is often overlooked. This is particularly true for mental illnesses which are frequently comorbid with physical illnesses. Non-psychiatric specialists and general practitioners are usually focused on the illness about which they know a great deal and which they wish to treat, often missing or underestimating the importance of mental disorders that might also be present."  
~ Comorbidity of mental and physical diseases: a main challenge for medicine of the 21st century
Multiple Diagnoses in Children
Multiple diagnoses in children frequently lead to overwhelming frustration and lack of services/ accommodations. The child's "Care Team" - medical and mental health providers, education professionals, therapists, casemanagers, parents' supports... tend to focus on the area(s) where they have experience and training -frequently not understanding the child's other diagnoses and, more importantly, how those diagnoses interreact with each other. 
Each diagnosis not only has its own associated behaviors and behaviors that may overlap with the child's other diagnoses, but the behaviors and symptoms frequently interreact and intensify minor or more serious issues exponentially.



For example, Kitty has many diagnoses - ADHD, C-PTSD, Cerebral Dysrhythmia (brain injury/ damage), well below average IQ (low average verbal IQ, well below average memory, lower extreme range processing speed), bipolar disorder, GAD, FASD, BPD, emotional/ developmental age approximately 10 years below her physical age... 
Most people on her "care team" recognize and/or have experience with only 2 or 3 of these diagnoses/ behaviors/ symptoms. They have no understanding of how her different diagnoses interreact with each other or how that interaction can change on a minute-by-minute basis based on what all is going on {Spoon Theory}.  They see my friendly child who "presents well"  and make assumptions as to what she needs and is capable of. (They also tend to assume I am an overemotional, overbearing parent with Munchaussen by proxy).
{Unfortunately, many people in a child's life believe that telling a child the truth about his or her abilities and skills will damage his/her self-esteem. Personally, I believe that if you tell a child that he/she can do and/or be anything he wants to be and then the child fails, then the child assumes that the failure is his or her fault. {Dream Killer
I think children need encouragement to find the things that they enjoy but be gently directed away from unrealistic goals. A blind child who wants to be an artist might be guided away from watercolors and instead encouraged to become an amazing Sculptor or discovert an interest in becoming an engineer.]

One theory that explains why so many children have multiple diagnoses. People with mental illnesses are usually attracted to those who "get" them (meaning they understand and sympathize with the mentally ill person's issues - usually because they have personally experienced it. Kleenex Girls). 
People with issues are attracted to people with issues - creating babies with issues.
People with "issues" don't always make the best choices - which can lead to abused/ neglected children with genetic predispositions toward mental illnesses, who may have been "pickled in toxic soup" in utero (alcohol/ drugs/ adrenaline and anxiety hormones...). The combination of genetics and environment often leads to these children ending up in foster care.

People feel most comfortable with situations and people we know. My kids spend an inordinate amount of time trying to recreate the chaos they grew up with because those are the conditions they understand and know how to operate under. They know what to expect (even though that's usually abuse and more chaos)





DIAGNOSES

RAD and Trauma
I don’t believe the Overlappying Behavioral Characteristics Chart is entirely accurate (for example, it doesn’t include “Difficulty seeing cause & effect “ as a symptom of Reactive Attachment Disorder (RAD) when it most definitely is a very common one (Infants learn cause and effect from their primary caregiver. RAD is caused by the absence of the primary caregiver – whether emotionally or physically. Therefore most texts list this as a common symptom of RAD). 

I suppose it does depend on at what age the child developed RAD. For example, if the child was as an infant and the primary caregiver did not react consistently when the child cried (such as sometimes feeding the child or changing the child's diaper, sometimes ignoring the child, and sometimes beating him or her), then the child might not have learned "cause and effect." Whereas if the trauma began later then hopefully that stage would already be successfully completed. (Katharine Leslie Seminar - Infant Development)

Reactive Attachment Disorder Behavior Characteristics

  • acts cute or charms others to get others to do what my child wants.
  • often does not make eye contact when adults want to make eye contact with my child.
  • overly friendly with strangers.
  •  pushes me away or becomes stiff when I try to hug- unless my child wants something from me.
  • argues for long periods of time about ev.ry.thing., often about ridiculous things.
  • has a tremendous need to have control over everything, becoming very upset if things don't go my child's way.
  • acts amazingly innocent or pretends that things aren't that bad when caught doing something wrong.
  • does very dangerous things, ignoring that my child may be hurt.
  • deliberately breaks or ruins things.
  • doesn't seem to feel age-appropriate guilt when my child does something wrong.
  • teases, hurts, or is cruel to other children.
  • seems unable to stop from doing things on impulse.
  • steals or shows up with things that belong to others with unusual or suspicious reasons for how my child got these things.
  • demands things, instead of asking for them.
  • doesn't seem to learn from mistakes and misbehavior (no matter what the consequence, the child continues the behavior).
  • tries to get sympathy from others by telling them that I abuse, don't feed, or don't provide the basic life necessities.
  • "shakes off" pain when hurt, refusing to let anyone provide comfort.
  • likes to sneak things without permission, even though my child could have had these things if my child had asked.
  • lies, often about obvious or ridiculous things, or when it would have been easier to tell the truth.
  • very bossy with other children and adults.
  • hoards or sneaks food, or has other unusual eating habits (eats paper, raw flour, baker's chocolate, etc. )
  • can't keep friends for more than a week or so.
  • throws temper tantrums that last for hours.
  • chatters non-stop, repeated asks questions over and over about things that make no sense, mutters, or is hard to understand when talking.
  • accident-prone (gets hurt a lot), or complains a lot about every little ache and pain (needs constant bandaids). (Even though he/she may not complain about serious injuries or illnesses) {Psychosomatic "Illnesses"}
  • teases, hurts, or is cruel to animals.
  • doesn't do as well in school as my child could with even a little more effort.
  • sets fires or is preoccupied with fire.
  • prefers to watch violent cartoons and/or TV shows or horror movies 
  • was abused/neglected during thefirst two years of life or had several changes of the primary caretaker during the first several years of life. (This can include multiple or extended hospitalizations)
  • was in an orphanage. 
  • was adopted  (It is possible to have RAD even if the child was adopted at birth - if the child was "pickled" in utero with drugs, alcohol, and/or stress hormones...).

Triggered Behavior Characteristics
A child whose past trauma is triggered will likely exhibit several behavior characteristics/ syptoms/ signs at one time, and they may be even more exaggerated than usual.  Kids can be triggered by sights (violent TV shows, for example), smells (fried potatoes), sounds (a full laundry basket falling to the ground, a siren, a fire alarm at school, or a loud/sharp yell), and sensory feelings (a certain touch, a particular fabric, cold weather).   They can also be triggered by "traumaversaries" - anniversaries of significant events (like entering foster care), birthdays, and holidays. {Holidays, Birthdays, and Other Traumaversaries}


ADHD
ADD/ ADHD Behavior Characteristics
  • Easily distracted by extraneous stimuli 
  • Often does not follow through on instructions
  • Often interrupts/intrudes 
  • Often engages in activities without considering possible consequences 
  • Often has difficulty organizing tasks & activities 
  • No impulse controls
  • Might act hyperactive (constantly active and sometimes disruptive behavior )
  • Emotionally volatile, often exhibit wide mood swings
  • Depression/ anxiety develops, often in teen years
  • Over/under-responsive to stimuli 
  • Difficulty initiating, following through
  • Manage time poorly/lack of comprehension of time 
  • Often blames others for his or her mistakes 

Stimulant Medications and the "ADHD Brain"
I've always wondered why giving a kid with ADHD the equivalent of speed seems to calm them down when it makes everyone else so hyper. Katharine explains it in terms I think I understand.

ADHD increases a person's impulsivity and causes them to hyperfocus on everything. Our frontal lobe normally is supposed to be saying, "Stop that!" It controls our actions. When we take speed it speeds up the frontal lobe so that it catches up to the "ADHD brain" and can think before it acts! 

Meds aren't slowing kids with ADHD down.
They're speeding up the rest of the brain.

Stimulant ADHD Medication vs Non-Stimulants 
Unfortunately, my children can't take stimulant medications because they cause major side-effects. Both my children have bipolar disorder and stimulant medications can trigger mania. My personal opinion is that non-stimulant ADHD meds don't work as well but they're better than nothing. 




PTSD or ADHD or Both?

We saw a lot of overlap in behavioral characteristics especially between ADD/ADHD and PTSD.  


When Kitty first came to us (at age 11), she showed signs of extreme ADHD (she was diagnosed at age 4).  She couldn't sit still for more than a few minutes.  Meals were torture for all of us if we insisted that she stay through the whole meal.  We assumed it was because her ADHD was unmedicated, and quickly had her put on medication.  Her academic skills improved greatly (went from a 2nd-grade level work to testing at a 4th-grade level almost immediately).  

Kitty's behavior at other times (especially dinner time) didn't improve much, but we blamed that on other things (meds wore off by evening, ADHD meds tend to kill the appetite, she wasn't used to sitting at the table and having conversations...).

PTSD often causes issues with hypervigilance (very similar to the hyperfocus you see in ADD/ ADHD) and when you're feeling like you're living in a "war zone," you have a lot of trouble focusing and using other executive functions.  In other words, most of the symptoms of ADD/ADHD.  

Both my children had QEEG testing which determined that they do have ADD (Bear) and ADHD (Kitty), but they also both have Complex PTSD and it wasn't until there was some improvement with their trauma and attachment issues that we began to see more of the "ADHD" symptoms lessening.

3 Main Symptoms of PTSD

  1. Re-experiencing the trauma through intrusive distressing recollections of the event, flashbacks, and nightmares.
  2. Avoidance of places, people, and activities that are reminders of the trauma, and emotional numbness.
  3. Increased arousal such as difficulty sleeping and concentrating, feeling jumpy, and being easily irritated and angered.


Some examples of PTSD symptoms in Children

  • irritable, angry, or aggressive behavior, including extreme temper tantrums
  • hypervigilance
  • exaggerated startle response
  • problems with concentration
  • difficulty falling or staying asleep or restless sleep




Bipolar Disorder in Children
When children develop bipolar disorder, it is usually called early-onset bipolar disorder (or Mood Disorder NOS because many medical professionals won't diagnose bipolar disorder in young children). Trauma has been known to trigger early-onset bipolar disorder in children that have a genetic predisposition to it.

Early-onset bipolar can be more severe than bipolar disorder in older teens and adults. Young people with bipolar disorder may exhibit symptoms more often and switch moods more frequently than adults with the illness. 


Bipolar mania, hypomania, and depression are symptoms of bipolar disorder. The dramatic mood changes of bipolar disorder do not follow a set pattern -- depression does not always follow mania. A person may experience the same mood state several times -- for weeks, months, even years at a time -- before suddenly having the opposite mood. Moods can rapid cycle too - minutes, hours. Also, the severity of mood phases can differ from person to person.

Child Mania Rating Scale - 
  • periods of feeling super happy for hours or days at a time, extremely wound up and excited, such as feeling "on top of the world"
  • feel irritable, cranky, or mad for hours or days at a time
  • think that he or she can be anything or do anything  (e.g., leader, best basketball player, rap singer, millionaire, princess) beyond what is usual for that age
  • believe that he or she has unrealistic abilities or powers that are unusual, and may try to act upon them, which causes trouble
  • needs less sleep than usual; yet does not feel tired the next day
  • have periods of too much energy
  • have periods when she or he talks too much or too loud or talks a mile-a-minute
  • have periods of racing thoughts that his or her mind cannot slow down, and it seems that your child’s mouth cannot keep up with his or her mind
  • talk so fast that he or she jumps from topic to topic
  • rush around doing things nonstop
  • have trouble staying on track and is easily drawn to what is happening around him or her
  • do many more things than usual, or is unusually productive or highly creative
  • behave in a sexually inappropriate way (e.g., talks dirty, exposing, playing with private parts, masturbating, making sex phone calls, humping on dogs, playing sex games, touches others sexually)
  • go and talk to strangers inappropriately, is more socially outgoing than usual 
  • do things that are unusual for him or her that are  foolish or risky (e.g., jumping off heights, ordering CDs with your credit cards, giving things away)
  • have rage attacks, intense and prolonged temper tantrums
  • crack jokes or pun more than usual, laugh loud, or act silly in a way that is out of the ordinary
  • experience rapid mood swings
  • have any suspicious or strange thoughts
  • hear voices that nobody else can hear
  • see things that nobody else can see


Brain Injuries/ Brain Damage
Both my children have brain injuries (called Cerebral Dysrhythmia - the cause and time of injury is unknown - could be birth defects, could be from abuse).  The temporal lobe is definitely damaged in both children, Bear also has damage in the parietal lobe.  I always thought it explained a lot, and I believe more than a few of "our kids" have these issues.  

I always include the brain injuries when mentioning their issues to people who need to know, because I think it helps them understand that this is PERMANENT not something that therapy or medication is going to "fix." 

We are often told that brain damage can be "fixed," and honestly, I believe that to a certain extent that is true, but at some point we have to acknowledge that some of it isn't going to get better or we'll be blaming ourselves (or allowing others to blame us) for our child not healing.


Fetal Alcohol Spectrum Disorders (FASD)

Fetal Alcohol Spectrum Disorders (FASD) is an umbrella term describing the range of effects that can occur in an individual who is prenatally exposed to alcohol. These effects may include physical, mental, behavioral, and/or learning disabilities with possible lifelong implications. The term FASD is not intended for use as a clinical diagnosis.


FASD Behavior Characteristics

  • difficulty with memory
  • slow information processing
  • impaired executive functioning
  • problems generalizing
  • problems connecting cause and effect
  • poor repetitive language skills
  • perseveration
  • confabulation
  • difficulty setting/ reaching goals
  • trouble understanding abstract concepts
  • problems with social skills
  • trouble reading social cues
  • mood swings
  • lack of inhibitions
  • reacting poorly to changes
  • poor understanding of ownership
  • unrealistic expectations
  • poor expression of emotions
  • easily overwhelmed
  • interpersonal struggles
  • impulsive actions
  • inflexibility
  • repeated mistakes
  • vulnerable to peer pressure



Puberty

Puberty sucks. Those hormones rushing around adds a whole new layer of fun. The good news is that while ages 13 and 14 were horrible for my kids (biokids and adopted kids), things got better after that. More info in this post - The Teen Years


TREATMENT

Does It Matter What's Causing the Behavior?

The answer is, sometimes. Treatment can be different for different diagnoses. Some issues are biologically based, like the chemical imbalance leading to bipolar disorder. Treating bipolar disorder with therapy alone would be fairly ineffectual.

Neuropsychological Evaluations
The first step is a thorough neuropsychological assessment. This will give you a good picture of your child's physical, mental, and family history.  Assessments are critical because a thorough evaluation can provide recommendations used to create an individualized plan of care. 

Do remember that no one knows your child better than you do. The more information you can provide the neuropsychologist, the more accurate your child's evaluation will be.

Most important to understand is the necessity that comorbid disorders be treated concurrently. Mental illness with comorbid addiction disorders are intimately connected. Healing both means healing both as opposed to one or the other.

Why Won't My Child Just Behave?
We don't always know why children (especially children of trauma) act the way they do.  It’s possible that they just want to watch adults get all agitated, maybe they want adults to fight to distract them from the child (and thus avoid conflict), or maybe they're trying to recreate the chaos that their brains are used to and therefore it feels comfortable and familiar - often they were "pickled" in adrenaline (or alcohol) en utero.... 

Discipline vs Behavior Problems

Discipline problems (noncompliance, misbehavior) occur when the caregivers have not structured the child's environment for success or when parents are inconsistent (expectations or consequences), non-responsive, or inaccessible. When adults adjust their behaviors and attitudes, often children with discipline problems can be brought under control in as few as 3 to 7 days.
Behavior problems on the other hand lie within the child. These are persistent behaviors that do not disappear even with the best parenting (although good parenting can help to control the behaviors). These can include impulsivity, inattentiveness, and other behaviors like ADHD, FASD and immature behaviors associated with missing capacities in object relations.

YOU CANNOT EXPECT PUNISHMENT OR DISCIPLINE
TO "FIX" BEHAVIOR PROBLEMS!


Having behavior problems is like being born with poor eyesight. No amount of punishing or controlling is going to fix this problem. Glasses will help. However, the parent will be responsible for taking the child for regular eye check-ups, teaching him how to care for his glasses, and restricting activities where glasses might break. The goal is that by the time the child is 18, he will be ready and able to take full responsibility for the care of his own eyes and glasses.


Medication


Many of our children's major issues cannot be "fixed" by medication (C-PTSD, RAD...), and are trauma-based, not biologically-based. So why give them medication?

Alleviating Symptoms
I know a lot of times there is huge resistance to giving children meds, and while I agree that there are times some children are over medicated (particularly those in foster care), I believe that it often means kids with trauma issues are struggling more than most. 

For kids with trauma-based issues, I believe meds are not healing or correcting the child's brain, but they can calm down all the outside/extra input, so that the brain can focus on building those new pathways. 

Children can't heal if they feel they are living in a war zone or they are struggling with basic coping skills, unable to function.

In my opinion, you can't work on healing trauma if you can't sleep, focus, sit still, react normally to external stimuli (like someone saying, "you dropped jelly on the counter," which, in my opinion, should not trigger a screaming rage but has)... Handling Dysregulation/ Meltdowns

There's a reason doctors prescribe pain medications after major injuries - it's because people heal faster when they are not in pain.


Therapy 

On the other hand, you can't just treat with meds. Meds control the symptoms, but it takes a lot of work to retrain your brain to function in a new way. This is where therapy and therapeutic parenting come in. To help our kids you must have both.

Get a good therapist who understands and has experience working with adopted/foster kids with trauma. We love our EMDR therapist for our daughter, but still use a good attachment therapist too. Don't be afraid to "fire" the therapist if it's not a good personality match.
Questions to Ask a Potential Therapist

Therapeutic Parenting
Therapeutic Parenting is the term used to describe the type of high structure/high nurture intentional parenting that fosters the feelings of safety and connectedness so that a traumatized child can begin to heal and attach. 

Structure and Caring Support
When I realized this behavior was caused by anxiety, it made it easier to provide Calming Techniques and fight to make her world smaller and less overwhelming (by providing Structure and Caring Support). 

Age-Appropriate Parenting
Trauma can cause significant delays in development (emotionally, socially, intellectually...).  Frequent moves and other traumatic life events can also cause delays or even get them stuck at the age the trauma occurred.  Emotionally "triggering" events can cause a child to regress to a much younger age.  Most kids with PTSD (and brain damage from RAD) have a tough time with processing, memory, object permanence, emotional regulation...  


Expecting a child to "act his/her age," can cause frustration and anger for both of you.


EMDR therapy is the most recommended therapy for people with PTSD. It is most often used by soldiers and victims of trauma (like rape or being in a natural disaster), and usually only requires 2-3 sessions.  Obviously, people who have suffered from long-term trauma (Complex PTSD), such as child abuse, would most likely require more sessions.  

There are no medications specifically for treating PTSD, but with good therapy and meds that help with the symptoms, the child can recognize the effects of the trauma, learn to cope, and move on to dealing with the cause of the trauma.


Helpful Documents
Current Meds and Diagnoses 
New School Year Letter