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!

Thursday, December 24, 2009

ODD vs RAD

“What I'm wondering is, does ODD (Oppositional Defiant Disorder) pretty much exist with FASD (Fetal Alcohol Syndrome) or RAD (Reactive Attachment Disorder) or maybe the symptoms/actions are similar?

When Kitty first came to us (at age 11) she was diagnosed with ODD, but not RAD. I do not believe she has ODD, and they have actually removed that from her diagnoses and added RAD. (I don’t think she has FASD and neither do her doctors).

I think kids with RAD have many of the same or overlapping symptoms, but the focus is different. Kitty only shows defiant and oppositional symptoms at home with her family. In public she is completely compliant now that she is out of the traumatic biofamily and foster care environment. She does have revenge issues and hateful talking about non-family members too, but she only expresses it to us and her therapist. The school think she’s sweet and can’t believe we’re having issues.

I have a friend whose daughter has both ODD and RAD, and her daughter is definitely different from Kitty in that her refusal to comply with all adults is to such an extreme that they can almost use it to their advantage. For example, if the child doesn’t want to load the dishwasher and is doing it so slowly that she’s practically unloading it, they can prescribe her behaviors and tell her to do it slowly and poorly, and she speeds up just to “spite them.” I guess it could be a different cognitive level or being milder on the RAD spectrum, but we can’t “trick” Kitty like that. She is not oppositional to the point of losing track of what she wants from the situation. Or maybe she’s just not RAD enough to hate us so much that she’ll spite herself.

Bear was on the verge of being diagnosed with a Conduct Disorder (CD) when we got him at age 13 (It was once explained to me that CD is like ODD, but CD is willful – meaning they CHOOSE to behave in an oppositional/ defiant manner). He ended up being diagnosed with RAD and Bipolar Disorder instead – with traits (symptoms) of Borderline Personality Disorder (BPD).

Apparently, many kids with untreated RAD are often diagnosed with BPD when they turn 18. Many children with CD are diagnosed with Antisocial Personality Disorder (APD) when they turn 18.  In general personality disorders cannot be diagnosed until age 18. Before that it is usually referred to as having "traits of." Females tend to be diagnosed with BPD, while males with the same symptoms tend to be diagnosed with APD.

Many diagnoses have overlapping symptoms and they make things worse by interacting with each other. We decided to try for as accurate a diagnosis(es) as possible, and then focus on treatment. Treatment is the hard part when a child has co-morbid (more than one) diagnoses, because sometimes the treatment for the each diagnosis is dramatically different or even the exact opposite, and using the wrong one can make things worse.
Ex. Talk therapy is supposed to help with Borderline Personality Disorder (although DBT is better), but bad for RAD (Attachment Therapy is recommended). EMDR therapy helps with the PTSD but may bring up more issues than a child can handle (at least my child). Meds help with some diagnoses but not the brain damage. Stimulants for Attention Deficit Disorder - with Hyperactivity (ADD/ ADHD) often trigger mania in Bipolar Disorder. *sigh*

I recently received a chart of overlapping characteristics of several different disorders that I think explains well why our children are often misdiagnosed, especially if they have co-morbid (more than one) diagnoses.  Co-morbidity is very common for our kids.

Mary
Mom to biokids Ponito(10) and his sister Bob(13)
Sibling pair adoptive placement from NE foster care 11/06
Finally finalized on Kitty(14) on 3/08 - 2 weeks before her 13th birthday! RAD, C-PTSD, Bipolar Disorder, ADHD, learning disorders, cerebral dysrhythmia
Finalized on her brother Bear(16) 7/08. He turned 15 the next day. RAD, C-PTSD, Bipolar Disorder, ADD, cerebral dysrhythmia
"Life isn't about how to survive the storm, but how to dance in the rain."

3 comments:

Kristina P. said...

Dual diagnosis is very common. That's interesting about how ODD vs CD was explained to you. A dx of CD generally turns into a dx of antisocial behavior when they turn 18, as you can't be diagnosed as antisocial unless you are 18.

One trend I have been seeing in the past 3 years is a lot of kids being diagnosed as bipolar. It's a little disturbing. It's become the new ADHD.

I wish you and your family a very Merry Christmas, Mary!

marythemom said...

Thanks Kristina!

Yea, I love those diagnoses that can't be diagnosed until you're 18. As though you just spontaneously develop them at age 18 right? Borderline Personality Disorder is how it's often diagnosed for kids with RAD, but usually it's more common in girls. We were told that because he was male, Bear would probably get the diagnosis of Antisocial Personality Disorder or something similar (if I remember right). Hopefully we've addressed his issues well enough that he won't get this.

Actually, I wonder if bipolar really isn't a lot more common than people think? But I could be biased since pretty much my whole family has it.

Merry Christmas to you and Adam!

Mary

Struggling to Stand said...

And there is the probablity that antidepressants can cause or worsen bipolar. There are certainly more antidepressants being prescribed now.