I recently got a request for advice from a woman in the process of adopting a 4yo relative diagnosed with the usual letters - RAD (Reactive Attachment Disorder), PTSD (Post Traumatic Stress Disorder), ODD (Oppositional Defiant Disorder) ... I was quite concerned because the woman has a young family already, including an infant, and no experience with therapeutic parenting. She was given a lot of conflicting advice from the therapists/ social workers and foster mother.
**We had several emails back and forth. I don't feel comfortable sharing her emails, so please be aware that these are my responses to emails with information you're not seeing. In other words, sometimes this post will sound disjointed and random. **
Here's my advice:
Yes, there are different types of RAD and it's all on a continuum, BUT I don't know anyone that doesn't find that all RAD kids are pretty challenging, especially before any healing and attachment takes place. This is a post I wrote about this subject:
Here's some general advice based on what you've told me:
- Books and Methods - You mentioned Nancy Thomas. One of the most recommended books for parenting children with RAD is Nancy Thomas' stuff. Nancy Thomas is good, but when you're starting out, she will SCARE you!
I'd recommend reading When a Stranger Calls You Mom, by Katharine Leslie instead, which gives you the why of why kids with RAD act this way, AND the how to deal with it. This book and her other one Coming to Grips with Attachment are both excellent books that give practical advice (unlike a lot out there - which seem to say, love your kids more and if they're still messed up than it's your fault).
Nancy Thomas works well with younger children who are practically feral, BUT you have to be a strong person who can treat this one child VERY differently than your other kids. In front of your other kids - which is even harder than it sounds. If you're a laid-back parent, like I was, this is going to be one steep learning curve!
I would read the posts I wrote about Katharine Leslie (they're in a box on the right sidebar of my blog) I find her advice to be very practical and a little easier to adapt to my parenting style. As I got to know my kids better - discovering they felt safer with lots of structure and support - I found that it was easier to become the structured parent my kids needed. Eventually the strict structure recommended by Nancy Thomas became easier to fit into my parenting style, but I definitely wasn't ready for it at the beginning.
- Therapeutic parenting is different.
Speaking of your other kids- PLEASE protect everyone and start off parenting this child differently than the other kids.I know how hard that is, but she NEEDS a different parenting style if she's going to heal. Believe me, I was a laid back mom, and I learned the hard way that that was not what my kids needed.
Kids with severe trauma issues do NOT learn by watching and having you as a role model like other kids. They have to be taught things like reciprocity and empathy. You are very lucky that she is so young, but a LOT of our values are established before age 5 (some say all!).
RAD causes permanent brain damage and the brain has to be taught how to work around it (think of someone learning English for the first time - if they start learning before age 3, they will probably have no accent. Before age 10, maybe a slight accents and will have a lot of the nuances and colloquialisms. As an adult? You will always be able to hear that English was not their first language.)
- Constant Supervision. At first, do not trust her alone with the other kids (or pets). It sounds awful, but I can't tell you how many parents have said they found out later that their RAD child was abusing their siblings when adults weren't around. My girls were about the same age, so we let them play together, and found that our adopted daughter was doing a lot of trauma-processing with her doll play, and my bio daughter was being exposed to some stuff I didn't want her to have to handle! Our son also required constant supervision because he was "parenting" the other kids - telling them what to do, intimidating and threatening them to give him what he wanted (and sometimes just for the heck of it).
- Adopting out of
birth order is hard and not recommended for good reason - especially as the kids get older and the neurotypical kids
develop normally, and begin to pass their traumatized siblings. Let everyone (including the kids) know from the beginning that you
parent your children based on their individual needs. It can still be difficult to explain to the children. As mine got older, we used things like the trust jar to explain why.
- SUPPORT! Find some online support - local is great if you live in a big enough city to have other RAD parents, but it is DIFFERENT parenting a RAD child than any other child. There are some amazing groups on FaceBook if you want to friend me I can get you in. I moderate a group with a lot of parents of younger children, for which you might be a good match. You've heard the saying, "It takes a village..." - You need one full of people who "get it."
- RAD, ODD and
PTSD all go hand in hand. I don't think
it's possible for a RAD kid to not have PTSD or Complex PTSD. ODD is a VERY common diagnosis for RAD kids
who are under the age of 5, because caregivers always get the RAD
SOME RAD kids are what I call "Charming RAD" (aka Disinhibited RAD) and can fool the general public into thinking they're fine (and that it's YOU with the issues). These kids usually don't get diagnosed with ODD, because they're not defiant to everyone (just YOU!), including the person doing the testing, teachers, caseworkers...
The good news is, if your child really does have ODD then that can give you an advantage. I have a friend who’s daughter has both ODD and RAD, and she is definitely different from my daughter 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” our daughter 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. Difference between ODD and RAD.
- Find a GOOD
attachment therapist! It's not easy, but
it's so important. (Finding an attachment therapist - http://www.attachment.org/pages_find_therapist.php) A good attachment therapist will have you in
the room. Will support you
emotionally. Will not attempt to
establish a relationship with your child, but instead will help facilitate a
relationship between you and your child.
If you get a bad therapist (who wants you out of the room, who makes you feel bad as a parent, who doesn't have a good understanding of attachment therapy, RAD and trauma... ), FIRE them! A bad therapist is worse than no therapist at all.
At 4 years old, your child will probably be doing a lot of play therapy, but makes sure this is a specialist in attachment, trauma, adoption or you're wasting your precious time.
Questions to Ask an Attachment Therapist
- Primary Female Caregiver. When adopting a child with RAD, that primary mother/ child bond has been broken, and on an instinctual/ sub-conscious level, they get you mixed up with that birth mom. This sucks! Because it's not something they think about consciously, it's not easily accessed and healed.
They find you threatening - you represent the caregiver who did not protect them, and you dare to try to love them - which is scary- because everyone who they love leaves them or hurts them -see The Frozen Lake story* by Nancy Thomas at the end of this message.
Be aware that it's going to feel like your child hates you, and that most likely no one else will see it, even your spouse. My husband is wonderful, but my kids acted totally different toward me, as their primary caregiver, then they ever did toward Hubby. It took quite awhile to get him to see it. I think what helped most was reminding him that he knows me. I am not a liar. I don't exaggerate or make things up. I tried to get him to read books, go to seminars, talk to people who "get it," go to marriage therapy... it helped somewhat, as did finally seeing some of that the kids were so careful to hide from him and everyone else.
Do "tag team" wherever possible. Give yourself frequent breaks. This is a tough job, even with just one kid, let alone so many. Above all, TAKE CARE OF YOURSELF!! Remember if Mama ain't happy, ain't nobody happy!
- Developmental Delays. Remember that
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. Most kids with PTSD (and brain damage from
RAD) have a tough time with processing, memory, object permanence, emotional
Parent your child where they ARE, even if that means treating a teen like a 6 year old. Or a 4 year old like a toddler.
They may find normal kid stuff overwhelming - we had to keep our children's rooms stripped to the essentials, avoid overwhelming places like grocery stores and birthday parties, avoided letting them get tired or hungry...
Parenting Based on Developmental/ Emotional Age
- PTSD. It might help
if you picture PTSD like flashbacks into a warzone. Kids of trauma are easily triggered,
extremely sensitive to emotions, unable to regulate their emotions... causing
them to react as if they are in a warzone.
You can't learn and attach if you don't feel safe and you're living in a
If you are in fight/flight/ freeze mode then you are thinking with the reptilian part of your brain. The rational part of your brain just isn't online! It doesn't help to hold your child responsible for what happens in the middle of rages - instead it works best to just move on after it's over and try to figure out what triggered it so you can avoid it in the future. Hypervigilance (obsessively monitoring her environment) is super common among kids with PTSD. It relaxes when they start to feel safe, but I don't think it ever really goes away.
Why Doesn't My Child Feel Safe?
Meltdowns and Dysregulation
Most important, handle as much as you can now! Cause puberty is hell and you want a secure attachment long before then.
Good luck! Please feel free to ask questions and let me know if there is any way I can be of assistance.
Katharine Leslie. I hope you've started reading the Katharine Leslie stuff I have on my sidebar, it really helped me!! It not only has practical advice, but it also explains the why. Gives some idea of how to set up your household until your child is attached (Basic Package vs Luxury Package).
Abuse and Neglect. From what you say, I wouldn't be totally sure that she hasn't been abused. Neglect can actually cause MORE damage though. That many changes in caregiver is definitely a big factor in the RAD.
Holidays and other Traumaversaries. Sounds like she's going to have a LOT of traumaversaries; Christmas is a big one in our house too, and only because of what it represents, not even because they had anything in particular happen to them on that day.
Developmentally Appropriate - Play and Self-Entertaining. Not knowing how to play is pretty typical for kids of trauma. Remember she's probably developmentally much younger than her chronological age. Toddlers don't play with other children, but instead do what we call parallel play. It's not until empathy develops at age 3 or 4 that they start to be aware of their playmates' needs and feelings. It's a fact that toddlers, especially 2yr olds, are perfect examples of pretty much every major mental illness -
- Megalomania - it's all about me. MINE!
- Bipolar Disorder - happy one minute, sobbing the next.
- Schizophrenia - distorted reality
- Obsessive Compulsive Disorder - Food can't touch!
- Oppositional Defiant Disorder - NO!!!!!
- Attention deficit disorder with hyperactivity (ADHD) - I'm going to play with this... oooh shiny! Squirrel!
Trauma can trigger early onset of bipolar and schizophrenia in those with a genetic predisposition, and of course RAD and PTSD mimic a lot of these symptoms. Amazing chart that shows the difference between all the different typical childhood disorders. This makes it difficult to impossible to tell what is actually causing the symptoms (and therefore making it harder to treat).
First Priority - ATTACHMENT - I will say that attachment is your FIRST priority.
Medication. Once your child is attached, then you can start seeing which of these symptoms heal, and which might be symptoms of something that needs medication. Sometimes the medication has to come first (again, trying to heal in a warzone!), and then it can be reduced when the child starts healing. I know it sounds crazy to medicate a preschooler, and I'm not saying your child needs it, but remember that if a child is battling a chemical imbalance or suffering from extreme anxiety - then they can't focus on healing.
Puberty. Puberty can trigger a lot of issues as well, so it's best to get things as under control and healed as possible before then.
The Teen Years
"Tries to manipulate adults"
This is called triangulating, and RAD kids are EXPERTS at it! We are ALWAYS aware of this and document it as much as possible to protect ourselves (you might also be careful about her being alone with males - she's a little young now, but I can tell you a LOT of kids will accuse males of sexually abusing them). They can damage your relationships so fast it will make your head spin. Make sure your husband is as aware as possible about how RAD kids feel about caregivers. You need to be sure that he is aware of her manipulations.
I'm not sure why they do this. I think sometimes they just
- want to watch adults get all agitated,
- want adults to fight to distract them from the child and what's going on with him/her,
- are trying to recreate the chaos that their brains are used to -
Just like alcohol, our kids can be "pickled" in adrenaline (or other stress hormones) in utero. It causes damage, and also causes adrenaline, anxiety, and chaos to feel "normal" and familiar.
We don't always know why they act the way they do. The main thing is for parents to be aware of it.
Avoiding Triangulation. Constantly communicate with your spouse, it's probably easier with a 4 yr old, but my kids could ALMOST convince my husband that I said or did something. Luckily he believed me over them, even when evidence said otherwise. We tried to always back each other up. If a child came to one of us asking for something, especially if they said the other parent said it was ok, when we were pretty sure our spouse wouldn't have said that, then we usually said something like, "I need to talk to Hubby (or Mom) about this first."
Be aware that they do the same with caseworkers, teachers, neighbors... any other adult they can. I do believe that the child actually believes that "Mommy never feeds me," "Mommy said it was OK for me to cross the street by myself," "Mommy hit me." Their version of reality is pretty distorted and between the ages of 4-6 they have what's called "magical thinking."
Lying and Stealing - Why Do They Do That?
I think preparing for the worst, and hoping for the best is a good idea. Gotta run, more later!
"The social worker and therapist say that the child is 'fine and plays sometimes,' but the foster mom says otherwise."
Sorry, but the play therapist and social workers are being played (or seeing what they want to see). I'd believe the foster mother. RAD kids act very differently around caregivers. You need to go into this with your eyes wide open that this child is closer to the extreme end of RAD. You will need to protect your family, especially the younger children. DO NOT leave her alone with them, even during the honeymoon period you will hopefully get.
I'd start with life as structured as the foster mom has it set up. Get into a routine quickly. Do not have a lot of stuff in her room. Do not try to make her life in any way like your other children's - go for the "basic package."
You are going to have to get this little girl to trust you, and the best way to do that is to be consistently caring and keep her safe (even from herself). She will need lots of boundaries and structure to feel safe.
Think of it as childproofing for a toddler.
You want to set up her environment so that she doesn't hear a lot of "No"s, there just shouldn't be an option of doing things that need a no. If it were me, there would be no razors stored in the shower (that part of the FM's story scared me).
Kitty also deliberately pooped herself while in foster care, and they found some ways around it (if she wanted to go swimming, which she loved, then she couldn't have had a poop incident the day before) - which I find to be a much more effective alternative to shaming and punishment. We were lucky that Kitty didn't end up having this particular control issue with us, thank goodness, although we had lots of hygiene issues (The RAD Stink).
I think partly because we were very matter of fact about a lot of things, and since it didn't get a rise out of us, she eventually dropped it. Believe me, it's hard not to react!
Rewards and Punishments effect on attachment
I think you're lucky that she has a few things that she's allowed others to see are important to her (like wanting her hair looking nice), that shows trust. I agree with using this as a reward, but be aware that if you take away things they find important, you risk them cutting off that attachment.
My daughter had gotten to the point that she'd completely shut down her emotions even her physical feelings (she literally couldn't feel tickling or even pinching!).
My son had no emotional attachment to anything - there was nothing you could offer or take away that made a bit of difference to him. We tried to think of it as being a prisoner of war. He'd lost everything multiple times, so tried to avoid attaching to anyone or anything (see the Frozen Lake story at the bottom of this post.
When it come to discipline, the biggest thing to remember is that she's only 4, and I can almost guarantee that she's not really even that (trauma often damages/ delays development), so punishments that last longer than 4 minutes have little to no effect.
Time Ins vs Time Outs - Emotional Regulation
Most attachment gurus recommend "time ins" instead of "time outs." My daughter needed a lot of help with emotional regulation - she never learned how to self-soothe. She needed that from me. I had to stay calm, use a soothing voice and have steady, even breathing. Eventually she'd match my level (whatever that was, so if I was excited and angry...).
Lectures don't work
I've found that lectures that last longer than one word per year of the child's age is "heard" like the adults talk in Peanuts cartoons! Additionally, for some reason kids can't hear "DON'T" at all. Instead they take it as a suggestion! So instead of "Don't climb on the table," they hear "There's a dance party on the table!" A 3 year old should hear "Use walking feet" instead of "Don't run!!"
Here's some information I've posted about discipline/ punishment for kids under age 6:
One day when my daughter, Bob, was about 15 months old, she was sitting on the floor in the kitchen, slamming a cabinet door. Hubby came in and told her to stop. She looked at him, seemed to understand, gave him a big, toothy grin, and slammed that cabinet door again. Hubby was furious and wanted to give her a consequence. I reminded him of his 30yo friend who had recently slammed his fist into a wall and broken his hand (and the wall). This adult friend knew better and impulsively did it anyway. Can we really expect more impulse control from a child whose brain is not wired correctly yet?
If you can't do the time, don't do the crime.
A lot of people think that if a child knows the consequences of lying, stealing or any other "crime," then they will be less likely to commit that crime or confess to a crime to keep from getting more severe consequences.
There are several flaws in this theory:
- Lack of impulse control - means they might do it anyway without thinking
- Distorted reality - they may not be able to see what they're doing as wrong and probably do not (cannot!) believe they will ever get caught. Lying and Stealing - Why Do They Do That?
- Trauma history - in a lot of ways our kids are often like prisoners of war - no consequence is worse than what they've already lived through
- Trust issues - they protect themselves by deliberately prevent themselves from caring about anyone or anything enough to allow themselves to feel upset if they lose it, even if it's more of a "sour grapes" kind of thing.
- Life or death defense mechanism- these kids lie as if their life depends on it... because it does! It has in the past and it still feels like it does. This is a core belief! A lecture, time out, losing their cellphone or even jail time doesn't matter more than death!
*THE FROZEN LAKE By Nancy L. Thomas"In order to understand what an unattached child feels like, one must understand his perspective. Imagine that you are the young child who must cross a frozen lake in the autumn to reach your home. As you are walking across the lake alone, you fall suddenly and unexpectedly through the ice. Shocked and cold in the dark, you can't even cry for help. You struggle for your very life, you struggle to the surface. Locating the jagged opening, you drag yourself through the air and crawl back into the woods from where you started. You decide to live there and never, never to return onto the ice. As weeks go by you see others on the ice skating and crossing the ice. If you go onto it, you will die."
"Your family across the pond hears the sad news that the temperature will drop to sub-zero this night. So a brave and caring family member (that is you, the parent!) searches and finds you to bring you home to love and warmth. The family member attempts to help you cross the ice by supporting and encouraging, pulling and prodding. You, believing you will die, fight for your life by kicking, screaming, punching and yelling (even obscenities) to get the other person away from you. Every effort is spent in attempting to disengage from this family member. The family member fights for your life, knowing you must have the love and warmth of home for your very survival. They take the blows you dish out and continue to pull you across the ice to home, knowing it's your only chance."
"The ice represents the strength of the bond and your ability to trust. It was damaged by the break in your connection to someone you trusted. Some children have numerous bonding breaks throughout their young lives. This is like crashing them into the ice water each time they are moved, scarring and chilling their hearts against ever loving and bonding again."