It's official - ADD

It is official, there are no more ADD meds for Bear to try. Every one he has tried (both on and off list stuff) has given him tics and other side effects (sometimes really scary ones!). According to his psychiatrist this does not mean he does not have ADD, it means we are unable to treat it with medication. Poor Bear.

Overlapping Behavior Characteristics

Not sure I'm going to be able to display this correctly. Hopefully you can click on it and make it bigger. Here's the link to the original document.

I do have some issues with it.

I thought this was a very interesting chart of the overlapping characteristics of the different diagnoses. Of course I don’t believe it is entirely accurate (for example, it doesn’t include “Difficulty seeing cause & effect “ as a symptom of 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).

Actually I would guess it depends on when they got RAD. If it was as an infant and the primary caregiver for example did not did not react consistently when they cried (such as sometimes changing their diaper, sometimes ignoring them, sometimes beating them), then I would assume they would not have learned cause and effect. Whereas if they had issues that began later, then hopefully that stage would already be successfully completed.

This 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 (which is why I hope my kids don't have FASD). I just disagree with the fact that they don't have RAD checked off on most of the characteristics. I realize that how RAD effects 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?!!!

Often loses temper
Often argues with adults
Often actively defies or refuses to comply
Often blames others for his or her mistakes
Is often touchy or easily annoyed by others
Is often angry and resentful

Obviously they don't live in MY house. Yes, most of these are checked for Bipolar disorder, and I admit my kids were 10x worse when they weren't taking meds for their bipolar, but they are taking meds for bipolar and therefore the symptoms of it shouldn't be bothering them. Yet they are still actively dealing with all of these, and I believe it is both the RAD and the C-PTSD (trauma).

Kitty and Bear have more than half of the diagnoses on this chart (plus a few more) - *see below.

A friend's family with children who also have multiple diagnoses, works harder on the areas with more check marks. I think this is a great idea, but.

With Kitty we worked first on attachment, but with trauma running a close second. Med wise we’ve been working first on mood stabilization and then ADHD stuff mostly last. Of course the C-PTSD, RAD and cerebral dysrhythmia don’t have meds that help – although the mood stabilizers don’t hurt!

*Kitty(14) RAD, C-PTSD, Bipolar Disorder, ODD**, ADHD, learning disorders, cerebral dysrhythmia

*Bear(16) RAD, C-PTSD, Bipolar Disorder, ADD, cerebral dysrhythmia

**diagnosis of ODD has been removed -since those symptoms are being fully attributed to the RAD now that she no longer acts this way in school or in public if no family is present

"Life is not the way it's supposed to be.
It's the way it is.
The way you cope with it is what makes the difference."

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 unhealed 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."

Big Fat Liar

So we made it through a second day of Kitty coming to work with me - barely. Because of the doctor's appointment we didn't get to work until 11:30am! Almost not worth going, but silly me, I let Kitty leave her workbooks in the office. At least we were still home when they turned the power off so we found out about it quickly and were able to get it turned back on before the food all went bad.

20 minutes of school work before lunch. Well, sort of, she kept bugging me to let her write a report, or take a break because she was STARVING! When we stopped for lunch she was very cuddly - sitting right up against me and even putting her head on my shoulder while we watched TV and ate.

After an hour long lunch ending at 1pm she started work again. Her mouth didn't stop moving, but her hands often did. She babbled on about everything and nothing. At 1:30pm she needed a break and really wanted to just stop. I allowed her a 30 minute break to wash a few dishes - our lunch dishes mostly and watch 1/2 hour of TV. She cam back and worked for 30 minutes (with a lot of assistance and pushing on my part. At 2:30pm she decided she was done for the day! I told her she needed to keep going because she'd missed all morning. She argued and worked a little until 3pm - then she said school was out! I told her fine, then this was homework! Needless to say that did not go over well.

When I was helping her understand spots as she was having trouble with them, I would look back at previous pages. She openly admitted she just guessed because she didn't understand it. She does corrections, then immediately takes the test. When she finished the self-test on one workbook I told her the teacher had told her to go on to the next. She explained that she didn't want to go any further because then she would forget it all when she took the test. If she failed the test she'd have to repeat the workbook; therefore, she refused to work in the next workbook because she'd forget what she'd "learned" in it by the time she started working in it again.

She also argued that the teacher had told her to do just a little in the new workbooks. I had talked to the teacher on the phone, and she'd told me she wanted Kitty to go as far as she could because she's SOO behind. Kitty (deliberately?) had left her homework assignment at school last week, so when I told Kitty what the teacher had said, she accused me of being a liar. I know this is part of her attachment issues, but it gets SOO old. I asked her if I had ever lied to her (a risky proposition) in the 2 years I've known her. She, of course, brought up the Santa issue. I clarified that in the 2 years she's known me that the fact that I won't tell her Santa doesn't exist makes me a big fat liar. Yup! She would rather believe her beloved teacher who can do no wrong, over her me anyday. *sigh* I know this is part of her illness, but that doesn't always make me feel better.

I know she's having trouble processing all school work too. The vocabulary is gobbledygook to her, and I'd bet she is putting what little she understands in her short-term memory. I can't believe that if you asked her about something on the two workbooks she has managed to complete this year, that she would have one clue what they are about. She's doing 5th grade workbooks. I don't think she can go much further than this.

After 3:15 she refused to do any more work (even though I told her we were leaving at 3:30 to get to her dentist on time). We spent the next 25 minutes arguing. She refused to do school work, hates our family, wants to go back to Nebraska, wishes she'd never met us, threatened to cut herself and her hair, threatened to go "emo".... I fluctuated between commiserating with her, calming her down, arguing with her, threatening to keep her out of school even longer, rationalizing, and stopping her from hurting herself.... Toward the end, Hubby came in to help me deal with her and I passed the baton for awhile. At the end she'd argued long enough not to have to do anymore school work. She happily got in the car to go to the dentist - as if the last 30 minutes never happened.

The dentist fixed her chipped tooth and we rushed home to grab some dinner and head off to EMDR therapy. I waved at Ponito, first time I'd seen him all day - no quality time for us today - at least I got to kiss him goodnight. Bear lay on the sofa feeling badly but never threw up, I did get to have a 5 minute conversation with him before bed while he was talking on the phone to a friend (he likes to bring me in on conversations while I'm cleaning the kitchen - I guess his friends aren't entertaining enough). Bob was feeling 100% better and making Hubby crazy - she was "too sick" to do her chores though.

EMDR therapy was a "not tough" session (we alternate). After the session the therapist and I talked about Kitty's upcoming ARD/IEP meeting which is just for us to agree to getting her tested. The therapist believes that Kitty's current behavior is NOT her PTSD and not that her ADHD meds are not working any more. Instead she thinks it might be mania. Kitty is already on 3 meds that could also be used for bipolar disorder, but we discussed the fact that these might not be working on the part of her brain chemistry that is off-balance. We just saw the psychologist last week, but I've put in a call to see if we can try Kitty on Lamictal. The therapist really wishes we could get a brain scan by a neuro psychologist so see if Kitty has any damage like Bear's Cerebral Dysrythmia, but I know our health insurance won't pay for that.

*sigh*