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."