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."

FAS Awareness Day

This was posted by an adoptive mom with a son with FAS. It makes me cry but it is an important message. She has given everyone her permission and encouraging everyone to pass this along to everyone they know. EDITED TO ADD: THE AUTHOR ENCOURAGES YOU TO PLEASE COPY, PASTE, POST, FORWARD, AND PASS THIS TO EVERYONE YOU KNOW.

Just a quick reminder of 9/9 everyone. I was asked to speak at our local FAS Awareness Day, but Ben has a neuro appointment and considering what's going on, I can't put that off. This is what will be read in our absence though and I hope someone takes it to heart. It would be so wonderful if the news media would cover it this year, but they so rarely do. Anyway, here's our speech:

Hi. I'm Ben. I'm 4 y.o. My momma says I was born drunk and with meth in my body. I don't know how or what that is, but it must have been bad because the doctors didn't think I would live. I was tough though and came home at only 4 days old and I was a premie. At a week old something really bad started happening. I couldn't stop shaking and I stopped breathing. My momma was crying at the hospital. They called in some guy who was doing something call "last rites". I came home two weeks later. They told my momma I was blind, would never sit up, walk, talk and all that stuff. Well I proved them all wrong 'cause I do it all. But I still shake sometimes and forget lots of stuff and then I get REALLY mad but I can't control it. Momma says it's something to do with seizures and that's why once I learn something I forget it. It's big stuff too, like feeding myself, dressing myself, and even walking right. I have to use a wheelchair part of the time now. I didn't used to. I think it has to do with being at the doctor about a year ago and momma started crying again. They said these seizure things will be terminal, whatever that is. The doctor said something about the prenatal exposures have fried my neurological system, the seizures are going to all new parts of the brain and gaining in intensity all the time. Momma asked them how long it would be and they weren't sure. I hope this terminal thing doesn't happen anytime soon because it always makes momma and daddy cry. My sister gets very mad sometimes about all of this and says she doesn't like someone named our birth mother for hurting me. I don't remember anyone hurting me, but like I said, I forget a lot of things. Anyway, ever since the doctors told my momma about that terminal stuff, it's been harder to do things. I'm in a wheelchair part of the time now and I used to be able to run all day. I have a special feeding chair too. I just got it and it's the first time in over two years I can feed myself. I've also started sleeping a lot. I told momma once I was getting tired. She knew what I meant, not the sleepy like I need to take a nap tired, but like my body is tired and it's hard to keep going. Momma sits by my bed a lot at night and watches me. I wonder if she's thinkin' that terminal thing is going to happen. I don't know. I just like having her close. I tell her she has a beautiful heart all the time because she tells me that's where I grew.This is our life with my son Ben. He's not this articulate by any means. His sisters, who are very articulate, helped me write this for you. They said he deserves to have the words he may never be able to say himself, and I agree. We don't know how long Ben has with us, but we are thankful for every day. Education and programs must continue so everyone knows that no amount of alcohol is safe during a pregnancy. Programs must be in place to help mothers stay clean during their pregnancies so that another child does not have to live the life Ben does.