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."

And now for the fireworks

Christmas was quiet, but I should have known we weren't going to get off that easily. It could just be that I'm not home all day (I know Grandma, our childcare provider, would say they're always like this).

Because Kitty has missed so much school (due to starting a month late, daily "illnesses", being a slow worker, and days we take her out of school for assessments and mental health days) she had schoolwork to do over the Christmas break. Her sister, Bob, did too. Bob counted all the pages each girl had to do and divided by the number of days of break (not counting weekends). Kitty ended up with 20+ pages. She had Christmas day off, and hasn't been doing all her pages every day so she is behind, again. This morning I let everyone have the morning off and then start on chores. Kitty was to start on school work.

So my oppositional-defiant 13 year old daughter came to me about half an hour later and ranted for about 10 minutes. This is a typical pre-meltdown conversation. If I'm lucky, I can keep her calm enough not to have a true meltdown, and if I work it out just right I can actually get her to do/fix/calm down about some if not all of whatever it is she's upset about.

So you can picture the scene: Kitty comes up to me, kind of out of the blue, while I'm answering my e-mail (more on that later). She has a defiant look on her face and is clearly upset. This is just the highlights of the conversation. It was a lot more involved, but I don't remember it all and won't bore you with all the details (I know, I know, too late!). EVERY bit of it was interspersed with "You hate me. You don't care about me," but that gets repetitive so I won't bore you with it either.

There was No way I am EVER going to do my schoolwork. (I calmly sympathized that it is hard and I understand that she doesn't like it, but it has to be done.)

Schoolwork is NOT hard! she claims she was not thinking well on the day they did diagnostics and now she's having to relearn all that stuff and she doesn't want to relearn it - that's stupid. (I told her if she really felt that way we could have her take another diagnostic like they did last year. She didn't want to do this.)

I hate math and I'm not going to do it. (I reminded her that everyone needs math. I use it everyday. I confirmed she still wanted to be a doctor - which of course means she needs to continue school, math in particular...).

You're an idiot if you think I'm going to do any schoolwork again and you can't make me. (I admit I got a little frustrated at this point and spoke firmly about calling me names. I warned her that if she didn't do her school work she would go to work with me - where she would have to do schoolwork. She calmed down a little so I was able to switch back to "nurturing mode." I told her that she can't drop out of school. That she didn't want to be 14 and held back to 5th or 6th grade...).

I'm just the kind of girl who doesn't do schoolwork. (I reminded her that she has been doing well in school for the last year and a half).

I'm going to go emo. (I hear this a lot and she knows how I feel about it. I told her that I would have to assume that someone/something was negatively influencing her and would start taking away TV shows, makeup, music...)

You hate me. You don't care about me. I'm going to crawl in a box and not eat. You want me to be in a box and die. (I told her I love her even if she doesn't believe that right now. That she can only know how she feels, not how I feel. That if I didn't love her I wouldn't care if she was in a box.)

It is STUPID that I have to work on vacation. (I pointed out that she was behind and needed to catch up. That she had been sick a lot this year - not my fault either - and that it was much less work than she did on a daily basis in school. She did not have to spend "ALL" day doing school work. That it really wouldn't take that long...)

I want to go back to my old school in Nebraska where I didn't have to do this. (when I pointed out that it wasn't me that pulled her out of school in Nebraska she declared we should have moved to Nebraska to adopt her. Just because I hate snow was no reason not to live there. I pointed out that I also didn't want to move to Nebraska because I loved my home, my friends and family that live here, and we own a company that cannot be moved to Nebraska.)

Toward the end of the "conversation" she asked me if Dad was home yet. I said no, but I expected him home in 30 to 45 minutes. She said she was going to work on her homework until he got home, but then she was stopping for the day (and there was nothing I could do about it). She left. I almost called Hubby and told him to stay at work a little longer.

About 20 minutes later she returned and told me that she'd done some work and could she stop and take a break and go outside? We talked for a little bit about what all needed to get done (in which subjects she had the most pages to do). Then I said sure. She could go outside for 10 minutes, but then she needed to come back in and do 3 pages of math and 3 of word building. She had a snack. Went outside. Came back in, and verified that she only had to do 6 pages and she was done for the day. I said no. When she was done with the six pages we would talk. She left and did it.

Success! No meltdown. No regression to fight, flight, or freeze mode. AND some actual schoolwork done!

More meltdowns!

Kitty is going to make me crazy. I know she has O.D.D. I know she has mood swings. I know that this time of year is hard for her because of all the changes (Bear and Ponito going to school, Bob and Kitty spending all day with Grandma trying to homeschool them). I'm not sure how much more of this I can take though.

Today I called the house to let Grandma know I was on my way to get the kids to go to the psychiatrist. Kitty answered the phone and ranted for a good five minutes about how much she hated Grandma (the "evil meanie" in the picture here!) and Grandma hates her. This time it was because "someone" had left the toilet unflushed and Grandma assumed it was Kitty (usually it is). Kitty denied it and was furious that she was being accused.

I talked to Kitty about how it wasn't really important whether or not she did it, she needed to flush the toilet because she was asked to. Everyone has had to flush the toilet when they weren't the one that did it. She has been forgetting a lot lately and in the FAIR exam we talked about trust. How when you do something often (like steal or leaving messes) then it's going to take time of not doing that before people stop believing that you did it. Then I changed the subject to her nightmare last night. It worked as a distraction, by the end of the call she was in a better mood.

At the psychiatrist we made some med changes for her (reducing the Geodon which might be causing some issues with her jaw locking up) and trying her with Seroquel. She was loud and whiny all night. I found out she's still breaking food rules (making things - she's messy, doesn't follow instructions and usually makes something foul that no one will eat - wasting food or using up things that were going to be meals0. So she went in the FAIR Club. Instant meltdown.

She stormed upstairs threatening to kill herself. Hubby intervened and kept her from locking herself in the bathroom. I left him to it (I have a major headache!) and went to the pharmacy to pick up her new meds. Luckily both Geodon - at the regular dose and her new med Seroquel are major sleep aids. She eventually calmed down, gave me a hug, finished remaking her bed (she wets the bed almost every night and this should have been done in the morning), and ended up going to bed 15 minutes late instead of 30 minutes early. *sigh*

Somehow I've got to start taking her to work with us instead of leaving her with grandma. Tomorrow we've got an offsite meeting so I don't know what I'm going to do with her. *heavy sigh* I noticed blood on her pants tonight so maybe she's just hormonal and this will pass soon.

Hugs and prayers,

Mary

Kitty Meltdown

Kitty reminds me of a Chow I used to own (Chows only have 2 people in their life one person who is master that they obey and one playmate - everyone else does not exist - and they do not play with master or obey the playmate).

Kitty has certain people she Obeys (me and Hubby) - she'll whine, complain, tattle, and meltdown, but she'll do what we tell her to, if we insist - this was a long time coming by the way! She does trust us a little, but only allows hugs and affection on her terms. This is why I think of her as a cat!

She has certain people she idolizes - (Mrs M. our neighbor who is also her teacher at the private school; Aunt Christy who she wants as her mom because she "gives her kids thirty dollars a week in allowance for doing nothing Mom!"; Aunt Tammy a family friend who she wants as a mom because she isn't very strict with her son who is Ponito's age) - basically people who rarely tell her what to do and are very sweet about it if they do ask. She'll do almost anything for these people - even clean! She particularly likes to show them affection -especially in front of me - very pointedly letting me know she won't hug me, she'd rather hug them.

She has people she HATES (Grandma who Kitty insists favors Ponito because he's the baby and is always "yelling" at Kitty - FYI, for Kitty, any criticism or lack of praise is yelling; Mrs. P at school who Kitty says is alway yelling at her and telling her she's doing her work wrong; and anyone who is not currently her BFF - kids fall on and off her pedestal faster than Bear goes through Kleenex girls (that's another story!). Kitty's siblings are often members of this group.

There is really no one else in Kitty's life - everyone fits in one of these categories. She is a very passionate child.

It helps for me to remember that because of the past trauma she is emotionally only about 6 years old. If she is worked up about something - even younger. I think in some ways both she and Bear understand that they are different, and accept it. Most 15 year olds would not expect to have as much restriction on thier life as ours do (they are not even allowed to cross the street, they can only watch G rated shows for the most part, they can't have friends over without direct supervision, they can't go anywhere without adult supervision - and adults are Hubby and I and sometimes Grandma, not other people's parents). Our children rarely even complain about it. Truthfully I think they feel safer because of it. It can make parenting two totally healthy, "normal" kids like Bob and Ponito more challenging though. They end up with much more restriction and consequences then they probably should. All in the interest of keeping it "fair." Not that my kids would EVER say the word "FAIR" - thanks to the FAIR Club (I'll tell you about that some other time!).

This morning Kitty was exhausted and mad because we made her get up early even though she's not going to school yet. I knew we were going to have trouble because today was her first day at Grandma's house with Bob, doing their schoolwork.

Before therapy she got into trouble for tattling on Ponito's behavior while Grandma was supervising. Hubby came down on her kind of hard because she was being particularly obnoxious and justifying it by saying she was protecting Bob (who at 5'7" and 167lbs is perfectly capable of taking care of herself, especially from her little brother.) All the way to therapy I heard about how mean Grandma is and how much Grandma hates Kitty. What can you say besides, "No, Grandma doesn't hate you. Why do you think she might have said that? What were you doing at the time?" Of course all I hear is Kitty's side, to be honest though Grandma has gotten pretty tired of dealing with Kitty, and probably is a little hypercritical.

In therapy we watched a video on EMDR, but didn't have time to actually try it yet. I can't wait! The therapist got to see Kitty in all her oppositional defiant disorder glory for the second session in a row (last week Kitty insisted she was starving and ended up eating grass and chewing on her own arm). This is not her attachment therapist, who we love, this is a therapist who specializes in trauma work. I could see the therapist getting a little tired of Kitty's attitude too. At one point she asked Kitty, "Do you realize how many times you've asked for something? I'm going to keep track in my mind of the number of times you ask for Mom to give you something." Kitty was supposed to be talking about things that made her happy in her childhood. During the prior 2 minute conversation she asked -

1. "Can I go to the public highschool?" - she's in 7th grade and knows I think she does better in private school.

2. "Can you please get me the Jonas Brothers CD? Why don't you like them? I'm going to ask Aunt Christie to give it to me."

3. "Can I have a pizza?" This was random and what prompted the therapist to comment on the questioning.

I commented on the fact that all the questions had one thing in common. They were all questions she knew I would answer NO to.

We see the psychiatrist tomorrow and I think we are going to request another med increase for Kitty. The mood swings are getting wilder, and the therapist warned us to expect behavior issues to increase as we start this type of therapy.

Better get some sleep,

Mary