RAD: psychoses or syndrome?

J. over at Peace in Puzzles, recently posed a question, that I want to throw in my $.02 in on. Obviously her post was longer than the following quotes, I just wanted you to know what I was addressing.

"The real question I find myself pondering is at what point is RADs a psychoses that requires medication as opposed to a diagnosable syndrome that can be retrained and reconditioned through the often odd RAD therapy techniques? In other words, does trauma irrevocably alter brain CHEMISTRY and PHYSIOLOGY, not just cognitive reasoning and psychology? Does trauma induced RAD actually become a MEDICAL condition that would show altered brain functioning in an MRI?"

"And if you ask anyone that's been in mental health professions for any length of time, they'll admit to it. Individuals with unaddressed mental health needs are more likely to be attracted to other adults with unaddressed mental health needs so that they have children that have unaddressed mental health needs, children that are traumatized inadvertently BECAUSE of the parents' unaddressed mental health needs. It's a horrible vicious cycle that I suspect alters brain chemistry as opposed to just individuals perpetually modeling bad behaviors that psychologists say can be retrained by cognitive and dilectical behavior techniques."

Brain Damage

RAD most definitely causes permanent brain damage (I can show you my son's neurological assessments to prove it). There was this study done on kittens that might explain this: as an experiment, scientists sewed shut the eyes of healthy newborn kittens so that when their eyes would normally have opened they were unable to do so. Later they allowed the kitten's perfectly healthy eyes to open and the kittens were... blind. The part of the brain that should have developed for their brain to understand the input received from the eyes never developed. There is nothing physically wrong with the kitten's eyes, but the neural pathways that should have been made were not. This is permanent. Their brain has no concept of sight.

When children are under the age of two their brains are growing rapidly and making these connections constantly. In kids with RAD, not all the connections are being made - so if they don't get the concept of cause and effect or object permanence when they are infants...

That's not to say that they cannot learn some of these things later, but this is the brain working AROUND the permanent brain damage. It's like learning to use a prosthetic arm - you don't use the same muscles or pathways, but it's possible to approximate the original arm movements... mostly. Also, like learning a foreign language, the younger you are the easier it is to learn new things (like love, trust, object permanence). It also takes conscious effort and a strong desire to do the work. (Katharine Leslie's book "When a Stranger Calls You Mom" and her lectures are my biggest source for this). Some things cannot be worked around, and the child must learn how to accommodate this as well.

Treatment

Meds to treat symptoms, not to cure.

For kids with RAD, I believe meds are not healing or correcting the child's brain, but they can calm down all the outside/extra input so that the brain can focus on building those new pathways. Another example (can you tell I love examples) - imagine you are in the middle of a war zone with people running and screaming, soldiers chasing you, bullets flying, bombs going off... Are you going to be able to sit down and study your math homework? NO, of course not. You are totally focused on survival.

Like one of the commenters on J's post, I'm bipolar too, but luckily my disorder is not as severe. I can go without meds - if I'm taking care of myself and not under a lot of stress. Add in stress though and meds are not optional (needless to say I'm on meds right now!). The more stress, the more meds needed. So do kids with RAD and PTSD need meds even though meds cannot cure/fix them? I believe so. Otherwise you are asking them to try to focus on healing/therapy while still having to deal with the war zone.

Therapy to heal

On the other hand, you can't just treat with meds. Meds control the symptoms, but it takes a lot of work to retrain your brain to function in a new way. This is where therapy and therapeutic parenting come in. To help our kids you must have both.

Comorbidity:

People with issues being attracted to people with issues - creating babies with issues.

Like Attracts Like

Heck yea! My son has a giant sign on his forehead that says, "If you are cute and have issues, be my girlfriend!" I believe a large part of this is because only girls with the low self-esteem that comes from having major issues will tolerate his issues (he wants them to say they love him instantly, tolerate his intimidation and mood swings, and of course tolerate his possessiveness. They must focus only on him, to the exclusion of all else -he is incredibly jealous of others and even the time they spend on other activities). The fewer issues the girl has, the shorter the time period they date. And by the way, it only takes one "date" to make a baby (my kids' biomom had 5 - all with different dads).

Plus we are usually attracted to those who "get" us, meaning they understand and sympathize with our issues - frequently this means they "get it," because they have experienced it - which means they have/had those issues too.

I think we feel most comfortable with situations and people we know. My kids spend an inordinate amount of time trying to recreate the chaos they grew up with because those are the conditions they understand and know how to operate under. They know what to expect (even though that's usually abuse and more chaos). There's a saying that girls grow up to marry men just like their fathers and boys do the same with their moms. I have seen that many times. I almost married a man like my dad. My sister's first husband was a lot like our dad. It takes a conscious effort and a lot of support to change things.

Poor Hubby, I even tried to force him to behave like my dad and former boyfriend would have. ("Wow, that girl is thin, you think I should look like that don't you?!" - because I was so used to being compared negatively to others in an attempt to nag/shame me into changing to what that person wanted. By the way, HUBBY IS AN AMAZING MAN (or a masochist)!! He let my "attachment disordered" self try to push him away and attempt to manipulate him into proving he thought I was the horrible person I was convinced I was, and HE STILL STUCK BY ME!!).

My kids' biomom is diagnosed with borderline personality disorder, bipolar disorder, ADD, has gotten treated for cocaine and meth addiction, aged out of foster care, and apparently prefers abusive men with issues. The biodads have major issues as well. So yes, I think my kids have issues because the people who raised them had issues. Genetics and environment were both pitched against my kids.

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."

Bear doesn't love me

We first met Bear's current therapist a couple of years ago when he was working with a known attachment therapist. He didn't take our insurance so we found another therapist who was pretty good, but a talk therapist (FYI talk therapy does not work well for kids with RAD). The talk therapist worked with Bear for over a year and was able to get Bear to talk (something we had trouble with in the past). The talk therapist finally said there wasn't much more he could do with Bear.

I felt that the talk therapist hadn't helped Bear deal with his past and how it effects his future. We tried EMDR therapy with Bear, but again, Bear refused to talk so we stopped. Bear didn't go to therapy for about 6 months, but we were still having difficulties of course.

After Bear's adoption was final, he qualified for TX Medicaid. We didn't use it much because most of the doctors we used didn't take Medicaid. Then we just couldn't afford the $25 copays anymore and I started looking for someone who accepted Medicaid. I remembered the attachment therapist we'd met with way back when, and called him. He was taking Medicaid patients and we started seeing him.

We just kind of started seeing him, and didn't really go through an interview process. We didn't fill out any paperwork, because I had a 25 page time line (which the therapist didn't want to read until a couple of weeks ago so he could "form his own opinions. While I know that at age 16, Bear is a little old for attachment therapy I figured it couldn't hurt. Apparently the therapist didn't realize that attachment was my goal until this session!

He mentioned that he does EMDR therapy which I didn't know. In explaining this to Bear I mentioned that we'd originally come to this therapist for attachment therapy. The therapist made a comment about Bear of course being attached to our family. I apparently made a surprised derogatory noise - it could possibly have been a snort. Maybe.

The surprised therapist asked me if I didn't think Bear was attached to the family. Say what?! Why doesn't he know this?

I said that while Bear thought we were nice people, he has always said he didn't feel he was part of our family. I also said I understand that, and I do. The therapist seemed totally surprised. I turned to Bear and he confirmed this with a nod.

The therapist didn't seem to believe us, and asked me if I thought Bear loved me. Bear didn't say anything, but he made an expression with his mouth. The therapist didn't see it. I said no I didn't think Bear loved me, and told the therapist about Bear's confirming expression. The therapist didn't ask Bear if he loved Hubby, and that was probably a good thing. Bear would probably feel pressure to lie, while I felt that so far he'd been telling the truth.

It did hurt though. A lot.

Frankly I was glad that Hubby and the therapist heard it though. Hubby has been insisting that there is no difference between Kitty and Bear, and I've been saying over and over that Kitty is almost attached to me, while Bear is not. It effects how I treat them and how I feel about them.

It's hard to love care about someone who doesn't love care about you.

But I'm used to it.

What I got from the ACT conference - relationships

The main thing I got from Katharine Leslie's presentation was about Relationships (interdependence, reciprocity...). I learned that I do not have a relationship with my adopted children because a relationship is...


Relationship: A mutual satisfaction of each other's needs.



Correspondent Reciprocity: (big words, but don't worry it'll be OK!!)
Most friendship relationships are 50/50 equal. I pay for Jeri's lunch on the way to the seminar. She pays for mine on the way back. She drives, I offer a shoulder to cry on (not literally - she's driving!). Mike, the organizer of the seminar, offers us a place to stay. We volunteer at the seminar, lugging things, helping with check-in. We are all more comfortable with the equality of the relationship. As adults, we can handle things being uneven for a while, but usually, the person asking for more feels guilty (and the person giving might feel resentful) until the scales can balance.



Complementary Reciprocity: People give and take different things, but are equally satisfied.

75% (parent) + 25% (child)=100% or even 90% (parent) + 10% (child) =100% 

Complementary Reciprocity is typical for healthy parent-child relationships. For example, a parent may give an adult child $100 dollars as a birthday present. Both are comfortable with this exchange; however, if the child were to give the parent $100 or an equally expensive gift for the parent's birthday this would most likely upset the parent. A thoughtful card, a small gift, or a phone call would be more appreciated/ appropriate. (obviously, this is just an example).


An intimate relationship (like a marriage) is usually a combination of both correspondent and complementary reciprocity.



When Reciprocity is not working correctly in Parent-Child relationships:

Unconditional Caregiving
A child with Reactive Attachment Disorder (or really most children of trauma) has no idea how to reciprocate. They do not learn to have healthy relationships with others or themselves. They feel isolated, entitled, superficial love...

Providing unconditional love to a child without getting anything in return will make you sick. (If this were a stranger or a celebrity it would be called stalking!).{Giving Until There's Nothing Left - But My Child Needs Me!)} Instead, we should practice unconditional caregiving.

Children have to be taught how to reciprocate. Unlike healthy children who can learn through their parent's role modeling of appropriate behavior, traumatized children have to be taught - more on that in this post - Relationships(Cont.).



When Reciprocity is working correctly in Parent-Child relationships:

Correspondent:

• Positive interactions
• Each has pride in the other

Complementary:

Child needs:

• Accurate reflection of self as worthy and lovable
• Support for exploration and expression
• Knowledge and skills as to how to please the parent

Parent needs:

• Acceptance of parental warmth, affection, support
• Compliance with limit settings and directives
• Signs of appreciation and love/adoration

As a sweet biochild without a traumatic background, Ponito has Reciprocity down cold. Love that kid.

We had a skirmish today because he's been lying when he forgets or doesn't want to do something (usually a chore).

Recently, he was caught and confronted about a major lie (not feeding the dogs!). When I confronted him on the lie he pouted and then got angry. I tried to get him to understand that I wasn't mad, I just needed him to tell me when he didn't do something, so we could fix it.

Grandma is finally back from vacation (missed you, Mom!). She took an upset Ponito with her to pick up Bear after school. When Ponito came back, he was calm, and eventually climbed in my lap gave me a kiss (his Love Language, and one of mine, is Physical Touch), and said he was sorry. It took a little more coaxing to get him to talk it through.

**At bedtime tonight, we discovered that when he'd gotten mad and slammed around in his room, he'd ripped the shutters off one of his windows - destroying the shutters and damaging the wall.

Now, he'll have to reimburse us for the repair work. He recently earned almost $30 that he was planning on using to buy Speed Cups (toy). That money will probably get confiscated. Sad really. He worked hard for that. He won't like it, but (unlike Kitty and Bear) he'll understand that actions have consequences and learn from his mistakes.

Kitty also had a meltdown tonight. I'm putting it on a different post because this is already long enough.

**************

For more information about Relationships, see this post - Relationships(Cont.)

Touch issues

These are horribly blurry, but these are the picture of Kitty getting her award. I don't know if you can see it, but look at the expression on her face in the picture on the right. She looks miserable. Does that look like the face of a child who just got an award?

Kitty’s touch issues are complex. Some of it seems to be the attachment disorder stuff or the fact that she was physically and sexually abused. She doesn’t want people to touch her or get in her space – she doesn’t want anyone to get close to her. One of the reasons I nicknamed her Kitty on the blog is because of think of her as a lot like a cat. She will accept hugs and physical touch, but only on her own terms. She may be OK for a little while if you are “petting” her with permission, but sometimes she’ll turn and “bite” you for no apparent reason. She thinks she doesn’t need others and thinks she is totally independent.

She hates to have her hair and neck touched. Sometimes she’ll let me rub her back, but usually only when I’m tucking her into bed. That’s the one time she doesn’t want me to leave and will hang onto my arm if I try to go. I’m assuming it’s because her defenses are down when she’s tired. She sometimes plops in my lap (all 176lbs of her), but I’m not allowed to hold her while she’s there. She can kiss and hug me (rare but it does happen), but I can’t kiss her. When we’re around other kids she won’t acknowledge my existence (of course neither will Bob), but all other places, most of the time, she’ll walk next to me and hold my hand.

Part of what I understand about RAD is that the child is usually neglected. When they were babies, they cried and no one came, so they learn to ignore the body/ feelings. Or maybe someone came and took care of her or maybe hurt her instead. She didn’t learn cause and effect. The reaction of her caregivers was not consistent enough. I don’t know this for sure, but I do know her birthmother was treated for cocaine and meth within 2 years of her birth, so I make some assumptions. For kids with RAD, because no one interacted with them, they may not learn to associate touch with pleasurable feelings. Because of the C-PTSD they might feel overwhelmed by their feelings, so they dissociate.


Kitty isn’t ticklish, she is proud of the fact that you could hit or pinch her forearms and shins and she doesn’t feel it. She can’t tell you when she’s hungry or full. She doesn’t recognize most feelings and can’t tell you where in her body they are located, she often dissociates when the subject of feelings comes up.


I don’t know why she has this problem. One therapist (EMDR/ trauma) said that as she deals with and processes the PTSD/ trauma then she will be able to handle feelings (body and emotions), and begin to feel again, but she couldn’t handle EMDR and trying to process her trauma – she just dissociated.

The Attachment therapist is working on trying to help her recognize her feelings and where she’s feeling them in her body, but when she does (rarely) express an emotion, she can’t tell you where she feels it (like when I’m tense I feel it in my stomach and my jaw). We’ve also tried getting her to recognize where she is in space, by asking her how her feet feel touching the ground, does she feel pressure, any discomfort? We’ve touched her arms with feathers (if she gives permission), placed stones in her hands, had her hold weighted balls… then tried to get her to describe how they feel. What did we get? Frankly almost nothing, except more dissociation (this is when she loves to ask me for things she knows she cannot have, demand that it’s time to go home, mention she’s starving, or get up and go to a different part of the room to do something else). The attachment therapist’s reasoning is that if we can help her recognize her feelings (physical and emotional) then she will be able to recognize and process the trauma/ issues.

Both therapists are trying to accomplish the same goal, by coming at it from different directions. I feel that Kitty’s walls are so strong around herself that we may never break through and access her feelings, but then again, I never thought she’d accept my hugs at all, or come to me for even the littlest comfort. So maybe we’re making more progress than I think.

I guess I just thought we’d be further along after almost 3 years. Especially after Bear made such a huge turnaround when his bipolar disorder was finally treated. At least we’ve got some more years left with her. She’s only in 8th grade.

RAD child surrender

This was posted by a woman who lives near me. Unlike ours, theirs was an international adoption so they don't qualify for even the few services offered by Texas Medicaid (which does not include residential treatment anyway). Their child is violent and they cannot get the help he/they need. Their only option is to surrender him to the state and hope he gets some of the care he needs.
Their story reminds me that there, but for the Grace of God, go we. Please include Jeri and her son and family in your prayers.
http://withlovefromsumy.blogspot.com/2009/09/hmm-desperate-plan-for-this-mom.html
[Two days ago] we will have to sign the papers I have long dreaded.....he is becoming the "property" of the state. It is the only way to have his needs met and ...I...am...pissed. It should not be criminal to be mentally ill. It should be criminal to be treated by the insurance companies and our health system the way my son has been.

RAD boy

You asked what Bear did to get in trouble.

So far we’ve discovered that:

Bear’s lied about where he’s been for the past week and a half (or more). He’s missed at least 3 out of the 5 days of Summer school so far and we have no idea where he really was (he's admitted to wandering the school when he was unable to get off the bus without getting caught, working out at the rec center, and spending time with his girlfriend).

His girlfriend and friends have lied to us about where he was.

He’s started using tobacco again. Although he swears it's not his.

He’s hoarding food again. Wouldn't bug me so much if he didn't keep every single dish in his room (full of rotten rinds and things), leaving the rest of the family with no dishes. Plus according to the amount of candy wrappers I found he must be so high on sugar it's no wonder he can't sleep.

He is not regularly taking his sleeping medications, and probably not taking others. He admitted that when he doesn't think he needs them he just doesn't take his sleeping meds. Of course he firmly believes that it's normal to only sleep 4-5 hours a night. It's "my fault" he doesn't take his mid-day meds, because I forget to fill his box (mid-days are the one type of meds we let the kids take with minimal supervision - someday he's going to have to remember to take meds on his own.

He’s stealing electronic equipment from elsewhere in the house and using it to watch and listen to movies and music that are inappropriate. Not sure where all the CDs and DVDs are coming from. His little brother is happy to have his MP3 back.

He’s staying up till all hours. I’ve found evidence that he probably has a trac phone again so he’s most likely back in contact with bioparents, and texting until all hours of the night. This could explain some of the recent behaviors.

FYI, he never confessed to anything and denied most of it. The rest was OUR fault. This is not everything, just the stuff I can prove.

Right now he is defensive and angry. He's mad that he's in trouble and therefore mad at us/me.

After an hour long diatribe about how fast our heads are going to spin when he turns 18 and blows this popsicle stand, and how we're crazy if we think we can keep him locked inside all the time. (I pointed out that between school and swimming, he'd been out of the house most of the day, and I wasn't keeping him from going out, just not without supervision).

I told him he'd only been grounded for 2 days so far, and he knew this was coming. There was no way he wasn't going to get caught. He grumped, loudly, for about an hour - then Hubby came home and he shut down.

Within an hour he was watching the movie he'd chosen (so much for hating TV), I had doctored his hand from where a kid at school had somehow managed to get pencil lead stuck in it, let him talk to his Nebraska Grandma on the phone, talked to him about college and possibly being a police officer, he got to choose what we were having for dinner, and I gave him a haircut (his request).

But we're horrible parents who love the other kids more than him and want him to be miserable.

So which is the real story? He's miserable and we don't care about him or he's totally fine?! *sigh*

Bear, then and now

Bear came to us in November 2006 (picture on left). He was a very angry kid who kept everything bottled up inside - until it exploded (almost monthly). When he was stuffing things inside, he showed no emotions at all (not happiness, fear, or anger). He was like a volcano though - you could see the emotions - turned to anger - seething underneath. He told everyone he loved them, but had no idea what that meant. Bear came to us with RAD (Reactive Attachment Disorder) and a list of other diagnoses - some of which we've discovered since were inaccurate. His symptoms overlapped so many possible diagnoses and he was a very damaged "little" boy. At 5'9" and 200+ lbs he was very scary and intimidating most of the time.

The picture on the right is Bear the day after his adoption on his 15th birthday.

After 8 months of hurting himself, attacking Hubby, and scaring/intimidating the whole family so much that most of us had symptoms of PTSD. In one last attack on Hubby, D was accidentally given a minor injury, causing an investigation of Hubby for child abuse. While they were investigating BOTH Bear and Kitty were removed from our home and put in respite care. I can't tell you how much this set back Kitty's attachment therapy - even though they were only out of our home for one week, because their amazing Nebraska caseworker threw everything she had at Texas. It was the fastest investigation anyone had ever seen! The kids were back in our home in less than one week.

We didn't know what to do with Bear though. We were not allowed to restrain him, even if he attacked us. We were not allowed to let him escalate at all, which since he needed to escalate to vent off the pressure of all that seething anger - was an almost impossible task. We ended up basically medicinally restraining him until an opening in a residential treatment center opened up. Bear began taking mega doses of Depakote - which basically turned him into a zombie. At one point we asked him if he wanted to have his medications reduced, and he said No. I think Bear was afraid of his anger too.

Bear went into a residential treatment center with a strong neurological component. They took him off several of the medications he was on (not the Depakote!), and changed his diagnoses from RAD, PTSD, Conduct Disorder and Mood Disorder to

Bipolar Disorder
PTSD
Cerebral Dysrythmia (which for him is brain damage that effects his memory and learning)
ADHD
and they left the RAD on there.

They almost released him while he was still on the Depakote, but we insisted it be removed before he was released. This let some more of his issues come out and he ended up staying another couple of months. When he finally did leave Meridell he was on so many medications that it was pretty overwhelming. He was even on some medications to deal with the side effects of other medications. However, he was a changed kid.

We were afraid to trust it right away, but the lava was gone. He still has tons of issues, is rough around the edges, and is a teenage boy with a horrible past, but he's no longer out of control. We waited another six months to be sure, but this was a boy who could be part of our home. We adopted him one day before his fifteenth birthday. He's now MY pink loving, Superman cape wearing, goober. Just as weird as all the rest of us.

Mary