How common is Attachment Disorder

I don't know the statistics. I was very worried about it when I signed up with a fost-adopt program. Neither of children of my legal risk placements had attachment problems (I got to adopt the second placement). I also had two other placements of children who were not legal risk (regular foster) and neither of them showed any signs of attachment problems. Of the four kids, three were 7 yrs old and one was 4 yrs old. The problems the children had were grief, sexual abuse, and post-tramatic stress disorder (PTSD). The problems that they were stated to have by the county and their therapists were Adjustment Disorder. Some of the symptoms are common between RAD and PTSD, etc. So, I don't think a caseworker would ever put the terrible label of RAD on a child, how would the CW even be able to determine that, and they should not make that sort of determination. I think one thing to consider is to not finalize too fast if you have major concerns with a particular child. The county I signed up with was very clear at the classes that there is no need to finalize at the earliest allowed time. Also, some of the things you read in books is not quite as bad in real life. One of the foster children I had put smears of poop on her bedroom walls. Either she was very mild with this problem or else it is just a lot less of a problem in reality than it sounds like in print, but the reaction it caused in me was that this poor baby (she was 4 yrs old) just needed so much loving and healing. I don't know how many children with RAD heal, I think there is a book written by one of Nancy Thomas's children who did heal and wrote the book. I think the book has a name something like a Dandelion on My Pillow, Knife Under My Pillow. Also the books by Nancy Thomas herself are reassuring.

In my opinion, all children in foster care likely have some issues with attachment. However, this can very from extremely mild to extremely severe. All the kids in care have breaks in attachment and this creates loss of trust. This does NOT mean that all the kids cannot bond or attach to you over time. Many kids with attachment disorder do respond to attachment therapy and theraputic parenting and make progress on attaching. Social workers sometimes minimize children's behaviors but more often they just don't recognize them. Kids with true attachment disorder tend to be very charming and fool unsuspecting adults. The kids with just issues often, in an enviorment that facilitates attachment, learn to trust fairly quickly and are able to adapt. If you can find it, there is a fiction book called Don't Touch My Heart that explains this in very simple terms what it's like for the child. Also, Nancy Thomas has a book called When Love is NOT Enough and Greg Keck's book called Adopting the Hurt Child also shed light on behaviors you may encounter and where they are coming from. While this can be scary territory, being informed as much as possible helps greatly. And the parents here are happy to help you see through the wording on profiles for things that may signal more serious issues.

Wow thank you both so much for the information. (And I welcome any other comments as well!) It is reassuring. Howdy -- I think I too would have a sympathetic response to a kid smearing feces on the wall. But a child that could not love ...that would be just heart breaking. For everyone. Lucy, I had heard that sometimes the most damaged kids can be extremely charming. It makes sense if they are in survival mode. Thanks for all the referrals to books too -- I will look into them. So far we have just filled out a questionairre on line that we are interested in foster adoption -- apparently the first step will be to attend an orientation and then do the home study. Contrary to the norm, my husband was the "what could possibly go wrong?" optimistic one in regards to the idea of an older child. I read some scary stuff on a forum and sent him a link and it REALLY freaked him out. I don't want to do that but I also want to be realistic and not drag him into something he's not ready for.

I believe attachment disorder is much more common that people want to acknowledge. Of course, there is a spectrum. Some kids have slight issues that they can overcome in a loving, structured home. Others cannot love no matter what environment they live in. The ones who can't love aren't as common, IMO. But they are out there and they are placed in families.If I did another older child adoption, I would expect attachment disorder. I would begin parenting the child as if they had it. Lots of one on one bonding activities, lots of holding, with me all the time, lots of structure, etc. I think that would be good for any older adopted child, AD or not.I really don't believe you can enter older child adoption and say "I won't take a child with RAD." (believe me I tried). You will not know if the child has RAD until they are in your home. Social workers do lie, they do minimize disorders, and sometimes they just don't know. So, be prepared.

When I read about RAD kids being very charming, I can't help but think conduct disorder. Are these kids normally assessed for CD? It is basically the childhood version of antisocial personality disorder (i.e. being a sociopath) and has a genetic component. That said, only about half of kids who have CD actually go on to develop full-blown antisocial personality disorder. I have read that there is a high likelihood of comorbity between these two illnesses because a parent who is antisocial would be more likely to abuse and/or neglect a child. I'm just wondering if parents of RAD children even know about CD, or if it is just being assumed that all the problems are from RAD because the kid is adopted. When a non-adopted kid presents with pretty much the exact same symptoms, they are more likely to get the CD diagnosis. There are treatment strategies for CD that have shown some level of success, so I just worry that adopted kids may be missing out on these options.

We don't assume our kids have RAD, we take them to qualified therapists who do know what CD is and how different disorders present. I have raised kids with RAd and 2 also were diagnosed with conduct disorder. RAD is also directly linked to neglect and abuse in the first 2-3 years of life.

Diagnostic criteria for 312.8 Conduct Disorder

A. A repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated, as manifested by the presence of three (or more) of the following criteria in the past 12 months, with at least one criterion present in the past 6 months:

Aggression to people and animals

(1) often bullies, threatens, or intimidates others

(2) often initiates physical fights

(3) has used a weapon that can cause serious physical harm to others (e.g., abat, brick, broken bottle, knife, gun)

(4) has been physically cruel to people

(5) has been physically cruel to animals

(6) has stolen while confronting a victim (e.g., mugging, purse snatching, extortion, armed robbery)

(7) has forced someone into sexual activity

Destruction of property

(8) has deliberately engaged in fire setting with the intention of causing serious damage

(9) has deliberately destroyed others' property (other than by fire setting)

Deceitfulness or theft

(10) has broken into someone else's house, building, or car

(11) often lies to obtain goods or favors or to avoid obligations (i.e., "cons" others)

(12) has stolen items of nontrivial value without confronting a victim (e.g., shoplifting, but without breaking and entering; forgery)

Serious violations of rules

(13) often stays out at night despite parental prohibitions, beginning before age 13 years

(14) has run away from home overnight at least twice while living in parental or parental surrogate home (or once without returning for a lengthy period)

(15) is often truant from school, beginning before age 13 years

B. The disturbance in behavior causes clinically significant impairment in social, academic, or occupational functioning.

C. If the individual is age 18 years or older, criteria are not met for Antisocial Personality Disorder.

Reprinted with permission from the Diagnostic and Statistical Manual of Mental Disorders, fourth Edition. Copyright 1994 American Psychiatric Association My daughter has the criteria for RAD, but not for CD. All the psychiatrists that my daughter has seen has evaluated her for Conduct Disorder, but she has not met the criteria. I don't believe its over looked. Any good psychiatrist will look at all possible disorders prior to giving a diagnosis. The treatment strategies for CD and severe RAD are very similar.

We adopted two children internationally and just assumed that there would be attachment issues. I think it is very important to go in expecting to attachment parent and take things from there. I don't believe you can really understand where your child will be in relation to their ability to attach until you've been home. We've been home 3 years now and while neither of my children have ever been dx with attachment issues I still tighten up my attachment parenting during stressful times and transitions. I personally think it is always out there lurking and can come up much later when you think your child is adjusted. You've had some good book recommendations. Read them and be prepared to attachment parent regardless of how well you think the child is adjusting. I'm not trying to scare you but to prepare you. Good luck!

YIKES, that would describe more than half of the children in our town when I was growing up. I could immediately identify 7 items from the list that I would have qualified under at any given time from gradeschool age to adulthood. I knew there was "something" wrong with me!