"Attachment Issues" vs. RAD?

First off it is important to remember that not ALL attachment issues are RAD. RAD is the severe end of the spectrum. There is a spectrum (like most mental health issues) of severity. I would ask some very careful questions, such as how that diagnosis came about, if you can get a release to talk to the therapist/counselor the child is seeing, what are the behaviors that point to an attachment diagnosis

Found out that the kid does actually have a RAD diagnosis. Therapist believes he will be able to form a bond but in his own time & own terms. Kid seems like a good fit personality-wise. I guess I have to figure out whether to even pursue more information. Part of me hates to write off a kid based on a diagnosis (and I have heard that RAD is over-diagnosed). But I don't think I would be a good parent for a child who may never form an attachment.

Found out that the kid does actually have a RAD diagnosis. Therapist says that that the behaviors that point to this are that he physically recoils when touched, and was not able to form a bond with a prior adoptive placement. Says that he will be able to form a bond but in his own time & own terms. Kid seems like a good fit personality-wise. I guess I have to figure out whether to even pursue more information. Part of me hates to write off a kid based on a diagnosis (and I have heard that RAD is over-diagnosed). But I don't think I would be a good parent for a child who may never form an attachment.

my kid has a diagnosis of mild RAD--bigger than attachment issues but not as big as some of our a.com friends' kids. he was small--only 4--when he came as a foster child to our home. in no particular order, here are some of the things we had happen in our home: peeing. everywhere. and saving it. destruction of stuff--his, ours, everyone's. especially family photos. he broke the glass on ever single one we had. brutality towards pets. there was hitting, kicking, poking of eyes, and on at least one occasion, the grinding of a paw under his foot. gorging and vomiting. also the need to actually see the food at least 20 times a day. seriously--opening all cupboards, fridges, and freezers, and visiting the pantry. all day long. that lasted for nearly a year. crazy lying. about everything. intense anger but only a single rage. hypervigilance to the point that he could not fall asleep for hours and once there, any noise would wake him. that one is much better. i am positive there were more. he had therapy. we did therapeutic parenting--still do. and he's much better. he has a great personality and a sharp mind. but he still had RAD-colored glasses through which he views the world. he was able to form attachments. i know he loves us and we love him. but when that RAD behavior gets triggered? wow. and for all of that, knowing what i do now, i'd still adopt him. i love him. it hasn't been easy--and remember, he has a mild case. i suggest that you talk with his foster family, his therapist, his teachers--whatever adult you can find in his life. ask the hard questions about how he behaves when life is good and bad. find out about his ability to accept correction (being 100% right all of the time makes for a very aggravating child!). ask about his responsibilities at home and how he handles them. is he argumentative? does he have trouble at school? with friends? with authority? how does he behave with pets? you can find out a lot of the unwritten stuff from those who really know him. you might find out that his issues are mild and livable. then again, you might see something entirely out of your realm. don't be afraid to say yes--or no--based on what you learn and know you can handle. i've had some kids through my home who were far sicker than Bubba. i just could not with them. and it's still not easy. wishing you a clear mind and much information to help you make your decision. remember, the kid you meet will not be the one you get. RAD kids are fantastic at making great impressions.

This is something I've been looking into as well since a legally free 9 yr old boy we've been considering accepting placement of seems to have attachment issues and if I posted on here his behaviors, most would say he has RAD. But nothing has been told to us about that. He is violent towards foster parents but very well behaved at school and in hospital settings. But he does not have RAD, according to his CW, and has wonderful attachment to his biomom, sibling and grandparents so his violent attacks against his foster parents aren't attachment related (according to them). One thing to keep in mind, the diagnosis of RAD has changed under the new psychiatry diagnosis manual, DSM-5 and even under the old one, most of what people associate with the behavior of RAD kids is not listed. The new diagnosis criteria for RAD is:The child rarely or minimally seeks comfort when distressed and the child rarely or minimally responds to comfort when distressed. There's absolutely nothing about lying, manipulation, lack of conscience, controlling behavior or nearly everything listed on sites like this: [url=http://www.thelittleprince.org/symptomsandcausesofrad.html]Symptoms of RAD[/url]. This article has a lot of good information about the RAD changes with DSM-V. [url=http://drgrcevich.wordpress.com/2013/06/13/dsm-5-rethinking-reactive-attachment-disorder/]DSM-5: Rethinking Reactive Attachment Disorder | Church4EveryChild[/url] Kids with the behaviors listed on RAD sites are likely now going to be diagnoses with PTSD, ODD and ADHD, and their behaviors not linked to attachment but childhood trauma or major psychiatric conditions like Personality Disorders. That's what makes me so leery about accepting this placement. I'm not sure I can help a child like this when so many professionals can't even determine what is wrong with them or what to do. Some of the attachment therapies have resulted in children's deaths, and now it seems like the psychiatric community is backing off RAD diagnoses and going to trauma related diagnosis. Who knows if in another year it changes again. This has got to be so difficult for parents of kids with these behaviors and knowing what to do to stop them.

Any updates? My AS is currently dx'd with RAD. Something I have come to believe: The diagnosis doesn't matter to me. The behaviors do. My son has had so many different dx, it is ridiculous. He has/is dx'd with ADHD, ODD, PTSD, generalized anxiety disorder, conduct disorder, RAD, and pediatric bipolar. I finally told everyone to call it whatever the hell they needed to call it in order for the insurance to pay for treatment. Just get us help. The diagnosis is so important to the insurance company because they just want to "medicate it and forget it". They don't like paying for long term therapies, hospitalizations, and whatnot. So the diagnosis is important in so far as you need to get services paid for, but for a "can I live with a kid with RAD" soul searching mission, focus on behaviors and try to let go of that scary RAD word. This from greenrobin was spot on: i suggest that you talk with his foster family, his therapist, his teachers--whatever adult you can find in his life. ask the hard questions about how he behaves when life is good and bad. find out about his ability to accept correction (being 100% right all of the time makes for a very aggravating child!). ask about his responsibilities at home and how he handles them. is he argumentative? does he have trouble at school? with friends? with authority? how does he behave with pets? That saying of "I know he's lying because his lips are moving"? That's my kid. Stealing, incredibly intense anger, over the top defiance, inappropriate urination/defecation, and things like that are important to find out about. And the one greenrobin mentioned about how does the child accept correction... yeah. That's a biggie. At least for me. Maybe not for you. But on a day to day basis, it won't matter if the kid has RAD or PTSD. It will matter how either of those dx manifest themselves in his behavior. So talk to everyone you can about him and go from there. Good luck and don't let the description of attachment issues immediately scare you off.

Thanks for the thoughtful replies. Due to various vacations (it's that time of year!) We will be reading his file and speaking with some of the adults in his life in 2 weeks. Behaviors described do seem well within our capabilities and his therapist says that even the (manageable sounding) behaviors have decreased significantly with meds and therapy. But we all know reading about behaviors and experiencing them are completely different. This kiddo has been through a lot of placements including hospitals and RTCs. Nothing we have heard about would be a deal breaker for us but we need more info. Is he trying to find a way out of every placement, or is it situational? I feel like we can handle many difficult behaviors IF there is underlying attachment. There have been difficult times with our DS but we knew we would get through them because there was mutual love underneath the anger / acting out. He did not actually want "out" even if he felt like he did at the time.I just don't know how I could do it if the attachment was not mutual. My biggest fear about RAD is that if a kid wants "out" of a family, he can certainly find a way (for us that would be very severe violence or hurting our animals). Our area provides a great transition plan and a TON of pre and post-adoption support, so that's a real plus. Part of me wants more info now, but part of me is happy to put off any decisions for another 2 weeks.

Thanks for the thoughtful replies. Due to various vacations (it's that time of year!) We will be reading his file and speaking with some of the adults in his life in 2 weeks. Behaviors described do seem well within our capabilities and his therapist says that even the (manageable sounding) behaviors have decreased significantly with meds and therapy. But we all know reading about behaviors and experiencing them are completely different. This kiddo has been through a lot of placements including hospitals and RTCs. Nothing we have heard about would be a deal breaker for us but we need more info. Is he trying to find a way out of every placement, or is it situational? I feel like we can handle many difficult behaviors IF there is underlying attachment. There have been difficult times with our DS but we knew we would get through them because there was mutual love underneath the anger / acting out. He did not actually want "out" even if he felt like he did at the time. I just don't know how I could do it if the attachment was not mutual. My biggest fear about RAD is that if a kid wants "out" of a family, he can certainly find a way (for us that would be very severe violence or hurting our animals). Our area provides a great transition plan and a TON of pre and post-adoption support, so that's a real plus. Part of me wants more info now, but part of me is happy to put off any decisions for another 2 weeks.

There's a wide range of symptoms and severity, when it comes to attachment disorders. It's attachment-related if a child doesn't know how to accept hugs, to make eye contact, or to tell a parent that he has fallen down and scraped his knee. If a child has never known that parents "should" hold their child, should make eye contact, and should comfort a child when he is hurt, he may be shocked and upset when parents try to do these things. He may be used to doing things for himself, even as a toddler, like going to get a Band-Aid or making lunch. He may be used to holding back his tears because no one responded to his pain in the past. And he may think that eye contact is an aggressive gesture because he has faced adults who have behaved aggressively towards him. Fortunately, most children with these issues can overcome them quite quickly, and without professional help, if parents understand why he is pushing away when they try to hold him and so on.There are also attachment issues that can be addressed, to a greater or lesser extent, with professional help. Some attachment disordered children feel that they need to be "in control" all the time, because they don't feel that parents will keep them safe; they may be bossy and argumentative, because they don't want to cede control to anyone else. Other attachment disordered children have "anxious attachment," where they are so terrified that they will lose a parent, a home, etc. that they don't want to play with other children, go to interesting places, or even go to sleep. Hypervigilance, by night and day, is very common, to the point where, if startled by someone saying "Boo!" they will have a total meltdown or start hitting the person who surprised them.Some kids have learned that adults really don't care about them, so they try to show their own lack of interest in adults by lying to them -- often so outrageously that it's almost funny. As an example, they can have chocolate icing all over their faces, yet swear that they did not eat the cupcakes that were made for taking to a party. They may also want to "get back at" adults, who are perceived as uncaring, by stealing or breaking things; they tend to have a lot of anger.The scariest types of attachment disorder involve violence. While a moderately attachment disordered child may hit or trip someone, or steal or break that person's possessions, a seriously disordered child may actually make a careful plan to harm himself/herself or others. Children who are moderately to severely attachment disordered usually have so much self-hate and anger at others that violence is a strong possibility. The most severely disordered children have been so consumed with rage that they lose all ability to feel empathy, or to have remorse for hurting someone.It's not that these children want to leave the family. On some level, they probably want to be loved and to have a home. But their anger at past events is so dramatic that they just can't behave in a rational way. And it's not always possible to "cure" them.As an example, there are kids who actually steal a carving knife, hide it in their bedroom, and make a plan to kill their parents as they sleep. There are kids who wait till adults are elsewhere in the home and then try to molest their siblings, set a fire, or throw the dog out the window. They may be preoccupied with blood and gore, and may try to derail a train by putting objects on the railroad tracks or to set a fire in the school bathroom. They may cut themselves purposely and blame their wounds on other children.Unfortunately, with such children -- who are very few in numbers, but who get the most media attention -- remaining in a family situation may be impossible. No adult can stay awake 24/7 and keep watch over a child every single minute. And few parents are willing to take the risk that the attachment disordered child will harm or kill the other children in the family. It is these RAD children who usually wind up in residential treatment centers or other secure facilities. And it is the parents of these children who often wind up with fractured marriages and with formerly healthy children who were traumatized by their RAD sibling.I hate to say it, but there are too many social workers who are willing to gloss over a child's behavioral issues in order to get him/her a home -- ANY home. You really need to be sure that you get a report on the child you are considering that is as complete and accurate as possible. You should talk to foster and (if relevant) adoptive families who were involved with the child. And you should spend as much time with the child as possible before official placement. Yes, it will be harmful to the child if you decide, after spending time with him, that you cannot parent him; still, if you realize that he is a potential threat to your other children, to your family pets, and to schoolmates, and choose not to proceed to finalization, it is a lot better than waiting until you are frazzled, your marriage is on the rocks, and your other children are terrified.Sharon

There's a wide range of symptoms and severity, when it comes to attachment disorders. It's attachment-related if a child doesn't know how to accept hugs, to make eye contact, or to tell a parent that he has fallen down and scraped his knee. If a child has never known that parents "should" hold their child, should make eye contact, and should comfort a child when he is hurt, he may be shocked and upset when parents try to do these things. He may be used to doing things for himself, even as a toddler, like going to get a Band-Aid or making lunch. He may be used to holding back his tears because no one responded to his pain in the past. And he may think that eye contact is an aggressive gesture because he has faced adults who have behaved aggressively towards him. Fortunately, most children with these issues can overcome them quite quickly, and without professional help, if parents understand why he is pushing away when they try to hold him and so on. There are also attachment issues that can be addressed, to a greater or lesser extent, with professional help. Some attachment disordered children feel that they need to be "in control" all the time, because they don't feel that parents will keep them safe; they may be bossy and argumentative, because they don't want to cede control to anyone else. Other attachment disordered children have "anxious attachment," where they are so terrified that they will lose a parent, a home, etc. that they don't want to play with other children, go to interesting places, or even go to sleep. Hypervigilance, by night and day, is very common, to the point where, if startled by someone saying "Boo!" they will have a total meltdown or start hitting the person who surprised them. Some kids have learned that adults really don't care about them, so they try to show their own lack of interest in adults by lying to them -- often so outrageously that it's almost funny. As an example, they can have chocolate icing all over their faces, yet swear that they did not eat the cupcakes that were made for taking to a party. They may also want to "get back at" adults, who are perceived as uncaring, by stealing or breaking things; they tend to have a lot of anger. The scariest types of attachment disorder involve violence. While a moderately attachment disordered child may hit or trip someone, or steal or break that person's possessions, a seriously disordered child may actually make a careful plan to harm himself/herself or others. Children who are moderately to severely attachment disordered usually have so much self-hate and anger at others that violence is a strong possibility. The most severely disordered children have been so consumed with rage that they lose all ability to feel empathy, or to have remorse for hurting someone. It's not that these children want to leave the family. On some level, they probably want to be loved and to have a home. But their anger at past events is so dramatic that they just can't behave in a rational way. And it's not always possible to "cure" them. As an example, there are kids who actually steal a carving knife, hide it in their bedroom, and make a plan to kill their parents as they sleep. There are kids who wait till adults are elsewhere in the home and then try to molest their siblings, set a fire, or throw the dog out the window. They may be preoccupied with blood and gore, and may try to derail a train by putting objects on the railroad tracks or to set a fire in the school bathroom. They may cut themselves purposely and blame their wounds on other children. Unfortunately, with such children -- who are very few in numbers, but who get the most media attention -- remaining in a family situation may be impossible. No adult can stay awake 24/7 and keep watch over a child every single minute. And few parents are willing to take the risk that the attachment disordered child will harm or kill the other children in the family. It is these RAD children who usually wind up in residential treatment centers or other secure facilities. And it is the parents of these children who often wind up with fractured marriages and with formerly healthy children who were traumatized by their RAD sibling. I hate to say it, but there are too many social workers who are willing to gloss over a child's behavioral issues in order to get him/her a home -- ANY home. You really need to be sure that you get a report on the child you are considering that is as complete and accurate as possible. You should talk to foster and (if relevant) adoptive families who were involved with the child. And you should spend as much time with the child as possible before official placement. Yes, it will be harmful to the child if you decide, after spending time with him, that you cannot parent him; still, if you realize that he is a potential threat to your other children, to your family pets, and to schoolmates, and choose not to proceed to finalization, it is a lot better than waiting until you are frazzled, your marriage is on the rocks, and your other children are terrified. Sharon

I find this troubling. Kids with RAD should NEVER be able to 'bond' on 'their own terms.' Their need to be in control of a dangerous and hurtful world full of dangerous and hurtful people is overwhelmingly strong. Allowing them to bond 'on their own and in their own time' is incredibly damaging. I have had to force a bond with every one of my attachment problem or RAD kids in MY time and terms. That way, my kids understood that I was, indeed, the boss and the one in control and, ultimately, I could be trusted to keep them safe -even from themselves.

Since I last posted, it has been determined that this child will continue to need a higher level of care. Still, I'm interested in this statement: Say a pre-teen or teen with RAD is averse to hugs and touch when initiated by others, but would offer occasional hugs after becoming comfortable with someone. This is the sort of thing I meant by "bonding on his own terms". Is it common RAD wisdom that in this scenario, affectionate touch (by which I mean a pat on the back or a hand on the shoulder) would be recommended? I would clearly need to do a lot of reading & work with an attachment therapist if I were to go down this road in the future.

for us, RAD has been about power and control. when he was a baby, Bubba had no reason to trust that adults would keep him safe. he learned to manipulate people. imagine him crooking a finger in your direction with one hand while pushing you away with the other. if he could make you crazy, he won because he controlled you, your response, and the situation. we could not allow that to continue. for his emotional health, we had to find a way to be untouchable by his machinations. we had to dictate everything. everything--bed, stay here go there, play now, wear this, pick up that, eat, do a chore, sit near me--everything. we had to decide when it was hug time and hand holding time and physical touch time because if we allowed him to do it, we played push-me-pull-you. and he felt very powerful in doing this to any unsuspecting adult. and when he was powerful, he grew sicker. he needed to learn that ToolMan and i were safe, in charge, and trustworthy. we would take care of him and love him no matter what. and the matter whats could be pretty nasty--because he wanted us to fail in loving him because then he would be right, all adults were like that and he would continue to be even more powerful and smart because he already knew that. except he didn't want to know that. he wanted to know he was lovable and loved. so we did the attachment thing. and mostly it has worked. not because we are all that on a stick, but because he was ready to learn it. it's only taken us since 2007. he's not perfect, but he's a darned sight happier and more emotionally functional than he was back then. and we haven't had any long term pee issues in awhile, although we did revisit pee-fest in a limited way just before the school year ended. that's the thing--even if (and it IS if) they get better, they always look at the world through their RAD-colored glasses and their responses seem to keep going back, albeit in a lesser amount, to what worked in the past. i've read that borderline personality disorder is RAD all grown up. i've also read the different schools of thought on brain plasticity and the ability to heal from RAD. some think it's a done deal in the teens. others believe that there will always be hope for healing if the person is open and willing and meets the right kind of love at the precisely right time. i have no opinion. but i do believe that some kids heal and some don't and it's mostly their choice when they've been given opportunity. resilience. some have it, some don't. it's a fine line, Edy. that's why not on their terms. and affection and bonding isn't always about hugging and cuddling. it's about that emotional connection. with RAD it's about learning that connecting isn't an adversarial kind of proposition and that people aren't game pieces to be manipulated. it's really hard when the kiddo is 4. i don't know if i'd know how to start when he was 14. some people figure it out though. i'd really want to know the kid in real life before i decided. does any of that make sense?

I'm glad that you have chosen what is best for your family. I'm not saying there aren't super awesome parents out there who can effectively parent RAD teens, but I am not one of them. I can very effectively parent RAD children -think under age 12-ish. First, there is a HUGE difference between kids with attachment problems and kids who may be 'wary' of an adult or shy or unwilling to accept affection because he or she doesn't really know the person doling out the affection. If you work with an RAD kid for any length of time you will become very skilled at understanding the differences. The RAD child feels as if the world will stop if they do not maintain complete control of everything that occurs in their world. They need to micromanage every single aspect of what they do AND what the people around them do. They need to control what they eat, when they eat, how much they eat, when they play, how they play, how other interact during play. They need to control who goes where and who does what. For them, it literally is a life and death thing. They do not trust that adults can keep them safe. They don't trust that a family is forever. My kids called every man/woman 'mom and dad' and had no real attachment to those words. The words from that therapist about how a child can 'bond in his own time or in his own way" really bother me and that's exactly why we don't even bother taking our kids to therapists. (we live in a very small town and the 'city' within an hours drive from us is a very small city. I've tried and can't find a good attachment therapist) These kids need someone safe to be in control of them. The LAST thing they need is to be able to control such a crucial human need as bonding. When I say I've had to force a bond with every single one of my RAD kids that is exactly what I have to do. I have to be aware of what they do in every single moment and be there to micromanage them and correct them. I have to prove to them that mom is the boss and mom is in control. I get a lot of flame for my parenting -usually from people who have no clue what it's like to parent an RAD kid. I wrap them up in my arms when they are aggressive and trying to hurt siblings or break windows and when they are out of control. I show them, through my actions, that I am stronger and can therefore keep them safe, even from themselves. That holding forms a bond. I've had kids fight me for hours before -literally hours - before they are in control and listening well enough for me to let them go. I pushed my RAD AD away when she demanded hugs and kisses in public (after she would scream and hit behind closed doors when you tried to show her affection) I got nasty looks from strangers for those times, too. :) For us, we had to strip away every single bit of control from our children. We had to dictate what they did and where they did it. To a normal kid, whether or not they wear the red or blue shirt doesn't matter. For RAD kid - you don't give a choice. YOU choose. When they come to the realization that you can keep them safe, when they understand that what you say goes, when that bond starts to grow, then you give them control back little by little. I won't work with teens because I can't physically control them and therefore can't keep them safe. (from themselves and usually they are their own worst enemy) When my ten year old tries to go after his siblings with a weapon, I wrap him up and rock him and sing to him. That contact builds a bond. When a fifteen year old goes after a sibling with a weapon I call the police -which reinforces in his sick RAD mind that he is 'too strong, too powerful and therefore in control' of everyone around him. So much so that they have to call the police in order to control me.' That kind of control is danger for an RAD kid and I don't mess with it. It's early. I rambled. I'm tired, but hopefully at least some of that made sense. :)

Thank you, this makes total sense and I really appreciate you taking the time to give me so much info. This does reinforce my belief that we won't be the right family for a RAD teen. RE This: To be fair, this was said by an agency worker reading from a file. We had not gotten to the point of speaking with the therapist. It was decided by the agency that the youth is not yet ready for adoption.