HOW DO YOU KNOW?

If you're looking for optimism, I'm no help. We adopted a 15-month-old girl in China in 2004 and it's been misery every moment. We have a RAD diagnosis and what good did that do? Nothing. She steals from us, she lies like a professional actress, shows no remorse and is only emotional about getting caught. We've done the police scare, the groundings, the indulgence so she wants for nothing, cleared out her room after she stole $140 from my wallet and made her earn everything back... no changes. Nothing. Except I'm more and more despondent every day. She'll be 14 next month, and all I can do is count down the minutes till she's graduated and gone. Yes, I have been suicidal over this. Yes, I get psychological help. But nothing changes. Even on a massive load of antidepressants. I wish you better fortune than mine.

Don't wait at all. Yes, there is real help available, although real, good treatment for attachment issues can be hard to find. It's more important to find the right treatment than have the labor, and someone can have serious attachment struggles without meeting the criteria for a RAD diagnosis. Having the right attachment therapist early enough can help the child but can also help you, because it can be really hard to see the full picture from the inside.

First off, trust your gut. If you have a sense that something's not right, get it checked out. And that's true, whether it's a concern about a physical issue or a psychological one. The worst that can happen is that the professional will say, "Those behaviors are actually typical when an adopted child is newly home. Try these games/activities for a few weeks, and see if they make a difference. Come back only if the behaviors don't go away, or if they worsen."Remember that, while attachment disorders are more likely to be found in children who have been adopted at an older age, after having multiple placements and/or exposure to some unpleasant life situations, they can occur even in children adopted at birth or at a young age. And sometimes, even children living with the parents who bore them can have attachment disorders. I have a cousin who was adopted at birth, who showed signs of the serious attachment disorder that would ultimately lead to his imprisonment on federal charges, while still a young child Also, remember that attachment disorders fall along a spectrum, from mild to very severe. Also, it's easy to confuse certain typical behaviors of post-institutional children and children in foster care with attachment disorders, when they are simply adjusting to their new lives, and it is also common for attachment disorders to coexist with other psychiatric issues, which complicate diagnosis and treatment.As an example, when a child is newly home, he/she may grieve heartily for his/her biological parents, foster parents, or orphanage caregivers. no matter how bad they were . He may feel that he/she has been kidnapped and taken away from everything he/she has ever known; especially if you look different, speak a different language, smell different, and so on, he/she may well feel that he/she has been taken to another planet. As a result, he/she may not want to look at you, because it reminds him/her of his losses. He/she may also have learned some behaviors previously that worked well in that setting, but that do not work in your home, and that are hard to lose; as an example, a toddler may have been forced to keep his/her hands at his/her sides and let an orphanage caregiver feed him, to avoid making a mess, or may have learned to grab another child's toy because otherwise he/she might not get one. These are not signs of attachment disorder, and will usually pass, once a child adjusts to the fact that you are his/her forever Mommy.Many young children come home with an inability to make eye contact with their parents, and an unwillingness to give or receive hugs. While these behaviors are often suggestive of a mild attachment disorder, they will usually pass quickly once the child becomes comfortable with you. Often, you can help the child adjust with strategies like playing mirror games or having the child point to his nose, then Mommy's nose, etc. Once in a while, stiffening up when someone tries to give hugs can be an indicator of a child who has experienced physical or sexual abuse, however, so see a professional if things don't get better after a few months. Likewise, many newly adopted children try not to cry or show pain when they fall down, and don't come to Mommy for comfort; they may think that they need to go, on their own, to find a Band-aid. Again, these behaviors may suggest attachment disorder, but will often go away if the parent continues to rush to the child and comfort him when he/she falls, and lets the child know that someone will give him/her cartoon character Band-Aids and such.Moderate types of attachment disorder show more clearly that a child feels that adults are not to be trusted, usually because he/she has had multiple caregivers, abusive/neglectful caregivers, or other negative situations in his/her life. Many children of this type don't distinguish between parents and strangers. As an example, they may pull away from parents trying to hug them, but willingly rush up to the bus driver and try to sit on her lap. They may even attempt to charm strangers into doing things they want, but ignore their parents, who want to help. Some of these issues will self-correct, but others will require professional help. And professional help can often be very effective in dealing with these issues and helping parents deal with them.Somewhat more serious symptoms of attachment disorder include compulsive lying and/or blaming others for actions he/she took. Even if you were standing right near the child when he/she took cookies from the cabinet, he/she may deny taking them, or say that his/her sister took them. And even when you get notes from school saying that your child hit someone, didn't do an assignment, skipped school, or whatever, he/she will lie and say that the teacher made a mistake or is just being mean to him by saying those things. Chronic lying is very wearing on a parent, and is one of the most common things that parents of a child with attachment disorder often complain about. While chronic lying may simply be a survival tactic that worked in an orphanage where staff hit disobedient children, or in an overly strict foster home, it often doesn't seem to have a specific cause except for the fact that the child somehow learned to distrust adults. Professional help may be needed to identify the cause of the problems, if possible, as well as to try to modify behaviors and work with parents to implement them on a daily basis. These strategies may or may not work, though with a good therapist who is familiar with adoption issues and practices trauma-informed care, the odds are good that at least some improvement can result.Children who are severely attachment disordered tend not to have developed much of a conscience, and they are the hardest to treat. If they don't have a conscience, they may know what is right or wrong, but simply don't care. Lying increases. Stealing/shoplifting is not uncommon. Harming others -- people and animals, and especially if they are perceived as weak or vulnerable -- is not unusual. Parents may be targeted for physical harm if, in a child's mind, they are stopping him/her from doing things he/she wants to do. Siblings may be targeted for physical or sexual abuse. In some cases, the children hoard things that can be used as weapons, such as a carving knife. In some cases, suicide is a possibility.Unfortunately, these children are the hardest to treat, and even the best therapies may have only limited effectiveness. Some of these children simply cannot continue to live with their families, especially if there are other children in the household. In some cases, placement in a residential treatment facility, a secure place designed to keep children from harming themselves or others while receiving treatment, is necessary. Some RTFs do have a certain degree of success in working with children with attachment disorders, but usually only if the children continue to receive intensive outpatient treatment once they are back home, and the parents are taught techniques for better management of their behaviors.One problem, of course, is that RTF care is not always covered by insurance, especially if it is likely to involve inpatient treatment for a year or more, and good quality RTFs are very expensive for the average family. There have been some families that have had to dissolve their adoptions, simply so that their state would have to bear the cost of putting the child into a facility. In some states, it can be difficult to relinquish a child to the state, yet doing an ethical and legal rehoming with a private agency may also be difficult. The good news is that some agencies, especially international adoption agencies, have become more aware of the incidence of dissolutions resulting from problems like attachment disorders and fetal alcohol spectrum disorders, and more involved in finding new homes for the families facing such a need. Some now keep lists of families willing to take in children who need new homes and open to being therapeutic parents. But family life is simply not appropriate for some children with serious RAD. There are some programs that have been started to provide alternatives to rehoming or RTCs, including at least one started by an adoption professional -- Ranch for Kids in Montana. While such programs have had a good deal of success with some children,who have gone on successfully to new homes or independent living later, they do have their critics. Any such program should be checked out thoroughly. The programs generally require state licensure, and should be willing to give references and allow families to visit and see how they operate.All in all, I believe that it is ALWAYS worth seeking help if you think that your child is showing signs of attachment disorder, and not just behaviors that derive from being in a new situation. Getting a diagnosis is only the beginning. A good therapist, experienced with adopted children and with any traumatized children, will implement strategies to help your child heal. There is no sure cure for attachment disorder, but there are many approaches to changing negative behaviors and promoting better relationships with parents and others.Sharon