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Originally Posted By JerryWe have a sib group with #2 diagnosed as bipolar (very clear and distinct bp behaviors). The psychiatrist feels that #1's behaviors are related to bp (being a genetic disorder and so forth), yet we (and the therapist) have seen clear disassociative behaviors in this child. I didn't expect the behaviors we've seen with this almost 9 year old child. If I understand correctly there seems to be a set of circumstances, or pattern, in a child's life history that can "predispose" them to have multiple personality disorder. This child fits the "profile" perfectly. I'm not seeing much that states the two disorders are related. There is a family history of severe depression (manic, maybe bp just not diagnosed as such) in the parents and schizophrenia two generations back. Are these disorders related in that both have some neuro chemical impact?The third sib maybe the most troubling. This sib is 4 and we're begining to see some destruction of property, and this kid is a master of manipulation (besides lying about almsot everything). This child was the youngest when removed from their parent. I think some of the children's behavior is a result of coming to an adoptive placement from a long term foster placement (fp "said" they wouldn't adopt, but send mixed signals). I believe this really hurt the kids, and we're paying for it. FP also refused to medicate the children while in their care.I know I have a lot more reading to do on BP. Just looking for some insight where I can. We attended two attach seminars over a year ago and going back through the materials I'm a little concerend, but I really don't think we're looking RAD because I'm not seeing the physical aggressiveness. I've tried to imagine these children as teenagers, without having received any treatment. That scares me
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Originally Posted By JerryWe are firm believers in parenting with consequences. We have used the Love and Logic "isms" and have for years and years. Our kiddo's weren't prepared for that and it has been a pretty tough adjustment. They were pretty much given anything and everything they asked for before coming to live with us. We rarely have candy or sweets (and I do mean rarely). Our #1 kiddo craves sweets, and we have to constantly remind her behavior classroom teacher that we don't want her to have sweets. Used to be the same for #2, but since she's been on meds it's not as bad.
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Originally Posted By Dr. Arthur Becker-WeidmanDissociation is a common "symptom" of bipolor disorder, and also quite prevelant with children with reactive attachment disorder. Given the little you've described, I think it most likely that the children do have Reactive attachment disorder and bipolar disorder. About 50 to 60% of children adopted through the US foster care system who have Reactive Attachment Disorder also have comorbid bipolar disorder. Aggression is not a necessary symptom of Reactive Attachment Disorder. It is actually more common among bipolar children: extended temper tantrums that last 45 min to hours and that the child cannot stop. That is why these children are frequently treated with a mood stabalizer such as Depakote and then an atypical antipsychotic such as Risperadol or Seroquol. I hope this helps.Arthur Becker-Weidman, Ph.D.Center For Family Development716-810-0790[url="http://www.center4familydevelop.com"]http://www.center4familydevelop.com[/url]AWeidman@concentric.net
We had a little girl for 4 years who came with no diagnosis at 4 years old. She often seemed disassociative, sexualized, destroyed property, lied, stole, she used to bite the skin off her fingers and was very manipulative. I took her to a neurologist as she used to roll her eyes back in her head and had other behaviors that seemed "not here". After spending a couple of years searching out answers and services, trying different meds and parenting strategies; we got some idea of her issues. She was prenatally exposed to drugs and alcohol and this affected her ability to recognize and accept affection after she was born. The drug exposure made her a difficult infant and she was neglected and abused from a bipolar bmom and alcoholic bdad. Then she was spoiled by her grandparents who felt bad about her beginnings and never required much from her before she landed with us. Her result was FAE which helped precipitate the RAD because it affected her ability to take in caring interactions. She also inherited Bipolar from Bmom, who was Bipolar, which also helped cause the subsequent abuse and neglect she suffered after being born. So my point is that the FAE, Bipolar and RAD interacted together to create her situation. There was not a clear indication of any one thing just a jumble of things.
Originally Posted By Dr. Arthur Becker-WeidmanChildren can have a variety of difficulties: Reactive Attachment Disorder, Bipolar Disorder (those two often go together. About 50 to 60% of children with Reactive Attachment disorder also have Bipolar disorder), FAS, etc. However, I've also found that such children are very often misdiagnosed with ADHD, Oppositional Defiant Disorder, and other conditions.About 50% of children in U.S. foster care have attachment disorder symptoms and 80% of maltreated infants have such symptoms...so the likelihood of a foster child have reactive attachment disorder is quite high. My experience is that one must appropriately medicate the Bipolar disorder and also treat the RAD with Attachment Therapy and Attachment Parenting for a child to heal.Parenting without therapy often is very frustrating for the parents and may not be effective. Therapy opens up the child so that what the parent has to offer can get in. Generally I give about 2/3 of the credit for a child's healing to the praents and about 1/3 to the therapy. Nancy Thomas' material is great. However she really doesn't give enough empahsis to the emotional attunement dimensions of parenting (she generally assumes most people know how to do the "love stuff.") Effectively parenting a child with Reactive Attachment Disorder requires a parental attitude of empathy, acceptance, love, playfulness, and curiousity. Otherwise the structure will be experienced as cold, rejecting, and harsh. Best of luckArthur Becker-Weidman, Ph.D.Center For Family Development716-810-0790[url="http://www.Center4FamilyDevelop.com"]http://www.Center4FamilyDevelop.com[/url]AWeidman@Concentric.net
The experience blew our family out of the water so to speak. We had adopted this girl and her sister, who was one year older and with the same problems, at the same time. We were successful with one girl who was a milder RAD, through an excellent child psychiatrist, attachment therapist, regular therapy and attachment parenting mostly from Nancy Thomas's book. I need to add marriage counseling also. It was a long hard road and now we are very happy that we were effective with one child. The other child was beyond our abilities. We were unable to help her and care for our other children. She is the only child in her grandparents home now. They have stayed with an excellent attachment therapist so I have hope for her. I am very grateful for those who offer hope and help for these children and their families.
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Originally Posted By JerryI appreciate the responses. I see more what you mean Dr Art, I didn't realize the numbers were so high for foster children. We've discussed FAE/FAS with the childrens physician and he sees no physical evidence, but there is family history to indicate substance abuse. I think Lisa Riley was one of the ATTACh seminar speakers we heard that said something to the effect that many well trained and experienced mental health professionals are often fooled by RAD children. It makes me think that we need to really begin documenting the behaviors (just the facts) and then re examine where we are with each one of our kiddo's.As a side note the 4 yo's placement history described by the annon poster was the same as our kiddo's.Something else you said really struck a nerve with me. "The emotional attunement issues to parenting," really does seem to be overlooked. We learn how to use techniques, but not how to integrate these techniques into our self concept, or our spirit if you will. I have to detach sometimes, and the more I do it the easier it has come. Recognizing that lead me to think a lot about my parenting and what I may have been unconsciously communicating. I try to communicate genuine empathy for the "dilema" my child has, without taking responsibility for their problem. I think I'll looking for more to address this issue as I continue my reading. Thank you again for your responses.
Originally Posted By Dr. Arthur Becker-WeidmanTwo very good books that address the attunement issue are:Facilitating Developmental Attachment by Daniel Hughes, Ph.D.This is a technical book for therapist and child welfare workers. I use chapter's 11 and 12 with the parents we work with as part of our training program. (We also use Nancy Thomas book, When Love is Not Enough)The other very good book, which is really written like a novel isBuilding the Bonds of Attachment, Daniel Hughes, Ph.D.Best wishes,Arthur Becker-Weidman, Ph.D.Center For Family Development716-810-0790[url="http://www.Center4FamilyDevelop.com"]http://www.Center4FamilyDevelop.com[/url]AWeidman@Concentric.net
I'm a little late adding in my 2 cents worth. Sorry- been basking in sunny Florida. Now back to reality and 30 degree temperatures!!!I agree with the above postings. My son, adopted at age 4 has been successfully treated for RAD, and is doing well on medications for bipolar. He was violent, I see that now as a combination of both disorders being untreated. We have not had any of the violence in over 1 year. Efforts at med changes/reductions have been unsuccessful. He has not gone back to violence (short of 1 episode where he threw a few things). Mainly what we have seen during med changes is extreme non-compliance, desrespect of authority, etc. For some reason Risperdal (only .5 mg for a 9 year old), works wonders for him. We don't even seen the rapid, rapid cycling on this. We did the Nancy Thomas parenting, along with theraplay and Dan Hughes stuff for attunement. Also attachment therapy and meds for bipolar. The combination of all 3 worked wonders. I went from a violent 7 1/2 year old, that I could no longer physically keep safe (his rages went over 1 hour) - to a fun to be around 9 year old. Also, if our kids have been neglected enough to develop RAD, then there's likely to be other neurological issues - such as sensory integration disorder. This also has behavioral elements to it. In reading The Bipolar Child, I found symptoms of SI woven throughout the book, also leading me to hypothesize that children with Bipolar may be more prone to sensory integration issues also. DimasMom