6 year old child may be BiPolar!

Your child should not need hospitaliztion, if it's truly bipolar, there are good meds for that, but I'd tackle the RAD first to be sure that's not the real issue.(I'm sure I'll get disagreement on this, but that's what I would do). We use in home therapy, but I'm not sure why they call it mobile unless they just mean coming to you. If it's a good therapist you will need to be involved in the therapy. They will be giving you special parenting instructions for Rad specific to your daughter(if they're trained to treat RAD) and also she'll need to bond to you. I Rocked my RAD kids 30 min a day also which helped a lot with the younger ones. You didn't say how old your other children were. If they're young, get a sitter for the first visit and you'll know what you need to do after that. Good luck. If she has RAD IMO, bipolar often gets misdiagnosed because a RAD kid can display the same type behaviors. When the RAD starts healing, the behaviors should subside, if not, then bipolar is the issue and meds can be very helpful. I'd be curious to know what you think of the therapist after he leaves.

Word of warning - it's only been very recently that dr.'s have started recognizing BPD in children and it's often misdiagnosed as ADHD - and then everyone wonders why the Ritalin doesn't work - it can even make things worse by triggering more manic behavior than the child would experience otherwise. (I know of what I speak; my boyfriend was one of those kids and didn't get properly diagnosed till his teens.) From what I've learned about BPD, the more episodes an individual has, the harder it gets to treat successfully. Your daughter is still very young and if she's in proper treatment for an accurate dx as a child, she will almost certainly grow up to be *fine*. (You will have raised her to understand the importance of taking medication as prescribed, recognizing symptoms & reaching out for help when needed, etc.) It can be hard to find the right medication or combination for her, and it needs to be monitored & adjusted as she grows, but you're on the right track. Make sure you get a dx that *feels* right - you know your daughter best. Good luck to you & much love - it may be a bumpy road for a while but you and your daughter will make it through all right.

You should be sure that the person coming is a trained and experienced mental health professional (MSW, Ph.D, etc) with specific training (at least 2 weeks) in treating children with RAD and who primarily treat such children. I would also get an eval by a child psychiatrist who has lots of experience evaluating and treatment children with Bipolar Disorder. The Comorbidity of RAD nad Bipolar disorder is about 50%. Of US children in Foster care with RAD, 50% also have Bipolar. And, yes, it is frequently misdiagnosed as ADHD. Regards

Para, my son has been treated for rad and medicated for bipolar. Until we went to Art, no one else recognized the bipolar and of course he only got worse, not better. I'm a bit stubborn and anti-meds. So was not to eager to initially follow Arts suggestion to treat the bipolar. Well he stonewalled the first 3 months of therapy, made very minimal progress until I finially agreed to medication. Then he made wonderful progress and has fully resolved his rad. Not to say there is not scar tissue, but he definately no longer has rad. As Art suggestd, I would strongly urge you to seek out someone skilled in differential diagnosis. It can be difficult to tease out the bipolar from the rad, there is a large overlap in symptoms. But the sypmtoms need to be treated based on their cause, if the child is to get better. Art - could you post the link to the John Alston (??) article on differential diagnosis if you have it. I found it to be a good read, but can't recall where I saw it. Life with bipolar sure is interesting. I agree with slowdrowned - get it treated now. Both rad and bipolar only get worse with time. The manic state can be reinforcing and if a kid experiences it too much - they may not want to take their meds (more of an issue in adolesence, but still a concern at any age). Bipolar will take a lot of tweaking of meds over the years. As they grow, hormones kick in, medication needs changed. My son is on the horizon of adolescence and we will be exploring a med change next month. A bit scary, since he has traditionally not done well off Risperdal, but he definately seems to need a more traditional mood stabalizer now. Best wishes to you. DimasMom

Dr. Alston's article can be found at: [url]www.rainbowkids.com/Articles/298rad.html[/url] Another good site for articles is: [url]http://noetic.oathill.com/bipolar/chiladl.html[/url] Regards

Dr. Art, Am I reading what you wrote correctly? Is someone qualified to assess/treat RAD after 2 *weeks* of specific training? If so, I have to say eeek! I don't allow a vet to treat my pets if without at least 2 *years* of experience dealing with specific breeds/species/conditions.

Dear Lady, You've misread my comments. I stated that one needs to be a licensed mental health professional (so that would mean an MSW, Ph.D. or MD) and then have at least two weeks training in evaluating and treatment trauma-attachment disordered children beyond their graduate education and licensure. Hope that clarifies.

Dr. Art, I understood the part about them having advanced degrees. But I'm still not understanding how one treats a specific condition with 2 weeks of training on that condition. I have an Msc in Celtic studies (and am a 3 year PhD candidate)----but that isn't what makes me an "expert" on revival in celtic language speaking regions. My 6 years of study on that aspect of Celtic Studies is. After 2 weeks of training I still wouldn't have been able to tell the difference between revival experience in various regions......which leads me to wonder how someone could tell the difference between mental health conditions which mirror each other within a similar 2 week specialization training. Also, I wonder what you think of this statment: "Richard Barth thinks the emphasis on attachment is misplaced. 'The adoption field's near obsession with attachment issues as the cause of difficulties in parenting is leading the field astray, in some cases with tragic results,' he says. 'There is no scientific basis that I am aware of that points to attachment problems as a primary cause of parent and child problems or suggests that any of the attachment-based therapies are effective in reducing these problems.' "Barth says that other proven interventions, such as multisystemic family therapy and Assertive Community Treatment, could be adapted to meet the needs of adoptive families." [url]http://www.ncsl.org/programs/cyf/adoption.htm[/url] I had been under the impression that attachment issues had been well researched and that attachment professionals were well trained....now I'm starting to wonder (2 weeks just doesn't seem like good training to me.). As I think back on my reading, almost all of it has been anecdotal. I haven't read any peer reviewed studies. Where are they? Which journals should I be looking up?

Dear lady, There are a number of differences between your field and mental health. First, all well-trained mental health clinicians have recieved training in a variety of areas. People who work with children usually specialize in that as part of their Master's or Ph.D. work. The post graduate training to do attachment based therapy is usually about two weeks, followed by supervision and continued training. But no one can do attachment-based treatment without at least a min of that. Just in the same way that one cannot be a social worker without a two-year MSW...but obvioulsy, someone with five years experience and training beyond the MSW will probably be more competant. It sounds to me like Richard B is quite uninformed. Attachment Theory as been around for over fifty years and is THE theory used in the the child develoment field. The evidence is clear that traditional forms of treatment are ineffective for children with Reactive Attachment Disorder. Family therapy, play therapies, etc just don't work. You can find research on this on my website and you can find a bibliography that lists publications in the peer reviewed lit. My article is in the process of being reviewed for publication in a peer-reviewed professional publication. Regards

Hi Lady, You post a good question. After all, us parents do want to know that we are not jumping into some crazy band wagon out of desperation to help our kids. I read and researched RAD pretty extensively in making decisions on what to do for my son. I think you might greatly enjoy a book by Robin Karen. It's called "Becoming Attached" (I hope - I have lost track of my bibliography). It's a bit techy, but basically outlines all the research behind attachment theories. I recall it detailing a lot about Bolby (40's or 50's), Ainsworth, (70's or 80's). The book probably only covers up till the 90's. But it was a big help to me in understanding the research being the development of the theories. I was able to get the book through inter-library loan. Like Art mentioned, there are newer studies out now that actually look at the treatments based on the theories. It's a field that is still growing and developing, but it has come a long way. Also like Art mentioned, the attachment training builds from years of previous degree work. It's the decorations on the icing on the cake. It builds from the foundations already there. Obviously the more experience someone has, the more versed they will be. But a newer trained attachment therapist generally is able to mentor from their trainer for quite a while - the wonders of cyber space. In a realted field - that of sensory integration. Likewise the training to treat a child with this disability is build upon the foundation of general OT training. My son just started back into SI therapy. He really has a rookie this time, and I mean a rookie. She graduated in Dec, has been training at the clinic, he is her first patient. He's only had 1 session with her and I was extremely impressed. Yes she may be learning as she goes, but her support network is just down the hall. and she obviously has a good foundation to work from. Our story may be annecdotal, but pretty much correlates with the results of Arts soon to be published study. Check out the states on his site, the preliminary results are amazing. My son started briefly in traditional therapy, got sicker. Went to Theraplay and he got sicker. Then went to attachment therapy and finially he got better. He has been out of therapy for almost 2 years now and the rad is definately resolved. Yes he's more insecure than other kids, yes he's more sensitive - but he is not rad. He went from a violent and out of control 7 year old, to a pretty close to typical 10 year old. Lady, not sure where you are at, but would encourage you to come to an AttaCh conference. They are awesome. It's the big think tank for work in attachment. This year it is in Pittsburgh, PA at the end of September. I'm sure you could find out more at [url]www.Attach.org.[/url] DimasMom

Dimasmom, Thanks, I'll consider it. I think I want to read some of the dissenting work first though. I'm always a bit suspicious when one treatment claims to be the answer to everything---which is what I often hear when it comes to attachment therapy. The more I think back on what I've been reading, the more I start wondering why attachment therapy was always the "first" answer. Perhaps as a layperson, from a completely different field, there is something I'm missing. I kind would want my (sometime in the near future) child to have a full medical work up, to see if any systemic problems may be the source of behaviors...or an attempt to learn more about the birth family---were mood disorders part of the family history? To use the cake analogy, it just seems like professionals who specialize in "attachment" seem to think all cakes need attachment icing....and all "bipolar" specialists need bipolar icing....and all ADHD specialists need ADHD icing. All of which leaves me very suspicious.

Dear Lady, Your point is precisely why you need to have a licensed mental health professional who is also trained in treating adopted and foster children and attachment work do a thorough assessment. Anyone with the background I've suggested should be able to do a comprehensive assessment. Typically when my group does an assessment we are screening for various mental health issues such as mood disorders, attentional problems, and attachment issues. We also screen for Sensory-Integration issues and various neuro-psychological issues. Frequently we then refer a child on for a full SI evaluation or a neuro-psychologcal eval, etc. based on our comprehensive assessment. Anyone who practices without doing a comprehensive assessment may be missing important issues that can affect treatment. Again, you should look at the real professional lit as it is clear that for RAD traditional forms of treatment just don't work...but may feel more comfortable trying something else first. About 80% of the families we treat have had over three prior episodes of treatment before they come to us...previous treatment without any positive effect regards