RAD and PTSD Defined
My son James has RAD (Reactive Attachment Disorder) and PTSD (Post Traumatic Stress Disorder) to battle. As his family, these have become our battles, as well, and we are learning as we go how best to help him, how best to help ourselves.
Here are a couple baseline, clinical definitions of what these diagnoses mean.
You'll also find plenty of posts in which I've addressed these demons, just look in the label cloud in my sidebar. Or check out some of these links from when I wrote a series on attachment.
Reactive Attachment Disorder
By Mayo Clinic staff
Reactive attachment disorder (RAD) is a rare but serious condition in which infants and young children don't establish healthy bonds with parents or caregivers.
A child with reactive attachment disorder is typically neglected, abused, or moved multiple times from one caregiver to another. Because the child's basic needs for comfort, affection and nurturing aren't met, he or she never establishes loving and caring attachments with others. This may permanently alter the child's growing brain and hurt their ability to establish future relationships.
Reactive attachment disorder is a lifelong condition, but with treatment children can develop more stable and healthy relationships with caregivers and others. Safe and proven treatments for reactive attachment disorder include psychological counseling and parent or caregiver education.
Posttraumatic Stress Disorder
Posttraumatic stress disorder (PTSD)
Posttraumatic stress disorder(PTSD) is a severe anxiety disorder that can develop after exposure to any event that results in psychological trauma. This event may involve the threat of death to oneself or to someone else, or to one's own or someone else's physical, sexual, or psychological integrity, overwhelming the individual's ability to cope. As an effect of psychological trauma, PTSD is less frequent and more enduring than the more commonly seen acute stress response.
Diagnostic symptoms for PTSD include re-experiencing the original trauma(s) through flashbacks or nightmares, avoidance of stimuli associated with the trauma, and increased arousal – such as difficulty falling or staying asleep, anger, and hypervigilance. Formal diagnostic criteria (both DSM-IV and ICD-9) require that the symptoms last more than one month and cause significant impairment in social, occupational, or other important areas of functioning.
This is a timeline of events with James, from our initial meeting, to the adoption, to his time home with us which progressed from the cliched honeymoon period to some strife and stress and on to an official diagnosis of Reactive Attachment Disorder.
Since many adoptive parents prefer not to talk about RAD, but all of us are afraid of it, I'm adding this timeline to show what we're experiencing. I know everyone who deals with RAD will go through something very unique, but maybe this will help someone gain some perspective.
8/03 Met James in Kazakhstan while adopting Bella.
12/05 Found him again in Ridder and began a correspondance with him.
8/07 We were told we could try to adopt James
10/07 Began the adoption paperwork
10/08 Began the adoption proceedings in Kazakhstan for James and his younger sister Julie
1/09 James and Julie arrived home in America
2/09 Began school
7/09 Started seeing some emotional difficulties with James, where he would get tearful and withdrawn over what seemed like small triggers
8/09 James would at times get mad at me, which led to disrespect in the forms of refusing to do what I said, sitting on couch for days, using a mocking tone with me. This was usually triggered by me telling him to do chores he didn't want to do or giving him a consequence for an unacceptable action.
9/09 This behavior became more and more problematic. There were several incidents where he hit (always Patrick, never the younger kids), stretches where he didn't speak to anyone or do anything. At one point he attempted to run away but was caught a mile from home and returned home when told to do so. The problems were limited to home, as he never refused to go to school or acted out at school.
We tried working on an incentive chart to improve his behavior. We rewarded him with small weekly rewards as well as a larger reward at the end of a couple months. This worked for awhile and seemed to motivate him, but when he did not get his weekly reward one week it seemed to worsen things and he withdrew into an "I don't care" posture about everything.
9/09 James began seeing a therapist who specializes in working with adolescents with Reactive Attachment Disorder. He also saw the child psychiatrist, and between the two had several letters added behind his name. Began visits with the therapist once a week, and started on a course of medication.
10/09 Began seeing improvements at home. James was becoming more interactive and showing a sense of humor. He did not seem as sad and started showing affection again.
11/09 More improvements, including being able to accept no as an answer, and to accept consequences. He was even able to apologize at times. He began to show renewed interest in some of his hobbies, like magic tricks, cooking, and creating things from stuff lying around the house
With caution, we began again the incentive program so he can earn a visit with his best friend in Mass. He seemed on board with it, but also a little scared that he might blow it.
12/09 We have a lot of smooth stretches where I get fooled into thinking all our problems are behind us. Though I know this isn't the case, I think it's a protective game that my brain/heart have invented. Because we always have setbacks. And I know we probably will for a very very long time to come. Setback behaviors have included:
A threat to punch Dad in the face (never acted on).
Some pretty ugly cussin' to me.
In-school suspension for grabbing something out of a teacher's hand, in the process hurting her thumb.
Lies to teachers about homework.
Lies to us about many things.
Falling asleep in school a lot.
Lots of irritating, passive-aggressive behaviors towards myself and siblings, apparently looking to stir up trouble.
Lots of little, petulant, immature stuff.
At least the smooth stretches make it all bearable, b/c he really is a wonderful and charming boy with many gifts and lots of love. To be honest, there are days when I wonder what I would do if I had the chance to do this all over again. But I know it's a matter of getting through these next few years, and then I feel sure I will never look back. To think of him remaining where he was, with such a bleak future for such a special boy, makes every bit of heartache and stress worth it.
1/10 A slow realization on our part that bad behavior leads to immediate consequences, the tried-n-true formula that has served us well over the years, does not work with this kid. In fact, it escalates the problem to a new level. It goes against the grain, but we have learned that in the worstof times, we need to back off and give him time and space to get himself under control, then deal with consequences in a cooperative way when he is back to baseline.
2/10 A show of trust, as James revealed a personal side to his past that he had been unwilling to talk about till now.
3/10 There have been a few times recently that I've had to tell James no to something, or insist that he do as I say. In these instances he has been starting out defiant, but if I quietly hold my ground about the point and don't start escalating the 'what-if' consequences, he will comply with an "I'm sorry, Mom". Big step in the right direction. HUGE.
3/12 Guess I fell behind, huh? I promise to update soon....