Concerned About Unconventional Mental Health Interventions?

Concerned About Unconventional Mental Health Interventions?
Alternative Psychotherapies: Evaluating Unconventional Mental Health Treatments

Thursday, October 20, 2011

More About Reactive Attachment Disorder: "The Boarder" Movie

I’ve mentioned misconceptions about Reactive Attachment Disorder many times before on this blog. But it would seem that it’s possible to promulgate myths and misunderstandings on this topic a lot faster than I or anyone else can correct them.

A new example of the spread of misconceptions about Reactive Attachment Disorder is the movie “The Boarder”, created by Jane Ryan and based on her book “Broken Spirits, Lost Souls: Loving Children with Attachment and Bonding Difficulties” (iUniverse Star, 2004). (Incidentally, iUniverse is a “professional self-publishing” company rather than a traditional publisher that sends manuscripts for expert review before accepting them.) “Broken Spirits, Lost Souls” includes a foreword by Foster Cline, the well-known advocate of holding therapy and proponent of the belief that “all bonding is trauma bonding”; following the surrender of his medical license, Cline became a self-proclaimed expert on child psychopathology and effective parenting. “Broken Spirits” begins with unsubstantiated claims about the increasing incidence of Reactive Attachment Disorder and describes cases of teenagers planning Columbine-like massacres as if this behavior is caused by Reactive Attachment Disorder. It goes on to quote with approval the ideas of advocates of holding therapy like Martha Welch.

www.theboardermovie.com/what_is_rad.html provides a page that purports to offer definitions and descriptions of Reactive Attachment Disorder. In fact, its answers to the question “what is RAD?” are a mélange of accurate and inaccurate statements. Curiously, there is a link to http://en.wikipedia.org/wiki/Reactive_attachment_disorder, a Wikipedia featured article which in fact I wrote much of myself. But much of what is argued on the “Boarder” page is highly questionable. One inaccurate statement is that Reactive Attachment Disorder was once rare but is no longer so, as the number of children affected by neglect or abuse is rising “exponentially”; neither of these claims is supportable by evidence, nor is there necessarily a connection between them.

The author of the “what is RAD?” page-- presumably Ryan or a colleague—states that one possible cause of Reactive Attachment Disorder is separation from primary caregivers in the first 33 months of life, “including while in utero”. This is far from accurate, and is of special concern because of its implications about the developmental effects of adoption. While unpredictable and unresponsive care are factors in the development of Reactive Attachment Disorder and other problems like language delays, separation in the first six months does not appear to be problematic. Abrupt long-term separation after 6-8 months, when attachment emotions and behavior emerge, is associated with intense grief and other emotional reactions for a period of some months, but care by normally responsive and consistent caregivers facilitates recovery and the outcome does not involve Reactive Attachment Disorder.

Ryan (or her colleague) goes on to say that the “criteria for a diagnosis of Reactive Attachment Disorder are more severe and pronounced than the criteria used in the assessment or categorization of other Attachment Disorder styles such as insecure or disorganized attachment”. This statement shows a complete misunderstanding of the nature of Reactive Attachment Disorder and the concept of attachment styles (not Attachment Disorder styles). In “Broken Spirits”, Ryan makes it clear that she believes Reactive Attachment Disorder is shown through the checklist so often presented by proponents of holding therapy/Attachment Therapy-- the fascination with blood and gore, the “crazy lying”, fire-setting, animal torture, sexual molestation of other children, etc., etc.

These “symptoms” are completely non-overlapping with the description of Reactive Attachment Disorder given on the “what is RAD?” page, with any description in DSM or ICD, and certainly, as I can attest, with the linked Wikipedia article. Such child behaviors do occur, sad to say, but they are not aspects of Reactive Attachment Disorder. To claim them as signs of Reactive Attachment Disorder is like saying that because some (unimmunized) children do get an illness that involves swelling of glands in the neck, that kind of swelling should be called chickenpox. Understanding and treatment of mumps would be much lessened in effectiveness if the disease was assumed to be the same as chickenpox, and in the same way understanding and treatment of disorders like early-onset schizophrenia would be lessened by assuming that its symptoms were indications of Reactive Attachment Disorder.

Some readers may find it unimportant whether Ryan speaks of “Attachment Disorder styles” or “attachment styles”. In fact, the difference is an important one. To say “Attachment Disorder styles” implies incorrectly that a wide variety of psychopathologies are based on attachment problems, and that the standard Reactive Attachment Disorder is only one among them. Describing insecure attachment as an “attachment style” communicates corrrectly that this type of attachment behavior is in the normal range of development. Some have even argued that there may be social and family situations where insecure attachment is healthier and more appropriate than secure attachment. Disorganized attachment may be a normal response of toddlers to temporary family dysfunctions like divorce and custody disagreements, and a return to more stable relationships may enable the disorganized child to return to a better attachment style. (However, some methods of assessing attachment do not even use the “disorganized” concept, and it is not a basic part of Bowlby’s attachment theory.)

Will “The Boarder” ever be released? The web site indicates that contributions of money are needed to make this possible, and I have little doubt that it will occur. There are quite a number of quasi-professional therapists who benefit greatly from the spread of the inaccurate beliefs presented in Ryan’s book. Regrettably, there are also many parents-- especially those who have adopted-- who will rush to have their expectations confirmed by Ryan’s book and movie.

Meanwhile, those of us who know something about early development had better do our best to argue against these false and potentially harmful beliefs.

23 comments:

  1. So are you saying that blood/gore obsession, crazy lying, animal torture and such is not due to Reactive Attachment Disorder? I thought that RAD was a more palatable way of saying "Child Sociopath." Sort of like, proper society would find it bad form to call a child a sociopath, so came the RAD diagnosis. It is really is confusing!

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  2. Yes, indeed, that's exactly what I'm saying. A lot of people get the idea that you had, because some "therapists" outside the professional mainstream have used the term incorrectly, for their own purposes. Some journalists have also picked up this usage and have confused everybody.

    But don't rely on what I say. You can look up Reactive Attachment Disorder in DSM-IV-Tr (the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association) and read the description.

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  3. Thank you so much for this articale! I am self-diagnosed (later officially diagnosed by professional) adult with RAD. I discovered this around 16/17 and I kid you not, reading about the disorder on the internet nearly traumatized me. There was so much information on only the absolute extreme's or assumed knoweldge that I was terriefied that one day I would just wake up having lost control and turned into a sociopath. It took a lot of research, a lot of self discovery, and a lot of compassion from others to realize that these were all huge misconceptions. I am so glad that I didn't run from my discovery, but rather educated myself and used common sense. I truly appreciate your article and standing up for a disorder that is not only misrepresented so often, but under researched as well.

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  4. What a shame that you had to be so miserable because of the misinformation that's out there!
    Congratulations on facing up to what was being said and finding out for yourself that you are you and not a list of symptoms someone has posted--

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  5. Dear Annoyed, I wonder how many people, diagnosed with "RAD" live with the terrible self-doubt you experienced. Thank you for writing.

    There is a Facebook site called "Attachment Therapy is Wrong" that might interest you. Part of this abusive therapy is the horrid label they put on children.

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  6. I appreciate that you are trying to clarify matters on the definition of RAD based on the criteria listed in the DSM-IV. However, I do have personal experience following a fostering, and then a failed adoption of an older girl previously diagnosed with RAD. One important factor that gets overlooked is that many of these children are diagnosed with other conditions in addition to RAD. My daughter for example also had PTSD, and was exhibiting many symptoms of Borderline Personality Disorder as well. Both of her bio-parents had been identified as Bi-Polar, so the genetic factor of that couldn't be ruled out either, since so many of the symptoms among some of these diagnoses overlap. There are several very good support groups on facebook with many people sharing very similar stories, that are sad and frightening in their familiarity. I think RAD is one piece of the puzzle, but regardless of the diagnosis itself, there are many, many children (and parents trying to help them) out there that are exhibiting dangerous symptoms. Self-harm, running away, threats, abusive toward caregivers...the list goes on and on. In many cases, the children have learned how to manipulate the system, because really, who doesn't want to believe a child? Sadly, many of them have learned manipulative tactics to get what they want, and because they lack the attachment bonds, they also lack a basis for conscience. Some have happy endings, but they are in the minority from what I can see.

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    1. Of course you are right that there are quite a number of children, adopted and non-adopted, who present very concerning behaviors, dangerous to themselves and to others, and they and their families need effective support from their communities. I am far from saying that these cases don't exist!

      My concern is that if those problems are equated with RAD, it's all too easy for families to be attracted to various problematic methods that are claimed to treat attachment, and to do this somehow in ways that work on the child alone and do little for the parents. At a meeting I attended this morning, someone said it very well: "our patient is the relationship" between parent and child. Yet people who work effectively on those relationships (as Iin CPP or PCIT) don't say they are doing "attachment therapy"-- they are dealing with all aspects of relationships, which change with time and development. The concepts of RAD and of "attachment therapy" have become popularized and garbled so that many troubled families regard them as identical with all the other problems you mentioned and with their treatments. They accept the idea that all mental health issues are basically about attachment-- e.g. your statement that attachment is necessary for conscience-- and this is not necessarily correct. They also accept the ideas that an aspect of emotional development that normally occurs in the first year or two can be artificially produced later, and that disobedience or aloofness means that the child is "not attached". Contradicting those assumptions,I'd call attention to the early kibbutzniks of Israel, who were brought up in "baby houses", often by uninterested adults, and commonly left alone at night-- all factors likely to interfere with attachment, yet these were people with no unusual mental health issues or lack of conscience-- a natural experiment with a lot of relevance for the connections between attachment and socialization.

      A focus on the other conditions you mention might be very helpful for families with seriously troubled children.

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    2. Is there a secure link to the kibbutznik reared children concerning attachment? I would be very interested to read it. I agree with you about all individuals needing to be involved in order for attachment therapy to work. I don't have personal experience with it, but it makes sense in light of what I know about attachment. I would be interested to learn how the kibbutz system differs from our foster system, in terms of the attachment environment. We can probably all agree that the foster system in the United States is completely broken.

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    3. The Wikipedia page on the kibbutz movement gives some information in the child-rearing section and also gives some references.

      Yes, certainly I think it's agreed that the foster system is broken, and broken in more than one way. In my opinion one of the problems is the series of fads we've been through, from "reunification at all
      costs" in the '80s to Safe Families (again at all costs) more recently. Until people are trained to treat different cases differently,and to decide how reunification could be brought about,or whether it can't, I don't see how the system can be corrected. But Philadelphia and some other cities now have SAMHSA money for 5-year projects in providing evidence-based treatment to help reunification, so I have some hope for the future.

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  7. Thank you for the information. I read some on the Wikipedia page, and it is quite interesting. Regarding attachment, however, there is mention that the children who were least likely to experience attachment issues were those whose biological mothers spent three hours each day with their children in the kibbutz. These children were likely able to attach because of the consistency, despite the addition of other caretakers. It also seems as though basic needs were met, and the children were not shifted from one environment to another, such as in the foster care system. I won't take the position that development of a conscience is impossible without attachment, but from what I've read it seems highly unlikely. Isn't a secure attachment necessary in order for an individual to be able to "move forward" and empathize with another? An attached child implies a meeting of basic needs; allowing such a child to care for another. Children whose basic needs haven't been met are forced to fend for themselves, and it would make sense that conscience development would be arrested in these cases.

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    1. I didn't mean to suggest that the kibbutz children had experiences anything like those in foster care, just that the kibbutz material shows personality development within the normal range with a set of experiences that are pretty different from the ones we usually think of as ideal. As to whether secure attachment is needed for development of empathy and conscience, this is still an open question.

      Here's the thing: it's by no means abnormal to have insecure attachment of one kind or another. About 35% of normally developing children have insecure attachments, and I can't believe that 35% of the population is without any capacity for empathy or for conscience, nor can I believe that all those children failed to get basic needs met! It's not yet completely clear to what extent temperament (for example, an innate tendency to avoid new experiences) affects insecurity of attachment.

      The period during which attachment is developing is between 6 and 18 months, and children who don't get their basic needs met then are not capable of fending for themselves, however much they are forced. This makes me think that it's a big logical jump from failure to have needs met to lack of conscience.

      In my opinion, the big attachment problem that's related to early experience is disorganized attachment.It's much less common than the insecure kind and is related to the caregiver's fearfulness and past experience of traumatic relationships. If a child whose experiences with caregivers have created disorganized attachment stays with the same caregiver (who behaves very strangely, even acts afraid of the child sometimes), it would not be surprising if the child did not have experiences that supported development of empathy.

      When young children (or actually,most people) see someone else hurt, they may respond with caregiving, or they may get angry,laugh, or attack the hurt person. How do they become more likely to respond with care? It seems to have to do with whether others respond with care to the child's troubles, over time. Presumably children whose caregivers respond nurturingly to a problem are also children whose caregivers have fostered attachment-- so it could just be "good things go together" rather than attachment causing empathy.

      You might like to read some of the work of Grace Kochanska exploring how different parental patterns seem to work differently to produce conscience in different children.

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  8. There seems to be a lot of splitting hairs in the name of a sort of uber-correct clinical pathology definitions that are always changing, anyway depending on what wind is blowing. The fact of the matter is that attachment issues/disorder is a real thing with broad features, symptoms, behaviors and difficult often to define. You do protest too much and lose sight of the bigger picture -- Now, I haven't seen "Boarder" but conceptually, I completely "get it" and it behooves all clinicians and parents to not get bogged down with "what is RAD, exactly"?.
    I am impressed that someone made their experience into a film, if for any reason other than to learn that I am not alone in my process of raising an "attach challenged" (or whatever) child and that parents need not feel they got the clinical language down before they move ahead, especially with the most recalcitrant cases of RAD. BTW, the DSM is not the Bible and is often a blunt instrument convenient for third party payment.

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    1. If you want to talk about something as general as "attachment issues", fine-- I'm just suggesting that it is not helpful to use an "official" term if you're not talking about the problem as it is "officially" defined. If I have a bad headache, I need help, but it won't be useful for me to say I have chickenpox.

      The problem with re-defining RAD ad lib is that this action confuses many matters by making people think that information about RAD of necessity applies to the "attachment issue" they're working with.

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  9. Hi Jean, First, just for consistency, I am the first Anonymous poster on this thread; the second is a different person. I found this thread again, because I just watched The Boarder last night, and it reminded me of our discussion.

    I don't have statistics to demonstrate a rise/increase of people with attachment/empathy issues, but there are many, many stories of torture (of animals, people, children, and the ongoing saga of the CIA colluding with psychologists to allow torture of suspects) We are still recovering from the devastating affects of the subprime meltdown, which was planned deliberately to allow investors to maximize profit, then use tax payer money to bail them out and give CEOs their golden parachutes. These are just some of the cases, and they involve millions of people, not just isolated cases. I would argue that all of these perpetrators lack empathy, and are all sociopaths.

    I agree with you that in order for children to respond with care/empathy to others, that those children must first have others respond to them. However, I would classify this as a basic need. The need would not have to be met by a parent or even a biological parent, but if would have to be met my someone. (If you're familiar with Alice Miller, her theories are in line with this idea)

    I am now convinced that the only method that is successful in the long run with these children is the "mirroring" or "reflecting" technique when children are dysregulated.

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    1. I certainly agree that experiencing empathy is the best foundation for later feeling it, and that feeling empathy helps people treat others well.

      However, I am not sure what is the relationship of other things you say to the original problem about RAD, its nature, and its causes. Yes, there are plenty of people who behave hideously toward others-- but has this not always been the case? Are not cruelty and oppression just as "human" as empathy and kindness? Like our monkey relatives, we human beings seem to need limits set for us by the world, or we will often torment and destroy each other. I find it hard to accept that such behavior is more common than it once was, and even if that were the case I am not sure what the "moral" would be.

      I do not know exactly what a sociopath is, or how I would identify one. It seems to me that our identification of such people is simply a matter of seeing that they have done certain acts under certain circumstances. A soldier who shoots a group of people who have not offended him ,when ordered to do so ,is not a sociopath by most standards, but a civilian who does this may be called sociopathic. And a person who is completely lacking in empathy and would like to torture and kill others may never get the chance to do so-- is he not a sociopath because circumstances didn't allow him to do harm? I just don't find this a useful category, nor would I assume that cruel behaviors are necessarily indications of lack of empathy.

      I would certainly not assume that secure attachment, per se, was required for empathy to develop. As long as there is some organized form of attachment, and perhaps even when there is not, children have the capacity to learn about others' reactions and to respond to adult injunctions not to hurt others. This may take a lot longer than the early years of life and may involve cognitive development and theory of mind as well as the emotional response that seems basic to empathy.

      Curiously, some of the most important caregiving functions require people to "turn off" an empathic reaction in order to create a better future outcome. Parents can't decide not to take an injured child to the hospital because he's crying and scared of going, even though everything in them cries out not to cause any more distress. Medical practitioners often have to cause pain in order to start a healing process. Responsible people may need to be able to choose between an intuitive empathic reaction and a cold but helpful attitude. Not just feeling, but actually using, empathy is a complicated matter that takes into account the anger we sometimes feel when we have caused someone else distress.

      But, all these things to one side, I do not think I've followed all your argument. Why would the need of young humans for experiences of empathy mean that Reactive Attachment Disorder is characterized by intentionally cruel actions? I don't see the point, Alice Miller, "Boarder" et al aside, in using a diagnostic term to refer to behaviors that are not part of the symptom list.

      BTW, in your first message (if that's you), you said "who doesn't want to believe a child?". Well, many people who advocate the "Boarder" view of RAD don't want to. For instance, at the website of the Institute for Attachment and Development, in Colorado, there is a document to be signed by caregivers declaring whether a child has ever complained of abuse. If they have done so, any further complaints are seen as symptoms, not reality. Those guys don't want to believe children and they are not alone in this.

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  10. I should have clarified: All the anon posts are mine except the January post.

    Perhaps many of the "unofficial" symptoms of RAD cited by those who've lived with children diagnosed with it (like myself) are not official because they are difficult to measure in a diagnostic way. This does not mean that they don't exist. While I agree that spreading misinformation does not help anyone, I do believe that the people and families who care for children with RAD, and who experience the behaviors on a daily basis, are frequently ignored, dismissed, or simply not given real consideration. There are several support groups on Facebook that are overflowing with stories that are far too similar (even eerily so) to be a coincidence. And not just general behaviors; very specific behaviors like urinating in their bedrooms and spreading their feces on the wall. That's not in the DSM either, but it's rampant in these families struggling to help children.

    Please don't think I'm trying to categorize everyone who is diagnosed with RAD. Personally, I believe RAD is a manifestation of unresolved emotional reaction to past trauma. Further, I believe they need a genuine empathic response to THAT initial trauma for healing to occur, because they never received it at the time.

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    1. I don't really see why the behaviors you mention are difficult to measure-- aside from the famous "love of blood and gore", most of the behaviors ascribed to children with RAD on Facebook etc. are readily observable and even quantifiable,

      But what is the point of saying they are part of RAD? Challenging and frightening behaviors are listed as part of many childhood mental illnesses, although not as part of RAD. Why is it so difficult to think that the children you describe have more than one problem, caused in more than one way? Wouldn't it be more reasonable to speak of the children as having symptoms of RAD plus symptoms of other disorders, rather than trying to redefine RAD?

      Now, a couple of points I feel I must make:

      About the children described on Facebook-- who diagnosed them, and how did they do it? It's well-known that diagnosing RAD in children beyond preschool age is very difficult, and in fact there is no established protocol for doing it.
      Were the kids you speak of diagnosed as having RAD simply because they showed the "extra" symptoms? If so, you must see that this is rather a self-fulfilling prophecy.

      Second, I want to point out that people who join FB groups to talk about their problem children often have a very specific view of what can be wrong with children and how those wrong things are caused. They seek out others who agree with them. Some of the eery coincidences you mention may result from these people exchanging stories and interpretations of events, and even from the awful paper by Keith Reber that is still around. I know it's impossible to do this, but to be convinced about your claims I'd have to see reports from the people who don't go on Facebook and don't associate with other members of what is essentially a cult, but who are able to seek help from professionals who don't tell them how "awesome" they are.

      Finally, let me say one or two things about the urination and defecation business. As it happens, in the last two months I've been in contact with two young women who were diagnosed (mainly by their mothers) as having RAD and placed in residential treatment. One described to me how she was locked in her room at night and told to bang on the door if she needed the bathroom-- nobody came, and eventually she peed in the wastebasket as the best option. (And I'll bet that was considered a "symptom".) The other young woman described how she was refused permission to use the toilet for many hours at a time because she refused to "confess" that she had molested her younger brother (which she had not done). I would not claim that no child will eliminate inappropriately if not forced to, but I would suggest that less of the locking in rooms and ofinsistence on permission to use the toilet might well reduce the frequency of these events a good deal.

      When you say that you think RAD results from an unresolved trauma reaction, do you mean RAD as per DSM-5, or RAD as per FB group? And what are the ages of the kids you are thinking about? Also, can you say how there could be an empathic response to the initial trauma-- or do you mean an empathic response
      in the present to feelings related to the initial trauma?

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  11. Perhaps it wasn't intentional, but your comments regarding facebook groups sound dismissive and rather presumptious. I've been a member of two such support groups for over three years. I, like many other members, sought out these groups for support and a voice of sanity when there was none from the so called "experts." While it is true that some people post symtoms looking for advice, the majority from my observations join after getting a diagnosis. Most parents, myself included, were not seeking an online diagnosis but reassurance that we were not crazy, the behaviors were not typical, and our own feelings of guilt, sadness, anger, and exhaustion are shared by others. I cannot tell you how many posts I've read over the years with people posting their stories and the details are so similar they could have been scripted. Similar and specific behaviors that arise and frequently and the same age....even some of the exact words. My girl did not have the bathroom issues but watching The Boarder was enough to trigger my own flashbacks, palpitations etc because so many of the behaviors were the same. I do believe she killed her hamster by putting it in the washing machine. She had said repeatedly she didn't like its long hair and wanted a short haired one. She was ten at the time. Excessive lying, triangulation, cutting, acting like an angel in public and doing a 180 as soon as we were back home. A drawing pad with a picture of three graves and our names on them. Knives hidden under her bed. False allegations. Yes, all of these things happened long before facebook. I ended up in the emergency room with panic attacks and needed anxiety meds.

    They're looking for an empathic response to the initial trauma that was missing at the time. Empathizing with current emotions and crises I believe can eventually help them to heal more completely.

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    1. Actually, it was completely intentional that I dismissed some aspects of FB groups and various listserves that claim to involve RAD. While I would not for a moment deny that the children are very troubled, as the parents report, I do deny the capacity of these parents to do the difficult job of diagnosing RAD or even of choosing mental health professionals who are actually competent to do this.

      Looking at some of the FB groups just a few days ago, I noticed their links to diagnostic checklists that use exactly the behaviors you are describing and state that these are diagnostic of RAD. But the briefest comparison to the DSM-5 or even earlier criteria will show that those behaviors belong to other diagnoses and not to RAD. For that matter, the people responsible for those checklists (e.g., Elizabeth Randolph, Conrad Buening) stated that their diagnosis was not of RAD but of some other problem, "not yet" in DSM, that they called "attachment disorder".

      So, why am I insisting on the DSM version of what RAD is, and arguing against the term being applied to a completely different set of symptoms? The reason is that as long as people insist on calling symptoms "RAD" when they are caused by some other problem such as PTSD or depression, the chances are small that the child will get appropriate treatment. In addition, as long as people use the word "attachment" when discussing a child's problems, it will be likely that they will assume that "fixing attachment" will solve the problems. In fact, well-trained mental health professionals do not try to "fix" children's attachment, although they may treat or train parents to make them more capable of recognizing and responding to their children's attachment bids.

      By assuming that all children with certain behaviors experienced some attachment-related trauma, and that empathic responses are what is needed, you are missing the complexity of early development and of the multiple causes of both typical and atypical behaviors.

      I certainly agree that parents of severely-troubled children need much more support and attention than they usually get from conventional practitioners, but this does not mean that all those who are supportive are necessarily correct in what they say.

      I am curious about two things: 1) who diagnosed your child -- what kind of training did that person have? 2) what response are you trying to get from me?

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  12. My daughter was placed through the foster care system with us just prior to age of ten. She had been diagnosed before we met her, I believe at the age of six or therabouts. I don't know the person or anything about his/her credentials.
    I no longer have the paperwork because she ran away, refused to come home and demanded that the state rehome her into a friend's house and she got all her demands. The two year ordeal/process to achieve these goals lasted longer than the month she actually lived with them before running away and repeating the process.

    I'm not looking for a particular response from you.

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    1. This all sounds very difficult for you and everyone else, but it does seem a bit Q.E.D. on the diagnosis.

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  13. I just found your blog site and I am sure you have mentioned this in the past. What are you feelings about utero onset of RAD? I am watching Facebook pages explain how they adopt children at birth and that their RAD child had to experience trauma or genetic predispositions prior to placement. Any thoughts.

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    1. Attachment does not begin before birth in any form that we can measure, so Reactive Attachment Disorder could not begin before birth either. A troubled adopted child may have genetically-influenced predisposition to antisocial or other problematic behavior (which is a better topic to focus on than RAD and often popularly confused with RAD); nowadays, most children who are adopted become "available" because at least one of their parents behaves inappropriately--only a very few are adopted after socially-appropriate parents die of disease or injury. Disturbing behavior in the adopted child may thus occur, not because of RAD, but because of genetic factors.

      Many adopted children today have been through various care placements , themselves possibly traumatic, following traumatic experiences like domestic violence. When trauma has been at work, its effects are most likely to be seen following that kind of history. Individuals who are adopted in the first few months of life are not traumatized by separation from the birth mother because they have not yet developed an attachment to her, so unless the adoptive family has not maltreated them, any behavior problems they have cannot be attributed to trauma (although they may have genetic problems as mentioned earlier).

      We should keep in mind also that adoptive parents who expect adopted children to present problems or who do not have adequate parenting skills can cause difficult behavior in a child who did not come to them with a tendency to undesirable actions. This may (I'm speculating here) particularly be the case when parents have chosen to adopt an older child because they want to avoid "the mess" of infancy and toddlerhood.

      I hope you will read some of the posts on this blog that examine people's concepts about RAD and point to the differences between antisocial behavior and the signs and symptoms of RAD itself.

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