tag:blogger.com,1999:blog-2743746633913926150.post3648682687324154261..comments2024-03-12T07:00:44.143-04:00Comments on CHILDMYTHS: Got RAD? DSM-V Rethinks the Diagnosis; Maybe You Should TooJean Mercerhttp://www.blogger.com/profile/14619393019771381980noreply@blogger.comBlogger55125tag:blogger.com,1999:blog-2743746633913926150.post-44093087877899886692017-09-03T21:55:15.026-04:002017-09-03T21:55:15.026-04:00This!
RAD is certainly a very real disorder but I...This! <br />RAD is certainly a very real disorder but I think that many might find it helpful to step back from the RAD diagnosis and consider other diagnoses that may more completely encapsulate the symptomology that the kiddo is presenting. <br /><br />I'm not a RAD parent but a cheerleader who wants the best for your families. ICarehttps://www.blogger.com/profile/09319834217569770608noreply@blogger.comtag:blogger.com,1999:blog-2743746633913926150.post-57906623725020544082016-01-11T09:51:45.206-05:002016-01-11T09:51:45.206-05:00I think there is a considerable difference between...I think there is a considerable difference between the concerns you express and the ones I have. I am worried about the experiences the children have and their long-term effects, while you are worried about how the parents feel. In addition, we seem to have different views of what courteous discourse is.Jean Mercerhttps://www.blogger.com/profile/14619393019771381980noreply@blogger.comtag:blogger.com,1999:blog-2743746633913926150.post-218881000642606652016-01-11T04:15:21.194-05:002016-01-11T04:15:21.194-05:00If your problem is with RAD therapy then bash it a...If your problem is with RAD therapy then bash it all you want but quit attacking parents of children with severe disabilities and making ignorant assumption after insulting assumption about our motivations. Why anyone would answer your intrusive and rude questions is beyond me. Frankly, you are just a nobody looking for your niche and doing it in a way that suggests you yourself have a problem with empathy. Nemesishttps://www.blogger.com/profile/17250753848404030518noreply@blogger.comtag:blogger.com,1999:blog-2743746633913926150.post-54742238860497776022015-11-16T11:31:28.352-05:002015-11-16T11:31:28.352-05:00Ladies, no one is contradicting your stories about...Ladies, no one is contradicting your stories about what the children. Why is it so important to you that these problems be called Reactive Attachment Disorder, when the symptoms of RAD are quite different? I am suggesting that there are existing diagnoses that describe the kinds of behavior you are talking about. These include conduct disorders, early-onset schizophrenia, PTSD, ODD, etc. Why not use these diagnoses, whose symptoms can include the things you are talking about? Is it because saying "RAD" allows you to seek "attachment therapy" as advocated by persons like Nancy Thomas?<br /><br />BTW, none of the possible diagnoses have anything to do with assigning blame or fault to anyone. Jean Mercerhttps://www.blogger.com/profile/14619393019771381980noreply@blogger.comtag:blogger.com,1999:blog-2743746633913926150.post-88064691162501593102015-11-16T10:40:51.122-05:002015-11-16T10:40:51.122-05:00I agree 100% My husband was awarded custody of his...I agree 100% My husband was awarded custody of his daughter. A local dcf therapist thought she had RAD. The next 3 years of our life was a nightmare. At the age of 7 she molested and threatened 3 children. She killed our family cat by snapping his neck (because the cat was annoying her) she threatened to kill our son who was 3 months old numerous times and was caught smothering him. Not to mention the lies about our family and friends. My husbands best friend molesting her, myself starving her, her father beating her, her teacher hitting her. This child laughed when she was caught in the lie because of how "stupid" we are.... and this is just the jist! We have NEVER harmed this child in any way shape or form!!!!! And the more therapy she is getting with all different kinds of specialist they are all believing she was never abused by her bio mother. She even stated she didn't like her real mom because she spanked her once when she stole her money and threw it away to see what would happen and she didn't like her because she didn't let her eat when she wanted too. So tell me Jean, what classification is this child?!? Attachment issues are clear but tell me, what have we done to her for her to violate our whole family so viciously? I guess I should have gave her extra cookies..........right? Oh and one last thing, the first 3 councelors she had diagnosed her with ptsd...well until the last one finally figured out she was being manipulated and caught her in a lie because she was actually paying attention! This child is now 10 and we have no life, no support system, and our home is so hostile because of all the games she plays. In counceling she would make up horrific stories about her bio mom selling her for drugs where she was repeatedly raped...yes at age 9 this started. This girl was never raped and drs proved that. When the councelor explained rape (penetration) she went on about yes it happened and how awful it is. The next session the councelor showed her the papers proving that never happened and the child smile and said well I must of had it mixed up with a movie I seen, but either way my real mom was horrible. hmmmmmmmm oh and her real mom is now dead, she commited suicide after her daughter was taken from her and in the note she left behind was a chilling tale of everything she went threw with the child.....and how she was the blame and stated maybe I just believed her too much, maybe I should have got her help sooner. So jean, clearly you haven't had enough experience because a LOT of families I now work with experience the same issues (not as bad most of the time thank GOD) but these parents are loving and amazing people. Thank you again for placing blame on parents who have children that are out of control and dangerous. I have ptsd from the trauma she put me and my family threw and so does her father....thank you for re interating into the minds of terrified parents that yes, this is your fault......Anonymoushttps://www.blogger.com/profile/09589163955796337405noreply@blogger.comtag:blogger.com,1999:blog-2743746633913926150.post-67314695955876012782013-11-25T16:57:40.072-05:002013-11-25T16:57:40.072-05:00Your point is so well taken-- that the RAD diagno...Your point is so well taken-- that the RAD diagnosis can be desirable as a way to place or deflect blame, and to suggest that the life adjustments you mention are not needed-- even though it's obvious that if you give birth, your life will have to change to fit with that baby's needs, and we can surely extrapolate from that to the needs of an adopted child.<br /><br />I would be very interested to hear specifics about the advice you received and the damage you felt the related attitudes did.Jean Mercerhttps://www.blogger.com/profile/14619393019771381980noreply@blogger.comtag:blogger.com,1999:blog-2743746633913926150.post-84881986835449572852013-11-24T08:28:11.565-05:002013-11-24T08:28:11.565-05:00Wow...reading through these comments remind me why...Wow...reading through these comments remind me why I don't do support groups. I am in the care of 3 rad children. Took me a year to undo the damage the "attachment therapy" and RADish advice. One child isn't aggressive and so is not considered RAD even though meets all criteria more so than other 2. One meets all criteria of severe narcissist personality disorder but due to aggression is diagnosed RAD. People seem to want to diagnose RAD as "so out of control that my parenting is above question". It is dangerous what message we are sending to our kids and and caregivers. I adjusted my life to work with these kids and we are all healing. I don't take a thief to the mall, engage in a rage, publicly humiliate, play the blame game. I limit their world to what they can handle and slowly work on emotion control. Its hard. i believe this RAD label is encouraging child abuse. Anonymoushttps://www.blogger.com/profile/05042694757910238001noreply@blogger.comtag:blogger.com,1999:blog-2743746633913926150.post-82276131474778497762013-09-26T08:30:45.113-04:002013-09-26T08:30:45.113-04:00Thanks for this very detailed description of your ...Thanks for this very detailed description of your therapy experiences. I think your comments on disengaging when you don't understand the signals or don't know what to do are right on the money for many adoptive parents and quite a few birth parents too.<br /><br />I'm sure you're tired of writing about this, but I do still wonder about the way you think your son felt about PCIT. It sounds as if your theory about this is the same as what Attachment Therapists suggest-- that the child is frightened or made uncomfortable by feeling close even when it also feels pleasant. I wonder whether there are other reasons for any post-therapy problems-- maybe, fatigue for him and for you?<br /><br />It does seem very beneficial to have the time to talk things over with your therapist, and as you say this is not often included in conventional treatment, so I think parents come to feel somehow in competition or conflict with the therapist.Jean Mercerhttps://www.blogger.com/profile/14619393019771381980noreply@blogger.comtag:blogger.com,1999:blog-2743746633913926150.post-19534373089206711002013-09-25T20:20:12.214-04:002013-09-25T20:20:12.214-04:00It didn't seem like it so much to me because I...It didn't seem like it so much to me because I loved having the chance to actually play with my son. He normally never wanted to be with me. I think my son thought it seemed like forced bonding because he had never had the intense attention that was so focused on him before that. The reflections, the labeled praise, etc. was something that he seemed to enjoy, but he would have extreme behaviors after the sessions. It was completely overwhelming to him to have such a focus on him. Part of him would eat it up and part of him wanted to run as far as possible away from such closeness and one on one time. I think it felt good inside and he'd never felt that before. I think it scared the heck out of him. We did this therapy for several months until we decided that it was just not helping. The forced part was somewhat because we had never required him to participate if he didn't want to, and he frequently didn't want to. With PCIT, if he wanted to use the special toys that were saved for the playtime, he had to be with us. Way too much closeness and happiness for a miserable child. <br /><br />Something our in home therapists are doing is lots of family activities but he is not required to participate if he doesn't want to. They push him sometimes, but if he is really feeling overwhelmed, they stop whatever we're doing and we change activities so as to not push him too hard. One nice thing is that the therapists have helped us identify definite physical movements and voice changes that indicate high stress levels for him. If he is pushed too hard he gets suicidal and self harms. Taking it slowly has been a great method. The difference between what we were doing on our own with trying to bond with him through normal family activitites versus what we are doing now, is that we would interact with him, but if he got aggressive, had a tantrum, withdrew, etc. we didn't know how to re-engage him without making it worse. If we tried to cajole him to participate it would just turn into an epic meltdown. So we frequently just dis-engaged ourselves because we didn't want/know how to handle him in the right way. With the in home family therapy, the therapists have gotten to see him as he really is at home, including him having a major tantrum with self harming behaviors, something his previous therapist of nearly 2 years never saw. He went to her office, they talked/played without either of us parents in there, and after about the first 6 or 7 months our son stopped progressing and his behaviors/mood remained stalled with no emotional growth or improvement in self soothing or anything. With the in home services, we get to see techniques modeled by the therapists, we get private therapy time with the therapists to ask questions and go over "paperwork" type learning. Parenting my son takes techniques that do not come natural to us, but we are learning. It is so very different than parenting our daughter, who is also a foster child but has been with us since birth and had no major traumatic experiences. She is actually developmentally advanced according to all training on child development we have been getting through our son's therapists. It is validating to know that we CAN be adequate parents but our son just needs us to parent differently than our daughter. We felt like completely abysmal parents for so long before finally getting the right help for our family. Sorry if this was rambling, I just am so grateful for our current therapists help that I could go on and on forever about it.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-2743746633913926150.post-87545140132991085012013-09-25T10:05:13.024-04:002013-09-25T10:05:13.024-04:00Sorry, I see that you didn't just want a RAD d...Sorry, I see that you didn't just want a RAD diagnosis-- but I was trying to talk about diagnoses in general. <br /><br />I am really curious about two things that you say here, and I hope you can take a few minutes to tell me about them. One is, in what way did PCIT seem like "forced bonding" to you? Second, what kinds of things does your in-home therapist do? <br /><br />I have never heard anyone say that about PCIT and would just like to understand your experience.Jean Mercerhttps://www.blogger.com/profile/14619393019771381980noreply@blogger.comtag:blogger.com,1999:blog-2743746633913926150.post-45126460579100593942013-09-24T21:56:53.961-04:002013-09-24T21:56:53.961-04:00Nowhere did I say I wanted a RAD diagnosis. I no ...Nowhere did I say I wanted a RAD diagnosis. I no longer care what they call it, I just want help. And he IS getting better with our in-home therapists and psychiatrist working together with us to help him. If there was a way to give one name to a disorder in which all of those criteria were under the same umbrella, that would be easier, in my opinion, for my son's case. Not so much of the multiple diagnoses and difficulty in getting the correct diagnosis and treatment due to overlapping symptoms/criteria. Either way, not every treatment works for different people with the same disorder, so we would probably still be where we are now.<br /><br />It is interesting to me that you mention PCIT therapy, as 14 months ago when he had just barely turned 5, we participated in a research study done by one of our local universities on the efficacy of PCIT with foster children, which my son was at the time. We had several months of participating in this therapy and it actually made things worse. I believe that is because the "special play time" was akin to forced bonding/attachment and he was not ready for it. But I could totally be wrong. I just know that it was not helpful for him. It was somewhat helpful for us as his parents because we did get reinforcement on how to appropriately respond to physical attacks. The therapy we are currently participating in has been enormously helpful and I am grateful for finally finding something that is helping us and him.<br /><br />The SuperNanny comments from the first psychiatrist made my jaw hit the floor. We continued to see him for 2 months while we transitioned to the new program we are with currently, simply so we could continue to monitor and medicate his ADHD. As well as it was not our choice on who to see for provider at that time as he was still a foster child.<br /><br />We have Medicaid for him. We have been told they won't authorize payment for our specific in home services if they try to send it through as a RAD dx. He does have anxiety. He does have ADHD. They can get authorization simply using those so that's what they send through. They just tell me that they feel he has RAD because they want me to have a diagnosis that encapsulates more of a "whole picture" I think. I told them not to worry about telling me the dx anymore as I am simply frustrated by any changes, etc. Just look at my boy and then tell the insurance what is honestly wrong with him in a way that will get them to pay for it. If they pay for anxiety treatment, great! Call it anxiety. If they pay for ADHD treatment, great! Call it ADHD. So long as the treatment you give him is the same, I don't care.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-2743746633913926150.post-45685384633077340522013-09-23T08:03:22.540-04:002013-09-23T08:03:22.540-04:00Dear Anon--
If everyone agrees on the problematic...Dear Anon--<br /><br />If everyone agrees on the problematic symptoms the child shows, I don't understand why a specific name that covers all bases is needed. You have some diagnostic categories that an insurer will reimburse for, and any treatment you seek should focus on the symptoms that worry everyone. The only reason I can think of that you want a RAD, or RAD plus, diagnosis is that you want a therapist who claims to treat attachment disorders, and I would suspect that your insurer does not fail to pay for treatment of RAD, but does refuse to cover "attachment therapy", an implausible, non-evidence-based treatment.<br /><br />No diagnostic category describes the reality of a unique human being, and that is not their purpose. But unfortunately we have worked ourselves into a situation where insurance and diagnostic categories are inextricably intertwined, so instead of just listing a child's problems we have to choose the item on the menu that's closest to the set of issues.<br /><br />If you are really ready to think how changes in yourself might help your son, I would suggest that you seek Parent-Child Interaction Therapy, a treatment that focuses on modulating ways that parents respond to children, with the goal of making parents more appropriately responsive and children more cooperative. You don't say how old your son is, but PCIT was developed to work with preschoolers and early school-age children.<br /><br />I can't for the life of me see how "watching SuperNanny" would be helpful to anyone!<br /><br />I am very curious as to which insurance company you have. I'd like to look up their policy about payment for RAD treatment. Jean Mercerhttps://www.blogger.com/profile/14619393019771381980noreply@blogger.comtag:blogger.com,1999:blog-2743746633913926150.post-8658291618525820972013-09-22T18:50:37.160-04:002013-09-22T18:50:37.160-04:00I was hoping that DSM-V would have a more inclusiv...I was hoping that DSM-V would have a more inclusive definition to fit the profile of a child who is unable to regulate their emotions, full of anxiety, fear, and anger, is often hyperactive and unable to focus, has great difficulty accepting parental authority, has difficulty with transitions, is unable to handle emotional vulnerability, etc. These behaviors tend to cluster together and the DSM does not account for this. What I often see is they end up with multiple diagnosis. Often each provider (therapist, day treatment provider, psychological evaluation, psychiatrist, and residential providers as they are often in and out of residential placements) will make a different primary diagnosis. Some say RAD, some say PTSD, some say bipolar, etc etc (usually all of them will diagnosis ADHD in addition to other diagnoses) The DSM it is still so primitive in my opinion that it often confuses more than it helps. <br /><br />This is exactly what we are going through with our adopted son. His therapist said RAD. The Department of Children and Families requested a psych eval from a psychologist who said that although he could tell there was something else going on, his ADHD was too intense to figure it out. Said that we needed to medicate the ADHD before we could look deeper. Psychiatrist insisted it was just ADHD and recommended we watch SuperNanny as that was all he needed. His pediatrician thought he had conduct disorder. We were referred to in-home services at which point we got a new therapist, psychologist, and psychiatrist. The psychologist that came out dx'd as ODD and a mood disorder. The therapist that came out felt that the problem was rooted in attachment. The new psychiatrist dx'd ADHD, ODD, and an anxiety disorder. The psychologist and therapist have now decided he does have RAD but that our insurance won't pay for that so they have to tell insurance things like ADHD, mood disorders, etc. I have finally told them all to stop telling me what they think he has. Tell the insurance. Just tell me what to do and how to change myself so that I can better help him. It would be great if there was a diagnosis that encompassed everything in the paragraph I quoted from Kathy Levenston, because my son has every single one of those problems.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-2743746633913926150.post-10593784147784576082013-09-16T11:15:39.431-04:002013-09-16T11:15:39.431-04:00Your comments make a lot of sense! There are some ...Your comments make a lot of sense! There are some interesting relevant letters to the editor in the NY Times this morning, commenting on an op-ed by Eric Kandel and discussing the problems of describing even so common a symptom as depression. It sometimes seems that we're still at the natural history, descriptive stage of studying mental illness-- but the advantage of a scientific approach is its stress on public communication and sharing of information, rather than having some individual declare that because they have seen ten cases of something, there must be thousands just like that. <br /><br />You may be right that people were drawn to the AD idea because there were no legitimate alternatives-- but I think there was also an element of following the guru, especially in the 1970s when the whole mess seems to have begun.<br /><br />I certainly agree that there's a problem when people are looking for the "right fix", but how we can help them be comfortable with a more general approach-- that I don't know. It's probably a lot easier to do for parents of infants and toddlers than for parents of older children.<br /><br />Anyway, my thanks for your thoughtful contributions to this discussion!Jean Mercerhttps://www.blogger.com/profile/14619393019771381980noreply@blogger.comtag:blogger.com,1999:blog-2743746633913926150.post-1318125537960067342013-09-15T23:12:26.524-04:002013-09-15T23:12:26.524-04:00I don't see it as an either or. At times it is...I don't see it as an either or. At times it is very helpful to be specific and concrete, and to focus on a single behavior. But when children have complex and extreme behaviors resulting from past trauma and loss, it is usually very important for the family (whether adoptive, foster or birth family) to have a concept of the child's problems that makes some sense of the whole picture. This helps them to understand the anxiety driving many of the behaviors, and to empathize with the child, rather than try to control them with anger, shame, escalation, punishment, ultimatums, and threats of abandonment, as the most well-meaning and loving adults tend to do when faced with a child who frightens, disrespects, and often seems to reject them. One problem I see with multiple and changing diagnoses is that families and sometimes even providers start to get very confused and we start to think that if we can just find the "right" diagnosis or set of diagnoses we will get the right kind of treatment and be able to "fix" the child. We can lose sight of the bigger picture of a child in need of unconditonal safety, unconditional love, and enormous patience, as well as what parents do have full control over, which is working on themselves and how they relate to their child. I understand how the idea of "attachment disorder" got started, and I think part of the reason it became so cultish and dangerous is because the research community was not (and is still not) really providing an alternative paradigm. So a lot of people who worked or lived with these children were drawn to the fringe. Anyway, I am not a scientist, these are just my observations as a practitioner. I am guessing that the idea of a developmental trauma disorder is elusive and hard to tease out, thus the failure to find enough evidence to support inclusion in the DSM 5. At our agency we work with people who have all sorts of relationship and mental health issues, but personally my focus has always been the children who have suffered from these very difficult circumstances. Therefore, I am grateful for the work you are doing, as I think you are cautioning people to be skeptical, to rely on science rather than the compelling story or anecdote, and above all to strive to do no harm. Anonymoushttps://www.blogger.com/profile/03713264270114847285noreply@blogger.comtag:blogger.com,1999:blog-2743746633913926150.post-56947061187259313772013-09-15T11:39:34.928-04:002013-09-15T11:39:34.928-04:00Are you suggesting that a treatment should focus o...Are you suggesting that a treatment should focus on the posited "inner problem" behind the various behaviors? My opinion is that if we can safely and effectively address any of the separate behaviors, we're way ahead. For example, I've just been reading a report on an 8-year-old boy who freaks out at bedtime. The evaluator has a lot to say about his inner pillar of confidence or something like that. Why not start by addressing the bedtime situation and seeing if that can't be eased for everybody?<br /><br />If you have an effective intervention that has been shown to work on everything at once, that's great. Otherwise, I'd go with a step-by-step approach and hope that each improvement will foster others. Michael Linden has recently written about the emotional burden clients may feel while in treatment, and if a gradual approach helps with that, I see it as all to the good.<br /><br />But you're certainly right that either the DSM or some alternative diagnostic concept will influence how clients are approached... as do all assumptions about how a problem was caused. Jean Mercerhttps://www.blogger.com/profile/14619393019771381980noreply@blogger.comtag:blogger.com,1999:blog-2743746633913926150.post-60215564027534608862013-09-15T11:31:31.241-04:002013-09-15T11:31:31.241-04:00I think your points about diagnostic categories ar...I think your points about diagnostic categories are very well taken, but I would go farther and say that a child's diagnosis needs to be in context. When you say that a child is fearful, what are his or her daily experiences like? Are caregivers able to detect cues about fearfulness and help before it becomes overwhelming to the child? And-- when you say the child has great difficulty accepting parental authority, how is that authority expressed? Are the parents too frightened by the child or by their own impulses to be able to exert authority effectively? What is the nature of the transitions that are hard to handle?<br /><br />Similarly, when it comes to treatment for the child, is there parallel treatment and guidance for parents?<br /><br />I agree that DSM leaves much to be desired, and with respect to children it is especially lacking in developmental concepts and makes few efforts to deal with the meaning of a behavior at different ages. In my earlier post, I didn't mean to say "DSM is great"; I am just concerned about the tendency to invent new diagnoses that go through periods of being the latest thing and then lose traction, without ever being supported by serious investigation. People like Elizabeth Randolph have declared the existence of a problem that is not RAD, but just Attachment Disorder; Randolph has stated that she can diagnose AD because the children cannot crawl backward on command! I believe that bad as it is, DSM has the edge over that kind of thing. <br /><br />Can you explain to me why you think it would be good to have a single diagnostic category for the children you describe? I don't see why, given that categories are to be used, multiple categories are not satisfactory.Jean Mercerhttps://www.blogger.com/profile/14619393019771381980noreply@blogger.comtag:blogger.com,1999:blog-2743746633913926150.post-58110207425407575102013-09-15T11:16:58.691-04:002013-09-15T11:16:58.691-04:00Also I should add that in our program we measure o...Also I should add that in our program we measure outcomes using a global measure of functioning (the Outcome Rating Scale), which is particularly helpful when you have multiple interconnected issues that you are addressing. My concern is that the DSM affects the way that we treat clients by affecting the way we conceptualize their issues. Treating each behavior problem separately with specific targeted interventions is not always the best strategy. Anonymoushttps://www.blogger.com/profile/03713264270114847285noreply@blogger.comtag:blogger.com,1999:blog-2743746633913926150.post-5465567139912526122013-09-15T11:00:32.176-04:002013-09-15T11:00:32.176-04:00Sorry for not being clear-I mean working with many...Sorry for not being clear-I mean working with many children over the years who have been neglected, abused, passed around, and traumatized since birth, many of whom exhibit constellations of behavioral problems that cannot be captured very well with current DSM categories. In order to capture a reasonably full description using the DSM you often end up diagnosing several conditions. This I think is the reason why the RAD diagnosis has accrued so many characteristics in general use that are not actually contained in the DSM. I was hoping that DSM-V would have a more inclusive definition to fit the profile of a child who is unable to regulate their emotions, full of anxiety, fear, and anger, is often hyperactive and unable to focus, has great difficulty accepting parental authority, has difficulty with transitions, is unable to handle emotional vulnerability, etc. These behaviors tend to cluster together and the DSM does not account for this. What I often see is they end up with multiple diagnosis. Often each provider (therapist, day treatment provider, psychological evaluation, psychiatrist, and residential providers as they are often in and out of residential placements) will make a different primary diagnosis. Some say RAD, some say PTSD, some say bipolar, etc etc (usually all of them will diagnosis ADHD in addition to other diagnoses) The DSM it is still so primitive in my opinion that it often confuses more than it helps. Anonymoushttps://www.blogger.com/profile/03713264270114847285noreply@blogger.comtag:blogger.com,1999:blog-2743746633913926150.post-63233660489628370642013-09-14T16:17:47.524-04:002013-09-14T16:17:47.524-04:00I don't think that's the "whole probl...I don't think that's the "whole problem" although I certainly agree that it's a problem to have to put square people into round categories in ways that are useful mainly because both public and private insurers demand them. For example, as I understand it, PDDs were invented because various insurers would not pay for autism treatment.<br /><br />However, my reasons for saying that therapists are using fringe methods has to do with two things: the plausibility of their methods in terms of well-established evidence about child development (i.e., the assumptions of these methods are not congruent with known characteristics of children's developmental paths), and the absence of well-designed research showing that the treatments are effective.<br /><br />That last part is intertwined with peculiarities of diagnosis, because it cannot be very clear whether a treatment has ameliorated a problem when the problem hasn't been stated in a way everyone can understand. For instance, when people conflate attachment with aggressive behavior, and say that if they've reduced aggression they must have increased attachment, this will be meaningless to anyone who follows conventional diagnostic methods in describing outcomes.<br /><br />How would you describe "these kids", by the way? Can you say what they have in common, without using any conventional or unconventional diagnostic categories? It's rather mysterious just to call them "these kids", and I would not want to swear that I know what problems you are trying to treat.Jean Mercerhttps://www.blogger.com/profile/14619393019771381980noreply@blogger.comtag:blogger.com,1999:blog-2743746633913926150.post-84210615501420745252013-09-13T22:28:51.259-04:002013-09-13T22:28:51.259-04:00The whole problem is pretending that the DSM refer...The whole problem is pretending that the DSM refers to something in the real world. Sure it is based on research, but the research is necessarily self-referential, as it presumes the categories that it creates. Reliability and validity are not the same thing. Anyway, there is no reason to believe that the therapists are using fringe methodologies just because they see the world a bit differently that you do. Those of us who work with and diagnose these kids every day know that the DSM-IV does not seem to be very helpful with this population, as evidenced by the alphabet soup of shifting diagnoses that we often see. Re the DSM-V I confess I have not read it yet but it sounds like it will be even less helpful. Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-2743746633913926150.post-59520592577205337422013-07-27T22:10:15.991-04:002013-07-27T22:10:15.991-04:00Thank you both for your advice. I'll read the ...Thank you both for your advice. I'll read the article proffered. <br /><br />Best wishes.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-2743746633913926150.post-8014120387026392372013-07-27T14:43:01.554-04:002013-07-27T14:43:01.554-04:00Thanks so much for commenting and "following&...Thanks so much for commenting and "following". You have said a mouthful when you say that "making everything an attachment issue reduces people's capacity for complex thought and thus problem-solving". My crystal ball tells me that in a few years we'll be making the same statement about developmental trauma, which is shaping as the next big thing.<br /><br />And thanks for the very nice RAD guidelines document. I hope people will read it. I do have one beef about it-- the inclusion of Reber's 1996 article in the references. I don't see it in any in-text citation (thank goodness), so it's unnecessary. But in addition I would classify that paper as the Typhoid Mary of child psychopathology -- appearing innocent itself, it spreads incorrect and potentially harmful staements, many of which were made up out of the whole cloth, whether by Reber or other Attachment Therapy proponents I don't know. Reber himself had to surrender his license because of his practices and at least briefly got licensed as a massage therapist, presumably because it allowed him to do the hands-on stuff.<br /><br />I've just come across some very interesting work related to ideas about attachment disorders, by the Australian social worker Sara McLean.I'm going to do a post about this in the near future, so I hope you'll "tune in".<br /><br />Best wishes to you also-- Jean Mercerhttps://www.blogger.com/profile/14619393019771381980noreply@blogger.comtag:blogger.com,1999:blog-2743746633913926150.post-42781477685532219852013-07-27T01:24:12.311-04:002013-07-27T01:24:12.311-04:00What a fascinating conversation between two commit...What a fascinating conversation between two committed and passionate women who care deeply for the well-being of children. <br />I've followed your work, Dr. Mercer, for years. I seem to hear some weariness in your "voice" after years of fighting the cottage-industry that's built up around RAD/AD. Our agency has long been concerned about the catch-all diagnosis of the popularized version of RAD. While many, if not most, children in care have significantly compromised attachment histories, making everything an attachment issue reduces people's capacity for complex thought and thus problem-solving. Case in point is this little girl the grandmother is so concerned for...by the clinical community reducing her problems to RAD, it limits a more complex view of what actually may be happening. As discouraging as it may seem...there is much more than just attachment issues going on with this girl...many complex and interacting layers that may take years to discover and work through. I would highly recommend http://www.pbhsolutions.org/pubdocs/upload/documents/radguidelines2009.pdf. It covers much of the RAD controversy and discusses alternative/co-occuring disorders and empirically supported treatment. Best of wishes to all who are seeking to help children heal in peaceful ways. Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-2743746633913926150.post-59286131326054408192013-07-26T07:21:44.089-04:002013-07-26T07:21:44.089-04:00Is a labotomy the surgical removal of a laboratory...Is a labotomy the surgical removal of a laboratory? As for lobotomies, I don't think anyone has ever thought they would cure intellectual disabilities.<br /><br />I am not at all sure what your unfortunate family situation has to do with my statement that aggressive behavior is not a symptom of RAD. A person is not the same as a diagnosis, and there are obviously people who have a range of problem behaviors. The fact that a person diagnosed with RAD is aggressive does not mean that the aggressiveness is a part of the RAD, only that it's a part of that person's behavior.<br /><br />If you have a list of little-known research work on RAD, I would appreciate being told what's on it.Jean Mercerhttps://www.blogger.com/profile/14619393019771381980noreply@blogger.com