Pound Pup Legacy

For many years, on my own, I have been studying and researching Reactive Attachment Disorder.  This has been more hobby than work-related interest, as I really want to know what is being done to and for adoptees who have been abused by their parents and those closest to them.   In the course of my self-study, I have read and studied papers on neurobiology, to see how stress hormones affect the brain and it's development.  I have read and researched articles that studied pregnancy and how stress affects the growing fetus.  I have looked at published case studies of children labeled with RAD.  I have personally spent hours that could be measured in months discussing RAD issues with parents living with RAD children, adults experiencing RAD symptoms and behaviors, and adults wanting to get closer to those with an attachment disorder.  Last but not least, I have experienced therapy first-hand to learn just how little professionals in Attachment Therapy know about adoption issues and abuse post child placement.

I want to discuss why RAD behavior is so difficult to understand and manage, and why conformity to "normal behaviors" is not at all easy for those who have been manipulated, controlled and abused.

There are several different sub-types of Reactive Attachment Disorders. The ambivalent sub-type can be described as an "in-your-face" child. This is the child who is angry, oppositional, and who can be violent. The anxious sub-type is clingy, anxious, shows separation anxieties, among other symptoms. The avoidant sub-type is often overlooked. This child is very compliant, agreeable, and superficially engaging. This child often has a lack of depth to his emotions and functions as an "as-if" child; meaning that he tries to do and say what you want, but is not genuine, authentic, or real in emotional engagement.  http://www.psychnet-uk.com/dsm_iv/attachment_disorder.htm

I would have to disagree with the assumption that RAD has two or three types.  As one who experiences almost all the "symptoms" on all sides, this (and my own limited "research") tells me RAD is nothing more than a person's reactions to anxiety.  If one could stop and consider how change alters the developing brain, how stress and it's hormones alters ones senses and ability to learn, and how the behavior of others alters one's own behaviors, one could see how grief (mourning and loss) and anxiety (the fear of safety) relates to each and every behavior mentioned in the lists generated by attachment therapists.

I want to know why RAD is given such a poor prognosis given by para-professionals, when very little scientific study has been done to prove or disprove the origins of a child's maladaptive behaviors.  What is it in the brain that makes a RAD child (or adult) so different from all the other anxiety-related disorders already published?  What makes a RAD child so difficult to comfort and soothe and how can trust be learned for those who know little more than displacement, pain, trauma, and betrayal?

[The disorder information sheet from Psychnet-UK is really no different than any other RAD information sheet.  I choose to use it because it's clear and simple and easy to read for those wanting to learn more about what's being offered to those struggling with RAD.  I choose this page, too for others to see how differently an AP would read the information and how an adult who has been abused after being fostered/adopted would read the same exact information.]

Treatment:  Traditional 'talk' or 'play' therapies do not work with these children because such therapies depend upon the child's ability to develop a trusting relationship with the therapist. Children with Reactive Attachment Disorder are unable to form any genuine relationships. Therefore parenting must be very structured and very nurturing. Natural consequences, not lectures work best. If the child does not want to eat and you've put a meal in front of them which they will not eat, If the child complains and begins to ruin the mealtime, remove them from the table. The key is to not let such a child make everyone feel like she does. Such children are very good at externalizing their feelings and getting everyone else to feel as miserable as the child does.

Counseling and Psychotherapy [ See Therapy Section ]:  Many therapeutic methods are employed: re-parenting, role-playing, therapist-supervised parent holdings, modeling of behaviors, behavioral shaping, cognitive restructuring, Gestalt Therapy, family therapy and general psychotherapy. Effective therapy requires a team approach which must always include the child's parents.  http://www.psychnet-uk.com/dsm_iv/attachment_disorder.htm

I disagree children with RAD are unable to form any genuine relationships.  Without diagnostic proof (like fMRI brain scanning) showing a child's brain is incapable of learning, how can such a statement be made?  Perhaps this explains why so many adopted children are labeled as "autistic", or within the autism spectrum, by therapists "trained in the field of psycho-social development".  Because there are no studies done to test genetics or brain function, many are left to label a person based on behaviors that could be the result of something other than what's been determined.  For instance, how many would want to go to a doctor with fatigue, a fast heart rate, pain and poor coloring and be told, without testing, "you have sickle cell anemia, and this is what we're going to do...".  It just isn't done because medicine and science would kill people if other problems were not ruled out before a final diagnosis was made.  In similar fashion, how many would want to go to a doctor with fear and anxiety, and be told "you have an Attachment Disorder, and this is what we're going to do..."? 

In terms of therapy always including the parents, I wonder just how many read this assuming the parents are without a history of family dysfunction and it's only the child who needs to accept new re-parenting and new behaviors?  What if the new parents are causing stress and trauma for the one who does not feel loved or safe, does that make therapy with them safe?  I am always highly suspect of those who insist a child must change to please the parents.  Again, without thorough diagnostic testing, and proof that says, "Here's the problem", I can't see how one can determine - just by looking at a person, and asking a few questions - who is right, who is wrong, who can be trusted, and who poses the the most dangerous threat to others.  Most people may not want to admit this, but there are many parents/people in this world who may seem like they are loving, kind and patient in public, but completely different creatures once they are behind closed doors at home.  I think it's a huge disservice to children to assume all foster/adoptive parents who take a child to a therapist are doing so because they can recognize a problem and want to deal with it.   I think it's also very wrong to assume the person who was placed into a foster/adoptive family was a)  abused or neglected by first-family members and b) NOT abused, ignored or rejected by members of the replacement family.  If a child or adult seems to despise a parent, or hate all those who surround him, I believe one of the first questions that should be asked is: "What sort of behavior is each person displaying at home, and how could any of these behaviors trigger the emotions of the angry/troubled child?".  In other words, what is making the child react so badly to people who seem to be loving and attentive?  Does the child feel a threat that's being ignored?  If so, what can be done about it? 

For the sake of discussion, because I am NOT a certified trained RAD specialist.... I am merely a RN, a Stay-at-Home mom, and an adoptee with a quest for more insight and knowledge, if we changed the term Reactive Attachment Disorder, to "anxiety and mistrust of others", how would treatment therapies change?   Can someone who has been so badly hurt, (by those who should have been safe and loving), learn how to trust others enough to accept warmth, love and comfort?  If so, how can this be done safely without causing more hurt and injury?