where parents of kids with special needs connect
Reactive attachment disorder
My name is Emma and I am a mother of 4 children, 3 biological and 1 foster child, who is also my neice. We have had Lacey in our home since November 2003, and in that time we have had many state appointed psychiatrists and therapists. We have participated in parenting classes, behavoiral therapy both in office and in home, and tried countless avenues to get Lacey help. She came to us with the diagnosis of ADHD and PTSD, and each assigned psychiatrist had usually focused on one of them as the key issue and medicated as they sought necessary. We have never really seen an improvement in behavoirs and find ourselves now at the peak of all behavoirs. In August 2008 on the advice of her then therapist, we decided to seek an intense in home therapy due to self harming behavoirs. This was described as an intense and structured therapy designed to address the self harming behavoirs that were at an increasingly alarming rate. Twice a week the therapist came into our home, we were also assigned a psychiatrist(who immediately medicated with Yvanse (for ADHD) and Abilify(basic mood stabilizer for PTSD I am assuming), a case manager (she was a contact between the psychiatrist and the therapist), and we also had access to a family advocate.At that time based on my input through paperwork/info I filled out and conversations with each party involved.
The in home therapy began twice a week, monthly psychiatry appts(mainly medication management) and bi-monthly visits at the school or home with the case manager. After 9 months of in home therapy that consisted of board games(feeling and emotion based for the most part) and art(sometimes with a theme sometimes just free draw) we were told that we would be graduating out into a step down in- office therapy weekly with a new therapist in the same organization. I expressed my concern about the fact my daughter had not met the goals we had established and refused to sign the paperwork transferring the case to outpatient. The case was subsequently transferred in Sept 09 (this was following a graduation ceremony they gave my daughter complete with a cake, presents and a laminated certificate stating she had completed their program) to the in office therapist and we would remain with the assigned psychiatrist and loose the case manager and family advocate(not that she really did anything for us)
At this time I expressed my concerns to the psychiatrist about the "graduating" and transferring into a step down therapy without the goals being met(some behavoirs had actually increased from when we started the in home therapy) I also expressed concerns over her medications being inaffective and brought up that my daughter had all the symptoms of Reactive Attachment Disorder (RAD) and wanted her evaluated(this was brought up a year or two prior by a former therapist) The psychiatrist told me to bring it up with the therapist when we started seeing her in the next couple of weeks.
At our first office therapy visit I brought up RAD, she explained she was not all that familiar with it and would do some research. I also brought up my concerns about the in office therapy being one on one between my daughter and the therapist, and my objections to play therapy or art therapy. This was because my daughter is sooo classic RAD totally engaging with strangers and an unbelievable con artist. She also is unable to play a game or do art and conduct any sort of meaningful conversations. We agreed half the session would be talk and the second play or art therapy.
A month went by and my little con artist had communicated a total fabrication of an event to the therapist and at the end of the session(not knowing what had transpired) was asked to participate the following week. That day my daughter had a complete meltdown and told me all about the session.I quickly corrected and reminded her of the actual events in the incident and said we would discuss them with the therapist. I called the therapist and discussed the even with her and asked about her looking into RAD. She informed me it was not listed as her diagnosis and she couldn't treat her for it. I would have to talk to the psychiatrist to change her diagnosis. I explained that I did talk to her and she told me to discuss it with the therapist. She suggested I order a complete psych eval to change diagnosis, I made that request. Two weeks go by and I called to check the status of the eval request and she informed me that back when we discussed this she checked her file and it was in fact added as a diagnosis in September. I was fuming! Why didn't she call me two weeks ago when she found out? Why if the diagnosis was changed in September and we began seeing the therapist in October did she not have the current diagnosis before treating her? And why hadn't the psychiatrist told me or the therapist(whose office is 3 or 4 doors down from hers) Oh and the kicker----I am then informed they don't offer that therapy and medi cal probably wouldn't cover it.
I call my social worker here in CA and the one in AZ (she is a ward of the state of AZ so both states are involved-HUGE HEADACHE) get the numbers and begin calling. Access who has been assigning psychiatrists and therapists to us since 2003 basically tells me they have no specific providers for RAD(can't even do a search to see based on diagnosis) and they give me about 12 general numbers to call. None offer attachment therapy. Do my own research and find only 2 providers in our area. I contact both, neither accepts medi cal, but would be willing to contract with the state on an individual basis. Ca social worker states that it would be AZ that would have to do that, call AZ they tell me medi cal is through CA it's up to them.**(Neither social worker has ever really offered me programs, resources, or any beneficial avenues since they were assigned. We would go to them asking about certain programs we had found or had heard of and were told one of two things- she is not a ward of the state of CA you are not eligible, or you do not qualify because she has not been hospitalized or is not at risk of loosing placement.) Neither agency takes my private health insurance(we have her on out policy) but both give the option of contracting as a single provider through Aetna.
I start that process. I also call the laywer in AZ and ask him to go before the judge in the case to ask someone in either state pay for the therapy. The social worker in AZ is also exploring some options, this was I guess a unique request so the steps were unfamiliar to her and time consuming.
Aetna comes through, and approves therapy with the provider I found and preferred. We also found our own private psychiatrist(billed through our private insurance). I did let both AZ and CA know as I wasn't sure if I needed permission, worker in AZ said she never had a situation like this she would have to check, but it was beneficial to the child so she didn't see a problem.
Behavoirs at home in the past 6 months have reached an all time high, physical aggression towards the younger siblings (4 and 7), verbal manipulation, angry fits and tantrums, damaging property, self harming behavoirs(even resulting in trips to urgent care), and threats of I should just kill myself. Our household is consumed by this child 24/7 and we are scared of where these behavoirs are going as she is approaching puberty and teen years. There is also the affect that it is having on the other 3 children, and the behavoirs that are manafesting because of it.
We now have the diagnosis, an AWESOME committed and experienced therapist, a highly recommeded psychiatrist, and are desperately seeking the light at the end of the tunnel.
I am looking for support,resources,advice, and just a place where I don't feel alone in this.
The in home therapy began twice a week, monthly psychiatry appts(mainly medication management) and bi-monthly visits at the school or home with the case manager. After 9 months of in home therapy that consisted of board games(feeling and emotion based for the most part) and art(sometimes with a theme sometimes just free draw) we were told that we would be graduating out into a step down in- office therapy weekly with a new therapist in the same organization. I expressed my concern about the fact my daughter had not met the goals we had established and refused to sign the paperwork transferring the case to outpatient. The case was subsequently transferred in Sept 09 (this was following a graduation ceremony they gave my daughter complete with a cake, presents and a laminated certificate stating she had completed their program) to the in office therapist and we would remain with the assigned psychiatrist and loose the case manager and family advocate(not that she really did anything for us)
At this time I expressed my concerns to the psychiatrist about the "graduating" and transferring into a step down therapy without the goals being met(some behavoirs had actually increased from when we started the in home therapy) I also expressed concerns over her medications being inaffective and brought up that my daughter had all the symptoms of Reactive Attachment Disorder (RAD) and wanted her evaluated(this was brought up a year or two prior by a former therapist) The psychiatrist told me to bring it up with the therapist when we started seeing her in the next couple of weeks.
At our first office therapy visit I brought up RAD, she explained she was not all that familiar with it and would do some research. I also brought up my concerns about the in office therapy being one on one between my daughter and the therapist, and my objections to play therapy or art therapy. This was because my daughter is sooo classic RAD totally engaging with strangers and an unbelievable con artist. She also is unable to play a game or do art and conduct any sort of meaningful conversations. We agreed half the session would be talk and the second play or art therapy.
A month went by and my little con artist had communicated a total fabrication of an event to the therapist and at the end of the session(not knowing what had transpired) was asked to participate the following week. That day my daughter had a complete meltdown and told me all about the session.I quickly corrected and reminded her of the actual events in the incident and said we would discuss them with the therapist. I called the therapist and discussed the even with her and asked about her looking into RAD. She informed me it was not listed as her diagnosis and she couldn't treat her for it. I would have to talk to the psychiatrist to change her diagnosis. I explained that I did talk to her and she told me to discuss it with the therapist. She suggested I order a complete psych eval to change diagnosis, I made that request. Two weeks go by and I called to check the status of the eval request and she informed me that back when we discussed this she checked her file and it was in fact added as a diagnosis in September. I was fuming! Why didn't she call me two weeks ago when she found out? Why if the diagnosis was changed in September and we began seeing the therapist in October did she not have the current diagnosis before treating her? And why hadn't the psychiatrist told me or the therapist(whose office is 3 or 4 doors down from hers) Oh and the kicker----I am then informed they don't offer that therapy and medi cal probably wouldn't cover it.
I call my social worker here in CA and the one in AZ (she is a ward of the state of AZ so both states are involved-HUGE HEADACHE) get the numbers and begin calling. Access who has been assigning psychiatrists and therapists to us since 2003 basically tells me they have no specific providers for RAD(can't even do a search to see based on diagnosis) and they give me about 12 general numbers to call. None offer attachment therapy. Do my own research and find only 2 providers in our area. I contact both, neither accepts medi cal, but would be willing to contract with the state on an individual basis. Ca social worker states that it would be AZ that would have to do that, call AZ they tell me medi cal is through CA it's up to them.**(Neither social worker has ever really offered me programs, resources, or any beneficial avenues since they were assigned. We would go to them asking about certain programs we had found or had heard of and were told one of two things- she is not a ward of the state of CA you are not eligible, or you do not qualify because she has not been hospitalized or is not at risk of loosing placement.) Neither agency takes my private health insurance(we have her on out policy) but both give the option of contracting as a single provider through Aetna.
I start that process. I also call the laywer in AZ and ask him to go before the judge in the case to ask someone in either state pay for the therapy. The social worker in AZ is also exploring some options, this was I guess a unique request so the steps were unfamiliar to her and time consuming.
Aetna comes through, and approves therapy with the provider I found and preferred. We also found our own private psychiatrist(billed through our private insurance). I did let both AZ and CA know as I wasn't sure if I needed permission, worker in AZ said she never had a situation like this she would have to check, but it was beneficial to the child so she didn't see a problem.
Behavoirs at home in the past 6 months have reached an all time high, physical aggression towards the younger siblings (4 and 7), verbal manipulation, angry fits and tantrums, damaging property, self harming behavoirs(even resulting in trips to urgent care), and threats of I should just kill myself. Our household is consumed by this child 24/7 and we are scared of where these behavoirs are going as she is approaching puberty and teen years. There is also the affect that it is having on the other 3 children, and the behavoirs that are manafesting because of it.
We now have the diagnosis, an AWESOME committed and experienced therapist, a highly recommeded psychiatrist, and are desperately seeking the light at the end of the tunnel.
I am looking for support,resources,advice, and just a place where I don't feel alone in this.
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Replies to This Discussion
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Permalink Reply by Marcie Hunnicutt on -
I have 2 biological boys and 2 adopted daughters with RAD. Fortunately for us we had read so much on RAD prior to adopting them when they were 26 months old which really helped. You are not alone in your experience of therapists who mean well but aren't truly qualified. The good ones are few and far between. Congrats on finding one! It will get better but there is never a solid timeframe for "results/improvements". It varies so much with each individual!
My husband works outside the home and I am the primary caregiver. It can take its toll on you! Make sure you are getting some downtime. The best thing I ever did was start exercising regularly. It helped with my own depression, stress and overall well being. We found the following books helpful: Parenting the Hurt Child by Keck and Kupecky; Building the Bonds of Attachment by Daniel A. Hughes; Attaching in Adoption by Deborah Gray. Hope this helps...you aren't alone:)
Marcie
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Permalink Reply by emma wiegman on -
Just read this post which answers some of the questions I had. I have heard of the first book and am looking into the second one thank you. I have been given an assignment by the RAD therapist in therapeutic parenting (I believe based largely on the book Beyond Consequences by Heather Forbes) I am to only address my childs emotion to a situation not the action, I am not to give consequences but state in a nurturing was the correct behavoir. It's a challenge! She was very sweet and on me constantly with this that and the other for the first day or two but is now starting to show anger and even break into tears instantly. What approaches have you tried?
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Permalink Reply by Marcie Hunnicutt on
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Our situation was a bit different. Our girls were severely delayed at 2 years old so we did a lot of holding therapy (Holding Time by Martha Welch) similar to holding an infant and cooing to them to calm them down. Dasha would pinch my arms to try and get me to not hold her. I had bruises for a long time. She (and Mia- my other daughter) would not want to make eye contact and would cry, first shallowly, then her cry would become angry, and then last of all it would turn into the most grief stricken and mournful sound I have ever heard. It would make me cry. The whole time I was holding her and telling her how much I loved her and that no matter what I would love her and not let her go. The girls were not held or interacted with much as babies and if they cried in the orphanage they were either ignored or smacked. Being held was definitely hard for them and uncomfortable.
We do not medicate, although the girls are not violent. Mia does struggle with anxiety but we have chosen not to medicate as her anxiety is not severe and may interfere with her on other levels.
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Permalink Reply by Mary Greene on -
It's good to know, at least, that none of us are alone. That's what's so great about sites like these. I'm new and just joined and am already feeling a little encouraged. Hang in there everyone. And remember, with our kids its baby steps. I too have an attachment disordered son, adopted from Russia. I have to celebrate our successes and find some way to accept and not get bogged down in our failures. It's very hard.
I'm trying to write a book about it, to help myself (I guess!) as well as other parents. Please visit if you like.
http://whenrainhurts.wordpress.com
BTW: We do medicate our son - heavily in fact. I'm not happy about it - and its evolved slowly over the course of 3 years - but I know for certain he wouldn't be able to be at home with us without it.
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Permalink Reply by emma wiegman on
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May I ask what medications you are using? We are in the process of researching and starting medication. We have added depakote so far. I am interested in feedback on meds.
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Permalink Reply by Mary Greene on
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Yes - he takes lithium, risperdal, tenex periactin and lamictal. We started just with risperdal when he was 4 1/2, then added lamictal about 18 months later because he was diagnosed with a seizure disorder (tho lamictal has the added benefit of being a mood stabilizer). As he grew, risperdal wasn't doing it for him anymore and increasing the dose had a negative impact, as did simply trying to substitute something else. So, after lots of trial and error, we stuck with the risperdal and added tenex to combat agitation and then when he had another growth spurt and very prominent mania/depressive cycles, we reluctantly added lithium. We were so scared of it but it has done wonders for him. We have tried taking away some of the others - risperdal and/or tenex from time to time but it just doesn't work. He takes periactin to stimulate his appetite since he won't eat otherwise.
Sorry for the longwinded response . . . but its complicated. Always complicated. I hate that he's on all this medication - and I worry what its doing to him - but at the same time, it wouldn't be safe for us or our other child to keep him at home without it and he wouldn't be able to participate in an inclusion classroom either. Plus, he feels so much better about himself . . .
Hope this helps - Mary
http://whenrainhurts.wordpress.com
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Permalink Reply by Susan on -
I just read your post and you are not alone. We adopted our granddaughter who is now our daughter. Before I figured out she had RAD I was convinced I was a very bad parent. Our Daughter was put in our care by the state of CA at 6 months we were sure our love would make all the difference for her. What I want you to know is that how we might parent attached children will not work with RAD kids. It is a very different style of parenting and it seems to draw other parent to give you advise. Remember you know your child and deep inside you know what they need to feel safe. Believe in yourself and use these sites to help keep you strong.
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Permalink Reply by Ce Eshelman on -
Emma,
Thanks for referring to me as an awesome, committed, and experienced therapist. I am glad you feel this way. Also, I am so glad you are reaching out to other parents. Support for you is essential. Support for all the parents is essential.
By the way, you are an awesome, committed, and experienced parent. Pass it along.
Ce Eshelman, LMFT
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Permalink Reply by Desiree Spence on
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I've been reading a lot about RAD because my foster girl seems like she could fit that diagnosis. Only she has been with me since she was 2mo old and I know we don't abuse her. I believe she has FASD but I know she has attachment issues as well. We are seeing a mental health specialist shortly who wants to observe us play together. I'm a pretty reserved person and am not really looking forward to it as I know I won't be my goofy self with people watching. But hopefully they can help us.
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Permalink Reply by Mary Greene on
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My understanding from seeing Dr. Ron Federici twice (and heading back this coming wknd for a 3rd visit) re our FAS/attachment-disordered Russian adopted son, is that FAS kids tend to have lots of attachment issues but they generally derive from neurological (ie, organic/physical brain problems) damage rather than emotional/physical abuse. Having said that, he has helped us make tremendous progress with our son - across all domains, including attachment. Slow but steady over the years . . . one little trick I do (or at least try to do - I am by no means always successful) is avoid eye contact when I'm angry. I reserve the "eye to eye" moments for when he is connected enough (and not lying) to want to look into my eyes - and then I turn on the biggest "I'm in love with you" look I can. Try it - it really has made a difference. In short, it seems to me FAS kids need a very different approach to attachment then non-FAS kids. This has certainly been true in our family. Our daughter, also adopted from Russia, does not appear to be alcohol-exposed but she does have some rather obvious attachment issues. We have her in therapy - therapy wouldn't do a lick of good for our son. Enough for now but good luck -
Mary
http://whenrainhurts.wordpress.com
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Permalink Reply by Jolene Mittelstadt on
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Ok I am at step not even one. In talking to a co-worker regarding her son that had RAD, a lot of the symptons remind me of my cousin. My parents took her in when she was about 7. She was taken from her mom at birth as she was on drugs at the time of delivery. She was then placed into a foster home for a few months. At that time her father potioned for her, which at the time he was well over 60 years old. He was given cousty of her. She was pretty much rasied my her older brother and sister, which are just 4 and 6 years old. Well her bad became ill and her and her sister came to live with my parents. She is now 11 years old and is not abusive in any manner. But she has not attachment to anything. She constantly lies with out any cause. Recently my mom was daignoses with Stage 4 uterine cancer, not once do I remember my cousin upset or crying because my mom was in and out of hospitals. My mom is a very loving and caring person. She went through Chemo, may months of her being sick. And she still continues to lie to my mom to the point that it upsets my mom and she crys. And with in the past few weeks my mom was diagnosed with tumors on her liver. She has went to Mexico for treatment and not once has my cousin asked about her. Ok, all that said. How do I got about getting tested to see if she has RAD?
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