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Author Topic: Reactive Attachment Disorder  (Read 7434 times)

ClintMemo

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on: May 21, 2007, 03:48:41 PM
In the tolerance thread, I mentioned "Reactive Attachment Disorder" or RAD. Since some others asked about it, I promised I would talk about it in another thread - so here we are. :P  (Someone else asked me to talk about my experience as a foster parent, but I'll put that in a different other thread.)

As a foster parent, we were required to take, IIRC, about 30 hours of training.  Talking about RAD was the focus of at least one of our training classes because it was so common amongst their foster children.  In Kentucky, foster children are rated from 1 to 5 based on how much extra care they would require in terms of therapy and extra assistance - 1 being a child with the least issues and 5 being a child with the most issues. The agency my wife and I dealt with only dealt with kids rated 4 or 5. I bring this up because I don't want to give the impression that all foster children are like the ones I have experienced. Not all of them have RAD issues. Also, I am not a psychologist or a social worker or a mental health expert. I am only presenting information as it was presented to me and how I understood it.

RAD
When a child is first born, there a cycle of dependency that happens between it and it's caregiver (mom, dad, daycare worker...). 
The process is very simple:
1) Baby senses that something is wrong (hungry, thirsty, stinky, in pain...)
2) Baby cries
3) Caregiver arrives
4) Caregiver addresses and fixes the problem (feeds baby, changes diaper...)
5) Baby senses that everything is OK and stops crying
6) Time Passes
7) go to step 1

This cycle repeats thousands and thousands of times in a babies life in its first months of life.  Through this process, the baby learns several important lessons:
1) I can effect the outside world (when I cry things happen)
2) Grownups are here to help me
3) I am worth being taken care of

This assumes that the caregiver is doing a good job and the babies needs are being met. People are human and make mistakes, so caregivers don't always get it right the first time they show up, but in general, they are always making things better for the child.

However, if the caregiver is doing a poor job, the cycle starts to fall apart in step 3.  The caregiver may ignore the baby, stop trying to help too soon, or, if they are physically abusive, hit the baby, shake the baby or yell at the baby. When this happens, the baby never gets to step 5.  Obviously, if the caregiver NEVER did the right thing, the baby would die.  But, what often happens is that the caregiver does enough to keep the baby alive but fails so often that the baby doesn't learn the lessons that the good caregiver's baby learned. 
An abused/neglected child might learn:
1) Nothing I do effects the outside world (crying may bring help, harm or nothing so it is not effective)
2) Grownups are here to harm me as much as help me
3) Grownups are not predictable
4) Grownups cannot be trusted
5) I am not worthy of being taken care of

It is especially important understand 1).  If a baby thinks it cannot effect the world around it, it does not learn about cause and effect.  The world is just a series of unrelated events that happen for no reason.  As they get older, they can't help but get past some of this when dealing with the physical world (gravity is pretty constant :P), but when dealing with people, the lessons they learned as a child are very hard to change.  It's much easier to learn a new behavior than to replace an existing one.  RAD sets in when they cannot learn to properly attach emotionally to another person.

Complicating things, children have a built in attachment to their parents, even abusive ones. Their distrust of adults often gets worse when child protective services enters the picture.  From the child's perspective, a bunch of adults come in and take them away from the only adults they know, the abusive parents they are attached to.  Most of the time, it is not discovered that a child is being neglected until it is 5 or six years old. Younger children can be shielded from the outside world.  It is generally not until they go to school and their teachers see them and know that something is obviously wrong.   So, you have a child that has been living in a highly dysfunctional environment for 5 or 6 years and then a bunch of other adults take it away from its parents.  A daycare worker might also recognize the symptoms of abuse but these kids generally don't end up in daycare.  They are generally left alone for hours on end while the parents (or parent) goes out and does whatever they do.

Because the child has been neglected, they have had to learn to do things for themselves. Their primary concern is for themselves. They care nothing for other people other than as a means to obtain what they want.  RAD kids will steal and lie and think nothing of it.  They place no value in other people.  There is no such thing as "right" and "wrong" there is only "what is good for me" and "what is not good for me."

If there are multiple children involved, very often the oldest is made responsible for the younger ones. This sense of responsibility may take hold and the child will work very hard to take care of younger brothers and sister and will become attached to them. The child is doing the parent's job.  It has become "parentified."  If the older child does not take that responsibility, or worse, treats their siblings as their parents treat them, you could have children abusing their younger siblings when the adults are away. One of my foster kids was in charge of her 4 younger brothers and sisters when she was only 5 years old.  She was 8 when she came to us and she was often worried about how here brothers and sisters were doing.  (They had all been adopted into good homes.)

Dealing with RAD children is very difficult. All therapy is based on a level of trust between the child and the therapist and when the child cannot learn to trust an adult, it makes therapy a challenge.However, children have a deep-seated need to be loved and accepted that directly conflicts with their RAD.  RAD kids will often sense that they are getting close to someone and then try everything they can to push them away.  Since they feel they are not worthy of being loved, they often harm themselves in order to scare people away or as a form of blackmail with the adults they have to deal with.  You have probably heard the expression "tearing your hair out."  I had a foster child that actually did that. When she was upset, she would sometimes grab locks of her hair and rip them from her head. She would also bite herself and destroy things that she valued, like breaking toys, tearing up pictures.  She would purposely soil herself so that she would smell bad in hopes that we would send her away.  She would refuse to take a shower or lie and say that she took one, including going through all the motions of going into the bathroom and tuning on the water...

RAD kids are often developmentally behind other kids their own age, not just academically, but also socially and at with their level of maturity.  It is not uncommon for a RAD 10 year old to frequently throw a temper tantrum like a two-year old - including getting down on the ground and kicking and screaming and hitting, etc...

RAD kids are master manipulators.  They view people as things and have spent their whole life getting those things to try and do their bidding.

Never get in a battle of wills with a RAD kid.  They may not have a limit as to how far they will go to get what they want and if they do, it is almost surely farther than you are willing to go to stop them.  Remember, if they don't respect you as a person, they have no problems with hurting you or destroying your property.  And because they have no sense of consequences, they won't feel bad afterward.

Having said all that, RAD can be overcome. It just takes lots of patience, lots of work and lots of love.

For more information about RAD, there is an excellent website here:
http://www.radkid.org/index.html


Life is a multiple choice test. Unfortunately, the answers are not provided.  You have to go and find them before picking the best one.


FNH

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Reply #1 on: May 21, 2007, 07:35:43 PM
Remember, if they don't respect you as a person, they have no problems with hurting you or destroying your property.  And because they have no sense of consequences, they won't feel bad afterward.

If you have other children in the house,your own perhaps, you may be putting them at risk.  The RAD kid could see the other children as things to be "used" for bargaining purposes.

Big Ups to anyone who has the guts to handle these kids.


ClintMemo

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Reply #2 on: May 22, 2007, 12:27:01 PM
Remember, if they don't respect you as a person, they have no problems with hurting you or destroying your property.  And because they have no sense of consequences, they won't feel bad afterward.

If you have other children in the house,your own perhaps, you may be putting them at risk.  The RAD kid could see the other children as things to be "used" for bargaining purposes.

Big Ups to anyone who has the guts to handle these kids.

My wife and I have a biological daughter about the same age as the second foster child we had.  She was with us for 51 weeks. We eventually had to "disrupt" (the term used for "remove them from my house") because of safety issues.  She had a lot of internal anger (understandably) and she would sometimes have violent outbursts, destroying toys, papers, kicking holes in the wall... Only very rarely would she ever lash out at someone else.  Usually, when she did,  she lashed out against my wife.  Over the last few months she was there, we saw that when she had outbursts, her level of violence was increasing.  After one particularly intense episode, we realized that the next step might involve a kitchen knife or something equally dangerous.  It became too risky for us to continue.

But not all stories have unhappy endings...

A family in our community has a foster child that they adopted several years ago.  Had she not told me, I would not have known he was adopted.  He acts like a typical teenager.  He even resembles his adopted father.  They had several of their own children and were foster parents for several others.


Life is a multiple choice test. Unfortunately, the answers are not provided.  You have to go and find them before picking the best one.


ClintMemo

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Reply #3 on: May 22, 2007, 08:00:25 PM
Looking at my post, I realized that saying that overcoming RAD "takes lots of patience, lots of work and lots of love" isn't terribly useful, so I thought I'd say a little about some of the techniques we tried.  Some worked better than others and very often you have to try new methods so they don't get bored from the old ones.

Safety and security are very important.  When dealing with a RAD child (or any foster child) it is vital that you make them feel safe. These are children whose entire world's have pulled out from under them (often many times) with little or no warning.  It is important that they see that everyone in the home's needs are met (food, shelter, clothing...) and that everyone is safe (nobody beats up anybody).

Structure is also very important. Structure implies predictability which in turns implies security.  Children feel safer when they know what's coming next.  My second foster child never had any behavioral issues while she was at school. It was structured and safe. She could blend in, relax and follow the crowd.  We were lucky in that she had a teacher that was very nurturing and patient.  She came to us in November as a second grader.  From that day until the end of the school year was by far the longest she had ever been in the same classroom. As you can imagine, she was very far behind academically. It took her a few weeks to settle into school, but once she did, she went a long way towards catching up to where she should have been.

Structure requires having clear rules. We had a big poster (I still have it) with "House Rules" listed.  There were also "consequences" listed (we tried avoiding the word "punishment").  Both lists were broken down into three sections: small, medium and large.  If a rule was broken, the adults got to decide the most appropriate consequence. 

It is also important to have positive rewards. It is just as important (maybe even more so) to reward good behavior as it is to punish bad behavior.  Remember, these are kids that don't understand that their actions have consequences.  It is important that they realize that consequences can be good as well as bad.
We had a calendar "smiley chart."   If she had a good day, then she got a smiley face.  When she earned 10 smiley faces, she would earn a reward.  Fairness became an issue. It wasn't fair that these rules and charts only applied to her, so we made duplicate ones for our biological child as well.  This brought up another problem because my biological daughter has no behavior problems, so she almost never got bad consequences and had nothing but smilies on her chart. Still, it did seem to help.  I recorded every day separately so could go back and look for trends.  We could see that she could generally go 4 or 5 days in a row without having some type of emotional episode.  Sometimes she had several bad days in a row.  On the other hand, her personal best was 21 good days in a row (ahhh, that was a blissful three weeks).

The two scariest words that came out of her mouth were often "I'm bored."  She often had no ability to entertain herself and could not function without direction or a task to perform.  Keeping her busy was a good strategy.

You also have to avoid letting things spiral out of control.  They do something and earn a consequence and then get mad about it, act out and earn another one and then get mad at THAT one, etc...

Looking back, I would say that we would probably have done better to have even more structure than we did, but it's hard to live your life like you are in boot camp all the time if you aren't used to it and we definitely were not used to it.


Life is a multiple choice test. Unfortunately, the answers are not provided.  You have to go and find them before picking the best one.


Rachel Swirsky

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Reply #4 on: May 22, 2007, 09:44:39 PM
These posts are really interesting, and again, I thank you for making them.



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Reply #5 on: May 22, 2007, 10:10:46 PM
It sounds like you're doing some really valuable work.  Props to you.

Someday, when I have enough money to buy a big house, my wife wants to take in/adopt foster kids.  We have a bit of experience with it, and it's both a lot of work and lot of reward.  That's time invested, not just spent.

What staggers me is the absolute selfishness that many parents exhibit, leading to problems like these.  It's abhorrent how many people just don't care about their kids, but it's good to know there are people in the world who do care and are willing to do something about it.  Props to you.

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ClintMemo

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Reply #6 on: May 23, 2007, 02:17:56 AM
Thanks for the words of encouragement. 

My wife and I are taking a break from fostering right now. We are really trying hard to decide if we are even cut out for it. Not everyone is.  One of the very humbling things I have learned is that there are some things I cannot fix and some people I cannot help.  That can be a very bitter pill to swallow.

Anyway, if I can think of any more information, I'll post it.  I don't want this thread to become my personal emotional dumping ground. I also don't want it to become a "true life horror stories" thread.

Again, thanks for reading. 

Life is a multiple choice test. Unfortunately, the answers are not provided.  You have to go and find them before picking the best one.


wakela

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Reply #7 on: May 23, 2007, 03:28:21 AM
Those posts are fascinating.  Thanks, Clint.  You and your wife have my admiration.



Rachel Swirsky

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Reply #8 on: May 23, 2007, 01:32:51 PM
Quote
I don't want this thread to become my personal emotional dumping ground. I also don't want it to become a "true life horror stories" thread.

Well, if it becomes either of those things, and either is helpful to you, then I think that's worthwhile.

Are you keyed into a good network of other foster parents? I imagine there's got to be a section of the blogosphere dedicated to meeting those community needs.



ClintMemo

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Reply #9 on: May 23, 2007, 02:11:28 PM
Quote
I don't want this thread to become my personal emotional dumping ground. I also don't want it to become a "true life horror stories" thread.

Well, if it becomes either of those things, and either is helpful to you, then I think that's worthwhile.

Are you keyed into a good network of other foster parents? I imagine there's got to be a section of the blogosphere dedicated to meeting those community needs.
The agency has a support group that meets most months to talk about foster care issues.  Sometimes we talk about a specific topic. Other times we discuss one or more parent's particular current problem and how to deal with it.

Life is a multiple choice test. Unfortunately, the answers are not provided.  You have to go and find them before picking the best one.


clichekiller

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Reply #10 on: May 25, 2007, 03:16:36 PM
Clint, if this post becomes an outlet for you to use as a sounding board or just a dumping ground I think this community can handle that.  What you and your wife do is incredibly generous.  It's a rare person that looks outside of their immediate circle, much less invites someone from the outside in.  This is something I've always felt strongly about.  Both my wife and I don't plan on having children but if we ever felt the need for one we both agree that we would foster and/or adopt one.  These posts have been an excellent insight into what that experience might be like, sobering for sure but enlightening at the same time. 



ClintMemo

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Reply #11 on: May 25, 2007, 06:54:20 PM
Just a quick update...
I asked my wife to read the posts to make sure I didn't leave out anything or get anything wrong and she gave me a few more details.  Our training was 24 hours - 8 Monday night classes, 3 hours each week.  Also, the organization we dealt with only dealt with "special needs" foster children, which is why they were all rated 4 or 5.  Special needs includes emotional or psychological issues, not just medical issues, though they had children with medical issues as well.

I have started working on a longer piece that I plan on putting on my blog site.

Life is a multiple choice test. Unfortunately, the answers are not provided.  You have to go and find them before picking the best one.


Anarkey

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Reply #12 on: May 26, 2007, 11:55:30 AM
I have started working on a longer piece that I plan on putting on my blog site.

I hope you'll provide a link when you do.  I also hope you'll eventually get around to doing the post "about my experience as a foster parent, but I'll put that in a different other thread", because I was the one that asked.   :)

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ClintMemo

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Reply #13 on: May 27, 2007, 01:39:22 PM
I have started working on a longer piece that I plan on putting on my blog site.

I hope you'll provide a link when you do.  I also hope you'll eventually get around to doing the post "about my experience as a foster parent, but I'll put that in a different other thread", because I was the one that asked.   :)

I'm including our foster experiences in the post(s) I am writing.  I'm hoping to finish up the first part this weekend, but it's a three-day weekend here in the states, and the weather is great, and I just got my pool open, and I have at least two parties to attend, and lots of outdoor work that needs doing...yada, yada, yada...:P

Life is a multiple choice test. Unfortunately, the answers are not provided.  You have to go and find them before picking the best one.


ClintMemo

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Reply #14 on: May 29, 2007, 02:43:15 AM
The first two posts are now online

The first post covers what I wrote here plus more information
http://clintmemo.blogspot.com/2007/05/my-experience-as-foster-parent-part-1.html

The second post covers our experience with foster child #1
http://clintmemo.blogspot.com/2007/05/my-experience-as-foster-parent-2.html


Life is a multiple choice test. Unfortunately, the answers are not provided.  You have to go and find them before picking the best one.