Sunshine and Reactive Attachment Disorder

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I don't know which phrase repeats itself in my mind more.

"There's still something else going on with Sunshine.  Yes, she has autism.  She most definitely has RAD.  But there's something else.  We're not finished yet."

or

"If the medication helps a lot, then we'll know she has a mood disorder as well.  If the medication only helps a little, we'll know the behaviors are from RAD (Reactive Attachment Disorder)."

or

"Once the medication starts helping, you've got this.  You've done this before.  You know what to do.  She's just a combination of your three other kiddos and then some."

Sunshine's last appointment with her developmental pediatrician was just over a month ago.  It was an appointment I dreaded more than any other I'd ever gone to for my children.  Sunshine was not doing well.  Her negative behaviors kept escalating.  And then there were the nights...  It just never seemed to end.  The parenting choices I was having to make in response to her behaviors were maddening.  I would plead in prayer for help, guidance, and alternatives, but none came.  Situations I was dealing with brought new meaning to the concept of being the parent my child needed, versus the type of parent I wanted to be.  The tears seemed to come every day.  No matter what I did, things just kept getting worse.  Furthermore, both my husband and I recognized a pattern.  We knew where this was headed, and I was not up for it.

Sunshine has Autism Spectrum Disorder, RAD (Reactive Attachment Disorder), PTSD (Post Traumatic Stress Syndrome), a developmental delay, and a Sleep Disorder.  She is being watched closely due to mood disorder like behaviors and symptoms.  Over the past 6 months it has been confirmed that she experienced drug exposure while in the womb.  These diagnoses do not include her medical diagnosis of Mild Cranial Facial Microsomia.  Do I like these labels?  Absolutely not!  Then why have them?  Sunshine needs help, and the ONLY way to get it is through the labels.  (So sad, but true.)

Many are familiar with Autism Spectrum Disorder, PTSD, developmental delays and sleep disorders.  Their treatment protocols are well known.  But, not many are familiar with Reactive Attachment Disorder, so I thought I'd share a little bit about it.  This way when I mention the word "behaviors," you'll know what I mean.  It is important to understand that those with RAD can appear bi-polar, schizophrenic, oppositional defiant, hyperactive, autistic, etc.  Those most prone to RAD are children in the foster care system and orphanages in your home country or abroad.  RAD can also occur in homes where the main caregiver suffers from Postpartum Depression or other medical issues, unable to care for baby or young child.  Lastly, RAD can occur in situations where the baby and/or child experiences significant medical trauma.

Children with Reactive Attachment Disorder display a variety of behaviors.  Some include pathological lying, chronic stealing, hoarding, refusing to eat, gorging to the point of vomiting, manipulating, destructiveness, vandalism, self injurious behaviors, cruelty to animals and children, fire setting, sexual behaviors, sexual activity with other children, bestiality, angry rages, physical aggression, violence, verbal attacks and abuse, passive aggression, and absence of guilt.  Children with Reactive Attachment Disorder are great at putting on a show for others (it's called artificial charm), but then as time passes and you get closer to them, their negative behaviors increase at rapid speeds.  Another aspect of RAD is the child's need for control.  Whether it be creating complete chaos or being the center of attention, the child can easily manipulate any situation.  Lastly, RAD children are experts at provoking others to anger.  Subconsciously they want to recreate that same negative cycle they had with their "abuser," because that's what they know.  That's how they feel safe.  The most important thing to remember is that these behaviors were developed due to the child's need to survive whatever circumstance they may have been put in, during the earliest days, months, and years of their lives.  It is not the child's fault.

When an infant or child must act that way for an extended period of time the brain becomes permanently programmed do these things.  It can not accept love.  That is too dangerous.  The child cannot attach to others.  The brain no longer allows this.  As one tries to get close to the them, RAD children will push others away in whatever ways they deem necessary.  Thus parenting a child with RAD is one of the most difficult things one could ever attempt to do.  (I still remember the day my developmental pediatrician told me this.)  Not only will you not have a reciprocal relationship, but the child will actively destroy any form of relationship you try to create.

One might think that Reactive Attachment Disorder isn't real, supposing that, if you love someone enough, they will learn to accept it.  Oh, how I wish this were true.  However, it is not.  Once the area of the brain that controls emotional attachment has completed it's development (when a child is developmentally five years old), the damage cannot be undone.

I read a story once about building self esteem.  It compared the child with a lack of self esteem to an empty bucket.  The parents, caregivers, and/or others that loved this child were asked to fill the bucket with pennies that represented loving acts of kindness and praise.  One would think that as each person added more pennies to the bucket that the child's self esteem would grow.  But... what if the bucket had a hole in it, or no bottom at all.  Such is the case with  children with RAD.  One must repair the bucket before adding pennies to make any difference at all.  In other words, children must work through the trauma they experienced, before they can learn coping mechanisms to help them with their day to day life experiences and circumstances.  Trauma can not be worked through until a stable and safe environment is provided for an extended period of time.  None of this repair can take away the permanent brain damage already done, but it can help the RAD child learn to cope in situations they may not otherwise be able to handle.

 Parents or caregivers of a RAD child can easily feel as if they're going crazy, thinking they're doing something wrong, when in actuality, it's the child.  They may have the urge to reject the child all together.  At times they may be embarrassed or ashamed by their negative thoughts about the child.  If there is not an understanding of the child's subconscious desire to provoke others to anger, a caregiver can easily be provoked to hurt the RAD child, completely losing control.  Some parents of RAD children develop Depression, PTSD, and Anxiety Disorders.  (I've been very fortunate in these ways.  I think it helps having a Mental Health Therapist in the home and a great team of doctors, specialists and extended family members over the years. You cannot do this alone!)  And then there is the never-ending and extremely difficult job of parenting a RAD child.  On one hand, a parent or caregiver of a RAD child must be unbelievably strict, consistent to a T, and vigilant.  The best way to describe it is to say to parent like a drill sergeant.  This may appear over the top to others, but what others don't know is how extreme behaviors can become in an instant, if minor behaviors are not addressed in a firm manner.  Remember, we as the parent of RAD children are not only trying to protect our children and ourselves, but all others around them.  This includes you.  If you give a RAD child a inch, they take a mile.  On the other hand a parent or caregiver of a RAD child must be extremely compassionate and loving to accept and understand the child's fears, triggers, anxieties, and deep seeded emotions, that may or may not get better or worse over time.  And then there must be an understanding of the child's prime target(s).  Some RAD children target males, others target females.  Over time the RAD child may target their primary caregiver, no matter who that may be.  Our girls have different targets.  One targets females, primarily me, as her mother.  The other targets males, primarily my husband, as the father.  If you are in a target role, you can expect the worst behaviors aimed at you.  If you are not in the target role, you may not think there is anything wrong with the child.  Instead you may feel your partner is going crazy.

If you haven't already guessed, parenting a RAD child can be very difficult on a marriage.  I admit in our case, when it came to my husband and I recognizing me as the target, he was very compassionate and understanding.  In fact, he was the one who noticed it first.  He may not have been 100% supportive in every situation, when it came to my need for strict discipline and consequences, but he knew I wasn't the one going crazy, even when I thought I was.  When he was the target, I didn't see it for a VERY long time.  I did think he was going crazy.  Our relationship suffered.  It wasn't until after our daughter was diagnosed, that I was able to be supportive and understanding of my husband's parenting choices.  Now that we've adjusted to two children with RAD, both with different targets, as strange as it may sound, our marriage has improved immensely.  We are able to sympathize with each other on a new level and support each other with back up whenever necessary.  In situations where there were only tears with the first, there is laughter the second time around.  (In order to survive RAD, you must have a sense of humor!)

A child with RAD feels that the world is a frightening, chaotic, and hostile place.  Most RAD children feel unable to trust.  They are anxious, and afraid ALL of the time.  They feel stuck and worst of all, unlovable.  Children with RAD can not and do not accept praise.  If you praise your RAD child, most often significant negative behaviors will follow.

Our girls' trauma occurred in infancy, during the first six months of life.  They were very fortunate to leave that life so early, but sadly, they didn't leave early enough to prevent the permanent neurological damage.

Lark Eshelman is an expert in the field of adoption and childhood trauma.  She describes the world of a baby that has no secure attachment in her book, Becoming a Family.

"A baby in this situation can not figure out why he is being neglected or abused or why things are changing so drastically.  The baby has no means of deciding if someone's action is a threat to him or not, so to be safe, he perceives everything instinctively, as a threat.  The child has limited ways to negotiate his own safety, except for behaviors that get immediate attention or provide for relief from frustration.  Physically, the baby does not have a wide range of behaviors; he can lash out, cover his head, or pretend he is not there if the fear or pain is too intense.  If this happens enough, or if it goes on for long enough, the reaction becomes a pattern; a pattern of neurologically based mistrust.  Even when we know he is safe, almost anything from the environment can trigger emotional "cues" that make him feel threatened." (Eshelman p. 41-42)

New people, new places, unexpected company, public gatherings, changes in teachers, and so many other things can trigger RAD children.  When they feel fear, they make bad choices.  Negative behaviors escalate.  It is up to the parent or caregiver to recognize the trigger and remove the child from the situation immediately.  A wise adoptive mother once told me to keep the world of my adopted daughters very small, because they can't handle more.

So how do you help a child with RAD?  Unlike mood disorders that can most often be helped through medication, there is no medication to help RAD.  One can try to treat anxiety or agitation, but it still won't take away the behaviors.  For RAD children who won't or don't sleep, a medication can be prescribed, but it may or may not help.  The first step to helping a child with RAD, is to provide a stable routine, and consistent environment, with as few changes in caregivers as possible.  Any change can trigger behaviors.  Next, begin the journey of working through trauma.  In most cases a licensed mental health professional with A LOT of experience in RAD will be needed in this process.  (Please note play therapy does not work with most RAD children.  An inexperienced therapist can cause more harm than good.)  The journey is never ending and will vary significantly depending on the ages, cognitive, and adaptive abilities of your RAD children.  We have been very fortunate with Princess that her cognitive ability is so high.  Her developmental pediatrician has been amazed at how she has been able to work through trauma thus far.  We do not expect the same quick results with Sunshine as she has developmental delays, Autism Spectrum Disorder and a possible mood disorder.  The road will be longer and most likely more difficult.  Third, have your child's sensory and adaptive abilities evaluated.  Most children with RAD can present similar to those with Autism Spectrum Disorder due to their inability to form relationships, lack of adaptability, and sensory issues.  If therapies are recommended, attempt them.  They may or may not be effective based on your child's behaviors, anxieties, etc.  Lastly, endure to the end.  Love, when it is hardest.  Accept what is and what is not.  An amazing therapist once told me I would be considered a successful parent of a RAD child if my RAD child could form ONE successful, reciprocal relationship in their life time, that was not abusive, manipulative, and/or influenced by addictions.  In the case where I am the target, the successful relationship will not be with me.  Knowing this information has helped the relationship between my RAD daughters and myself become healthier and safer for all of us.

When Princess was first diagnosed with RAD, my husband resigned from his position as a therapist at a mental health clinic and returned home.  Princess was 2 at the time.  Knowing we had until she was about 5 years old to make any difference, when her brain was concerned, we wanted to do ALL we could to help her.  While he was home for 2 1/2 years, we were both full time foster parents to over 20 children.  During this period in our lives, we also transitioned from sending our boys to a private special needs preschool to schooling them at home.  Princess joined them shortly after the transition.  It was quickly discovered that all three kiddos responded positively to Montessori-inspired activities.  The Montessori method provided hands-on manipulatives for the boys.  Princess was able to choose her own work trays from the shelves, providing her with the control she desperately wanted.  Controls for each activity prevented battles between her and I, as she could check her own work for accuracy.  Lastly, she could move at her own pace.  This was a huge benefit with her cognitive abilities.  She quickly caught up with Dinomite, (who is 2 1/2 years older) in almost every subject area.  Both my husband and I feel confident that the changes we made when we learned about Princess' diagnosis have significantly impacted who she is today, and will continue to influence her.  As things became more stable with Princess, we turned our attention to Sunshine.

As Sunshine's negative behaviors have increased, it has become extremely difficult for me to manage all four special needs children, on my own, at home, on a daily basis, especially as we try to help all four kiddos progress academically.  In public settings, it has been difficult for my husband and I to handle Sunshine's behaviors.  Others have attempted to help, and the situations become worse.  More people are affected.  In regards to mood disorder type patterns, there have been some nights and mornings when behaviors are so severe, I've been unable to get any sleep and/or get breakfast for the other three kiddos.  Thankfully, (thanks to Montessori) Dinomite, Bulldozer, and Princess are becoming self sufficient and can help themselves if needed.  Sunshine has just been put on a medication that will hopefully help those manic-like behaviors, but it won't take away behaviors associated with RAD.  The safety and well being of ALL of our children is our first priority.  If we know temporary sacrifices will significantly improve the quality of life for one or more of our children, we will make the sacrifices, especially when RAD is concerned.

So...  After a month of planning, preparing, and communicating with others, and with a loving Father in Heaven, Jason has decided to return home once again to help Sunshine (and me), as he did with Princess.  We discussed our plans in great lengths with Sunshine's developmental pediatrician, wanting to make sure that it would in fact improve things and make a difference, especially as Jason is trying to manage his own disabilities.  Financially, we are fine.  Any income Jason brings into the home is extra at this point, and unnecessary.  The plan is a temporary one.  Sunshine will most likely reach that five year old developmental status in about 3 years.  Once she is at that point, we can reevaluate and adjust accordingly.  In the meantime, both Jason and I will be working full time on the blog and on our first book, which we hope to finish by the end of the year.

This was definitely not an easy decision to make.  Jason thoroughly enjoyed his job and did very well at his place of employment.  We have grown accustomed to the extra income and would be lying if we didn't admit it will be hard to part with.  (Thankfully our trip to Disney World is completely paid for already!)  At first we were hoping it would be possible for Jason to switch to an earlier schedule, but in the end, this did not work out.  We are aware that Sunshine's behaviors will become much worse once Jason stays at home full time.  This will not be a pleasant experience for any of us.  But, over time it is expected that behaviors will improve slightly, and if not, at least there will be two of us to handle situations, rather than just one.  Jason's last day at work is May 8, 2015.  The transition of having him at home will most likely take about 3 months as all of us adjust.

Once the initial transition is made, there are definite perks to Daddy being home.  The kiddos can once again participate in a variety of extra curricular activities.  If I'm needed as a one-to-one for Bulldozer at activities (which is usually the case), I'm available.  Jason is looking forward to learning time, baseball games, trips, and vacations he's missed since working again.  The kiddos can't wait to have him home.  I'm excited to start the HUGE list of home repair projects around the house.  Just today he fixed our dryer vent.  Hooray!

Obviously this isn't a choice everyone can make.  We consider ourselves extremely blessed to be in a position to even consider it.  There are definitely doubts and fears about the journey, but as I pray, I am filled with peace and comfort, knowing we will be taken care of, and that there are bigger and better things waiting for Jason, myself, and our family, if we only make this sacrifice for our daughter.

We appreciate your prayers and support for our family as we embark on this new phase of life with Sunshine.  I am 100% certain it will be worth it in the end.  She is most definitely worth it!