[angelkisses0102]

Originally Posted by tbristow

Thanks for the lists. I hope Karen does post hers. We've seen none of the above, but it's good to have anyway. Some of the 21 seems to overlap some of the other issues that may occur in these children (I would swear some were common in FAS children as well--it's been many years since I studied that in depth due to my step-dd). Best of luck to Mike and the others of you dealing with RAD.

Yes, many other 'issues' overlap...ADHD, SID, PTSD...

PTSD Symptoms in Infants/Toddlers Posttraumatic Stress Disorder (PTSD) affects many of our children. It often goes hand-in-hand with attachment disorders. The American Psychiatric Association's Diagnostic Manual of Mental Disorders (DSM-IV) definition of PTSD is confusing for many parents because the criteria were designed for adults, not for children. When parents read, "the person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others," many breathe a sigh of relief, thinking their child couldn't possibly have PTSD because he never experienced any type of trauma. The child was never threatened. He was in good, loving foster care. Someone fed him, clothed him, and kept him safe and warm since the day he was born. Yet, the experience of being separated from the birth mother could have the same effect on a child as dying. (Refer to Emotional Development; A Discussion of Abnormal Function for more information.) Multiple transitions/placements may have the same effect on an infant/toddler as kidnapping.
Some children have PTSD, some have attachment spectrum disorder, and many have both. The symptoms of the two disorders overlap and it may be difficult for anyone but a professional to identify the difference.
One mom writes that her son's symptoms (likely a blend of PTSD, attachment issues, and/or SID) include:
Severe stranger anxiety
Excessive fear and whining for unknown reasons
Never being comfortable being left--there is NOTHING fun enough (Candyland itself couldn't do it), to make him forget about me and want to separate. Period.
Extremely alert to changes in routine or the environment
Comforted by strict routine and ritual
Sleep problems/fear at night
Playtime: he concentrates on ONE activity for a very long time, and will repeat movements, like driving a car in back and forth in the same way over and over
Hoarding food, inappropriate eating (like stuffing mouth till overfull)
Extreme emotional reactions to mildly upsetting events: terrified of dogs- even OURS, hanging on my neck for dear life in physical therapy as if he expects to be hurt terribly--even though our dogs are sweet and therapy has never hurt

She writes, "He seems to kind of expect the worst possible scenario when confronted with a new situation, and his fear is profound. He needs constant reassurance that all is well and we are still here for him." (a. 14mo, FC)
Many professionals believe that a child must have PTSD in order to have an attachment disorder, but doesn't necessarily need to have an attachment disorder to have PTSD. If the child has attachment issues, it may be difficult to see PTSD until the attachment issues have been treated. As the child begins to feel safe, he may be more apt to share his scary feelings with his parents. As a result, PTSD issues may present themselves quite a while after the child arrives home. One adoptive mom reports that her daughter's issues did not begin to surface until she'd been home about 18 months. (a. 7mo, OR)
Many times, PTSD reactions are so delayed, or so unrelated to the original trauma, that it makes it difficult, if not impossible, for families to identify the PTSD triggers.

We went to a friend's barbecue for the 4th of July. Our 35 month old seemed to enjoy himself, only acting slightly nervous around the fireworks. (Just store-bought. We didn't attend a large fireworks display.) That night he went to bed fine and slept great. The next day he didn't have any noticeable problems, save being a little tired from staying up the previous night. But the next day (36 hrs+ after the event), he was a mess. Luckily we had a regularly scheduled visit to the therapist that day. Sure enough, it was all related to being around the fireworks. Yet he really looked like he enjoyed himself that night. Often when we see PTSD symptoms we are unable to figure out the trigger because the reaction can be delayed by hours or days. Before his PTSD diagnosis, I'm certain that I attributed symptoms to tiredness or teething, not realizing that what I was seeing was emotional pain. (a. 5.5mo, FC)


PTSD Symptoms may include (but are not limited to):


Angry Outbursts
Exaggerated Startle Response
Dissociation
Extreme Emotional Reactions
Hypervigilance
Sleep problems
Recurring Play Themes
Acting Younger Than One’s Age
Unusual fears

Sensory Integration Dysfunction Many children with attachment spectrum disorder and/or PTSD also have Sensory Integration Dysfunction (SID). A child with SID may overreact or underreact to sensory information.

Any kind of indoor social gathering is very difficult on my son. Birthday parties are nightmares for us. He will just meltdown completely in less than 5 minutes, and the melting down just does not end. He will flail about in my arms screaming and crying or throw himself down on the ground over and over. It is physically exhausting for me because I cannot control him or comfort him as long as we stay in that environment...the noise, people, running around of children...he just cannot handle all of that stimulation at one time. As soon as we find a quiet place away where he can walk around and play, he is fine again. If the party is outside; however, he can handle it a million times better. The sounds are not as intense to him, and the air and space are very calming for him.
I started a music class with my son over a year after he came home and months after "graduating" from attachment therapy. My son loves music and playing with musical instruments, and I thought this would be the perfect mommy and me type class. He sat in my lap perfectly content for all of a few minutes and then the class started. With all of the children playing with instruments, the teacher playing the guitar, and mommies singing along, my perfectly content boy just lost it. He cried a most painful cry for an hour straight while hiding in my chest. Many of the moms commented on how sensitive my son must be. A few told me that theirs were the same when they were 4, 5, 6 months old. My son was 19 months old! It took him well over a month to stop crying during music class. He no longer cries, but he is exhausted at the end. It's like processing all that stimulation wipes him out. I think the only thing that gets him through music class is the very consistent routine the teacher sticks to. He knows that routine very well! (a. 6mo, FC)
I feel that my children both exhibit behaviors of SID, but I think the SID stems from their attachment disorders. Just like PTSD and attachment disorders are so intertwined. I notice that when my son isn't doing well with his attachment, he exhibits lots of SID symptoms and when he's doing well with attachment, the SID symptoms greatly decrease.
For example, we were at the park (first time going to that particular park). There were those pesky flies that swarm around your face and don't fly away even when you shoo them. My son started SCREAMING every time a fly was in his face. I don't know if it's attachment issues, SID or something else, but he was the ONLY child screaming because of these flies. There was also another incident at church one day when we were in a room while they were setting up and testing the microphones. He SCREAMED this blood curling scream when the microphone made that high echoing pitch. Again, he was the ONLY child who screamed. (a. 4.5mo, FC)

Parents have noted that treatment for attachment disorders often has the side benefit of reducing SID symptoms.

We started attachment parenting and therapy when our son was 10 months old. It was very clear that attachment was the root of our problems and we started there. Our son made huge steps in the right direction, and once we had the attachment issues under control (about a year after our son came home), we were able to look at other issues with symptoms that resembled attachment. Had we not worked on the attachment first, I don't think we would have gotten very far with other therapies. Looking back, a lot of what we did to work on regulating emotions, self-soothing, eye contact, and closeness from an attachment perspective appeared to alleviate sensory related symptoms as well. It was actually our attachment therapist who at our last session asked me to look into SID. She felt that the majority of his remaining symptoms were sensory related. She explained to me that he showed all of the signs that he trusted his mommy and wanted his mommy to take care of him, but that he did not trust the world. Now that he had trust in Mommy we could conquer the world and what it did to his senses. We had our son evaluated by an OT (occupational theraist) and he qualified for services. He has a wonderful OT who is very knowledgeable about sensory and behavioral issues, and we've continued to see more progress. (a. 6mo, FC)
My son was obsessed with holding objects in his hands soon after he came home. At first I thought it was normal and curious exploration typical of an 8 month old. When he started to walk at 13 months, I noticed it was interfering with his development. He would be so fixated on carrying objects in his hands that he would trip and fall to the ground rather than let go of the objects he was carrying to help him gain his balance. As he grew older, small objects became my nemesis. He would walk around and hold crayons, marker caps and chalk rather than coloring with them. The playground was a nightmare because he wouldn't play. He would instead spend the entire time picking up rocks, mulch, bottle caps-anything small on the ground. We couldn't go for a normal walk. He was constantly scanning the ground for things to pick up-even if I carried him!
After I removed my son from daycare and was home with him more, he started carrying objects around less and less. I had almost forgotten about it until we moved, and I started noticing him carrying objects around again. I believe it is his way of micro-managing his world. It is another way he tries to control his environment. Yes, it is a sensory issue, but I believe his sensory issues are caused by his attachment disorder. Occupational therapy has helped him to a degree, but I think the attachment work has helped him more. (a. 7.5mo, FC)

For more information on SID, visit:
http://www.radzebra.org/whatsensory.htm
Information on sensory issues from Attachment Disorder Network.
http://www.attachmentcoalition.org/
Go to "Adoption Parenting Information" for the article: "Sensory Integration and the Internationally Adopted Child"
http://www.spdnetwork.org/
Resources for the Sensory Processing Disorder Community.


SID: Putting It All Together by Brian J. Bittner, OTR/L
The Out-of-Sync Child: Recognizing and Coping with Sensory Integration Dysfunction
The Out-of-Sync Child Has Fun: Activities for Kids with Sensory Integration Dysfunction

I think/hope these links are all OK?!