[ProspectiveSingleMom]

I have a question for parents whose children have been diagnosed with RAD. In particular, I am interested in hearing from those whose children have the characteristic of being very charming when they want be. Have any of your children been assessed for conduct disorder? I used to work on a locked psychiatric unit and dealt with a lot of kids who had conduct disorder, and some of the descriptions I read on hear sound exactly like the CD kids I've worked with (most of whom were not adopted). I'm curious as to whether this disorder may be underdiagnosed in adopted kids because it has so many similarities to (and may co-occur with) RAD.

[lucyjoy]

There are alot of diagnosis that overlap. However, there are differences in CD and RAD. Two of my children were diagnosed with CD later on but also had RAD. RAD occurs in the first 2-3 years of life and is directly linked to neglect and abuse, not the adoption-though abandonment can play a part. Unhealed RAD kids tend to grow up to have borderline personality disorder.

The therapists I've used to diagnose and treat my children were well aware of CD, ODD and a host of other illnesses. Many RAD kids have more then one diagnosis.

[ProspectiveSingleMom]

Thanks for the reply. The age issue probably is a major factor in differentiating between RAD and CD. On the unit I worked, we occasionally got kids as young as 6 who had very clear CD, but most were older than that when diagnosed. The link with borderline personality disorder is interesting. I've worked with adults who have that disorder as well as teens with "borderline traits" (since you can't be diagnosed with a personality disorder until age 18). Since BPD also has a high correlation with neglect and abuse, I would definitely be interested in reading any research linking the two diagnoses. BPD is still poorly-understood. It has been argued that BPD may be a variant form of PTSD, and the most recent research even suggests it may be related to bipolar disorder. There are some newer treatments that have been effective with BPD -- such as biofeedback and dialectical behavior therapy. I wonder if those same types of treatments could be used for kids with RAD.

[lucyjoy]

Those therapies are being used with RAD and most kids with RAD also have PTSD due to the truama of abuse.

[Lorraine123]

I do not believe that a child can have RAD without having PTSD to some degree. I waffle back and forth on which needs to be treated first - the trauma or the attachment. Lucy is right in that untreated RAD becomes BPD. Read the criteria for both. Such similarities. Biofeedback is regularly used to help with RAD. DBT, however, requires that the person realizes that they need to change. This is a problem with RAD and/or BPD patients.

[ProspectiveSingleMom]

Yeah, it is hard for me to imagine DBT working for a young child because of the level of insight needed. I'm still amazed that I had never heard of the RAD/BPD connection before -- considering people with BPD were a large portion of our patient population at the hospital where I worked.

[PabloandCarlosMama]

This is an interesting thread, and I think each child is different, and that's what makes it all so complicated.


With my older son who was 12 at the time of our adoption, he entered residential treatment a few months after leaving Guatemala. He was having awful flashbacks, night terrors, and dissociates in dangerous ways. We've had to deal with the PTSD first, and from there, have determined that he's bipolar, and as he has gotten more stability, we are able to build attachment slowly. He was given a conduct disorder rule out, odd rule out, adhd rule out. Last summer, everyone wanted to label both children as RAD and hopeless, and then I began to find good professionals who have been conservative in applying the labels and who work with attachment-disordered children.

As he has been working through his trauma, and learning that family and other people can be trusted, it's like the attachment and trauma work go hand in hand. We've needed to do this at a distance for now, but I'm hopeful that he will be safe in our family and will be living at home in the future. He no longer has the RAD label, no conduct disorder or adhd, but still has odd ruleout, and his defiance has decreased as he's growing closer to other people and me.

My younger son, age 9, also suffers from PTSD, and his therapist has done EMDR with him, and it is amazing how his self-image has grown and the empowerment he's gotten from this technique. But with him, we had to work on the attachment first, and then the trauma.

Same family, bio brothers, but two different treatment methods.

[marythemom]

When my son first entered our home, he was diagnosed with conduct disorder, mood disorder, and PTSD. After living with our family for awhile, we had him reassessed and they added RAD and traits of borderline personality disorder. He was having trouble sleeping (nightmares) and was very aggressive, particularly with family.

When he went to the RTC they changed his diagnosis to PTSD, cerebral dysrhythmia, ADD, bipolar, and RAD. The new meds had removed his underlying rage. I still see symptoms of BPD, but believe his med cocktail allows him to start addressing many of his issues (focusing on the abuse and neglect from his childhood for now). He still doesn't sleep well, but doesn't have the vivid nightmares either. He is still not very attached to us, but at almost 15 we probably weren't going to get much attachment anyway. Now that he is no longer aggressive, and is trying to attach - or at least is accepting of us, we feel comfortable finalizing his adoption.

There seems to me to be a LOT of overlap for all of these diagnoses.

[scandi]

my oldest was not able to address his trauma until there was some level of attachment. Once that was there he was able to really address the trauma issues and heal.

[ProspectiveSingleMom]

I found one article that described a theory that the disinhibited for of RAD can lead to BPD if unresolved and that the inhibited form can lead to schizoid personality disorder (symptoms of which include a lack of interest in interpersonal relations, inhibited emotional expression, excessive focus on fantasies, and a preference for being alone). Schizoid personality disorder is rare and generally does not need any treatment -- the person who has the disorder doesn't feel any distress over it. It's not like social anxiety -- they just don't care to make friends, and there's no link between this disorder and violence. I'm not sure if I buy into the link between inhibited RAD and schizoid personality disorder, but it is an interesting possiblity. Does anyone know of an adult who had RAD as a child and now has schizoid traits?

[Lorraine123]

The only RADs that I know are disinhibited and do show BPD traits. However, it does make sense to me that inhibited RAD becomes schizoid personality disorder. The symptoms are very close.

[ProspectiveSingleMom]

Originally Posted by Lorraine123

The only RADs that I know are disinhibited and do show BPD traits. However, it does make sense to me that inhibited RAD becomes schizoid personality disorder. The symptoms are very close.

Yeah, that's what I was thinking as well. I actually have some schizoid tendencies myself, though not bad enough to qualify as a disorder, so now I'm thinking back to my own family background. I didn't experience any abuse or neglect (at least not that I know of), but it was a pretty unhealthy environment (alcoholic father, mentally unstable mother, very unsafe neighborhood). I can remember as a child using fantasy as a way to escape (I had many very elaborate fantasy worlds and would imagine myself as an additional character in any book I read or TV show or movie I watched).

Do RAD kids tend to do this (use fantasy as a way to escape reality)? I realize that most RAD kids have the disinhibited type, so if this is only a trait of the inhibited type then it might not be very common.

[ProspectiveSingleMom]

Upon thinking about the question I asked in my last post, I realize that it's not something anyone can probably answer. No one who was around me when I was a kid had any way of knowing that I was in a fantasy world during the times when I was staring blankly off into the distance.

On a positive note, as a result of counseling that I participated in after my divorce, I have learned to overcome my fears of emotional closeness and have learned to love and accept my family members for who they are (after initially having to process through a lot of repressed anger). I also have friends who I am very close to (something I never really had when I was growing up).

[momraine]

If it helps I did the same thing as a child. If I only had the talent to write them down some of mine could have been great books! LOL. However, I also had a pretty messed up family.

[Sheriv]

Mine is charming....but the one thing I would say is that RAD is just an umbrella for a bevy of disorders. I personally think that RAD is on the far end of the Attachment Spectrum but that all the other things like ADHD, ODD, FAS, Autism, and various other neurological and emotional disorders are manifested because of PTSD which is the underlying cause of RAD.

Sheri