[Abdulina]

Since Mike has recently told us about his dealings w/ raising a child w/ RAD, I was wondering how many others on here deal with RAD? I myself have a child with RAD. He in fact had 20 of the 21 symptoms of RAD. And if you've ever read some of them, you know how scary that list truly is. But to live it is a whole different ball game. My son has indeed healed alot but it is always present. Like Mike said, RAD is a lonely place, especially in public when you have to parent your child differently than what most are used to. I think it would be an eye opener to some others to see how many of us on this forum have dealt with or are dealing with RAD. If any of you out there are dealing with RAD, could you please maybe share it with us all. I think putting this out in the open may in fact help others recently home or who are coming home to possibly know what to look for or at the least, to know they are not alone in this. Together, we may be able to bring a sense of relief to some and help each other out.

Take care,

[momto4boys]

What are the 21 symptoms? Can you list them? It may be that some of us are dealing with it and don't even realize we are dealing with a mild form of RAD. I would appreciate any information you could provide.

[Abdulina]

I found this list of symptoms. Has more than the 21 but gives a little more as well. Here goes:

Symptoms of RAD in Children

Superficially charming and engaging, particularly around strangers or those who they feel they can manipulate

Indiscriminate affection, often to strangers; but not affectionate on parent’s terms

Problems making eye contact, except when angry or lying

A severe need to control everything and everyone; worsens as the child gets older

Hypervigilant

Hyperactive, yet lazy in performing tasks

Argumentative, often over silly or insignificant things

Frequent tantrums or rage, often over trivial issues

Demanding or clingy, often at inappropriate times

Trouble understanding cause and effect

Poor impulse control

Lacks morals, values, and spiritual faith

Little or no empathy; often have not developed a conscience

Cruelty to animals

Lying for no apparent reason

False allegations of abuse

Destructive to property or self

Stealing

Constant chatter; nonsense questions

Abnormal speech patterns; uninterested in learning communication skills

Developmental / Learning delays

Fascination with fire, blood and gore, weapons, evil; will usually make the bad choice

Problems with food; either hoarding it or refusing to eat

Concerned with details, but ignoring the main issues

Few or no long term friends; tend to be loners

Attitude of entitlement and self-importance

Sneaks things without permission even if he could have had them by asking

Triangulation of adults; pitting one against the other
A darkness behind the eyes when raging

[Abdulina]

What is RAD?

Reactive Attachment Disorder is a psychiatric disorder that begins before age 5 in which a child who has experienced extremely poor care or abuse exhibits very disturbed and inappropriate social relatedness for his or her age. For example, the child may exhibit contradictory or disorganized responses to caregivers such as alternately approaching, avoiding, or resisting the caregiver's efforts to comfort or care for the child. Or, the child may not adequately distinguish between his or her primary caregiver and strangers, exhibiting excessive familiarity with people the child has never met.

How Common is RAD?

There is very little information regarding the frequency of occurrence of RAD because it is a relatively new psychiatric diagnosis. Initial research suggests that RAD is a fairly uncommon disorder. Although many young children, especially those in the child welfare system, have been abused or neglected, a very small percentage of these children exhibit the seriously impaired social relatedness that is required to obtain a RAD diagnosis.

What Causes RAD?

By definition, a child must have experienced abuse, neglect, or suffered extremely poor care to be diagnosed with RAD. This includes a child whose basic physical or emotional needs for comfort, affection, or stimulation have been disregarded, as well as a child who has experienced repeated changes of primary caregivers which have prevented the child from forming stable attachments. The risk for RAD increases for children whose parents are isolated, depressed, lack social support, or who were themselves extremely deprived or abused as children. Children who as infants were "difficult," lethargic, chronically ill, or who were separated from their caregivers during the first weeks of life may be at risk for developing RAD.

[mikeintexas]

Stephanie - thanks for starting this thread.

Karen/Angelkisses has some good checklists too for kiddos under 5... I pm'd her and hopefully she'll post them.

[blueprints]

Stephanie,

I've got two children with RAD, adopted Sept 2004. They have all the symptoms except a few, we are in therapy biweekly. It's been extremely tough parenting, especially in public and around family members who, no matter how many times I explain... They will just NEVER understand.

Al

[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.

[angelkisses0102]

OK...here's what I've got...is from the www.A4everFamily.org site. Whenyou go to the link and get this checklist, it shows what 'real life' examples look like for each sympton.

Infant Attachment Checklist Copyright by Walter D. Buenning, Ph.D., 1999



Symptom Examples

Adoptive moms share examples from their children’s daily lives. Just a few of these symptoms may indicate a problem. Please consult with an attachment therapist if you have concerns about your child.


On Dr. Buenning's website, you may download a pdf file and print this checklist as well as a separate symptom checklist designed for children ages 5 years & older. Each symptom is on a continuum from 0-10. Individual symptoms may present from mild to severe.


Examples are coded by age at adoption (a. ___months old) and by the child’s primary pre-adoptive care (FC=foster care, OR=orphanage.)




1. Cries; miserable all the time, chronically fussy
2. Resists comforting or nurturance
3. Resists or dislikes being held
4. Poor eye contact or avoids eye contact
5. Flat, lifeless affect (too quiet)
6. Likes playpen or crib more than being held
7. Rarely cries (overly good baby)
8. Angry or rageful when cries
9. Exceedingly demanding
10. Looks sad or empty-eyed
11. Wants to hold bottle as soon as possible
12. Stiffens or becomes rigid when held
13. Prefers being held with back toward mother
14. Does not hold on when being held (no reciprocal holding)
15. When held chest to chest, faces away
16. Does not return or reciprocate hugs
17. Generally unresponsive to parent
18. Cries or rages when held beyond his wishes
19. Overly independent play or makes no demands
20. Reaches for others to hold him rather than parent
21. Little or reduced verbal responsiveness
22. Does not return smiles
23. Shows very little imitative behavior
24. Prefers Dad to Mom
25. Gets in and out of parents lap frequently
26. Physically restless when sleeping
27. Does not react to pain (high pain tolerance

HERE"S another checklist, just click the attachment.

[angelkisses0102]

Same as above...go to the site and each will be described.

Additional Symptoms of an Attachment Problem Parents of babies and toddlers have noted several symptoms of attachment problems in addition to those found on Dr. Buenning's infant list. As the child grows, some signs may disappear, only to be replaced by others. Many of the following symptoms can be found on checklists developed by other attachment therapists.
Note: just a few of these symptoms may indicate a problem. Please consult with an attachment therapist if you have concerns about your child.

Examples are coded by age at adoption (a. ___months old) and by the child's primary pre-adoptive care (FC=foster care, OR=orphanage.)




Self-Destructive Behavior
Whines Excessively
Up/Down Syndrome
Velcro Baby
Temper Tantrums
Aggression toward parent
Autistic-like Behaviors
Gagging/Choking
Aggression toward siblings or peers
Inappropriate Reactions to Others
Violent Language
Body exhibits little tremors/shakes without obvious cause
Extreme stranger anxiety or total lack of stranger anxiety
Extreme separation anxiety or total lack of separation anxiety
Hides Abilities
Language/Speech Problems
Playtime
Eating Problems
Repetitive Chatter (or Repetitive Signing)

[angelkisses0102]

From the same site...

Red Flag Phrases
You may not think of these phrases as red flags. The scenarios we describe could all be "normal" or "age appropriate." Many parents, especially first-time moms, are likely comforted by moms of biological children who share stories about their children with the same traits—sometimes even more severe!--who grew up to be perfectly "normal."
First, let us say, attachment issues are not exclusive to adopted children. (For a thorough account of attachment studies with biological children, read Becoming Attached.) Second, similar symptoms can have very different causes and may need very different approaches.

Think of it this way. Your child doesn’t want to go to sleep. OK. We all know it is perfectly normal for children to sometimes have trouble sleeping. But what if you knew your child had gone to sleep with one family and woken up with another family? Would you think and treat his/her fear in a different way? That's what it's often like with attachment issues…something that could be “normal” takes on a different light when put into context of a child’s life experience. We cannot know what our children have experienced. But we do know two things--they have been separated from their birth mothers and have endured at least one, if not more, subsequent moves—enough loss to incite symptoms.

Many of us had a nagging feeling that something just wasn’t quite right. But many of us also admit to using these phrases to spend some time living in denial; time that is precious and irretrievable for finding and implementing the correct treatment.


Red Flag Scenarios

You notice something one day, something you'd taken for granted. You realize your daughter never faces you. Hmmm, you think. You notice she always takes a hug with her back to you. Not only that, she doesn't like it when you two are face to face. You mention it casually to your husband who says:
"She's probably just more comfortable that way."

Your daughter is the sweetest child in the world--everyone says so--your playgroup, school, church. Sometimes you wonder how you got so lucky. You realize that at home, she is very directive. You're glad though, because you want your girl to be strong. It's just that sometimes you wish she'd listen to you without so much opposition. She tells you what she wants to wear, what to play, how to play, whether she wants pretzels for a snack. But, you remind yourself:
"She's just strong-willed."

You child is in the "I'll do it myself stage." All children go through that, right? You just didn't think it started this early or was this persistent. If you help her with something, she flies into a rage! Your cousin says:
"Independence is good. Consider yourself lucky!"

You go to the playground with some friends. Your son takes off across the grass toward another family. He allows them to pick him up, laughing and chatting all the while. Your friends reassure you, saying:
"He’ll probably be a politician!”

A friend comes to visit. She also has a baby, 11 months old, the same age as your son. You notice that her child comes to her for comfort and will sit contentedly with her. You try to hold your son on your lap for a quick cuddle, but he slides right off and heads back to the toys. You mention to your friend how your son never seems to stop long enough to snuggle with you. She replies,
"He's just curious. A busy boy!

Your 16-month old son doesn't handle crowds very well. Whenever you go to a party or gathering, he will have a meltdown within 20 minutes. Of course you are embarrassed and you say your son is just tired and over-stimulated. You are glad people around you seem to understand:
"That's just early two-year-old behavior; he's maturing early."

Your toddler has started hitting. He occasionally smacks you in the face. Nothing seems to deter him from hitting his siblings. Your neighbor says that, just like her son:
“He's all boy!”
(Adoptive mom's note: "all boy" should apply to the fact that my son would sleep with a matchbox car if I let him. It doesn't apply to him hitting me or being oppositional.)

Ever since your child was very young, he would play quietly by himself. In fact, he doesn't seem terribly interested whether you come or go. He pays attention to a toy for long periods, playing it over and over again. You secretly think he must be highly intelligent. Something nags at your heart, though, but the nursery school teacher says:
“He's just the quiet type."

You love your baby to pieces but she just won't give you any peace. She watches your every move and must have you within arm's reach every waking second. It's wearing on your nerves. When you confess this to a friend, she says:
“She's a Velcro baby. Enjoy it! It won't last." Or, "You should have seen my (bio) daughter! Don't worry!"

Your 10-month-old throws fits. He pitches food from the highchair and screams. Your mother-in-law, a teacher, says:
“He's just frustrated because he can't talk to communicate what he wants."

You visit a new church. Your baby reaches out her little hands to strangers to be held. Everyone tells you that she is the cutest thing they’ve ever seen. You’re proud, but wish she would look as adoringly at you as she looks at the strangers. Everyone says:
“She's just such a friendly, out-going baby.”

He's drinking his bottle ... you look into his eyes...and he turns away. You also think it a bit odd that he doesn't hold you back when you hold him. You mention this to your doctor who says:
“He's just not an affectionate/cuddly baby." (Phrase courtesy of a pediatrician who did not recognize this symptom in a child with attachment impairment.)
Or, "Boys tend to be like that." (From a registered nurse friend.)

You call your son and he doesn't respond. This is happening so frequently that you begin to wonder if he's hearing impaired. You take him in for a hearing test and he passes with flying colors. Yet the minute you get home, it appears that he can't hear a word you're saying. Your mom says:
"Selective hearing. All kids are like that. It's payback time for when you used to do it to me.

And, a note from an adoptive mom, "If you have to ask, "Is this normal?" it's worth getting it checked out by an attachment therapist.

[angelkisses0102]

More from www.A4everFamily.org

What some of these "Red Flag Phrases" mean to us
Strong-willed
A child with an attachment issue feels an overwhelming need to control everything in his world. He may demonstrate what appears to be "strong-willed" behavior, that is actually masking his huge need for control. He may tantrum easily if he doesn't get his way. He may also try to enforce this "strong-will" more at home with his family--especially his mother--than he does out in public.
Control issues we've noticed:
Brushing teeth
Getting dressed
Getting into/buckling/riding in the carseat
Diaper changes
Eating (including "picky eater", holding food in mouth for long periods of time, refusing to eat, throwing food)
Sleeping
Refusal to hold parent's hand
Insisting that parent ________ (carry him, stand when carrying him, come the second he calls)
Ignoring when he hears his name called (leading some to wonder if he is hearing impaired)
Refusing to follow instructions (leading some to believe that his language reception is poor)
Taking photos (child refuses to cooperate during photo sessions or develops a "quirk" such as always winking, frowning, sticking out tongue, etc… that parent cannot convince him to stop)



Independence
He may show signs of wanting to be prematurely independent: holding his own bottle, wanting to walk by himself and not hold hands with Mommy, not wanting to be held, walking away in the grocery store, showing a lot of interest in strangers. People may say, "He's just curious."

Early Two-Year-Old Behavior
Everyone knows about the "terrible twos": tantrums, short fuses, wanting to be independent, being bossy, etc… But what about when these signs appear at 9 months or 11 months or 15 months old? Often, parents of attachment-impaired children are told not to worry about their child's behavior, "Oh he's just more mature than most. It's the terrible twos setting in already." But what about when it only happens with mom? Or only when at home? If a child is in daycare, sometimes the behavior upon arriving home is called the "witching hour," chalked up to just being "really tired" after being gone all day, not recognizing that the behavior is happening primary with Mom and/or Dad.

Quiet
Children with attachment issues may seem to fade into the background, never asking for anything, always complying. She may sit on mom's lap for a long meeting and never move or make a sound. He may play quietly for hours, never calling out for mom. In many ways, these avoidant symptoms are the hardest to detect. No one questions the normalcy of a quiet, independent, well-behaved child.

Velcro Baby
Many of us (and the professionals around us), assumed that our children were well-attached because they wanted to be with us all day, every day. We failed to recognize this common symptom of anxious attachment.

[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?!

[angelkisses0102]

Oh, and Stephanie I now have an AD child...not a baby RAD'ish...as we had feared (or he has progressed/healed to this point?)

[Movingon]

bumping up

[karenjoe]

Angelkisses - thank you for all of the info! A question: Is it possible that it is normal to have some of these issues but not all? Or is it something that should be checked out? For example, our daughter is 18 months old. I've thought of her as strong-willed. She cries/gets angry at trivial things. However, she makes eye contact, sleeps well through the night and doesn't seem to have a problem sitting in my lap or being held (though still doesn't really like being cradled). She does understand "no" and gets upset if you tell her no in a strong voice. Would you consider this just issues that come up as you form/grow attachment? Or is it all warning signs of RAD?