Educating the world about Reactive Attachment Disorder through experience, hope, humor and love.
(Warning: nothing here should be taken as medical advice)

Wednesday, September 21, 2011

Mixing RAD and Diabetes for fun and... well... not fun

I think one of the more frustrating things about RAD is the intensity of the childs “need” for control.  Oftentimes, I don’t think they are doing it on purpose, but I can’t imagine what else they are thinking.  Let’s take my oldest.  She has both type-1 diabetes (insulin dependant) and RAD… NOT a good combination! 

Since one of the easiest things for children in general to control is their food, it’s not uncommon to have food “battles” from time to time.  But with a diabetic, that “control” can have disastrous consequences if it’s allowed to run amok.  I’ve spoken with other parents who have children with type-1 diabetes and they all tell the tales of food battles and the daily drama of trying to help their teenager maintain their blood sugars.

So… teens in general can use food as a control issue
Children with diabetes can ramp up that as a controlling issue simply because they can
Now add RAD, which comes with a deep rooted NEED for control at any cost, and you can imagine (or probably not, but you’re welcome to try!) the daily battles that are fought.

“Pick your battles” we are told often.  Sure, believe it or not we do.  Have a nighttime accident? Whatever – just clean it up.  Don’t want to do your chores? OK, that’s your choice but you aren’t getting desert if they aren’t done.  We’re not going to fight over that.

But when it becomes a battle that has potentially fatal consequences, that is one we have to fight.  Whether we want to or not.  And she knows this.

 At her age, she SHOULD be able to handle her diabetes appropriately.  Not perfectly, appropriately.  There is a difference and we recognize that.  Her diabetes doctor and nurse often tell us we shouldn’t be so “controlling” over it, that she’s certainly old enough to handle it.  But they aren’t familiar with her RAD – they know of her what she lets them know when they see her once every three months.  And that includes years of triangulation efforts.  So they don’t really know her. 

We really wish we COULD back off and give her space to handle it herself.  We WANT to not have to lord over her and check and double check that she has done what she needs to do to keep herself safe, but again we’re back at that darn control issue.  If she can keep us dancing around her diabetes, that puts her in control.  Even though it sends the message she’s not ready to have the control, which ultimately removes the control from her resulting in even more intense control battles.  A downward spiral for sure.

To those who wonder how bad it could be to give her a little more control over it since that’s what she desires?  Let’s take an example from the other day.  She is supposed to check her blood glucose levels at lunchtime, and again before she leaves the day treatment center.  This allows her to determine whether she needs insulin or a snack.  On this particular day, her case manager went home early which gave our daughter the opportunity to take things into her own hands.  So she didn’t test before leaving school (“I have the power to control whether I test or not”) and, because she didn’t get the message that my wife was going to pick her up from the library, she went to the local dog park where she thought she was supposed to meet. 

For those who aren’t familiar with diabetes, people with a working pancreas tend to have blood sugars that range between 90 and 120.  I personally can feel it when I drop below 90.. when I hit the mid 70s I start to get a little cranky, and when I drop below 70 I find it hard to think.  On this particular day, when my wife (who wasn’t going to go to the dog park but decided to at the last minute) found my daughter there, she asked her to test her glucose (we always do when she comes home so we know how to plan our dinner).  At first she was resistant and didn’t want to test (more control anybody?).  Eventually she relented and it turns out her glucose was at 51 and dropping.  I’ve seen her drop to the mid 20s and still be able to talk.  I have also seen her drop so low that she can’t walk or speak coherently, and once she had such low sugars that she got on a bus heading in the wrong direction.  Had my wife not changed her mind and gone to the dog park, our daughter would have been walking around, with her blood sugars dropping and without her emergency carbohydrates on her (she usually carries around a bag of raisins, but frequently ‘forgets’ them.  In this case, she actually DID have them with her, but didn’t realize it because her sugars were too low for her to think clearly).  By the time she would have realized my wife wasn’t coming to pick her up, she would have easily been in the low 40s.  Then, she would have had to make the 11 block walk home, which would have dropped her into the 20’s and the possibility that she wouldn’t have made it home at all (passing out along the way) would have been very real. 

If this were an isolated incident, we wouldn’t worry about it.  But it’s a pattern.  A pattern those who say “just give her more control over it” don’t see.  A pattern that that, quite honestly, scares the crap out of me.  And those people who say “give her more control”, well they aren’t the ones who would be subjected to yet another CPS investigation if she were to end up in the hospital yet again.  They aren’t the ones who would have to live with themselves if something were to happen to her because they didn’t do everything they could to keep her safe.  We are.  And it takes its toll…

She wants X (more control), We want X (for her to have more control).  So why must she fight us every step of the way?  Why can’t she see that if she were just to do things our way, that she would get what she wants (control) without all the drama, headache, heartache, and bad feelings.  Oh yeah, RADs have to do it their way.  No matter the cost.


Monday, September 19, 2011

When a simple request turns into a nightmare...

Lately there have been some definite improvements in my daughters behavior.  Certainly she’s still up to some of the same old tricks, but the massive blowups and WWIII style drama explosions are further apart.  

So imagine my surprise when a simple request to “please feed the cats” would cause such a ruckus!!  We were in the kitchen, I was finishing up the days dishes, wife was preparing dinner, and my daughter started to unload the dish drainer.  The cats hadn’t eaten so I asked her to do that instead. 

From there it was all downhill.

For some reason that really seemed to dysregulate her and I could practically feel her frustration.  Then I watched her fill up 2 bowls (we have three cats) to overflowing and put the cat food away.  When I pointed out that was too much food, especially for our overweight pig.. err I mean cat, as well as for the older cat who tends to overeat and then vomit, I could practically feel her ready to explode.  So she returned almost all the food to the container, leaving about 7 pieces in each of 2 bowls.  When I said something along the lines of “come on, really? They need more than that” it was ON.  So she ended up in her room for the evening and wouldn’t talk to me when I went back to show her that although I didn’t approve of her behavior, I still loved her. She hasn’t had a blow up like that in MONTHS and I really couldn’t figure out wtf was up.  It was like she went from 0 to 100 in 20 seconds and I was at a loss… where did this come from?  It’s not like we asked her to paint the bathroom with her toothbrush, or cut off all her hair, or some other odd request.  Just asked her to feed the cats – something we all do.

Then, a day or two later we figured it out.  When she returned from grandmas the Sunday prior, she lost her anti-depressants.  Why she didn’t tell us, I have no idea.  But when we would ask if she took them, she would tell us yes – but obviously she hadn’t.  Turns out they had fallen out of her backpack in the trunk of the car and gotten into another bag with some camping stuff (we had just returned ourselves and hadn’t gotten around to completely emptying the trunk).  Thankfully we finally found them.  But I really don’t understand why she was telling us she was taking them when she wasn’t.  Or why she didn’t tell us she couldn’t find them?  Would have been a simple matter to look for them or even just refill the prescription.

I knew there was something different about her all that week.  I thought it was just the beginning of school, but it was definitely noticeable.  She, of course, says she’s no different on or off of them, but I’m not the only person who noticed.  When I spoke with her case manager this morning and mentioned it to her, she had an “a-ha!” moment – apparently my daughter had been VERY volatile all week and they were trying to figure it out also.  Like me, they had attributed it to it being the first week of school but thought there must have been something else going on. 

I’ve been sitting here trying to figure out her thought process and why she just let it go.  But I can’t.  And she’s not telling….. 

Wednesday, September 14, 2011

How her RAD came to be....

Reactive Attachment Disorder typically affects adopted children or those who live in the foster system for any length of time. And once you understand what causes the issue, it's not hard to see why. Less obvious is why children who live with their biological parents develop the disorder. Especially to parents who cared for their children and can't imagine a mother (or father) being any other way. After all, who could not love and care for their own child? Especially to the point where it causes lifelong problems? I know I have often felt awkward or misunderstood when I talk to people about my daughters issues. After all, with the exception of the first 6 months or so when I was in the US Navy and stationed on the other coast, and another 3 months while we were separated and going through the divorce and custody proceedings, I was there with her. Granted, I worked all day so I wasn't there the way her mother (who didn't work) was, but when I got home I would do what most parents do - I would bathe her, feed her, play with her, put her down at night, etc. So how bad did it have to be for this problem to develop? Well... oddly enough, when packing up for the move my daughter and I stumbled across my saved divorce paperwork. well ok, I found it and she noticed it when I picked up the folder wrong and it all went sliding out onto the floor. And of course, the worst of it was right on top. Which she read. This was the brief that I had filed with the court requesting immediate custody be granted out of concern for my daughters physical well being. Because it was filed with the court, it's all a matter of public record so it's not like I'm divulging any secrets here. But if you were to meet my daughter today, you would never know some of the things she endured. You might never guess that she had been through so much as such a young age. But it did, and she did, and I'm only putting this up here to show that you never, ever know what you don't know, and this paints a pretty good picture of how her attachment disorder came to be.

Names have been redacted since they aren't really relevant, but if you really HAVE to know it is, like I said, a matter of public record and you can go look it up :) A. is my daughter, and S. is her older, half-sister who was about 8 at the time. Also, I'm taking it directly from the brief since that is more accurate than my memory (some of these I had forgotten about even)...

A. During my visits to the apartment since the date of separation, I have found dirty dishes stacked up, garbage cans which had spilled over onto the floor, food and drink left on the kitchen floor, and sharp objects left with the baby's reach. On several occasions I have seen A. taking food from the garbage can and putting it in her mouth. There was no apparent supervision.

B. On several occasions during my visits, I have found the front door unlocked and the children unsupervised. Several times, Respondent was asleep in the rear bedroom with the door closed, and on April 19, 1997 Respondent was unaware that S. had left to go somewhere with the neighbors, and insisted S. was in the front room. During recent conversations with S., she has indicated she has assumed increasing responsibility for her baby sister's care, in that she has been allowed to bath the baby unsupervised and is allowed to play outside with A., again without supervision. During a conversation on April 21, 1997, S. pointed out new scrapes on her elbows from a roller-blading mishap. When I asked why she hadn't tried to break her fall, she replied "Because I didn't want to drop A.". As the apartment is on a long road which parallels Highway 80, it is common for cars to speed past on a regular basis, creating a potentially hazardous situation.

C. On or about April 3, 1997, Respondent was served with a 30 day notice to vacate the apartment in which she and the minor children reside. To date, there has been no indication she has made any efforts to obtain replacement housing. during a discussion on April 30, 1997 with S.T., Owner and Landlord of the apartment building, he advised me he has made several attempts to collect the rent but Respondent filed to open the door or make any attempt whatsoever to resolve the situation.

D. On April 6, 1997 Petitioner took A. to Childrens Hospital Oakland Urgent Care Clinic for treatment of Chicken Pox. She had been suffering from a full outbreak for three days prior to that time, during which Respondent made no effort to obtain medical treatment.

E. A. suffered severe nerve damage in her left arm at birth, resulting in initial inability to use her arm. She has slowly been gaining limited use of the arm; however, continued improvement is dependent on continued physical therapy. She had been receiving physical therapy through California Childrens Services but was dropped from the program due to Respondents's failure to keep scheduled appointments.

F. On April 26, 1997, Respondent, upon learning that my health care coverage had been extended to cover A., demanded said coverage be cancelled in order to receive additional treatment through CCS at no cost. Respondent insisted A. had been re-enrolled in the physical therapy program due to a lack of insurance and had already resumed treatment. however, during a phone conversation on may 1, 1997 with Cynthia at California Childrens Services, I was informed that although A. could be considered for reinstatement to the program upon re-referral from her physician, there had been no such request, nor was there any record of contact with Respondent during the past 6 months.

Interestingly, there has been no repercussion from my daughter having seen and read this brief. I would have thought for sure that it would have triggered something.. anything... but it didn't. I think if we had come across this even 6 months ago, her reaction would have been very different and we would have had fall-out for days. Between that and the improvements in both her behavior and attitude, I know we're on the right track. She has been through so much - much more than many people - and every time I think about it, it breaks my heart. But it's going to be ok. SHE is going to be ok. I know it.

Love alone can't make up for the experiences she's had. But with our love, commitment, and lots and lots of work, there is hope for a better future.

Monday, September 12, 2011

Why you need an attachment therapist

There has been some discussion lately about the effectiveness of therapy for RAD, and the general consensus seems to be "not traditional therapy". Nor does typical "play therapy" seem to be of any use. In fact, traditional and play therapy tend to make things worse. One on one therapy means the child is alone with the therapist. This gives the child the room and freedom to manipulate and triangulate the therapist, and the more they get their hooks into the therapist, the more empowered they become. That isn't the only problem either. The child is quickly learning how people want/expect them to behave and act. They are learning better methods of getting what they want.

Look at the following traits:

Factor 1:
Glibness/superficial charm
Grandiose sense of self-worth
Pathological lying
Lack of remorse or guilt
Shallow affect (genuine emotion is short-lived and egocentric)
Callousness; lack of empathy
Failure to accept responsibility for own actions

Factor 2:
Need for stimulation/proneness to boredom
Parasitic lifestyle
Poor behavioral control
Lack of realistic long-term goals
Juvenile delinquency
Early behavior problems
Revocation of conditional release

Look familiar? Certainly sounds like a list of RAD traits, but that's not where I got it from. The above comes from the Hare Psychopathy Checklist, which is the psycho-diagnostic tool most commonly used to assess psychopathy.

Because traditional therapy allows the RAD to perfect many of the above traits in factor 1, you are, in effect, training them to become a better sociopath. And I'm guessing that's not anywhere near the top of your list for "things I want for my child". Luckily, just as the attachment issues took time to develop, the child can relearn ways of dealing with the world in time. There is a reason the diagnosis of "sociopath" isn't given before a person reaches age 18 - the brain is still growing and learning throughout childhood, and just as the child can learn manipulative ways with traditional therapy, proper attachment therapy can help reverse that process.

This is why Attachment therapy focuses less on the child and more on the parent, especially working with the parent on finding ways to get the child to attach. If you are seeing an attachment therapist, they may rarely ever meet with your child, and certainly will never meet with them alone. Unfortunately, attachment therapists aren't easy to find - you can't just look in the phone book for a list of names!

So... where to find them? A great place to start is on Nancy Tomas' website where she has a list of attachment therapists by state. She only lists therapists that have been recommended by parents. If you have had success with any that are not on the list, please let her know.

If you currently DO have your child in traditional therapy, look back over the past year and ask yourself if he/she has improved or worsened.  Only you can decide whether your childs therapist is right for them. 

Friday, September 9, 2011

Attaching to your child

You may not know this, but I actually do enjoy getting emails from people - especially people who have children with issues similar to mine. It's not that I'm glad others have to deal with the problem, but it does provide a sense of solidarity and let's us know we aren't alone (and we don't have to navigate this by ourselves). However, I'm not a doctor, or a therapist, or anything more than a father just trying to make sense of all this as I go. That said, there are certain things I have found that work better than others. While I'm not perfect at these, I find the more I utilize these approaches, the stronger my daughter seems to be attaching - which is the ultimate goal, is it not?

For starters, I've learned that children with complex trauma backgrounds tend to be hypervigilant and easily triggered by any irritation, sarcasm, anger, impatience, or hostility that my creep into your tone of voice. Think back to the last few times you were frustrated or upset with your child - if you can honestly say you were able to avoid all of the above, you are a saint. Seriously. It's definitely something I am working on, but it isn't easy (go ahead, try it). However, any time your child senses any of the above, they can quickly become defensive and dysregulated. So rule #1 is to remain mindful of your tone. If possible, step away if you feel you are getting triggered yourself.

Since our children are wired to control and resist (yay us!), any direct commands tend to elicit a reaction to an authoritarian stance. If you think that is going to get you anywhere, well... So rule #2 is to try some skillful redirection by prefacing your request with:

1) A caring expression that the child matters to you.
i.e. "I care too much about you to let you run away. I hope you stay here with us where it is safe"

2) Staying emotionally attuned to the child's inner experiences.
i.e. "Your feelings are important to me and I can see you were really hurt by what Susie said. I can't let you go punch her and I don't want you hurt either. I want to understand and help you through this"

3) Focusing on the child's strengths or commenting about your child having been successful previously and you are asking them to do again what they did before.
i.e. "Last week you really worked hard at being respectful and considerate, and it really paid off for you. That seems difficult for you right now and I wonder if you could try as hard as you did last week"

Above all, avoid power struggles at all costs. Any time you are in a position where your child feels you are controlling them or telling them what to do, you risk triggering reactivity and power games. Remember, the child must always feel they are "in charge". Try giving your child permission to do the action while describing the consequences. This is called a "No Problem Attitude". An example of this is something like "We care too much about you to let you get hurt, because you are important to us. If you decide to cut school, you could do that and we would have to call the police to make sure you don't get hurt. But you can do that if you choose". At this point, walk away to give your child space and time to think over her choice. Oftentimes, this will lead to a good choice (assuming they have decent cause and effect skills).

In short, if you find your child is dysregulated, tantruming, or in a PTSD triggered state...
Talk calmly and slowly, using a few short words
Avoid long discussions or lectures
Avoid becoming triggered into your own anger - this just adds fuel to the fire
Side-step power struggles
Calmly describe the choice
Calmly walk away to give compliance time
Do NOT administer any consequences while your child is dysregulated. This will only increase a sense of deprivation and fuel dysregulation
BUT, DO give consequences later on once your child is regulated. Be sure to remind them that you want them to try again next time because you want them to get the rewards and privileges they want.

If you can catch your child when they are just beginning to move into a dysregulated state, you can try to head it off using the PACE method. These are simple attempts at establishing a connection:
P - Playfulness
A - Acceptance (i.e. "I'm sorry it is so hard. Sometimes I don't like rules either")
C - Curiosity ("I wonder what is going on today? Yesterday it was easy for you to help out, yet today seems harder?")
E - Empathy

Lastly, whenever possible apply the 4:1 Rule of Positive Comments to Consequences (pretty self explanatory)

Anyway, these guidelines have helped me establish better attachment with my daughter and I hope they can help you. I would be curious to hear how they work for you!

Wednesday, September 7, 2011

A source of stress.....

The other day when we were heading downtown to pick up my daughter after her visit with grandma, I found myself really stressing over her being down there alone. She’s almost 16 and when I look back on when I was 16 I was so very different. I was going everywhere by myself and rarely home. I had a job, money, and lots of places to hang out. So why was I so stressing over her walking 2 blocks from the train to the library?

Oh yeah, her poor decision making skills and lack of cause and effect thinking. My wife and I have joked about how my daughter would sell us out for a bar of chocolate (ok, we were only half joking) but it’s really an indicator of how she thinks. She lives in the moment, rarely considering how things will affect her even 10 minutes later. Combine that with her need for attention and we have a potentially disastrous situation when she’s out walking around. There have been more than one occasion where guys have hit on her while she was out, and no matter how many times we tell her she needs to get away from them rather than respond, she can’t help but engage in conversation with them. And it’s not just conversation either – there have been a couple of times where they have managed to get close enough to actually touch her.

As a father, that’s both scary and infuriating.

Who are these men and why are they touching my daughter?

But although she says she wishes they would leave her alone, she won’t do anything really to stop it. We tell her to ignore them, duck into the closest store and tell the person working there that she is being bothered by some guy. But what she does instead is engage them in conversation (even if it’s just one word answers, that’s enough for some guys to think it’s all good) and continue walking down the street as if nothing is wrong.

So yeah, I was really worried and stressed about her wandering around in downtown San Francisco even though it was in such a public place. I don’t even like being down there by myself in certain areas, and I’m not a little guy, so the thought of her weaving her way between homeless drunks and drug addicts that have made their way down from the tenderloin really freaked me out.

I wish there was some way to get her to understand the dangers. She’s tall, she’s thin, she’s beautiful, and she is incredibly naive. Even her case manager fears for her safety and well being due to her naivety around social issues such as boys. She calls her an “unwanted pregnancy waiting to happen”. Not exactly what I want to hear – especially having been a teenage boy myself. Yet, no matter how many times we try to impress on her the dangers out there, she seems to remain oblivious. The ‘instant attention’ is far too alluring and outweighs any ‘possible problems’ that might arise from it.

And people wonder why we keep such close tabs on her…. “back off a bit and she’ll blossom”… yeah, right. People have no idea….

Monday, September 5, 2011

A breakthrough... small, but huge!

My daughters don't do well with change. Not at all. So this upcoming move 2 states away seems to be really stressing them out. They have both been acting out in ways we haven't seen in quite a while. But there have been incredible breakthroughs as well. Last week my oldest was in group at the treatment center when she volunteered she starts trouble with her step mother because she's there. She admitted (all on her own, with no coaxing by staff) that she's really pissed at her bio-mom (and I think 'pissed' is too soft a word for how she really feels, but it's the one she used) but since bio-mom isn't around, she takes it out on step-mom because she is the only mother figure that is available.

While this isn't news to us (we've been telling people this for many years), for her to have expressed it is HUGE! It tells us that whatever we've been doing is working. That the way she has been looking at things is different. I mean, we've noticed it - her behavior has improved in general, her attitude has improved in general (we still have huge outbursts of drama, but it's not constant like it used to be) - but we've never actually heard her express her anger for her bio-mom.

We've always known it was there though. All you had to do was mention her bio-moms name and the tears would start. So perhaps this breakthrough will propel her on towards more healing? Sometimes it seems to be just the opposite though - each breakthrough brings with it yet more intense drama. But that's understandable, and we can work though all of that as long as we know we're heading in the right direction. I don't think she's quite ready to sit down and write her bio-mom a letter yet, but I think someday she's going to have to do that. Even if she never mails it (and we wouldn't know where to send it anyway), she needs to get all of that crap out of her. Much like you need to clean your cars oil pan to get all the gunk out so it runs smoother.

This treatment center and it's staff have been such a Godsend for us - I pray they have something similar in the Seattle area....

Friday, September 2, 2011

Saddest. Day. Ever.

Sometimes we really have no idea what is going on inside somebody elses head. Even if we think we do, and we try really hard to, if you haven’t lived it you just can’t fathom it. For example, if you have never experienced an episode of major depression, you don’t realize just how debilitating it can be. It’s not something you can just smile your way out of. I was reminded of this just recently.

I was watching a movie called Wake Wood. Without giving it away, it’s about a couple who loses their daughter in a tragic accident and moves to WakeWood where there is a Pagan priest who offers to bring their daughter back to life for 3 days. At a price of course, but that isn’t the point. I hate movies like this. They always make me think of how I would feel if I lost my daughter(s).

So it was time for my daughter to check her blood sugar levels for the final time of the night and I mentioned this to her – that I was watching this horrible movie about a mom and dad that lost their daughter and how horrible I would feel if I lost her. How much I would miss her and just couldn’t imagine how terrible it would be. She quickly began making a joke of it, saying things like “oh you know you’d be happy, you’d probably have a party”. I was shocked. I told her that I was serious, that I wouldn’t miss anybody more than her but she kept on with her “you’d be really happy” dialogue.

After a couple of minutes I asked her if she was joking… I mean, she couldn’t possibly feel that way right? Her answer was “sort of”. I knew that wasn’t a lie. I know when she’s lying about her feelings and she was dead serious. Deep down inside of her, there is a part of her that truly believes nobody would miss her, nobody would be upset if she were to die.

How heartbreaking is that? To hear something like that come from your own flesh and blood. It bothered me all night long and I slept horribly. I haven’t always been the most attentive parent (untreated major depression will do that), but I’ve always been there for her, have always done things I felt were best for her, and have always thought we had this bond.. a bond I have with no others (I have a bond with my other daughter too – just as strong, but different). So for her to feel this way just blew me away. That’s how deeply she was affected by the trauma she suffered as a baby. It was a brief glimpse into the dark inner workings deep in her mind, and I felt powerless. And sad.

I had a long discussion with her caseworker at the day treatment center, and she says this isn’t uncommon among children who have gone through what she has. That all we can do is keep showing her that she’s worthy of our love and care, that we’re there for her, that she doesn’t have to be alone. But ultimately it has to come from within her.

As we ramp up to possibly move out of state, her behavior is similarly ramping up. However, along with that have been several major breakthroughs – this being one of them. Certainly there’s some good to be had from this. It’s information we can use to help her continue to heal. But in the meantime, wow….

Just. Wow.