adoption, BiPolar (BP) and Reactive Attachment Disorder (RAD)

[barneysmom]

Hi Midwest Mom and all,

Regarding adoption, BiPolar (BP) and Reactive Attachment Disorder (RAD) --

We dealt with the physical and psychiatric disorders in our adopted difficult child first, long before considering Reactive Attachment Disorder (RAD).(Our difficult child was diagnosis with mood disorder not otherwise specified,probably BiPolar (BP).) I didn't want to consider attachment issues in difficult child because he seemed well-attached. (Also, when I speak of Reactive Attachment Disorder (RAD) here, I don't mean full-blown Reactive Attachment Disorder (RAD), but attachment issues -- grief, shame and loss -- which can inform the anger of bipolar.)

One day I got a flyer in the mail for a conference on pediatric BiPolar (BP). I noticed that Reactive Attachment Disorder (RAD) was subtitled under it.

Since then I have learned that Reactive Attachment Disorder (RAD) issues can accompany a mood disorder, even in "biological" children, because of the effects that a child's, even a baby's, mood disorder can have on attachment. For example, my baby difficult child raging for a solid year unless he was being held.

The child's temperament also affects how he looks at life's issues (glass half full or empty). My son has a very negative, anxious outlook on life because of his BiPolar (BP), and possibly because of his inherited temperament in general. This has informed his outlook on his relinquishment -- negative and anxious.

Regarding Reactive Attachment Disorder (RAD),the age of the child really is irrelevant. Genetics and temperament play a much bigger part, along with environmental factors like relinquishment or extended foster care. This is supported by the latest adoption research.

Lots to think about.

 

[timer lady]

I totally agree with you. We're dealing with severe Reactive Attachment Disorder (RAD) in wm, not so severe Reactive Attachment Disorder (RAD) in kt, along with the PTSD & BiPolar (BP).

We weren't able to address the attachment issues until BiPolar (BP) was stabilized in both my tweedles.

Reactive Attachment Disorder (RAD) is a real disorder with long term consequences on all involved with the child who suffers this very insidious disorder.

 

[BusynMember]

First of all, I think I've read every book on Reactive Attachment Disorder (RAD) there is, so I do know about it, although I don't think anyone really can pin it down in a scientific way, and I disagree that it doesn't have to do with what age they are adopted. We had a foster child who was doomed. He had Reactive Attachment Disorder (RAD), and was very friendly and likeable and nobody knew he was killing animals and abusing young kids---the kids were too scared of him and the adults loved him. But we adopted him when he was 11. My adopted kids think about their roots sometimes, and do not have Reactive Attachment Disorder (RAD). I am very skeptical of Reactive Attachment Disorder (RAD), unless the child was adopted older and is doing what our child did---charming on the outside, cruel behind our backs. Also Reactive Attachment Disorder (RAD) and autism mimic each other. I'm glad our little guy didn't get the Reactive Attachment Disorder (RAD) diagnosis...I do think it is slapped on all adopted kids who act out. I have a friend who just got it too, and she's had the child from birth and her twin doesn't have it...I just don't buy it (nor does she), and there is much controversy within the medical community about it. I won't change my mind and will continue to caution people to make sure it really is Reactive Attachment Disorder (RAD), especailly if the child has been loved by you since birth. I just don't buy that the child knows from the womb....etc. The therapy is quite brutal and could be harmful to a child with bipolar or autism. Sure, many diagnosis. can co-exist. I've just never heard of a Psychiatrist diagnosing Reactive Attachment Disorder (RAD). It's usually therapists who claim to "understand" adoption, and I'm sure many well-adjusted adopted adults, my best friend for one, would take issue with the amount of adopted kids dxd. with Reactive Attachment Disorder (RAD), especially when adopted at birth. Since I don't want to get into a debate, and am just happy I didn't have to go there with the Reactive Attachment Disorder (RAD), I'm not going to read anymore on the thread and just let the discussion continue without me. There are many non-adopted kids who act just like they have Reactive Attachment Disorder (RAD) because Reactive Attachment Disorder (RAD) is very vague, and nobody says they have Reactive Attachment Disorder (RAD). I'm sure our foster child is a psychopath....he has no conscience, but part of Reactive Attachment Disorder (RAD) is the ability to be charming. This child never lost it to those he wanted to impress. He was very much in control of himself. When he set fires and peed in our closets and pooped on the floors (at age 11) he made sure other kids of ours confessed to the crimes, and they were too afraid not to listen. He turned our house upside down, but he was very subtle. Reactive Attachment Disorder (RAD) was alot more serious than tantrums here. This history on this child was that his birthmother tried to k ill him and he stopped breathing, she had used drugs, she left him at home for days at a time, and finally she dumped him with a friend and never returned for him. He may also have fetal alcohol issues. With that history, I can understand a child becoming psychopathic, especially since he then went from home to home until we got him. But from birth? Naw, that's pushing it. My opinion, but also those of many professionals I know, and I don't buy it. So you all know where I'm coming from. Four adopted kids, all attached, no Reactive Attachment Disorder (RAD)....it can happen. Have a good day. I won't respond again /importthreads/images/graemlins/smile.gif

 

[Nancy]

Thank you barneysmom. I have been telling MidwestMom just this for a while now.

Our daughter too has attachment issues although I did not want to believe it because she was adopted at birth. Some believe children adopted at birth do not have Reactive Attachment Disorder (RAD). Our attachment therapist is currently working with 9 children with attachment disorder all adopted at birth.

Midwestmom you really need to learn more about current adoption research. Our therapist, Dr. Keck, who has written several books on the issue and works exclusively with adopted children, will be happy to point you in the right direction I'm sure. You also make your statements and then say you won't respond anymore and then you do again to someone else, the same thing. As I've said before I'm so glad you aren't dealing with Reactive Attachment Disorder (RAD) in the many kids you have fostered and adopted. But do not deny it exists and do not deny that there are those of us who are dealing with it in our at birth children. Do you realize they miss their moms from the moment they are born and don't hear her voice or smell her? I suppose not.

Nancy

 

[KimS]

I've got to say, I agree with MidwestMom. My difficult child has been with us since birth. He has no issues with Reactive Attachment Disorder (RAD). Even his therapist has said it is obvious there are no attachment issues. We are very close. He is bipolar/adhd/odd. Since I am his primary care giver, I'm the one that has the most difficulty with him. I've been told it is because he feels safe.

 

[barneysmom]

I think it is good for all of our ideas to be out there -- so that anyone dealing with attachment issues, or wondering about them in the back of their minds, can get a taste of what others are thinking, reading and experiencing, from all viewpoints.

Obviously it's a difficult, controversial, scary issue and we deserve a safe place to discuss it, and put forth all of our ideas while supporting each other and our kids. My .02

 

[Nancy]

I am convinced that many of our difficult child's problems would still be present if she were not adopted. Her temperament and personality and genetic makeup wouldn't change. In fact I believe she would be far worse off because I have to believe that her stable environment has done some good. But we are limited in what we can change because she is who she is.

by the way she told me the other day that she thinks we should not have told her she was adopted until she was grown. I don't know that I agree with that but in her mind she feels that knowing it from the beginning helped cause a lot of her problems. Interesting to get her perspective. I told her that is not what the experts recommend and she said we should tell them they are wrong.

Nancy

 

[Martie]

Well...

I have to jump in here because I just read a paper a student wrote on Reactive Attachment Disorder (RAD) that speaks to this issue very clearly.

I definitely agree that Reactive Attachment Disorder (RAD) exists and that it is thrown around too loosely--so everybody is right.

What is wrong is the DSM-IV. According to the DSM, to have Reactive Attachment Disorder (RAD), a child must have experienced seriously negative parenting in a truamatic living situation. This fits the type of child MM is describing.

By the DSM criteria, none of Dr. Keck's clients CAN have Reactive Attachment Disorder (RAD) assuiming that their parents are psychologiclly fit to be parents, which, of course, it is extrememly likely they are.

So what happens in my opinion is what Nancy is saying: adopted children have "issues" that come along with temperament and inherited tendencies that are quite stable despite living in good and loving homes. Because the child is adopted and there ARE adoption issues, the Reactive Attachment Disorder (RAD) diagnosis gets loosely used.

Unless one wants to go back to something like the Bettleheim version of the causes of autism (NOT) in which apparently competent and warm mothers were accused of "causing" their child's autism by being 'refrigerator moms,' it is important not to attribute causes to counter intuitive, non observable structures. When the refrigerator moms defended themselves, they were told that they were cold in subtle ways. Likewise, Reactive Attachment Disorder (RAD) is being used too loosely and the "trauma in the home" is supposedly subtle (so much so that it can't be seen, I guess.) Wrong--that is not what the DSM is saying. It is saying patholgic parenting and many placements cause Reactive Attachment Disorder (RAD). The DSM doesn't say what causes problems such a J. has--but clearly it is not due to the criteria stated in the DSM. by the way, several authors have noted the above: the use of Reactive Attachment Disorder (RAD) with children whose home situation doesn't fit the diagnosis criteria--but questioning the DSM doesn't change anything at least until the next edition (currently due out in 2007--but it will be postponed.)

Nancy: J.'s comment on not being "told" about her adoption is very interesting to me. If you hadn't told her, the modern adoption professionals would be blaming her problems on that. Since "telling or not" isn't an option for us, I never thought about it. However, occasionally, both my kids have commented on being tired of being the "poster family" for adoption. I ate in a Korean restaurant with MrNo tonight (husband and easy child are out of town), the hostess was rather cold to me--I attributed it to lack of English. I walked out slightly ahead of MrNo and I overheard her ask him is he is Korean. He said yes and then she looked at me. O well--what do people think that all those cute little Asian babies grow up to look like? It never ceases to amaze me that most people don't realize that adoption never goes away--it just is part of our kids' lives and therefore, our lives, forever.

I'm glad you have found a therapist who is helping with J.'s issues but I know she doesn't meet a DSM diagnosis for Reactive Attachment Disorder (RAD). Not that I think it matters, except to the extent it fuels the type of disconnect that is represented in this thread.

On second thought, I guess what is in the DSM does matter because it is so widely used by everyone in the mental health profession. by the way, it is not true that psychiatrists don't diagnosis Reactive Attachment Disorder (RAD). Psychiatrists are the biggest users of the DSM.

Take care all.

Martie

 

[Nancy]

Martie,

I understand and agree with most of what you are saying. Here is my problem. To say that children who were adopted at birth or those who did not go through a traumatic parental situation cannot have Reactive Attachment Disorder (RAD), denies that often adopted children have attachment issues and it is those issues that are usually the core of the disorder, along with genetic components of their personality. The real Reactive Attachment Disorder (RAD) is being overused here due to lack of a better term. I know my difficult child does not have Reactive Attachment Disorder (RAD) either and I doubt whether the majority of Dr. Keck's nine patients who were adopted at birth do either, but attachments issues are clearly the issue with them. It is not autism or any other disorder that is being suggested. The office is filled with children who are being treated for attachment issues with their adoptive families. They are not being treated for autism or BiPolar (BP). They don't come there first. They come there after years of searching for answers everywhere else. It comes after all the professionals in the medical field have said there is nothing wrong because they don't recognize attachment problems. It comes after years of denying to oneself that attachment is the cause because after all we loved this child from the beginning. It comes after years and thousands of dollars are spent on psychologists and psychiatrists who have no idea how to help these children. It is the treatment of last resort, it is when all else fails. So I disagree with the idea that Reactive Attachment Disorder (RAD) is diagnosed too early because if it were these kids would be getting the proper help much earlier in their lives.

One can simply not ignore that the majority of children who are adopted struggle with issues surrounding attachment to a family that is not their birth family and that this struggle crosses over into every aspect of their life until they are sometimes acting in an antisocial and even anti psychotic manner.

So I wish the DSM would come up with another term, possibly Reactive Attachment Effects RAE rather than Reactive Attachment Disorder (RAD), similar to Fetal Alcohol Syndrome and Fetal Alcohol Effects. That way we can stop arguing about the real cause of adopted children struggling so and possibly look for different methods in treating them.

From my experiences and those of so many others that I have come in contact with in the adoption world, these kids struggle with their identity like no others, and it happens at birth with many so obviously there is a sense of loss when they are infants that does not get resolved by inserting another loving caretaker. The bonding experience truly does begin at conception.

I too know that if I had hid the information on J's adoption from her that would be said was the reason for her problems. It was interesting hearing her perspective. It just helped point out in my mind that no matter what we do as adoptive parents it just simply cannot fill the hole left in their hearts. And that it is this hole that gets bigger and bigger and permeates every aspect of their lives.

I have not thought of a good alternative yet. I don't know if one exists. I do know our family would never qaulify for the poster family for adoptions and in fact none of the ones I personally know would either. It is a very sad fact that the very method society uses to build families for those in need also causes so much pain and suffering.

Nancy

 

[barneysmom]

Yes, I agree with Nancy about "RAE," or reactive attachment effects. In my initial post, I referred to them as attachment "issues," not full-blown Reactive Attachment Disorder (RAD).

My son was NOT diagnosis with Reactive Attachment Disorder (RAD). During his Reactive Attachment Disorder (RAD) evaluation,when asked to draw a picture of a nest, he drew a beautiful, intricate nest with a large mother robin and a tiny baby robin, obviously under her protection. "That's me," he said. He passed all the other "tests" with flying colors. But in the personality inventory which husband and I filled out during the evaluation, our replies zeroed in on a cluster of narcisstic and anti-social behaviors which I strongly believe stemmed from his rage and shame about his relinquishment. He told us as much himself in his subsequent attachment therapy, and has been much more comfortable with himself since. He still has psychiatric issues related to a mood disorder, but his BiPolar (BP) rages have radically been defused since therapy.

I agree that we need to get our definitions straight about this sensitive issue. I also believe that no one escapes from adoption, specifically relinquishment, unscathed.

Is there any way to take Midwest Mom's name off the title of this thread? It makes it look like a challenge or an affront to her, and I feel uncomfortable with that. Sorry Midwest Mom.

 

[busywend]

Yes, just click on edit post on your first entry and you can change anything you posted including the title.

 

[Martie]

Nancy and everyone,

I understand what you are saying and I agree with you.

Your analogy to Fetal Alcohol Syndrome (FAS) and Fetal Alcohol Effects (FAE) is very good. And although I believe some children escape relinquishment "unscathed" because that is such a negative word, clearly no adopted person is unaffected by the problem the birth family has in being unable to raise their child. It is interesting to me that children orphaned in wars often have fewer attachment/identity problems (although they obviously may have others such as PTSD) because the "cause" of the relinquishment is so abundantly clear to them and not of the birht families' volition.

Nancy, we are not the "poster family" because we have done anything right-- I meant we are the "poster family" because we stick out in a small suburb where from an early age, there was no hiding from the kids that we are a multi-race family. I hardly feel qualified to be a poster anything in the sense you took it. I feel that I barely squeaked by with MrNo alive to see his 15th b'day. That's not something others would wish upon themselves.

So I am glad that you all are finding help with attachment ISSUES. One more thought about this diagnostic mess: in the psychiatric literature "reactive" means a specific cause is present, as in reactive depression (following an identifiable truama, usually a loss) and non-reactive deoression (no apparent reason for it). Therefore, your kids may have attachment disorders (or problems) that are non-reactive. Just another way to solve the DSM problem--LOL--like the authors care what parents go through.

This is a very interesting thread to me--of course, with attachment such a topical diagnosis, it makes one wonder whether or not every problem a child has, is related to the core "shame" of being relinquished. This is what die-hard psychoanalysts believe which is why many advise people never to adopt. Such rigid Freudians believe that the adopted child is irreparably damaged, so why even try? Obviously thousands of families don't agree.

Final note: in some ways international adoptees may be at an advantage with the shame problem because at least my easy child believes her birth mother had no real alternatives but to place her internationally. Neither of my kids showed "attachment problems" and probably would have drawn great big nests, too, but that doesn't mean that there isn't a relationship between subsequent problems and adoption. However, I think identity is a bigger problem for tranracial adoptees that affects their whole lives, too, and for MrNo, at least, the genetics of depression are clearly in play--and would have been whether he was adopted or raised in Korea.

Best wishes to all,

Martie

 

[alphamember/theresa]

this topic ( Reactive Attachment Disorder (RAD)) is VERY interesting to me , as my son has been diagnosis ( more than once) with Moderate to Severe Reactive Attachment Disorder (RAD). Once he was stabilized on medications for BiPolar (BP)-- the attachment was easier for he was able to process several things in his life. Both disorders will be a constant throughout his life & he is aware of that.

We do know both diagnosis are correct just by looking at his background. He was severly abandoned, neglected & we suspect sexual abuse. ( so does s.w.) & has a history of BM being in Foster Care- on drugs & an alcoholic. Also was Borderline (BPD) & BiPolar (BP). I am not saying that no one can recover from these - certainly can do much more than his BM did. She couldn't even function.

This topic remains a "hot button" for some but once you have walked MORE than a mile in my shoes- I tend to listen politely as there is NO WAY one would believe what we have lived thru! ( I wouldn't , if I had been told- "issues" or not)

I congratulate those who listen & feel very much unsupported when I hear people refer to Reactive Attachment Disorder (RAD) as autism, Pervasive Developmental Disorder (PDD)- not otherwise specified, ADHD, just Bipolar, ( as if there's a just.....)ODD, CD,- alphabet soup diagnosis. A lot of us have been there done that.

My $02

 

[susiestar]

I find htis thread fascinating!

Each and every single therapist and psychiatrist we have taken difficult child to has askedus if he was adopted. Not just no, but he roomed with me at the hospital!! He was NEVER out of my sight! Or husband's!

He was always wanted and loved and nurtured. He is not bipolar. The docs ruled that out. But he still has Reactive Attachment Disorder (RAD) like symptoms. I think the RAE/Reactive Attachment Disorder (RAD) distinction is interesting.

Thanks to all of you who openly discuss the issues with attachment and adoption, it is hard to find info otherwise. by the way, none of my kids were abused, neglected, left alone, or placed out of myhome. With the exception of Brandon's abuse of Jessica and Tyler and I, and his subsequent 4 month Residential Treatment Center (RTC) stay.

Susie

 

[barneysmom]

Susie, thank you for your encouragement and support of this discussion.

In my reading about attachment, I have learned that the challenges of attachment are not specific to the adopted population.

A friend of mine is helping her son through some attachment issues. My friend suffered some post- partum depression and was unable to care for him for a bit, plus he had a significant amount of ear infections as an infant, was uncomfortable and ill a lot, had temporarily impaired hearing etc.

Factors which significantly interfere with the attachment process, for ex. a mom being in the hospital for a prolonged illness, can interfere with the normal attachment cycle.

Once again this is just FYI. I know it doesn't happen all the time, etc. But sometimes things just converge to get in the way of the relationship between the mom and the baby at crucial times.

 

[Penta]

I have been fascinated by reading these posts! It brings up so many issues that my girl has and that her mother had...her mother being my deceased, adopted daughter.

Both mother and daughter began to exhibit troubles at the onset of adolescence. My daughter's story is long and I won't get into it here.

But, I naively felt my granddaughter would not suffer the same troubles as her Mom....not so, she began exhbiting the same behaviors at the about the same age. Before then she was very attached to me, more so than normal, probably because of the death of her Mom when she was 4.

However, at about age 12, she began to distance herself from me and became downright defiant and hostile from then on. Our different racial backgrounds played a big part as well as her inherited behavioral disorders.

It just seemed there were too many issues for her to sort out and I never could find any therapist she would connect with on a long term basis.

At the point when she left for the Residential Treatment Center (RTC) over a year ago, we had no relationship. She hated me and I was scared of her wrath.

I would say she had attachment issues, but not until adolescence...she also has racial identity issues as well as behavioral disorders, dyslexia, and a very quirky, creative personality.

This is just all so enlightening to me.

Thanks to all who posted!

 

[barneysmom]

Penta I'm sorry you've had such a difficult and painful journey with your girls.

((((((((Penta)))))))))))

{{{{{{{{Penta's granddaughter))))))))

My condolences about your daughter.

 

[Nancy]

Martie, I did realize what you meant by the poster comment and I should have told you I was using it in another way. You know I often thought the same thing about international adoptions. Don't take this the wrong way but often when Mike and I see internationally formed families we look at each other with a wistful look and know what we each are thinking. And yet I often wondered if that didn't bring it's own set of problems in that the identity issues are so much more prevalent when the child is obviously a different race than both their parents.

I do a lot of reading on this issue and wanted to quote a particular paragraph that has helped me understand this issue. Since there is very little written about attachment issues beginning before birth, I found this particularly helpful:

"The traumatized early developing brain, starting even before birth, learns to regulate in such a way that it is not able to cope with stressors, nor is it able to respond appropriately to social signals or internal emotional or physiological signals. "In the developing brain states organize neural systems, resulting in enduring traits" (p. 212.) In addition, the infant stressed by trauma or loss experiences high levels of stress hormones which can actually cause brain cell death, producing "permanent functional impairments of the directing of emotion into adaptive channels" (p.212). The systems regulating release of stress and "comfort" hormones are also dysregulated. Schore goes on to explain how these types of dysregulation may lead to disorganized attachment, poor control of aggressive impulses, and to sociopathy and violence, as well as poor human relationships."

When I think about the stressors that our birthmother was under during her pregnancy it is no wonder that our daughter's brain never developed the connections it needed to in order to develop the attachments that she should have.

And this article is even more on target:

"One group of children who are traumatized are those who become available for adoption. Every baby who becomes available for adoption has experienced some trauma. The most common trauma they can experience is the loss of their relationship to their birth mother. Over the past ten to twenty years, there has been growing evidence that a strong or significant bond exists at birth between the infant and his birth mother. This bond develops during the nine-month period the child was inside his mother. When the baby is born, he already has a bond with his birth mother. In my experience, besides food and air, nothing is more important to a baby’s survival than his mother’s love. When the love from his relationship is lost, regardless of the reason, the bond is broken and the baby is adversely affected.

Many babies, who are adopted at birth or shortly thereafter, bond to the adoptive parent or mother without any problems. Others do not. We do not clearly know the reasons why. We also don’t know how frequently this occurs. Based on my clinical experience, my estimation is that it occurs in 10-30% of infants adopted at birth. If other harmful experiences, such as neglect, abandonment, abuse, or multiple placements are added to the loss of his birth mother, the resulting damaging affects are compounded. The more severe the problems in the relationship with the birth parents, the more difficult it will be for the child to receive and give love to the new adoptive parents."

It is of particular interest to me that this article states that 10-30% of babies adopted at birth have attachment issues. That is a significant number.

And yet another article about attachemtn issues prevalent at birth because of prenatal alcohol abuse:

"More common, but also more subtle, is Fetal Alcohol Effect/Exposure (Fetal Alcohol Effects (FAE)). There are normally no outward or testable signs of this condition. Affected children can be indistinguishable from their peers, with symptoms only appearing when a child is several years old. Fetal Alcohol Effects (FAE) children will frequently have learning disabilities, emotional control problems, or bonding and attachment issues. Probably 15 – 25% of children from all Eastern European countries will have to deal with one or more significant challenge in their lives from their birth parents' use of alcohol. Families adopting from the region need to be particularly alert to the needs of their children."

Anyway I always enjoy talking about this with you as well as other members who are struggling with these issues. You are in many ways my hero.

Nancy

 

[Coookie]

Well, I just want to add that I find this whole thread very interesting. While my difficult child is with his natural father, and has been with us since he was 2, I believe that we are looking at Reactive Attachment Disorder (RAD) issues as well.

I always thought that since we have raised him from 2yrs old that his time before that would not have an affect on him, or we could turn it around through love and a stable home. I am finding that that has not been the case.

I appreciate the open exchange of ideas on this issue here.

Thanks all...

Hugs

 

[timer lady]

This post has become quite informative to all who cannot begin to understand the relevance of Reactive Attachment Disorder (RAD) and attachment issues. The effect it has on both the family & the child.

There is no question that my tweedles fit the criteria set out by the DSM for Reactive Attachment Disorder (RAD).

I've read many many articles on the physical damage done to a child's brain resultant from abuse & neglect. Our biggest hurdle has become trying to rewire that part of the brain that was damaged due to the early trauma & neglect.

Creating a sense of self & permanency in our adopted children is a very high priority. That goes back to the very basics with games such as peekaboo. These children have no trust that when we are out of sight we are still here.

My tweedles are transient in attention, love, trust of adults, & in their sense of self. It changes from day to day & sometimes from minute to minute.

I have all the information, all the books, all the articles. And I live the real thing daily. The books & articles can explain the why's & wherefores & go into the scientific causation yet living this is a totally different situation. I know longer have the time for the why's - I just need to find help for the end result of the trauma.