As we go into the changing of services, we learn of new diagnosis

[tessaturtle]

So, many of you in previous posts of mine have mentioned the same thing I suspected, that difficult child was displaying many characteristics of a kid with attachment disorder. He just had his last appointment with his current psychologist today. difficult child moves back to the Community Mental Health system that treated him for 8 years with no success next week. So his current/ex psychiatric has never shared with us anything from his treatment - saying it is confidential. However today, gave us a copy of his memo to the psychiatric hospital (where difficult child recently spent a week) which included his diagnosis for difficult child. His diagnosis is Reactive Attachment Disorder (RAD) ("a mixed form not currently found in the DSM), BiPolar not otherwise specified, and Conduct Disorder juvenile onset. Prior to starting with this psychiatrist (after spending 8 yrs in the community system and phosps) his diagnosis was Bipolar, ODD, ADHD rule out. So not much difference, but clearly more significant. The Reactive Attachment Disorder (RAD) diagnosis does confirm my suspicions based on experience that he might have some type of attachment disorder - I am not convinced that it is full blown Reactive Attachment Disorder (RAD) however - according to one of the professionals I work with in the field, Reactive Attachment Disorder (RAD) is on the extreme end of the 'spectrum' of attachment issues; kids can have injuries, so to speak, to their attachment, that can be less severe but still problematic.

Anyway, it creates an interesting situation. In his transition back to a new therapist at the Community Mental Health Center, will they pay attention to his current diagnosis or come up with their own. I think its worth giving creedence to, because, even though it is a more serious diagnosis, it might help explain why 8+ years of previous therapies (aimed at the bipolar) did not work....

 

[InsaneCdn]

{{hugs}}
Yes, attachment disorders are a whole spectrum.
And yes... if you don't have the right diagnosis, all the interventions and medications in the world won't make a positive difference.

 

[buddy]

And there ARE treatments for Reactive Attachment Disorder (RAD), even more severe cases.... it is hard, but not hopeless but it takes a truly specialized therapist who gets it.

Certainly worth checking out.

 

[lovelyboy]

I would be so upset, because this changes the way you interact with your difficult child! The family can help so much more, if you knew!

 

[susiestar]

Interesting. It would explain why bipolar treatment didn't work. Before they ruled out bipolar or took it off, did ANYONE ever do a total medication wash and then follow the bipolar medication protocol that is approved by the Board of psychiatrists? WHere you first do only mood stabs (up to 2 of them) and antipsychotics until moods are stable? It can take a LONG time to get to the therapeutic level of mood stabs and 6 weeks at that level to know if they are really working, so it is SLOW. You MUST be off of all antidepressants, stims, etc.... because those actually CAUSE mood cycling in bipolar patients.

I actually think that you may get more help with these diagnosis's, but what does your gut say about bipolar? I know a few adults on here who SWORE that they were better on antidepressants for their bipolar until they actually got onto this medication protocol and off of them, and the difference was astounding. NOTHING really helped until then. Sadly, it seems that MOST psychiatrists are not willing to do this unless the parents are super insistent and that can be hard to do. After all, we have no formal training in these medications, right?

As stated, attachment disorders are a spectrum and it takes a great, experienced therapist to really help. I hope that they can offer these supports and services to you, and that this diagnosis opens up the door to whatever will help all of you the most effectively. The diagnosis change does put you on a really tough road, but at least now you know what road it is. You were already there, it was just mis-named and the wrong help was given. Sort of like you were in a Honda civic on a muddy country road. You are still on the road, but now that you know what road it is, you can take the 4 wheel drive jeep instead of the little Honda civic - and you will probably get through the rough spots easier because you will have the right equipment. I know, cheesy analogy, but it seemed to fit.

 

[tessaturtle]

Thanks everyone!
@Susie - He still has Bipolar diagnosis (which we agree with and would not change as that would not be accurate to get rid of it), the Reactive Attachment Disorder (RAD) was just added to it and his psychologist has it primary right now due to the bipolar being relatively stable. His bipolar was thoroughly diagnosed (first used as a rule out until they were certain) over a period of 8 years, using the medication protocol, (maternal) family history, and the 8 years of therapy (ages 5-13) at the Community Mental Health Center (where all the services are under one roof, medications, therapy, family services, community services). Untreated, he was like a roller coaster of moods, he couldn't/didn't need sleep, etc. When treated with Stimulants when he was younger for the (now abandoned adhd rule out) he was extremely manic/hyper/aggressive/etc. After many trials as you have described, Bipolar was confirmed once he had several years of mood stability on the tegretol and abilify. He has seen a different psychologist and psychiatrist for almost two years now because, he was getting worse as he got older and this particular psychiatric we switched to worked really well with teen boys with conduct problems. He is now switching back due to the hospital kind of making us do it, and his current psychiatric stating that difficult child is not able to do his CBT and needs more therapy based on the Reactive Attachment Disorder (RAD) (family work, which the psychiatric doesn't do).

 

[pajamas]

Side note - I'm outraged that a therapist would exclude the parents of a minor due to claims of "confidentiality". I can see occasional extentuating circumstances, but lacking those, it seems unprofessional/unethical in the extreme (I'm feeling extreme tonight). Here's hoping your next sojourn in the community system is more effective.