What is RAD anyway?

This post is also available at my new website Trauma Mama Drama.  If you enjoy reading my blog, remember to update your feeds, emails and bookmarks with the new link, because eventually I will only post updates on the new site's blog.

****************************************
Last night, a friend asked me about RAD and how to tell if a kid is suffering from this mental disorder.  Wellllll...

DSM-V Criteria

RAD has recently been divided into disorders: "Reactive Attachment Disorder" and "Disinhibited Social Engagement Disorder."

The DSM-V defines RAD with the following criteria:

• The child does not seek or respond to comfort when distressed 
• The child's emotional and social response and emotional affect are limited, and the child has episodes of irritability, sadness and fear that are evident in non-threatening interactions with caregivers
• The child experienced neglect of emotional and physical needs by caretakers, experienced several changes of primary caregiver (thus never developing a strong attachment to any one person), and living in an unusual situation where attachments could not develop (most commonly foster care or orphanages, and the behaviors listed above are direct results of these circumstances
• The child is at least nine months old and is not on the autism spectrum or diagnosed with other developmental disabilities
• The disturbances manifested before age five and have been present for at least twelve months  

The DSM-V defines Disinhibited Social Engagement Disorder with the following criteria to replace the first and second bullet point (the last three are the same):

• The child consistently approaches unfamiliar adults (as if they've known them for a long period of time) and acts overly familiar with the stranger, does not check back in with caregiver at a rate that is appropriate for the child's age, and goes off with strangers with minimal or no hesitation 

Middle and Little were diagnosed with RAD (Middle was diagnosed by two different doctors) before the split, but I'm pretty sure they both have both disorders.

Behaviors associated with RAD

Note: These behaviors are commonly associated with RAD, but are NOT "symptoms."  Does that make sense?  Not all kids who have these disorders have all the behaviors listed below, and the presence of these behaviors does not mean RAD is the correct diagnosis.  Only a doctor/psychiatrist/psychologist can diagnose a child with these disorders, and even then sometimes children are misdiagnosed as bipolar or having ADHD.  The trauma of a child's past should ALWAYS be disclosed when speaking to medical professionals, even if it is hard or embarrassing to discuss.  The kids' mom said a doctor diagnosed them with ADHD (which is probably not true... They were only three and four at the time after all), and several adults have suggested that they have ADHD not knowing their history of trauma.

Also, there is a movement to shift away from terms like "RAD" and instead utilize the term "Complex Trauma Disorder of Childhood."  I like that term much better and hope the DSM-V adopts it soon.

• Unable to give and receive love
• Oppositional, argumentative, defiant
• Emotionally hollow, phony or empty
• Manipulative or controlling
• Has frequent angry and intense outbursts
• Is angry inside
• Unable to cry about something sad
• Avoids or resists physical touch and closeness
• Can't be trusted and has no conscience or empathy
• Superficially engaging or charming
• Lack of eye contact and affection on parents' terms
• Destructive to self, others and property
• Usually more difficult with female caretaker than with male caretaker
• Cruel to animals
• Steals
• Lies about the obvious (affectionately known as "crazy lying")
• Impulsive or hyperactive
• Does not understand cause-and-effect relationships
• Gorges or hoards food
• Has difficulty with peers
• Persistent nonsense questions and chatter
• Overly demanding and clingy
• Sexual acting out
• Bossy with peers
• Preoccupied with the violent or destructive (ex: blood and gore, fire, natural disasters)

Middle and Little have ALL of these behaviors except the first (unable to give/receive love) and the sexual acting out (although there have been some "questionable" things Middle has done, I think it's more the normal stuff kids experiment with... Her therapist hasn't seemed concerned when the issues have been raised and we are 90% sure the kids did not experience sexual abuse before we got custody of them, so I usually say we don't see any sexual acting out).  The first time I read this list, I cried... Because that was EXACTLY what I was seeing.  We asked Middle's first therapist if it was possible she had RAD, and he said she was a "classic case" and that he'd already diagnosed her as having that a month before we asked (thanks for letting us know, doc!  Geez!).

Over the course of the next several blog posts, I will go over the behaviors I see to illustrate the struggles we face as a family.