Possible ADHD, RAD DX Today, What a Relief

[illinoisgranny]

My GS and I had our first visit with a CW from our community mental health agency. She was in the livingroom for only a minute or two and saw my GS literally bouncing off the furniture, the walls, and off the floor and said "Oh my gosh, this is a perfect example of ADHD. How have you coped with this for so long?" (It's been 22 months now)

I told her we had been given a DX of Sensory Processing Disorder, and she said it's way more than that! She continued to observe GS while I was filling out forms and giving information and concluded that he likely is also RAD. She said she works with many foster children and most of her foster cases have some RAD symptoms.

Believe it or not, I'm relieved! I was so happy to finally get someone to see what I've been coping with.

I wish my DD and her BF had gotten help with my GS long ago before they ended up hurting him. They both plea bargained on their abuse case. If someone had gotten an accurate DX for my GS long ago who knows how our situation would have changed.

[Polliwog]

I think it's pretty unethical of a social worker to even bring up ADHD or RAD during a short visit and without a LOT of evaluation. There could be a dozen (or more) reasons your grandson is the way he is. Especially Reactive Attachment Disorder. That is not an easy thing to diagnose and attachment is a huge spectrum with RAD at the very far end.

I hope that you get the help your grandson needs but I'd be really skeptical of someone who mentions these things right off the bat.

[queenjane]

How old is your grandson?

What symtoms of RAD are you seeing? I'm seeing some issues with my stbad too, although so far no one has labelled it RAD, i think right now they are saying PTSD but we dont have any kind of official diagnosis.

My dd also has a diagnosis of ADHD but i think those behaviors are attention seeking behaviors stemming from attachment issues, more than ADHD. So, she is no longer on meds. I notice when she is in situations where she has an "audience" she tends to spiral out of control...by the time we left her therapists office yesterday, she was falling to the floor, laughing uncontrollably and making lots of nonsense sentences, and generally being inappropriately silly. (She is 8.)

So are you able to get him into therapy? Is he on any meds right now?

Its very hard to determine the cause of behavior in a child who is suffering grief and trauma issues...things like SPD, ADHD, RAD, PTSD....they can mimic each other.

I understand your relief at having someone confirm that there is something "wrong"...while of course i dont WANT "issues" with my dd, i was a bit afraid that when we met her therapist she would dismiss my concerns and say there werent any problems...but instead she said she totally noticed some of the things i was talking about (like how she intentionally stands in the line of sight of two people talking so all eyes are on her, or her spiraling out of control thing.) So i'm not crazy after all.

[pumpkingirl71]

Originally Posted by illinoisgranny

Believe it or not, I'm relieved! I was so happy to finally get someone to see what I've been coping with.

I totally understand. It is so hard when "professionals" brush off your problems.

I too am very surprised that two pretty heavy diagnoses came after a short meeting. Honestly, ADHD is a dx that is given out very freely, but RAD is not.

[pumpkingirl71]

Originally Posted by queenjane

Its very hard to determine the cause of behavior in a child who is suffering grief and trauma issues...things like SPD, ADHD, RAD, PTSD....they can mimic each other.

[lauren]

Originally Posted by pumpkingirl71

I too am very surprised that two pretty heavy diagnoses came after a short meeting. Honestly, ADHD is a dx that is given out very freely, but RAD is not.

Be very very careful with this worker. Check out her credentials.

[illinoisgranny]

My grandson also seems to act out more if he has an audience, but he is quite high strung even when alone with just me. I'm divorced and it's just me and my grandson at home.

I don't think she was trying to diagnose, but saying she saw the signs were obviously there. She will have him visit the staff psychaitrist and staff psychologist as well. She is a licensed clinical social worker.

Here are some of L's behaviors:

When he was 3 he broke a window once banging on it when I left the house for a doctor's appointment (he was with a trusted friend who babysits when I have to go somewhere alone)

He will cry inconsolably when I'm gone until I come home

He clings to me like there's no tomorrow, preferring to sit in my lap as long as possible when he's not in school. (early childhood)

crossing his eyes for long period of time

growling like an animal repeatedly throughout the day

jumping off his dresser in his bedroom onto his bed (even though I try to stop him)

running into furniture and bouncing off one piece to another until he drops from exhaustion

twirling around in circles until he falls from dizziness

jumping up and down like a jack in the box

screaming at the top of his lungs over minor irritations

frequent nightmares (almost nightly)

inability to sit through even his favorite TV shows for more than 4 or 5 minutes*

*he only watches 1-2 hours of tv a day

[queenjane]

What signs are you seeing that indicate RAD though?

[illinoisgranny]

The attachment symptoms I see are:

1 Clinging to me far too much for a four year old

2 Destructive to his toys and other people's belongings

3 Trying to hurt our family cat

4 Rough, sometimes violent behavior with his peers

5 Inability to make friends with kids in the neighborhood

[queenjane]

I think many/most kids in foster care have attachment issues which isnt necessarily the same as saying they have RAD. Most kids, unless they went straight from hospital at birth to a loving stable long term foster home, have suffered neglect at the hands of ill-equipped birthparents who may not have met their needs in those early months or years before coming into care, add to that multiple moves through foster care....yeah its a recipe for attachment issues and dysfuctional coping mechanisms. Whether that turns into an attachment disorder depends on all sorts of factors, i imagine.

I am in NO WAY an expert, but i would expect a 4 yr old with RAD, when confronted with a friendly sw visiting the home, to crawl up into her lap or otherwise invade her personal space. He may interrupt any conversation to turn it back to himself ("look what i made, look what i did, look at me me me"), he may be unbearably cute and if the sw is a newbie (sounds like yours is not) she may think he is sooo adorable, and just eat up the attention he bestows upon her (which is really attention for himself but a naive person gets suckered and doesnt realize)...she would say that the problem is you, not him. He is just so charming. With my dd, when we were with the case manager at the therapy place, she charmed the heck out of her (a young pretty outgoing woman who was super duper friendly and super duper fun!) but with her actual therapist who was an older lady, who did NOT seem easily charmed at all and quite strict in comparison, my dd basically ignored her, was quite rude ("can you stop talking so we can GO?!") and clung to me like crazy, pressing her body into mine. She still tried to block the line of vision between the therapist and me.

Certainly problems with peers is one trait of RAD, although if your gson has an issue with aggression and can be violent with peers, that could account for it too. and that could be ADHD. or even sensory stuff (if he is overloaded/irritated by his peers he may lash out physically)...the hurting the cat...is he playing too rough? or does he intentionally seek out the cat in order to cause it pain?

One big thing i've noticed in my dd and in my friends soon to be dd...is the sneakiness, the crazy lying, the manipulation.

Two books you might consider reading are "Toddler Adoption: The Weavers Craft" and "Attaching in Adoption" , i read both awhile ago and somewhere in one or both it talks about the types of attachment, the spectrum of attachment.

[Polliwog]

I agree that there are many things, or a combination of things, that could be going on. In my work life, I've worked with hundreds of children from at-risk families. I've only met one child with a RAD diagnoses but many, many, many children who display the characteristics that you've described.

What's most important is getting as accurate a diagnosis as possible and finding the right therapists to help you and your grandson. That's the hard part.

[lauren]

I would echo queenjane and polliwog and add that many challenging behaviors in children with a hard start are either biologically based (as in ADHD) or related to trauma. Many symptoms can be a survival based adaptive response to trauma. A classic example is food hoarding in response to neglect and unavailability of food-- most of us would hoard food if we weren't sure when our next meal was coming, and pre-verbal children can begin to do this, then later when there is plenty of food, might still do it in a compulsive manner (this is an example, not something your grandson is doing).

Destructiveness and harming animals/peers can be related to children witnessing these types of harmful events perpetrated on others, and being traumatized by them, as with domestic violence, physical abuse, or even watching really scary TV shows.

Clinging to a caregiver can be a very adaptive and survival based response if as a child you have spent a lot of time wondering when the adults would appear and/or meet your needs. Once you are safe, you don't want to let your caregiver out of your sight!!

A really skillful clinician, in combination with a skillful child psychiatrist, will sort out, very carefully, how much is biological, how much is trauma based (post-traumatic stress disorder or acute stress disorder) and how much is attachment related.

[Smithie]

I agree that a supposition of RAD is jumping the gun here based on the symptoms you describe... but really, whatever the SW puts down on her little piece of paper that gets your grandson the services he needs, is fine by me and probably fine by you. I have a biokid with ADHD, anxiety and sensory processing issues, and early intervention services for him were SO hard to get, whereas kids with many of the same symptoms at the same intensity with an autism DX received the services he so desperately needed, for FREE, on the government dime.

This SW may be trying to get the labels applied that she knows will result in services being provided. That mayor not be the right thing in your situation. I'm just tossing the possibility out there.

[pumpkingirl71]

oops

[pumpkingirl71]

Originally Posted by Smithie

I agree that a supposition of RAD is jumping the gun here based on the symptoms you describe... but really, whatever the SW puts down on her little piece of paper that gets your grandson the services he needs, is fine by me and probably fine by you.

Such a good point! Our pediatrician just wrote "reactive attachment issues" on a note to the school nurse to try to get the nurse to take dd's medical issues seriously.

[junipermoon]

I haven't read this whole thread and I would never try to diagnose your grandson over the internet (and the social worker probably shouldn't jump to diagnosis without a full assessment); just thought I'd throw out some general info, fwiw...

In terms of the DSM-IV diagnostic criteria:

Disinhibited type RAD involves inappropriate attachment behaviors directed at people other than primary attachment figures; inhibited type RAD involves lack of attachment overtures. Oppositional Defiance or Conduct type disorders often co-occur with the RAD diagnosis.

Excessive attachment to the primary attachment figure would fall if anywhere in the criterion cluster attached to Separation Anxiety Disorder.


Hugs to you Illinios Granny. Whatever cluster of symptoms "fits" your grandson best, I hope you do get the support/services that you need to help him heal.

[illinoisgranny]

Thanks everyone for your replies and support. We had a second meeting last week and when I opened the door to let the caseworker in, my GS ran out the door and into the back yard! Between the two of us, we go GS back into the house but I was so embarrassed! Eventually he calmed down and they worked with some Playdoh. The caseworker said he was sitting and paying attention longer than most ADHD kids would be able to. One thing she noticed was that he doesn't follow directions very well and she had to repeatedly ask him to stay on task. He crawled under my Queen Ann chair, pushed all the diningroom chairs away from the table and crawled under it, and repeatedly ran into his bedroom and brought toys which he then threw at her. All this happened in a period of 45 minuts.

The caseworker will continue to evaluate him as they play each week for 3 months and we'll get a better idea of what to expect by then. I'm just glad he's getting services!