Question:
I am parenting an eight year old with RAD.  We adopted him just before his third birthday knowing that he had numerous moves in Foster care and had a failed adoption in his past. He was an extremely angry and aggressive boy but we saw through his pain and completed his adoption only 10 months after he arrived home.  We were fortunate to get his diagnosis and treatment when he was three. After 18 months of therapy and cosistency we left therapy and havecontinued on with life. He has improved greatly from the way he was, although we do seem to encounter a few "anniversaries" per year which can be difficult for only short periods of time. I have noticed that even these anniversaries are not as extreme as they once were and that I can manage to diffuse potentially explosive situations faster now that he can express his feelings better.   Will RAD children recover or will our future be one of us finding the "keys" to unlock his burried feelings of anger and loss and hopefully one day teaching him to do this for himself?

He will have responses to emotional triggers from early trauma probably throughout his life.  The limbic system of the brain stores emotion.  There are several pathways to trigger those emotions such as anniversaries, environmental cues, words, sounds, smells, etc.  The goal of his therapy is an attempt to connect the emotional triggers with how his cortex abstracts those feelings.  I also hope that he will learn how to express his feelings that get triggered and learn how to respond in a healthy way.  It sounds like you have a good handle on him.  Good Luck to you!!

Director Forrest R. Lien, L.C.S.W
Clinical Director/Therapist
forrest@instituteforattachment.org
1-877-886-1910


Question: 

I live in the United Kingdom but am having a very very hard time finding any kind of therapist or information here.  Do you have any contact addresses that I could contact?  If not, what would be the best way of raising awareness here in the UK?   On checking the UK 'disease' register they have listed Reactive Attachment Disorder but below it have written that not enough research has been done in to this to date. 

I know of one therapist in the United Kingdom that I trained.  His name is Alec Clark.  He is in Rushden and you can email him at a.clark9@ntlworld.com   Another way to bring awareness to a new area is to assist us in bringing a conference to your area.  I also organize treatment/training off-site.  There's also legitmate research in the field that should also be made known to create efficacy for the treatment.

Director Forrest R. Lien, L.C.S.W
Clinical Director/Therapist
forrest@instituteforattachment.org
1-877-886-1910


Question:
I have a nephew who will be turning 18 next week, and I believe he may have RAD.  My brother adopted him when he was 5 yrs old.  He was abused repeatedly (mentally and physically) by his mother, aunt, and grandmother before he was put up for adoption.  The stories on his record are awful.   He has always had anger problems, lack of emotion, and interest in blood, guts, and weapons since I have known him.  But they didn't become extreme until he became a teenager.  He became very violent against his parents and sister and they had no other choice but to put him in a boys home about 6 months ago.  I have always felt there was something not right about him but I could never put my finger on it.  When my brother and his wife finally told me all they had been through these past 4 years I started doing some research.  I was thinking maniac depression but when I came across RAD I realized a majority of it sounded just like him.  I gave the information to my brother and he agreed but neither of us know what to do now. How do we get help for him?  In one week he makes the decision if he wants to stay in the boys home or leave.  I am afraid that if he doesn't get help he will eventually hurt someone, or himself and end up dead or in jail.  What happens to most adults who have RAD and it goes untreated?  How as his aunt do I love him and show him I care when I am scared to be around him?  If you can offer any advice I would greatly appreciate it.  Thank you for your time.

At 18, he may not agree to get treatment for his disorder.  If he is truly an untreated Attachment Disordered young man his future looks dim.  He will have trouble in his adult life in intimate relationships, following the rules of society, and making excuses when he goes from job to job.  Several men in prison suffer from this disorder.  Most adults suffering from this disorder are usually diagnosed as one of the Axis II Personality Disorders.  My suggestion for his caretakers is to take good care of yourself and set firm boundaries with him around respect, responsiblity, and being enjoyable to be around.  As an adult he needs to feel the consequences of his bad choices until he sees his life as failing and wants to end the dysfunctional lifestyle and choose therapy.  I would encourage you to get him the information on this disorder and share my response.  Good luck to you and beware of the "con" to take what he feels he's entitled to have.  A colleague and I sucessfully treat adults with attachment difficulties but they are usually adults who have experienced emotional pain in their adult relationships and are "ready" to change.

Director Forrest R. Lien, L.C.S.W
Clinical Director/Therapist
forrest@instituteforattachment.org
1-877-886-1910


Question:
What states can you do intensives in?  Are intensives always two weeks, or are they sometimes less days?

Our treatment team will travel to any state to do treatment and/or training for clinicians.   The length of an intensive treatment program depends on the age and severity of the child.  Most cases take two weeks.

Director Forrest R. Lien, L.C.S.W
Clinical Director/Therapist
forrest@instituteforattachment.org
1-877-886-1910


Question:
We're raising our grandson who I believe has attachment disorder.  His therapist thinks so, but isn't definite.  How do we find out where he might be on the attachment continuum?  And, do you believe talk,play and sand play therapies are good for these kids or possibly detrimental?  He's been doing play, sand and theraplay for the past few months and started holding therapy yesterday followed by play therapy.  Thank you.

Dear Grandma & Grandpa, There is a continuum of  severity for Attachment Disorders.  One way of determining severity is using the RADQ(Randolph Attachment Disorder Questionnaire).  If your therapist does not have that assessment tool you can contact our Institute to have an assessment done.  The success of therapy used with these kids is determined by the improved quality of relationship in the family especially with the maternal figure.  If relationships are not improving than you look for another intervention.  The more severe the diagnosis, the more intense the intervention.  Be a good consumer!! Ask the therapist about their training and their success rate.  Good Luck!!!

Director Forrest R. Lien, L.C.S.W
Clinical Director/Therapist
forrest@instituteforattachment.org
1-877-886-1910


Question:
I have a 7 year old RAD child in my home as a foster child.  I was hoping to adopt him, but his behavior got way out of control.  He didn't have an attachment therapist, only a therapist who knew about attachment.  The boy has been in my home for almost 12 months, but now is being sent to an attachment center.  I wanted to go along with the therapist and children and youth worker to the facility when he was being admitted.  The therapist says I should not go because the child will associate me with the one who abandoned him.  My thought is that i should go, show him I love him, I am making sure the facility is safe and so on.  The staff  is recommending that he come back to my home after he goes through this facility.  In your opinion how should the transition from my home to the RTF take place?

I don't understand.  How can someone do attachment therapy with a child without the parent???

Director Forrest R. Lien, L.C.S.W
Clinical Director/Therapist
forrest@instituteforattachment.org
1-877-886-1910


Question: 
Is there anyone in Little Rock, Arkansas you would recommend for a child with RAD???

There's an agency in Little Rock called Treatment Homes, Inc. and they have three therapists there trained by The Institute for Attachment & Child Development.  Their phone number is 501-372-5039

Director Forrest R. Lien, L.C.S.W
Clinical Director/Therapist
forrest@instituteforattachment.org
1-877-886-1910


Question:
Hi, and I just want to say how much I have learned from this site.  Bless you for taking the time to answer our questions.  My question is this-our daughter is classic RAD at home and is totally the opposite at school.  So much so that she is being described as "brilliant, gifted, extremely intelligent; you get the idea.  How can she be so delayed and immature at home and so over the top the other way at school?  Do you think she may have Multiple Personality Disorder? 
Frustrated and it's been 7 years.

It's very common that RAD kiddos look different in school then at home.  Since 1995, we started looking at pre and post-treatment data using the Child Behavior Checklist created by Achenbach.  When we compared the child's behavior filled out by the homeroom teacher vrs the mom living with the child we see a wide difference of behavioral problems.  The Institute has actually experienced this dynamic since our treatment center started over 30 years ago.  Attachment Disorder or Reactive Attachment Disorder, as it's called in the DSM, is a disorder where the symptoms are manifested out of close/intimate relationships primarily with the maternal figure.  These kiddos are threatened by the closeness with the mother figure and are more superficially charming and engaging away from their family.  Attachment Disorder is a "maternal wound" as described by Nancy Verrier who wrote the "Primal Wound", a book about the effects of the break from the birth mother.   Also, when these kiddos first come into a new family they usually don't manifest their acting-out behaviors right away.  It may take 5-6 months into the placement before the relationship with the mother figure becomes threatening(mom's getting too close) to them.  We have find that the most intelligent kiddos tend to be more severe in their attachment problems. They are better at cognitively figuring out how to manipulate or control their environment on their terms.

Director Forrest R. Lien, L.C.S.W
Clinical Director/Therapist
forrest@instituteforattachment.org
1-877-886-1910


Question: 
I am a researcher of RAD form only recently.   I am reading all of the books I can find, but not many of these book have information about Attachment Therapy. All of them say this and that, but not I cannot find any indebt information about how you get into the therapy boots and all. What I would like to know is, "Do you keep a professional distance from these clients or do you get emotionally involved with them?"

Traditional psychotherapy works from the premise that you create a trusting alliance with your client and out of that trusting relationship you empower your client to change.  RAD kiddos don't trust anyone so if the clinician tries to create trust by believing what these kids tell you then you will be "taken for a ride".  These kids don't like me in the beginning because I confront their distorted thinking patterns and don't let them drive the therapy on their terms.  My job as an attachment therapist is to help these kids understand their behavioral problems in the context of their emotional developmental delays and why it's so hard for them to get what they need in a family.  They need to trust loving emotionally healthy caregivers and not develop their primary attachment to me.  We have a training program for clinicians at the Institute for Attachment & Child Development.  You can access the training institute through our website at www.instituteforattachment.org

Director Forrest R. Lien, L.C.S.W
Clinical Director/Therapist
forrest@instituteforattachment.org
1-877-886-1910


Question:
We were/are working with an adoption therapist for our daughter who was diagnosed with RAD, PTSD, and prenatal drug exposure. Our daughter is five years old. She was diagnosed at three and started doing theraplay at 4 years old. Our therapist told us at the beginning of this year that she feels our daughter is attached and theraplay no longer has any benefit for her. She told us to continue doing some of the games at home and call if we needed her. We also put ourdaughter on Adderall XP in December so we see a Child Psych. monthly for weighing and to see how she is doing.   I don't feel that a year of theraplay is all my daughter needs. She is attached, I believe, but we continue to deal with many RAD behaviors such as manipulation, lying, stealing, charming to strangers, etc. We explored the option of EMDR but decided it was not best for her situation. Is it possible to be "cured" after a year of theraplay and no longer need therapy? I didn't feel we were done and am sort of at a loss as to what our next step should be. Do you have any advice?
Thanks!

What does "she's attached mean?"  All children need to feel attached at some level to a mother figure in order to do any kind of attachment therapy.   Attachment Disordered kids generally will "honeymoon" initially entering a new placement.  In a few months kids will act out more because they are  becoming threatened by the closeness in the family.  These kids have to feel some desire to be connected to a mom or there won't be any conflict to change.  Control has kept them alive so giving it up is a life threatening experience for them.  Typically, we don't treat kids until they have been in placement at least 5-6 months because you won't be able to assess the attachment problems until then.  The longer a child is in placement the more defended they get and the parents become more angry and less available for nurturing.  Family therapy becomes critical because these kids are masters at dividing family relationships, especially a married couple. Some therapies will push through the grief and loss issues and just get so far in resolving the child's defended, controlling behaviors.  Some children require more intensive therapies to reach an infantile level of vulnerabilty so they can be reparented by loving and emotionally healthy parents.  Attachment Disordered kiddos are developmentally delayed in infancy and/or toddlerhood.  These kids need to "redo" those stages of development cognitively and emotionally.  The term Attachment Therapy describes a wide range of therapeutic processes which may include inner child work, re-parenting, cognitive restructuring, nurturing holds, psychodramas (role playing), among others.  Another intervention that may be critical in treating symptoms would be approriate medication for genetic mood disorders.  The best attachment therapy may not be successful  if a child is Bipolar and mismedicated.

Director Forrest R. Lien, L.C.S.W
Clinical Director/Therapist
forrest@instituteforattachment.org
1-877-886-1910


Question:
Have you ever personally seen a child who has RAD due to abuse and neglect actually get better completely?   No more rages or manipulative behaviors and respectful, responsible, and fun to be around?   Is there hope for recovery if we do all the right things?
Thanks!

Absolutely kids get better!!   A lot of these kids end up in families and don't have the tools to make it in a family so parents end up working harder than the kiddo to make it happen.  Parents are wore out by the time I see them and usually say, "I just want the battle to be over".  I often hear from the mom's,  "I'm tired and angry, my marriage is on the rocks, my husband doesn't understand, my birth children are upset, I feel like a prisoner in my own home, we can't go on vacation, therapists don't understand, I have no support, but who else is going to do it."  I always ask parents what their expectations are for their RAD child when they engage in therapy. I feel that all therapists and/or treatment facilities are obligated to tell parents what they can do or not as well as the treatment outcome.  Parents need to get a good assessment to know where their child falls out on the continuum of an Attachment Disorder.  The child's level of disturbance determines the level of treatment required.  Be a good consumer.  Ask the therapist about their training, their success rate, what can you expect from therapy, and ask to talk to others that have received their services.  At the Institute, we have trained over 100 therapists in the Intermediate Level which requires two weeks of training here in Colorado.  I would be glad to make a referral if I can.  Good Luck in finding a good therapeutic guide!!

Director Forrest R. Lien, L.C.S.W
Clinical Director/Therapist
forrest@instituteforattachment.org
1-877-886-1910


Question:
The children in China seem to fair better than Eastern European children (maybe that is not true?).  The children in Guat. are usually in foster homes.  Do you have any advice about which program might be "safest" in terms of adopting a child who can attach?  I would be eligible for a child 7-14 mos from China, and 12 mo and under from Guat.

I have also heard that adopted children from China fair better.  I have known three adoptive moms who received girls from China and they told me that the early care those children receive is much better.  In the last nine years at the Institute for Attachment & Child Development we haven't seen one child from China for treatment of Reactive Attachment Disorder.  It doesn't matter whether the kids come from China, Guatemala, Romania, or the United States foster care system. I want to know what the quality of their care was in the first two years of development and what was the psychological profile of the birth parents.  Another factor to consider is the resiliency of the child.  I have seen kids that were adopted early, say two or three months, and developed the same Attachment Disorder symptoms as a child abused and neglected for a year.  Some kids are not as affected by the development breaks as other kids might be.  Nancy Verrier wrote a book called, the Primal Wound.  Nancy's research explains the break from the maternal figure and how kids fair in their developmental years.  Some kids have a difficult time being separated from their birth moms soon after birth where they go to a mom who is totally different in her voice, smells, temperment, etc. and the babies have a difficult time making the transition. A good assessment by a trained and skilled therapist in bonding/attachment is critical after the child is placed in a family.  Orphans and foster children need to be considered for a family.  The good news is that there is hope for these kids if you find the right clinical guides to assist your family in turning around their developmental/emotional delays.  LOVE may not be the only factor in turning these kids around.

Director Forrest R. Lien, L.C.S.W
Clinical Director/Therapist
forrest@instituteforattachment.org
1-877-886-1910


Question:
I am writing a paper on how RAD effects the children of America and I am having a hard time getting through to my professor.  He can not grasp the concept of this disorder.  I was wondering if you had any ideas? 

If you would like I would be glad to do a conference call with you and your professor.

Director Forrest R. Lien, L.C.S.W
Clinical Director/Therapist
forrest@instituteforattachment.org
1-877-886-1910


Question:

Please tell me what to do when my twelve year old son (who is almost as large as I am) becomes enraged and starts running through the house refusing to do what is asked of him.  In the past I would HOLD him in my arms and let him kick and scream until he calmed down.  He's just getting too big now, and I cannot hold him anymore without getting hurt.  If I just let him run away from me and try to ignore the behavior, he resorts to breaking things.   This only happens once or twice a month, so I really don't want to use a residential facility if I can find a way to manage the occasional storms here at home. 
A Desperate RAD Mom

I believe that all behavior is purposeful from three areas of understanding behavior: neurological, biochemical, or learned response.  At 12 yrs of age, his rages are out of your control.  Rages can be a very manipulative behavior to get his way as we identify in the toddler.  In ages 12-14 this behavior can repeat itself especially if the child didn't accomplish the developmental task of a toddler ie. mastering autonomy vrs shame, guilt and doubt.  We often see this cycle repeat itself in the WANTS stage, as Erickson called it.  RAD kids are developmentally stuck in the stages of infancy and toddlerhood.  They feel entitled and rules don't apply to them.  Neurologically, we may find kiddos who rage as having their brains stuck in fight, flight, or freeze especially around any kind of containment or control.  The third area of concern would be in the biochemical area.  We often see a co-morbidity of problems i.e. neurological, biochemical and the RAD learned behavior.  When we explore the birth parent histories of these kiddos we find parents who suffered from mood disorders or Bipolar Disorder.  Dr. John Alston, an international expert in treating childhood Bipolar and RAD over 26 yrs, has identified 5 diagnoses of birth parents that hurt or neglect their children.  The five are: Anti-social Personality, Schizophrenic, Borderline, Substance Abusers, and Bipolar.  Three maybe four of the five are biochemical problems, highly genetic.  Anti-social and Borderline would be adult attachment disorder diagnoses.  There's getting to be more and more evidence that Borderline also has a mood driven quality to it.  Therefore, parents and professionals have to look at the biochemical reasons for rage reactions in RAD kiddos.  I always tell parents of foster/adoptive kiddos who have the genetic links from birth parents that they first need to rule out mood problems or Bipolar and see how many of the symptoms are eliminated.  Most psychiatrists are quite conservative with medicines for childhood Bipolar Disorder.  Dr. Alston feels that these kids require higher doses of meds to have any affect.  Most often, these kids are misdiagnosed as ADHD and are mismedicated and mismanaged biochemically.  If you would like to read more about this problem you can link to Dr. Alston through our website at http://www.instituteforattachment.org/bios.htm . I believe that any clinician that claims to be an expert in treating RAD needs to look through the three lenses: Biochemcial, neurological, learned survival behaviors.  Parents are often stuck managing these kid's behaviors by themselves ie. "Prisoners in their own homes".  You need the support of clinicians and docs that know how to deal with rageful behaviors.  If you would like referrals please contact me at forrest@instituteforattachment.org

Director Forrest R. Lien, L.C.S.W
Clinical Director/Therapist
forrest@instituteforattachment.org
1-877-886-1910


Question:

How do you stop a 2 year old with RAD from slapping, biting, and generally beating up the female caregivers in his life?

The survival symptoms of a two year old are going to be primitive survival such as physical acting out and it's based out of fear. He is afraid of closeness and probably has PTSD from being abused. I would suggest holding him close in a calm and safe way until he calms in your arms. It's important that the touch is not harmful or punitive to him. These holds may last a long time so be prepared to hold him through the fear-based cycle.
It's best to do this process with a therapist who can keep the parent calm and the two of you can cross-talk about things in a calm way. When he knows he can't control you through physical harm he may calm. He also needs to know that touch is not scary but SAFE and NURTURING!!!!!

Director Forrest R. Lien, L.C.S.W
Clinical Director/Therapist
forrest@instituteforattachment.org
1-877-886-1910

Question:

Is there any age in infancy where it is 'safe' to break the existing bond between a current caregiver to effect a move to a different placement? i have a situation where an infant was placed for neglect due to the parents' developmental delays and psychiatric conditions right out of the hospital. At age 3 months, an adoptive parent of a bio sib appeared, demanding we place the baby with them. We have not done so, baby is now 7 months old, been with the same caretaker entire time. My gut tells me that even at 3 months, given parents' special needs, that we are 'rolling the dice' when it comes to disrupting an existing bond, specially in light of the possible genetic component. My superiors are saying baby will re-attach. Am i off base?

It is possible to transfer the bond but it needs to be done in a sensitive way so the infant isn't set up by the transfer. Vera Fahlberg's book, "A Child's Journey Through Placement" is a good book to read about moving kids.
Any of our clinicians are available for a consult on this situation.

Director Forrest R. Lien, L.C.S.W
Clinical Director/Therapist
forrest@instituteforattachment.org
1-877-886-1910