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Originally Posted by fishsandwich
Yeah, once I dug around in it, it looked alarming. There are some interesting ideas though, like you say. I don't know much about children - never mind adopting them - so I'm not sure how else to evaluate it.
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My experience with adopting a child with a serious trauma history was ... educational.
You pretty much have to throw out all the parenting advice you ever heard, and then you don't know what the hell to do. So, you turn to the "experts." Most of the experts are going to tell you to do all that normal parenting stuff that doesn't work. Like giving "consequences" (i.e., punishments - which is where Beyond Consequences gets its name). Or setting up a reward system. Neither of these work with kids dx'd with RAD, but most therapists don't seem to get this. They just think you're doing it wrong. I had one traditional therapist who was very familiar with the types of behaviors you see in foster and adopted children. She admitted that reward systems don't work with RAD kids.
Here's the kind of thing a RAD kid will do - just an example. You tell him if he gets all homework handed in all week, he'll get to rent a video game Friday evening. He hands his homework in all week, but Friday afternoon he punches a classmate and is suspended from school for a week. But he
still insists on having the reward, because after all he "earned" it. No parent's going to give the reward under those circumstances. And any normal kid would understand
why. When a kid does that kind of thing over and over again, you realize it's not a coincidence. My son told me outright that he intended to game the system.
Funny story: I put braces on my son's teeth. The orthodontist had one of those reward systems. He'd give the kid a wooden token for, say, showing up on time or having his teeth brushed and clean. You could exchange the tokens for a variety of items which were displayed in a glass case at the entrance. Most kids earned 2 to 4 tokens
per visit. My son earned 5 tokens
total in 18 months of going there. The smallest item you could get there cost 6 tokens. So he never got a reward. I still have the 5 wooden tokens in my desk. It's almost emblematic of trying to use a reward system to change the behavior of an attachment disordered child.
Mainstream psychiatry and psychology really have nothing to offer here. I had therapists advise me not to adopt him, to return him to the state. After the adoption I had many, many people - including professionals of all stripes (special educators, police, etc.) - tell me it was hopeless, he'll never change. The wikipedia article:
http://en.wikipedia.org/wiki/Reactiv...hment_disorder; treatment section:
http://en.wikipedia.org/wiki/Reactiv...rder#Treatment (my bolding)
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Assessing the child's safety is an essential first step that determines whether future intervention can take place in the family unit or whether the child should be removed to a safe situation. [Note that I was the "safe situation" he was removed to!] Interventions may include psychosocial support services for the family unit (including financial or domestic aid, housing and social work support), psychotherapeutic interventions (including treating parents for mental illness, family therapy, individual therapy), education (including training in basic parenting skills and child development), and monitoring of the child's safety within the family environment.
In 2005 the American Academy of Child and Adolescent Psychiatry laid down guidelines (devised by N.W. Boris and C.H. Zeanah) based on its published parameters for the diagnosis and treatment of RAD.
Recommendations in the guidelines include the following:- "The most important intervention for young children diagnosed with reactive attachment disorder and who lack an attachment to a discriminated caregiver is for the clinician to advocate for providing the child with an emotionally available attachment figure."
- "Although the diagnosis of reactive attachment disorder is based on symptoms displayed by the child, assessing the caregiver's attitudes toward and perceptions about the child is important for treatment selection."
- "Children with reactive attachment disorder are presumed to have grossly disturbed internal models for relating to others. After ensuring that the child is in a safe and stable placement, effective attachment treatment must focus on creating positive interactions with caregivers."
- "Children who meet criteria for reactive attachment disorder and who display aggressive and oppositional behavior require adjunctive (additional) treatments."
Mainstream prevention programs and treatment approaches for attachment difficulties or disorders for infants and younger children are based on attachment theory and concentrate on increasing the responsiveness and sensitivity of the caregiver, or if that is not possible, placing the child with a different caregiver. These approaches are mostly in the process of being evaluated. The programs invariably include a detailed assessment of the attachment status or caregiving responses of the adult caregiver as attachment is a two-way process involving attachment behavior and caregiver response. Some of these treatment or prevention programs are specifically aimed at foster carers rather than parents, as the attachment behaviors of infants or children with attachment difficulties often do not elicit appropriate caregiver responses. [My note: I love the bland language. "Children with attachment difficulties often do not elicit appropriate caregiver responses." No, they certainly do not. You want to beat the kid to within an inch of his life!] Approaches include "Watch, wait and wonder," manipulation of sensitive responsiveness, modified "Interaction Guidance", "Clinician-Assisted Videofeedback Exposure Sessions (CAVES)", "Preschool Parent Psychotherapy", "Circle of Security", "Attachment and Biobehavioral Catch-up" (ABC), the New Orleans Intervention, and parent–child psychotherapy. Other treatment methods include Developmental, Individual-difference, and Relationship-based therapy (DIR, also referred to as Floor Time) by Stanley Greenspan, although DIR is primarily directed to treatment of pervasive developmental disorders.
The relevance of these approaches to intervention with fostered and adopted children with RAD or older children with significant histories of maltreatment is unclear.
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Notice the emphasis on infants and young children. For older children, they've got almost nothing - "adjunctive treatment" for kids with oppositional and aggressive behaviors (which my son did) means they herd them into a residential treatment facility with a bunch of other kids no one knows how to handle.
Medications aren't really helpful. They do prescribe them. My son was supposed to be taking depakote, but mostly he threw them away. Once when I cleaned out his room, I found about two months worth of depakote hidden all around it. That's why the pdoc kept saying his blood tests weren't at a therapeutic dose.
So, with no help from the mainstream, people turn to the alternatives - and some of those are
awful. At the very kindest they involve exerting absolute control over the child. So, yeah, when I stumbled on Beyond Consequences I was so delighted. It said I could love my son. No one adopts a child hoping they'll spend their lives in a constant power struggle. People adopt hoping to have a child to love. It's really hard when the kid rejects that love.
Anyway, probably way more than you wanted to know. Thanks for letting me talk it out. It really brings home to me why I take the stance I do with my older son. His psychotic illness exploded into my world while I was struggling with the younger son's problems and really influenced how I see things.
Some of my philosophies:
1. "Mental illness" happens between people.
2. You can help the person in distress by learning to calm and regulate yourself.
3. Try to see things from the distressed person's point of view. No matter how utterly bizarre it seems, you
can understand it if you start with the assumption that it makes sense to him - and
really work at it.
4. Even the biggest catastrophes can be weathered.
5. Time is a great healer, and time is on our side.