Friday, May 18, 2012

Foster Parent Friday - Breaking the RAD Cycle: Part 1

Q: A reader asked mie to offer suggestions on how to break the "RAD" cycle beyond the normal parenting techniques like interrupting with silly things, re-directing, etc.  This reader shared the following:

"I have a foster (now adopted) preschooler who is "RAD"ish.  My husband and I have noticed that she seems to go into a defiant, manipulative (RAD) behavior when I (mommy) leave the house.  She has overcome so many RAD things, but this is one we are having troubgle with.  I'm sure it is related to her past - feeling abandoned...insert typical foster care story...but I don't know how to help her "reset".

A: In all honesty, I'm not the best qualified for handling RADlets so to answer this question I've asked a guest - Laurie from Adopting Special Needs - to join us for a guest post to share her expertise with you.  I will post her response next week, but before I do, I wanted to share my experience with RAD with those of you who are not (yet) familiar with it.

In our experience as foster parents we have had only 1 RADlet out of the 10 kiddos we've had join our family in the past 2 years.  I'm hoping this is encouraging to those of you who are considering becoming foster or adoptive parents and who are "lucky" enough to hear about these challenging behaviors first.  The reality is that most children in care have some sort of attachment issues stemming from lack of quality parental care from their birth family and/or the break in attachment caused by removal from the home.  Many, many kids can heal with quality parenting from foster parents and quick, healthy permanency, but there are some children who experience such trauma in their young lives that leads to more moderate-to-severe attachment issues and disorders.  Before becoming a foster parent I had a solid understanding of attachment, not from our PRIDE classes but with my educational background, but I was completely blindsided by RAD.

When we got the call for our one placement I was told they were being moved because the behavior of one of the two siblings was overwhelming the single foster parent who was simultaneously trying to work full-time and go to school full-time while raising her two older (teenage) children.  I can sympathize with how difficult it can be to do all that stuff WITH a partner, so I completely understood how a preschooler and a toddler can really be challenging for all that as a single mom.  I didn't blame her for her decision, but I did find it a little bit odd that she couldn't handle the behaviors the placement worker described. She said he did things like turn the lights on and off and argued when he didn't get to do what he wanted to do.  They said they suspected she had spanked him and the decision to move the children was mutual.  I remember telling the placement worker "that sounds like normal stuff (for this age) to mie" and we agreed to take the placement.

Over the next week or two we quickly learned that this behavior was anything but normal.  There was no honeymoon period.  I read through the note the birth mom had sent when they entered care and it said stuff like "make sure you cuddle with him when he wakes up otherwise he'll throw a fit", "he only eats macaroni and cheese, dinosaur chicken nuggets, and french fries", and "Watch Out! Have an extra plate ready for him because if he doesn't want to eat something he'll vomit on it and he does it in time out too".  That information and the information I knew about the case made it clear to mie where the behavior challenges were coming from.  I was sure that with good parenting and extra love our kiddo would be on the right track in no time.

I was wrong.  Over the time we had this placement we observed the following signs of RAD:

  1. Is unable to give and receive love (Mild)
  2. Is oppositional, argumentative, defiant (Moderate)
  3. Is emotionally phony, hollow, or empty (Moderate)
  4. Is manipulative or controlling (Severe)
  5. Has frequent or intense angry outbursts (Severe)
  6. Is an angry child inside (Moderate)
  7. Unable to cry about something sad (Mild)
  8. Avoids or resists physical closeness and touch (None)
  9. Cannot be trusted (Moderate)
  10. Has little or no conscience (Moderate)
  11. Is superficially engaging and charming (Severe)
  12. Lack of eye contact on parental terms (Severe)
  13. Indiscriminate affection with strangers (Moderate)
  14. Not affectionate on parents' terms (Mild)
  15. Destructive to self, others, and property (Moderate)
  16. More disobedient toward mom than dad (Moderate)
  17. Cruel to animals (None)
  18. Steals (Moderate)
  19. Lies about the obvious (crazy lying) (Severe)
  20. Is impulsive or hyperactive (Severe)
  21. Lacks cause and effect thinking (Severe)
  22. Gorges or hoards food (Moderate)
  23. Has poor peer relationships (Moderate)
  24. Preoccupation with fire, blood, or violence (None)
  25. Persistent nonsense questions or incessant chatter (Severe)
  26. Inappropriately demanding and clingy (Moderate)
  27. Sexually acting out (Mild)
  28. Bossy with peers (Moderate)
This child vomited any time he wasn't getting his way as a form of manipulation, no matter where we were (though we learned to help control that).  He would scream at you from the top of his lungs.  He would throw wild tantrums.  This things were amazing to see and could push your buttons but the things that got under our skin the most were the incessant nonsense talking and asking questions, the lack of cause/effect thinking and ability to control his impulses, the stealing and lying about the obvious, and the lack of eye contact on parental terms.  Dealing with these things on a consistent basis, especially if you're not familiar with what is going on (RAD), can be grating and confusing.  It was indescribable.

On top of that there was this superficial charm and indiscriminant familiarity with strangers.  With people who only saw him for a few minutes at a time (people in the grocery store) or for an hour or so a week (friends at church, as an example) - he was amazingly sweet and charming.  They would see his behavior in mild forms and think it was cute and absolutely normal (remember my opinion of his flipping the light switches on and off?).  In small doses he seemed like a child with spunk who was fun and loving and caring and just a joy to parent.  The truth wasn't that at all - as a parent to a RADlet you not only get the worst of the behaviors but you get them nonstop (afterall, you are the parent).  Then I had a "wonderful" teacher at school who insisted on telling mie every bad thing he did at school (which, you know, was the same thing day after day).  It was like living in a crazy cycle.

It wasn't until at least half-way through the placement that I knew what was going on.  I'd come in contact with and got a lot of tips and suggestions.  I knew it wasn't mie but also learned a lot of tips to help him start the process of healing.  I didn't have him get tested.  I explained my concerns to the caseworker but we discussed waiting to get him evaluated.  He was receiving play therapy (it was a joke, really) and more than that he was showing signs of improvement.  If he had been diagnosed with RAD he would likely have to be moved to another home because we're only licensed as basic and that would likely have moved him up (rightfully so) to a higher service level.  I didn't want him to be moved, yet again, when we had the skills to take care of him and his case was where it was at the time, so what we agreed was that we'd keep working with him until it was decided what would happen to his case and then we'd get him tested once permanency was in motion.  Shortly afterward it was determined reunification would be imminent and at that point I insisted he receive a full psychological evaluation before he go home so that I could work with the therapist rather than his birth family who, understandably was eager to get him home and may not have been quite as familiar with his behaviors or the fact that they were a problem.  I was concerned that his behavior, left untreated, could be a trigger for the parents as they worked on their own healing, especially if his condition weren't diagnosed and treated prior to him going home.

We found a great therapist.  Within minutes of being in her office for the evaluation she told mie something to the effect of "you sure have been dealing with a lot huh?", acknowledging his behavior without letting him know it - I started to well up - she could see it, immediately.  Later that week I spent 90 minutes on the phone with her so she could talk about his behaviors with mie without him present.  This was such a healing phone call for mie.  It wasn't a therapy appointment for mie - in fact all she did was ask mie to describe his behaviors and asked follow-up questions to understand my concerns - but she validated what she saw in the office as supporting my concerns and my suspicion of RAD, a severe case, she said.  I didn't really need other people to agree with mie - I knew what I was dealing with - but it really helped to have an independent professional acknowledge what I had suspected, and, to know that he would receive follow-up care after he left.

It would have helped the healing process if I had been able to know what his fate in the case was earlier on - if he was going to be adopted by us (we were facing Summer's adoption so he heard us talking about it) or if he was going to return home.  I think it helped him to know he was stable in our home but the uncertainty of what was going on with his future was a lot for him to handle.  It would have helped if I knew more, at the time, about dysregulation and how to help him regulate himself.  In the end he was much better than he was when he'd arrived - I'm fairly sure his first foster home was detrimental to his healing, not helpful.  In the end I was sure that he'd been demonstrating RAD-ish behaviors prior to entering foster care and I was certain that it had caused stress that contributed to the factors around his removal.  Details about the case that I'll leave unsaid supported the fact that his attachment issues were caused well before his removal and I did extra to reach out to his parents to support them during the transition, to know they had someone else to support them as their kids came back home.  They needed that.

I no longer fear RAD but I am much more sensitive to the impact of its ugliness can have on everyone involved in foster care and adoption.

We foster and/or adopt anyway.

Stay tuned next week for Laurie's guest post with some very helpful suggestions on how to break the RAD cycle.

1 comment:

Anonymous said...

Thanks for sharing more about your RAD experiences. It helps to hear that other foster parents experience similar things. Like you, I was totally blindsighted by RAD - I am an experienced teacher, and had learned alot about autisim, ADHD, ODD, learning disabilities, etc. but not about RAD. Our foster training was very minimal on the subject. It was only as I started researching for new ideas ... because none of the traditional parenting techniques or my "teacher's bag of tricks" were working ... that I realized we were dealing with RAD tendencies and why our daughter was acting the way she was. We are blessed that there are no extreme behaviors - sexually acting out, preoccupation with fire, cruelty to animals or others ... but we deal with the defiance, incessant chatter about nothing, always questioning why (which is really a form of defiance), some lying, manipulation of adults, charming behavior with strangers (she can charm a new social worker like you wouldn't believe!) minimal hoarding, and trying to control through food (by how long!!! it takes her to eat her meal). We are looking for a therapist - any suggestions for finding out how effective they are with RAD? I've read that RAD kids can manipulate therapists that aren't experienced with it.