Child with attachment disorder - is this right?

[joblerone1]

(Sorry, long.)

I hope someone can help me. I am trying to find out more about attachment disorder and whether or not my sister is doing the right thing, or potentially damaging a very disturbed little boy even further.

Her 7year old stepson came to live with them 10 months ago. His mother was about to put him into care. He has been diagnosed as having attachment disorder and is very difficult to live with. At worst, he exhibits behaviours such as standing in the bathroom all night, wetting/soiling the bed/himself, ignoring direct questions, avoiding eye contact, screaming in swimming lessons, not putting his clothes into the wash, losing his glasses, lying about it, etc. He gets told off a lot for things which, I feel, as a teacher of 7 year olds, are part and parcel of being a child ? most of my class do some of the things she describes. She insists it?s his way of gaining control, and nothing to do with being a ?normal? child. She gets periodical respite care (twice a month?) and our parents look after him and/or her two other children regularly. I live more than 2 hours away, so cannot help much.

She feels so much at the end of her tether that she is intending to take the rest of the family away on holiday while he goes into respite care for 2 weeks. She wants time to ?regroup? as a family and spend time with ?her girls?. Although I recognise her acute stress levels and the need for regular respite care, I can?t help thinking that 2 weeks in respite while the rest of the family are on holiday (in a caravan, which he loves) can only reinforce this child?s feelings of rejection, separation and worthlessness.
My parents have offered to look after him for the whole two weeks, but my sister says he needs firmer boundaries, and that they are too nice. They regularly look after him at weekends, or if he is home ill from school, and for 45 minutes after school one night a week when the whole family comes for tea.
Have since found out that they've said to him previously that if he didn't behave himself at swimming then he wouldn't be allowed to go on holiday - and now he's not. They are not calling it a punishment, just respite for them, but if they've used it as a parenting tool then I think it is son wrong to withdraw it.
I have read some AD websites that actually warn against the overuse of auxillary services, but feel unqualified to comment. What do people think?

[Samantha28]

Danae, that is a very thoughtful post

[blueshoes]

thanks, Kew, granny, for taking the time to explain more about RAD. Samantha28, also very interesting to read your info about RAD.

KristinaM, what you said now makes a lot of sense. I have no doubt you make very valid points. Just that unless people understand a bit more about this condition (beyond saying what OP describes is typical of RAD), it sounds like "oh you don't anything, I am not going to explain further, but you are wrong to jump on the OP's sister". I think lots of people are happy to be informed about a condition they previously know very little about. Hope you don't feel put out.

granny, that book by Dan Hughes costs £20 on Amazon. I am going to have to go to a library!

[KatieMorag]

Can I check that I have this right?

You have one child aged two. Your sister has a seven year old and a two year old of her own and has given a home to her seven year old step son, to save him going in to care.

This boy has attachment disorder according to the experts. They must feel it is severe as he is receiving a lot of respite, which is hard to come by.

You have no experience of adoption, fostering or mental illness. You have, in fact, no experience of parenting a normal seven year old, as your child is only two. So you have come on to Mumsnet this weekend in the hope of getting the ammunition to tell your sister that she is doing it wrong ????????????

[blueshoes]

katie, I would give the OP the benefit of the doubt rather than and [hmmm]. She posted in Adoptions, so clearly she is going to people who would know a thing or two about this condition. It might be obvious to you, but I don't think you achieve anything or educate anyone by belittling them.

[Samantha28]

Thank you blushoes

Other good authors on this are Gregg Keck and Regina Kupecky. Kewcumber or granny slippers also recommended books called First Steps in Parenting I think.

IIRC Christina is disabled so she can't type long posts

[Samantha28]

these ones
here

[Samantha28]

Nancy Thomas book

[blueshoes]

Thanks, Samantha28, will look them up

[Kewcumber]

actually joblerone1 - KatieMorag's post is helpful because this is how your sister will react if you try to advise her!

It's frustrating for adoptive parents because their children look to all intents and purposes "normal" so everyone thinks that standard child-rearing techniques work and wade in with advice (not suggesting that you have done this) when they have very little understanding of the needs of the child.

[Kewcumber]

Nancy Thomas is very well respected in adoption circles and has been persuaded on occasion to come over and lecture to parents in the UK. Sadly I missed her last talk.

[edam]

Gosh, the latest posts actually explaining RAD are very helpful and fascinating.

Makes me feel even more sorry for the poor little lad. And wonder why his dad didn't pick up how he was being treated before such severe and long-lasting damage was done. Was he trying to get help but being ignored?

Still feel terrible for him that he's being punished for not behaving at swimming - given RAD = permanent brain damage. Is he being punished for things he can't help?

Agree obviously your sister needs support though, must be very, very hard for her.

[Flibbertyjibbet]

Thanks for your post Kewcumber it was very informative, I have followed your posts on adoption quite often. I also feel more sorry for the boy the more I read on here and think KatieMorag speaks a lot of sense. I have two completely normal little boys and sometimes I feel like I'm not coping with them. If a third child came into my family who was hard to cope with and someone with just one small child was critical of me, I'd probably want to throttle her.

[Fridayfeeling]

I worry about the labels and diagnosis given to this boy - RAD is a relatively new disorder that is not well researched and many conflicting ideas pervade. I am in shock that it is described here as 'Brain Damage'.

I would be very careful of descriptions of RAD as a pathology, rather than a theory of development....which is always multi-faceted.

I have problems with labels - and this sad situation shows that the labels often don't help - especially when the label is not explained thoroughly and in a balanced way. In no way is Attachment Disorder or RAD an undisputed 'disorder'.

[Kewcumber]

I would be happy to read any any information you have disputing reactive attachment disorder exists. I know that the description of RAD as "brain damage" is contraversial but is a fairly well accepted theory (I agree not without some caveats) but I felt it was helpful to put across to the OP that this is serious and possibly long term problem.

There are many overlapping and alternative explanations of this behaviour but I think we shouldn;t be trying to out-think the diagnosis of RAD presented.

In reposnse to the OP - labelling the child RAD (in fact I agree that labelling is rarely helpful unless it helps gain additional resources which is sadly ussually the case in the UK) isn't really the point here.

Even if you disagree with the RAD diagnosis or with my description of it as brain damage, the point is that the OP has no experience of the kind of issues her sister is dealing with. If (as I suspect you do) you have experience first hand of RAD (or a non-specific unlabelled set of behaviours which might be similar in presentation to RAD ) then you must realise how often outsiders reaction to it is to think that all this child needs is love and some extra cuddles. (of course he does need that but theres no evidence that will help him progress).

I thought a dicussion of "RAD as a pathology, rather than a theory of development" would not be terribly helpful to the OP in deciding how to deal with her sister and have therefore oversimplified my description but whilst accepting that my description is not undisputed, it is equally held by many respected practitioners in this field.

[Kewcumber]

its not RAD specific but MARTIN H. TEICHER of Harvard Medical School concluded "child abuse can cause permanent damage to the neural structure and function of the developing brain itself." based on his MRI scans of 253 absued patients (I'm no expert - there may be gaping flaws in his study)

More recently Victor Carrion at Stanford based only a pilot concluded "Results from this pilot study suggest that stress is associated with hippocampal reduction in children with posttraumatic stress disorder symptoms and provide preliminary human evidence that stress may indeed damage the hippocampus"

[joblerone1]

Just to confirm - my motivation on coming here was to find out more of the facts, because I felt he was being punished for something which isn't his fault. If in coming here to talk to people who know more about these issues than myself I find that some people think her actions are justified then that's fine.

She certainly does need a lot of support, and she thankfully gets it, both from family and supprt services. I fully recognise the stress and strain she is under.
However, certain treatments this child has been on the receiving end of lately had made me concerned. I feel that the little boy comes way down in the list of priorities (my sister has admitted he is 3rd in her eyes and 2nd in his Dad's ).
She was so fed up of him over Christmas that she was going to ban him from coming to my ds's birthday party, put him into respite and buy 'her girls' more presents, because they deserved it, and was talked out of it eventually. She wasn't going to give this child a birthday party himself in February because he didn't deserve it; our mother arranged one anyway. As several posters have said, he has brain damage - should he constantly be punished for this?

At what point should we stop saying that because he has special needs, we should be grateful that he is looked after at all when it is so difficult? At what point, if I suspect she is being too hard on the child, am I 'allowed' to say 'but hang on a minute, isn't that a bit unfair?' Who can stand up for this little boy when the treatment starts to seem as if he is resented by everyone in their family? So no matter how badly he is treated, I have to suck it up because I only have one child and therefore can't be worried about him?
I fully recognise that she needs a break - so why not have one week together with the girls and one week together as a family? Why not let him stay with his step-grandparents for a fortnight? The family get a holiday and he gets a treat too - he is looked after all the time by my parents in term time, this is normal to him.

[Kewcumber]

sorry that all sounds a bit defensive - just wanted to point out that my description of "brain damage" was not made lgihtly or wihtout some evidence.

It's not how I normally discuss RAD - only when people seem to be completely unappreciativeness of its potential seriousness.

Its a sensitive topic I have a friend with two boys who both suffer varying dgrees of RAD - the younger (in his teens now) is now institutionalised . She had no understanding of attachment problems and was not given his history before being place with her aged 3. Based on her sad experiences, I favour over-reacting when educationg people about this area than under-reacting. Appreciate I may not be the most clinically detached person about it though.

[Kewcumber]

I do understand your point Joblerone, really I do. I can only ell you that people at the end of their tether are not great at having their failings pointed out to them and she's unlikely to react well.

Your better approach is much more by stealth and making her life as easy as you can in whatever way you can. If you can't do anything for her then I would really try your best to stay out of it perhaps encouraging your parents to talk to her if they are more involved.

I promise you that stating your point of view to her is more likely to result in a break down of your relationship with her and not improve her relationship with him in any way.

I speak as someone who had a reltively seemless transition post adoption - but it didn;t feel seamless at teh time and my relationship with my mum who often supplied helpful commetns about what I should be doing took a while to recover.

[joblerone1]

Okay, I will definitely back off then. My parents have been talking to her which is how their offer of taking him for 2 weeks came about.

[Issy]

Thank you KC for some very interesting and pertinent information. I read a little about RAD and AD before adopting, but have been very fortunate in never having to deploy it.

[Fridayfeeling]

All learning causes changes to neural structure, that is basically what learning is. I would absolutely question that this is permanent, especially in children, where plasticity is generally accepted.

We are on dangerous territory for the people involved here.

You are saying the child involved has been damaged permanently, and that is unproven - I haven't looked at the particular study you quote but with the fMRI studies there are many confounding factors that may explain the result in the hippocampus.

It is dangerous because this is so complex and so acceptance of just one element of the 'disorder' is short-sighted. Generally experimental studies use numbers not individuals and there is a very important difference and much detail is lost.

I do not know what specific therapy is required here........maybe the holiday without the child will be best........maybe not...but all I wanted to raise was that AD and RAD are not straightforward and certainly are not proven permanent states. You say not to out-think the diagnosis, however I would always always question such a diagnosis - it is often more popular opinion than scientifically based - there is no consensus (just because people in the field such as social workers describe it that way does not mean that it is scientifically proven - there are many reasons why a 'disorder' may get status with the practioners).

I would recommend a book called "Putting Psychology in it's place" by Graham Richards.

[edam]

God, sounds worse and worse, joblerone. Whatever the status of 'RAD' as a diagnosis, he's certainly unwanted, isn't he, poor soul? Neglected by his mother and now treated as the 'difficult one' who gets worse treatment than his siblings - repeating the pattern (although clearly not with the same severity).

Maybe he'd be better off in foster care, poor love.

[Kewcumber]

I don't think any of what I've read has been written by social workers?! In fact my SW barely mentioned the possibility of RAD.

Joblerone - sorry I not trying to tell you what to do. I'm only putting it from my point of view. Perhaps a better way to put my point across would be to ask (given that you know your sister better than we do) "how do you think your sister will react if you tell her that she should take him away on holiday for at least a week of it or alternatively leave him at your paretns"? Maybe there is a way of phrasing it that she will accept?

[themildmanneredbunny]

at least 3 or 4 of the behaviours quoted in the op seem like normal small boy behaviour to me.

[Flight]

Joblerone - can I ask, did you write a thread last year re this poor little guy?

I seem to remember your sister really didnt want to take him on. It was an awful situation.

Apologies if i am thinking of a different thread altogether.