In early May, our agency worker and her supervisor arranged a conference call with the S-County caseworker and HER supervisor.This was just a few days after our most recent birth-parent visit.Now, this visit had been preceded by a bit of a “crisis” (that word gets used so often it loses its punch).So before I get to the conference call, here’s a bit of background.
In late March, D- and I had our worst travel home from one of these monthly, mandated, supervised visits.The drive is well over an hour and a half each way.We had often provided a “grounding” after the visits, having dinner with D-‘s mom, which often seemed to temper the impact of so much car time.This month, though, D-‘s mom was sick.On the drive home, T-4 and T-7 (actually, at that time she was still T-6) traded tantrums, screaming at the top of their lungs, fighting over toys, punching and pinching each other, pulling off their car seat straps, kicking the seats, etc.We pulled over four times to allow for sequential calming, and the trip home took nearly four (yes, that’s right – four) hours.Probably, T-7’s behavior was compounded by specific emotional issues: her birthday was coming up, she seemed to think she could invite her birth-mom to the party, she had received a lot of gifts, but mostly unsatisfying or inappropriate ones, etc.
As a result, we told the social workers we would simply NOT do this again.They needed to take responsibility for transportation.A lot of possibilities were raised (well, okay, they were things that only appeared to be possibilities until the social workers said they couldn’t do it), until finally, our agency supervisor agreed to drive along with me in D-‘s place.Because of this, the drive in April went quite a bit better.The S-County caseworker had also indicated that she would be available to talk with us together while the girls were in their visit.
Well, she apparently didn’t mean it, since she did not answer her phone and wasn’t in the office, but chance had it that she strolled through the parking lot while I was leaning against my car.The fakish half-smile she greeted me with disappeared pretty quickly when I told her that at the scheduled conference call the next week, D- and I needed ANSWERS, not just more discussion.Would they consider removing T-7 and placing her in a therapeutic home?This could be temporary (we would consider T-7’s return once she had resolved problems elsewhere) or permanent.Would they adapt our placement along the therapeutic model, that is, paying us for essential services like the private attachment therapist we’d just begun seeing ($125/session), and paying for proper respite care ($150/week).At this point, we were already paying upwards of $600/month of respite or afterschool care, to go along with T-4’s $1400/month pre-school.And really, the intensity of T-7’s behavioral problems was still consuming our lives.
The conference call was actually face-to-face for all but the S-County supervisor.The answers were clear.No, they would not consider splitting the girls.After all, there is such a thing as a “bad match,” and many children who do poorly in one home may, for reasons not well understood, experience less anxiety and disturbance in another.They seemed uninterested in hearing about T-4’s remarkable progress on every level, from the physical, to the cognitive, emotional, and behavioral.It was unimaginable to me that they would compromise her well-being in this way due to her sister’s developmental attachment problems (which nevertheless had only been informally diagnosed).Would T-4 ever have such support again?Who in her future life would send her to the very best pre-school available (one in which, let it be said, she responded with dramatic developmental acceleration)?Would they simply drag her from wrecked placement to wrecked placement, until eventually the girls were split anyway?
The answer, of course, was yes, that was exactly what they would do before even considering splitting the girls.There simply was insufficient paper trail to suggest that T-7 wouldn’t adapt better elsewhere.There was no reason to think T-4 would continue to do better in the absence of her sister than she would in her presence.Resources for therapeutic homes were highly restricted, and such homes were only for “unadoptable” children, whereas they still believed that the girls could be successfully placed in a new adoptive home.
They asked us for thirty days to find a new adoptive home.We said:
“No, you may consider this officially a seven-day notice of placement disruption.”
We knew in advance of the meeting – and so did they – that this was how it would resolve.We did not believe they would investigate any additional resources.And we also did not believe that the girls (or us) would be more likely to place into an adoptive home in 30 days than in 7.After all, they were four months in their previous temporary placement, and at the very least, T-7’s paper trail had lengthened, since we had troubling school reports, therapist reports, and had begin medication evaluation.No, they would be going to a temporary placement in any case, better sooner than later.
We had one week.This was a Tuesday.The next Tuesday, we would be accompanying them to S-County with all of their possessions.We wouldn’t actually tell them until Monday.But nevertheless, it was going to be a rough week.
I do not make decisions impulsively. Actually, I think I do the opposite. I look at situations and try to consider all options and almost compulsively research them and play them out. I do like to talk about the things that come up, even if they do seem a little far out. I like to brainstorm and sometimes I get excited about some wild ideas that I come up with. J- and I developed a rule that I had to say it 4 times before he is allowed to start dissecting it. By 4 times, we both knew I was serious.
We had been considering disrupting the adoption practically since the beginning. We were assured that things would get better and the beginnings were always rough. We took this at face value and could see that the girls had regression and an anxiety-induced wildness about them that would get better.
Although I hate to make dog comparisons, we also remembered the few weeks after we got each of our dogs. We actually made phone calls each time telling the shelters that we weren’t sure yet that it would work out. 6 months later, we couldn’t imagine the idea of giving back our dogs. We had a joke that we wouldn’t try to give back our kids like we did our dogs and we have actually wondered if we lasted longer before disruption because of the experience with our dogs.
When considering disrupting our adoption, the first thing that I did was to get on the internet and research it. There were some great sites for putting disruption in perspective, seeing that it is relatively common for older children and seeing the reasons (that really resonated with us) that people choose to disrupt. Then I found forums. The first round that I found basically had people posting that anyone who considered disruption wasn’t a person fit to be a parent. Digging deeper, I found discussion boards on RAD kids that said, anyone who says that doesn’t understand what it is like parenting these kids. Finally, I found a board of seasoned, successful foster parents who had also had to disrupt adoptions for reasons similar to ours.
We had been told by so many people including teachers, social workers, medical service providers, etc what a great job we were doing. I was pretty confident that we WERE fit to be parents and that we were great parents to T-4. I also became more aware that we just couldn’t handle T-7’s special needs. To those of you that don’t know about RAD kids, this may sound horrible, but she is unlovable. The mantra of parents of RAD kids is “fake it until you make it.” Not only did we not want to fake it, we were having some doubts that we would ever make it.
The girls’ therapist had said a couple of things to me throughout my course of contact that stuck with me. Although it was impossible for me to integrate what she said immediately, it did stick with me. First of all, she (and several other therapists) had told me that it wasn’t always this hard to do fost-adopt. She saw T-7’s ADHD-ODD-like tendencies to control their sessions. She watched T-7 run down the sidewalk away from the adults that could keep her safe. She watched her move from one toy to another in the playroom with the play patterns of a four year-old. During an advising session, she told me that she thought I should decide how long that we would keep on doing this. She saw the havoc that it was wreaking on us and the lack of progress that we were making.
It was the contrast of the leaps and bounds of developmental progress that T-4 was making that really demonstrated how little T-7 was. Behaviorally, T-4 had actually surpassed her. Academically, of course, she had not caught up, but we saw her learning and growing cognitively every day when T-7 had stopped. She had never once been able to describe something that had happened during the day and rarely demonstrated being able to retain information learned at school for the next day.
More and more, we felt that we had been set up for failure from the beginning. Our social worker had advocated making our relationship fun and bonding, but T-7 wasn’t really capable of having fun, she always sabotaged it by playing “bad kid”. What we did feel that T-7 needed in the end was more of a “tough love” approach, which we weren’t really prepared to offer and is much more difficult to have when you have started out with a love-fest. The attachment books that we read suggested starting with a bare-bones and structure-based approach for your new foster kids, since it is easier to get less strict than more strict.
I’ve finally caught up on my writing (and J- has helped!) We have 5 lengthy entries written and will be posting them over the next week of so (rather than backdating).
The last week of April, we’d had it. We realized that everything we were doing at that point was out of desperation. Trying to find a way that would get through to T-7, trying to see if we could find a way to make things work. We didn’t have a long-haul perspective on this and honestly, we simply weren’t willing to deal with serious behavioral problems and attachment issues. We never had been. And we were really tired from having dealt with them unexpectedly and unprepared for so long.
We did a whole lot within a few weeks to implement changes specifically directed toward kids with attachment problems, as I previously discussed here. Some ventured into a brick wall (no changes to birth parent visits), some happened (we split their rooms, started working with an attachment therapists and began doing what I would call “attachment parenting”, and began the psychiatric evaluation), and it became clear that some were just going to be a very long process (attachment work and getting meds). We were hoping for immediate change. We didn’t get it.
Actually, T-7’s behavior only seemed to get worse as T-4 got better and we got better at controlling things. J began timing her “meltdowns” at 20 minutes. The severity varied, but they did happen regularly, no matter what happened in between. I am not sure if this got worse or if I started to notice it more, but she was increasingly adverse to affectionate touch, although sometimes she asked for a hug, usually as a way to control the situation in some way. I was decreasingly able/willing to ignore her talking back and arguing and we were getting along very badly.
So the last Tuesday in April was the big therapy day. We had an appointment with the attachment therapist in the morning and PCIT in the afternoon. Attachment therapy went reasonably well. T-7 exhibited some of her difficult behaviors, which the therapist unsucessfully tried to deal with. When we spoke with her later, she felt that T-7 had a clear case of Reactive Attachment Disorder. She also said that she realized what she saw in T-7 was the tip of the iceberg.
I wrote a bit about the PCIT therapy session on that day here. We added Barbies to the mix of toys that we played with and got a violent reaction from her. She screamed at me and attacked me because I didn’t allow her to control the play with the dolls. What I didn’t write about was the trip home from therapy that day and how it became the last straw. The one that broke the camel’s back.
It became clear that we were not going to get any successes out of therapy that day, so eventually the therapist, M- came in the room to calm T-7 down and put the toys away. T-7 immediately ran down the hall and out the building ahead of us. She was out the front door when we were about halfway down the stairs. From then on, she began a game of “running” away from us. She took off down the sketchiest street in Berkeley (while staying in our sight) and began talking to strangers and doing just about anything to distract herself from what she was doing.
We decided that I should get in the car and begin driving off to see if she would get upset and want to get in the car. Didn’t work. I parked around the corner out of her view and J- and M- also moved around the corner. When T-7 came around, Jeff grabbed her and took her back into the therapy office. After a while, he brought her out of the car and put her in. She was fully capable of getting in and out of her carseat and using her seatbelt (which was definitely a turning point in our ability to control her for her safety), so she wasn’t about to stay in the car. We needed to get home for the sitter (and T-4), she he ended up holding her hands together and walking her home, while she screamed and bit him.
While I was driving home, I saw a police car. I had actually considered calling the police earlier, so I went ahead and grabbed them. I am not a big fan of cops, as you can probably figure out, but I knew this was going to be the only way to diffuse this situation. As soon as she saw the cops, she stopped strugging and began crying and hid behind J-. They talked to her for a few minutes trying to calm her down and eventually told her to get into the car. She did immediately as she cried, “But I don’t want to go to jail.”
Ever since the incident that I had in December, I have been terrified of somebody calling the police on us. We have had a few instances where both of the girls have caused problems in the car and we have had to pull over. Since T-4 could not get out of her carseat, it created a natural safety restraint. T-7, on the other hand required someone to hold her. The last time we had taken them to visit their birth parents, we had to stop several times and T-7 had a 45 minute tantrum in a parking lot. Needless to say, I was very self-conscious to know that my caucasian husband was restraining and walking with this 7-year old african-american girl in our mixed neighborhood. The saving grace was that when she screamed at him, she did call him “dad”.
For me, this day was a dealbreaker. It had become clear that even the not-so-quick fixes would take a long time…years. I knew that it was beyond me to handle these public situations that T-7 got us into and I wasn’t willing to have J- deal with them either. I was not willing to parent this kid and it was time to say “uncle”.
A few weeks ago, I took a walk in the park with T-7 and our two dogs. We’ve done this a number of times, though I’ve often had to wrestle/drag her back to the car, even with a lot of preparation. This time, I had a plan.
I chose a very precise walking pace, much slower than I would normally walk, and maintained it throughout the course of the walk. T-7’s m.o. had now become very clear to me: she is unable to match the “rhythm” of another person. When we walk from school or her afterschool program, she runs ahead or lags behind. If we’re in a store or a street that requires holding hands, she tugs and complains. This has a technical description: an inability to enter into “intersubjective [dyadic] affective states.” The idea here is that very young children learn their emotional range by participating in dyadic affectivity. By sharing an experience with a caretaker, looking in their eyes, laughing together, being held when she cries, the child distinguishes and learns to control and enjoy her mental environment. A child with an attachment disorder has never developed the ability to have coherent emotional states, due to neglect. After all, it takes hundreds or even thousands of intersubjective experiences for the child to be able to regulate her own emotional life. Children of neglect are thus typically “dys-regulated,” out of control, and they have no capacity to self-soothe or endure frustration, or to take pleasure in their own self.
On our walk, T-7 did exactly as predicted. She lagged behind, calling out to me to “Wait! Look! Stop!” I didn’t. She ran ahead, even turning corners so she was just out of sight, in the hopes that I would speed up or call out after her. I didn’t. She would return to me and walk alongside—but never in time with my step. Instead, she would take my hand and tug me back or forward. She even would step in front of me or bump into my side, all in a sort of unconscious effort to control the rhythm (actually, to produce an arhythmic chaos) of our walk. But my chosen pace was the right one, slow enough to give me the balance needed to remain on course, even with T-7’s 55 pounds bumping my side or tangling her legs in mine.
I could sense her frustration beginning to mount. The tricky moment had arrived. Would she turn and run the other direction? Would she lie down on the trail and cry? Would she find some stranger to talk to, perhaps begin following them for a bit? Would she start pushing and punching me aggressively? Bribery is useless at this point, as offering her a treat in the car or when we get home never stalls her tantrum. I sat down on some rocks by the water and waited. She poked listlessly at some nearby bushes. I waited. She sat down and bumped my shoulder repeatedly. I waited. She got up to play with a passing dog. They moved on. I waited. She then told me she was tired and wanted to go home right away. I nodded and resumed my slow, measured pace. She asked to be carried. No, my back hurts. (Being carried is her favorite method of transport, since with every step she can shift her weight and thus force adjustments by the carrier.) Defeated, she walked along to the car, and we drove home.
Children with an attachment disorder attempt to dys-regulate their environment at all times. One way I’ve heard it described is that “since their internal world is a chaos of a nonintegrated self, the only time they are ‘at-home’ in the world is when they can produce an external chaos to match their internal state.” T-7 cannot hold a gaze, play a game, take turns in a conversation, or stay quiet for more than a few seconds. Before bed, when we sit on the couch to read a book, she complains that my voice is too loud, too soft, that she doesn’t want to read this book, that I’m using “too many voices.” (I’ve been told that varying intonation when reading stories stimulates brain activity, and found her resistance to this very interesting!) She rolls around on the couch, grabs at the book, plays with a doll or toy, chews on her sleeve. Occasionally she can relate what has happened in a story or even a single paragraph, but not often.
D- and I were never especially idealistic or romantic about the relationships we would create with our children. I never expected that life with children of neglect and special needs would be “a walk in the park.” Though I recall some of my own happiest early moments walking along a beach with my Dad, listening to stories and watching swimmers and sunbathers, I never entered into an adoptive placement thinking I could or even should reproduce these moments. In our case, “a walk in the park” is just one more site in which the magnitude of T-7’s problems became visible.
We came up with this as a resource for friends who are in the matching process right now. This was basically written by J- and edited by me.
Find out as much as possible about previous placements and disruptions, and in particular, try to have your social worker review all the material. In our case, there had been so many changes in social workers for the girls (and mixed in was another foster family agency as well), that you should be able to put together a reasonable story about C-, rather than expecting disclosure to be a final and definitive information session.
Ultimately, we believe that we were dealing with the wrong person, and that there were other social workers and therapists who would have better served our understanding. The social worker is only expected to do monthly visits, it is the therapists, teachers and foster parents that area actually participating in their life and will give you a picture of who the kid is.
In some cases, there are IEPs and other sorts of documentation, and the reasons that any services were requested or granted are huge clues to the kinds of difficulties you might face. For instance, one document I recently viewed described a need for respite in a previous home based on the need for “24-hour supervision” of T-4. This is a huge clue that she is unable to be left alone, that she has a disturbed sleep schedule. Things like this might have helped us interpret the initial description of her as “really knows how to push her sister’s buttons.” Ha ha, sounds funny, kind of cute, right? But actually, she can reduce her sister (remember, her older sister by two and a half years) to tears in seconds, and does so with a vicious regularity.
Here are some very specific questions to ask, not necessarily of the social worker, but also of the foster mom if possible:
“Please describe to me, in detail, the girl’s daily routine around waking, breakfast, bathing, toothbrushing, and going to sleep.” These can be huge sites of conflict, and we are now familiar with many stories of foster children who have very serious night-time disturbances. We did not know that we would spend between one and three hours (each!) of devoted time every night to get the girls to bed.
“May I have a written report from her current and previous teachers on her levels of attention and grade-level achievements.” We were told that T-7 was doing “very well” in school, when in fact she’s a basket case, has been well below grade level, and deeply objects to even minimal school work.
“Please describe to me specific incidents of the described strongheadedness.” How does she respond to frustration? Does she tantrum? If so, how do the tantrums manifest, e.g., are they in public; how long do they last; do they involve breaking things, intermittent or incessant screaming, or physical violence toward others such as hitting, kicking, or biting? “How well does she transition between different activities?” Does she run and hide, in the house or out? Does she refuse to comply? Does she talk back? “Does she sometime require either physical restraint or being picked up from place to place.” If so, how does she respond to this? “Strongheadedness” can be a code for oppositional, defiant, and control-seeking behavior, and has been a plentiful fount of simple unpleasantness for us, when it does not balloon into tantrums, as it often does.
“What are some of the activities she has been involved with? What kinds of games, if any, is she able to play?” Has she taken care of family pets, been in an afterschool program, learned to kick or throw a ball, ride a bicycle, dress a doll, draw or paint? Both my girls are developmentally behind in basic pre-school skills and imaginative play capacities. They are catching up, but it helps to know just how “old” your new child “is.” We thought we were getting a 4 and a 6 year old, but really when they moved in they were developmentally all over the place. Mix that with regression (not unusual upon adoptive placement), and we found ourselves unable to generate age-appropriate behaviors from them.
And here are some comments on adoptions out of county:
We underestimated the difficulty of the travel. Even with family in Sacramento, visits are very difficult and trying. We were driving out there twice each week: Tuesdays we drove there and back ourselves, and spent a few hours with the girls. We were also driving there and back each weekend to pick up the girls and bring them back to our home. That was three days a week of substantial driving (the trip was nearly two hours, could be more with traffic, and the visits are basically as far out in Sacramento County as you can get). This meant getting dog care each time, disrupting our own eating and sleeping, and increased car maintenance at 600+ miles per week. It also meant driving out to meet the social worker, do the disclosure meeting, driving again back and forth to pick up the girls’s possessions, bringing T-4 back for a medical appointment… And now, any trip out there with the girls means nearly four hours for them in the car (more if they spend much of it screaming and we have to pull over!). Will you have parent or relative visits?
Accessing services via medi-Cal has been VERY complicated, and most of the complications had to do with agencies in Alameda that require Alameda residence status. The Medi-Cal bureaucracy is huge and disparate, and what one agency pulled up on its computer was (and still is!) usually different from what another pulled up. Our agency was initially very negligent on this score (”oh, they changed the rules and nobody understands it, and anyway, it’s your responsibility to take care of” — when we were thinking “uh huh, and you’ve been doing this for thirty years and have no idea what the fuck you are doing?”). Eventually, they did some important work that helped us get T-4 initial school covered, but the period of working through this was perhaps the worst few weeks of my life. Even so, I made a lot of mistakes, some of which I am still in the process of rectifying.
This is a part of 2, perhaps, but D- indicated that C- was not presenting for any therapeutic services. This is absurd. Most “normal” kids need therapy; all foster kids do. Get this set up in advance.
Also, adopting out of county means more distance between us, our social worker (M-), and the reams of people who are involved in the case in Sacramento. If C- is not post-.26 (legally free for adoption), then don’t believe what anyone tells you. Our girls were initially offered up as “will be smooth sailing to .26,” and then at the disclosure meeting it was “well, the parents will fight it, but it doesn’t mean anything.” While this could include delaying .26 termination resolution (taking it to “trial”), it also means that they appealed placement out of county, prevented transfer of educational rights, and asked for reinstatement of reunification services (the answer was “no,” thank goodness).
We spent most of our disclosure meeting discussing T-4’s medical history to make sure that she didn’t appear permanently unable to live independently. This was a mistake. We knew going in we were prepared to assist her in rectifying her long-term medical neglect, and though we have had to do a lot of work around her medical issues, it has never been especially onerous to us. What we should have discussed were the behavioral issues that were being hidden from us or minimized.
I sometimes like to say: “well, the social worker didn’t lie about everything, as there were some half-truths mixed in!”
A book that has been great for me the last month or so is my last tip: Daniel Hughes, “Building the Bonds of Attachment,” 2nd ed. I don’t know how much it would have helped me before the girls moved in, because I understand things now I never could have six months ago. But it is also excellent reading, and D- is planning on re-reading it. It is a narrative of the first 7 years of the life of Katie, who is a fictional composite of many foster children. “Katie” is even more pronounced in her attachment insecurity than my girls, and manifests it in ways that are more destructive. But, “she” has taught me a ton about why my girls are unable to do some very simple things, and why their initial external “charm” serves to cover over a profoundly dis-integrated sense of self, inhibiting them from experiencing self-satisfaction, and implanting shame deep into their core personality.
I no longer believe that anyone who has experienced several placements at a young age will be entirely free of attachment issues, and that they will manifest as behavioral issues in one way or another. As I said above, if C-has not been receiving therapeutic services, somebody hasn’t been paying attention, and if they haven’t paid attention to that, you need to know what else they have been missing.
In early April, T-7 was out of control. She was having tantrums multiple times a day, arguing about everything, physically attacking Jeff regularly and even acting up with her teacher. We thought it was because of her upcoming birthday. After her birthday things got a little better, but not much.
The ramifications of her difficult behavior was starting to wear on us. Jeff was doing all of T-7’s caretaking and I was doing most of T-4’s. We weren’t really able to take T-7 anywhere, because she would usually decide to stop minding us at some point and we would have to resort to carrying her to the car to leave. We basically felt that we could not operate as a family, except for morning and evening routines and we could not successfully leave 1 parent with 2 kids. Neither of us had been able to work at a level that is sustainable for our family. The really scary part is that we saw no end in sight.
So, we were on the brink of a number of changes and we decided to let these new services settle in and see how things went. T-4 had moved to a wonderful preschool that had wonderful effects on her behavior and development. We had just switched our therapists to a program called A Home Within. We also had a behaviorist coming into the home and we implemented a reward chart. We were strategizing to get more results from our PCIT sessions. All of our social workers had turned over and we hoped that the birth parent visits would change. We planned to create a very stable environment for 3 months to see whether we could get our family to a sustainable place.
Our previous social workers advice to “Just wait, everything will get better,” was no longer believable. She had encouraged us to not consider a direction of medications and diagnosis. They just need love, stability and time. She may have been right in the fact that in the first couple of months, it is too soon to tell. But we knew that she could not say with certainty that things would get better. We had heard too many nightmare stories of when they don’t. Not just in the media, but from people that we actually know.
We watched in awe as T-4’s behavioral maturity began to surpass T-7’s. She was learning, growing and changing, while T-7 had been completely stagnant for 6 months. We noticed that T-7 could not walk by our side, hold hands, look in our eyes or play mutually satisfying games. She squirmed away from receiving any touch, unless she was directing it. She could not calm herself down or reflect on her own behaviors and relationships. She did not learn, either. She was not able to recount anything that had happened to her during the day. It was as if experience and knowledge was something to have in a moment, but not to integrate. All of these things were confirming something that we had already suspected, that T-7 had attachment issues.
In the middle of April, we spoke with our friend B-, who has been our clearest advisor through this whole process. She hooked us up with new resources that we needed to evaluate the situation. We had heard many different milestones referred to as far as when it started “getting better”. Some people have said 5 months, some have said 1 year. B-, who has two boys that had attachment issues said that for them it was three years. She suggested that we forget play therapy and go directly to an attachment therapist, forget any other appointment…this is the most important thing. She said, definitely get meds for T-7 and start taking Excedrine PM myself. She said that nobody really can understand what it is like to parent an attachment-challenged kid, that there were no rules other than not harming your child and that social workers and other parents would not understand.
So, we took this advice. We had a couple of appointments with a well-known attachment therapist, who felt that she was a clear case of Reactive Attachment Disorder (I am still not completely convinced of this, but I do think she has attachment “issues”). We began T-7’s psychiatric evaluation. And night-time sleep aids were added to my managerie of bedtime companions (which has really helped). I read my second Daniel Huges book. This all served to move us in a particular direction, that we had been looking for, quite frantically, for some time. To some degree, these steps demoralized us. The book described to us how badly everything had been stacked against us from the beginning, following the advice of well-intentioned social workers and how misunderstood kids and parents with kids with RAD are. The medication process was long and honestly, not that promising. It made us realize how we have been hoping for quick fixes and that T-7 has years of healing still had ahead of her.
We began really reflecting on what we had wanted (and not wanted) and the ways that we had been misinformed about what we were getting into. We started to think about what we were actually capable of. We looked at our last 6 months and how hard we have worked and realized that we could not do that for another 6. We remembered reading a book about RAD in the beginning of our process and clearly ruling that out in our own minds as something that we could handle. So by the end of April were teetering on the edge of giving up.
About a week ago, a few of my drafts suddenly got posted with a bunch of viagra text at the end. Hmmm…sounds like it is time to change my password. I thought that I had deleted them all, but I found another today. Believe me, I am not selling viagra here :)
On that note, I am finally able to finish some of those old drafts. I decided to back-date a post that wouldn’t really make sensein the current context of life. I did want to include it, for obvious reasons. I am just posting here, so that you don’t miss it.
T-7 has all of the checkmarks for a Disorder called Oppositional Defiant Disorder, which a high percentage of kids that have ADHD have (which she also has the symptoms of). From Wikipedia:
A pattern of negativistic, hostile, and defiant behavior lasting at least 6 months, during which four (or more) of the following are present:
Note: Consider a criterion met only if the behavior occurs more frequently than is typically observed in individuals of comparable age and developmental level.
often loses temper
often argues with adults
often actively defies or refuses to comply with adults’ requests or rules
often deliberately annoys people
often blames others for his or her mistakes or misbehavioris often touchy or easily annoyed by othersis often angry and resentful
is often spiteful or vindictive
The disturbance in behavior causes clinically significant impairment in social, academic, or occupational functioning.
Since mid-January, J-, T-7 and I started a form of therapy known as PCIT. It has been emperically tested that the therapy leads to the improvement in behaviors of difficult children. It has been a really interesting experience and has led to progress, although honestly we have not seen any behavioral change. We have only seen change in our ability to navigate her behaviors. Increasingly, we have been suspecting that T-7 suffers from an attachment disorder, which really needs to be treated with attachment therapy and is a long, slow process.
PCIT is done in a therapy room, with one parent and one child behind a one-way mirror and the therapist on the other side (J- has also been in the room with the therapist). I have a bug in my ear and the therapist is able to direct me in playing with T-7.
Child-directed Segment
PCIT begins with the child-directed play sessions with the parent. During this part of the treatment, the parent acts as a play therapist. When a “mastery” level is reached byt he parent, then the therapy may move on to the second segment. “Mastery” is reached by eliminating questions and commands from her language and using a high number of praises, exclamations, reflections and descriptions within a certain time period. The only rules are that the child play with the toys gently and stay in their seat. If they break these rules, the parent ignores them until they do.
This segment is also accompanied by “homework” of child-drected play for 5-10 minutes per night.
This segment does several things. It increases the bond between parent and child and increases a childs self-esteem. It is actually pretty rare for a parent to spend a full hour letting a child direct everything and get praise and attention. It also (potentially) gives the child a taste of the difference between getting a lot of positive attention and being actively ignored by a parent. When I say “actively ignored”, I mean that I am saying things like “I sure wish T-7 would get in her seat, so I could play with her, she is sooo fun to play with!”
We were so motivated to see behavioral change, that J- and I joked that I would be the first person ever to pass out of this segment on the very first try. Well, I was close the first time, but the equipment was broken. The second time, I wasn’t quite warmed up and T-7 was being a bit difficult. The third time was a charm and we were able to sail into the Parent-Directed.
Parent-Directed Segment
We wondered if T-7’s behavior would really be triggered in this artificial context. Our concerns were put to rest during the very first “practice” session, when I played with her for 15 minutes. When I announced that it was cleanup time, she threw her body over the toys on the table and hissed at me. When I calmly restated it and started taking the toys away, she started screaming “No, no, no, no!” And fell out of her chair.
The rest of the sessions consisted of bringing out blocks, crayons, legos or cars. In addition to the regular praise, reflection and descriptions, I would give her commands of things to do with the toys. If she could not mind, she would be asked to take a time out in a chair for 3 minutes. If she remained in the chair and was quiet during the last 30 seconds of the period, the time out would end. If not, she would get another time out.
The main thing that I have gotten out of this part is that I am now very careful to use clear commands. I saw T-7 get really upset one time when she was confused about what I wanted her to do and she made the wrong choice. I realized that most of the time when we have problems with her, she has divided priorities. Usually, she thinks that what she is doing is more important than what we ask her to do. Well, it can be a bit like dawdling. The problem is that it is never a few minutes. If we do not demand immediate compliance (and escalate it), then she spirals out of control. Occasionally, she will feel that she is still on task with something else. So, when I use clear commands, there is absolutely no doubt what I am asking for and when it should be done.
Until our last session, we didn’t get much of a reaction from her. She did earn 1 time out, which it took 2 time-outs to complete, but that was a huge accomplishment for her. She would get bored and would complain. She also had an almost magical sense of pushing limits. She would always protest long enough so that she would be just about the get a time out, but then comply at the last moment.
We considered starting to do the therapy at home, that it was time to start integrating it into our everyday life, where we were still often relying on containment and restraint. Then I noticed that most of the time when she wasn’t complying at home, it was because she was doing something with her dolls (or sometimes her other toys). My feeling was that she didn’t care enough about the toys that we were using. Yah, she wanted control, but not enough to take a time out and stop playing. We decided to up the ante and Jeff and I brought her Barbies to the session. She loves everything about dolls, but especially doing Barbie hair.
T-7 was in a particularly difficult mood that day. We had trouble getting her into the building, we had had trouble getting her into the car earlier in the day. Well, it only got worse. In the beginning of the session, we played with blocks and trucks. I did have to threaten time outs a few times, but she complied. Then, I made the call for the doll delivery. That exploded the session.
It is almost a relief to be screamed at, grabbed and hit in front of a therapist. We can describe her behavior till were blue, but not many people actually see it and how awful it is. It is validating that the therapist is going to have to call in her supervisor to help. We have read a lot of freaking therapy books, but kids with attachment problems do not really respond to most things and none of the solutions work on an immediate or even short-term scale. Even the behavioral experts are at a loss with these kids.
It is even better that it was recorded on video tape. We feel that her behavior has been minimized by social workers (especially her county social worker) and we now have tangible proof that we are not simply bad parents or dealing with her in the wrong way. And we can’t wait for all of them to watch it.
6:00 – 6:20: Lie in bed petting dog and snoozing after the alarm goes off.
6:20 – 7:00: Make coffee, check email for emergencies (ignore), do some leftover evening dishes, and let the dogs out.
7:00-7:15: Wake T-7 and T-4, lay out their clothes, help D- get off to her Business Networking Group.
7:15-7:40: Our friend R- shows up to join breakfast and help make sure everything goes smoothly (since I’m otherwise outnumbered).Chat with R- while cooking breakfast (eggs, vegan sausage, croissants) and encouraging girls to get dressed.
7:40 – 8:20: Eat breakfast, clear and clean dishes, help girls get their teeth brushed and ready for school, get into the car.
8:20 – 9:00: Drop girls off at their separate schools and return home.
9:00 – 9:30: Feed dogs, eat a bit more breakfast, and browse the morning e-news.
9:30 – 11:15: D-returns from the networking meeting, we confirm plans for the day, talk over issues of obtaining proper respite care, and our thoughts on pursuing T-7’s psych evaluation.Spend 30 minutes talking with fost-adopt agency supervisor about yesterday’s conference call with S- County social workers.
11:30 – 12:30: While D- takes Rocky to the veterinary dermatologist to have his patchy fur checked out, I email and call T-7’s pediatrician, the family support representative at the hospital, and the new attachment specialist to see how best to proceed with obtaining a court order to prescribe meds for T-7.Also got confirmation that emergency respite provider used a few days ago can be added to our respite list, and had a registration packet sent out to her.
12:30 – 1:00: Get update from D- on Rocky’s apparent allergic reaction, and the course of treatment for him (baths, antibiotics, more Frontline applications, etc.). We sit down for a sandwich together.
1:00 – 2:00: Take dogs out for a quick run in the park (they run, I walk).We have to avoid one section due to Roundup application (ugh), but it’s ok since I only have an hour.
2:15 – 2:45: Pick up T-4 early from school, drop her and D- off at the hospital for an endocrinology follow-up appointment (they trade stickers for blood samples); I squeeze in a quick call with S- social worker to update plan for access to local A- County psychiatrist.
2:45 – 3:15: Head back to pick up T-7 from school, chat with teacher for a while about T-7’s attention difficulties and disruptive behavior in class.A trip to the principal’s office is imminent.
3:15 – 4:30: Take T-7 to the Public Library near the hospital so we can pick up D- and T-4 when their appointment is over.I drive home, D- and T-4 immediately head out to T-4’s new play therapy appointment.
4:30 – 6:00: Settle T-7 in for an hour or so of quiet play with dolls, as I clean kitchen and prepare dinner (tortelloni, salad, leftover egg rolls, steamed broccoli), set table, start laundry, feed dogs, talk on phone with attachment specialist to set meeting for next week and get her thoughts on the role of meds in her treatment approaches.
6:00 – 6:30: Dinner.
6:30 – 7:15: Help guide T-7 into and eventually out of bath, do dishes, get T-4 brushing teeth, assemble her new breathing apparatus for inhaler applications, and check the evening e-news.
7:15 – 8:30: T-7’s bedtime routine: lotion, jammies, brushing, put away dolls, reading on couch, bedtime hugs, 10 minutes sitting on chair in her room and she’s out for the count.
8:30 – 10:00: Take over D’s bedtime routine with T-4 so she can go out and have a dessert treat with her brother; sit with T-4 and read a book while she plays herself to sleep.
10:00 – 11:00: Fall asleep, mmmm.
11:00 – 12:30: Wake up, carry T-4 to her own bed, chat with D- (while she sits at the filing cabinet purging and organizing) to bring us both up to date on all the phone, appointment, and email traffic, eat ice cream, put off figuring out how to get through the weekend, move laundry along, and put out trash & recycling bins.
12:30 – 12:35: We watch a cute YouTube video.
12:35 – … Brush, think about taking shower, go to sleep…tomorrow’s alarm clock switched from 6:00 to 6:45…
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There are a wide-range of attachment-related problems, some that have diagnoses like Radical Attachment Disorder and Attachment Disorganization. Related may be other behavioral problems like Oppositional defiant disorder (which is T-7 current diagnosis).
We have been researching general parenting techniques for many months trying to figure out how to handle our troubled kids. It took us quite a while to figure out that we actually needed to focus our efforts on learning to parent troubled kids and now we are really honing on the fact that T-7’s attachment issues make parenting her a whole other exercise.
We were first really onto something when we read Daniel A. Hughes book Building the Bonds of Attachment. The book focuses on Katie, who is a composite foster kid of many different children that the author has worked with. She goes through several placements of both experienced and well-intentioned families that fail after truly admirable attempts to make it work.
Although many of T-7’s behaviors have not been as extreme as some of Katie’s, we noticed many of the overall threads to be parallel. T-7 always seems ready to move along to the next place, with not much of a feeling of loss or grief from her previous placements. She looks at J and I as a tool to get what she wants, sometimes as a slave to her needs and definitely not as the people that should be in charge of her. She is only happy when she is controlling us. She has also had a tendency to sabotage her own experience of happiness, as well as the happiness of those around her. She is filled with anxiety and rage that manifests frequently.
We are looking into medications to reduce T-7 anxiety and tantrums.
We are beginning to work with a therapist who specializes in attachment issues so that we have a better idea of how to help her and how long it will take.
We have learned a lot about parenting kids with attachment problems and it involves a hell of a lot of control and very little entertainment
We plan on separating the girls rooms to be able to have more control over the house and help the girls have more autonomy from each other. We feel that there are many ways that they impede each others developmental progress.
We have discovered something called “Therapeutic Respite Care,” which we plan on starting to use for T-7. It is not fun and games, but a lesson that if she cannot behave properly and/or receive discipline for that behavior than she is not going to be able to stay in our home. The provider means business and understands these kids. She will spend her time there talking about her behavior, writing sentences and learning. At this point, we plan on this being the primary respite that we use for her because sending her off to have fun with our friends really only tends to perpetuate her fantasy that she can behave poorly at home and look towards the possibility of having fun with other people and maybe that she will even be moved to a home that is “better”. When I told her about the consequence of her not being able to stay here when she could not receive discipline, her reaction was “They will have toys and it will probably be better than it is here.” When I told her there will be no toys, she said. “Oh, I don’t think I will like it there.”
We are working toward reducing or eliminating visits to their birth parents. Ideologically, we like the idea of them, but things are much more complicated than we expected. T-7 finds them very confusing and the last visit triggered weeks of disruptive behavior. If they are not eliminated, we are looking into other transportation options. The last return trip took over 4 hours because of the tantrums.
Maybe most importantly, we are looking for ways to contain our own selves a bit more so that we aren’t too emotionally spent to work or enjoy ourselves a little. We are actually really shifting our focus from working so hard to figure out all the best answers for the girls. We are acknowleging that this is going to take some time and maybe a long time and learning how to protect the integrity of the rest of our lives a bit more.
I would like to share some good news. T-4 is at a new full-day preschool! The transition has been a bit hard, it is a great move for her. She gets more articulate, creative and social by the day! We have eliminated most of her tantrums, although the ones that she does continue to have are still daily and very taxing. We feel that her attachment to us has gone really well. There is no doubt that we are mom and dad and she seems to mostly get what that means. We feel that many of our problems with her are age-appropriate and have been learned by watching T-7.
There was a time, which lasted for a few weeks where T-7 came home in a good mood, confident, loving and seemingly happy with few tantrums. We do hope that we can get back to that place and would love to see her as a kid who worries less and thrives more.
The other important news is that the .26 hearing has been scheduled for July 6th. This is the hearing that will determine whether the rights of the birth parents will be permanently terminated. It will likely be set for trial at the hearing, since the birth parents will fight it. We expect the trial to be short and for the rights to be terminated quickly after. The birth parents have already been denied the continuance of reunification services. Many families that we have spoken to have named this period as emotionally and symbolically important. At this point, the logistics and ramifications of the visits to the birth parents are more important to us, but we will take every step as progress.
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