It has been about a year since my husband Jason joined me in writing a post. I'm thrilled to welcome him back!
This post is the second in a series on parenting children with Reactive Attachment Disorder (RAD). In part one, Renae wrote about our personal experience as parents, raising two children with RAD. Please read that post first (if you haven't already), because it includes a fabulous description of the behaviors and general emotional chaos that children with RAD bring to a family. For part two, we will focus on behaviors and consequences. These topics are, at best, counter-intuitive, and at worst, just plain baffling and lastly, controversial. Our hope in writing about these topics is to help readers feel empowered and capable of meeting the challenges of this incredibly complex and devastating disorder. (We will use the clinical label RAD throughout these posts, rather than "attachment disorder" or "attachment issues.")
At the core of a child who has RAD is the absence of normal, healthy bonding and attachment with a nurturing, consistent caregiver. This results in brain development problems that have permanent, life-altering consequences. A basic sense of trust and safety around people and in the world develops in the first six month of life. This process is severely affected by neglect, disruptions of consistent care and abuse from caregivers. How these traumatic experiences impact brain development will be covered in more detail in an upcoming post, but for the purposes of this discussion, it must be very clear to the reader that RAD is the result of a specific kind of brain damage. This is vital in understanding the difference between "typical" parenting and RAD parenting.
When we think of traditional components of good parenting, terms such as positive reinforcement, time-out. social modeling, and quality time may come to mind. For a vast majority of children, tried and true behavioral supports such as sticker charts, positive parenting, and natural consequences will have many positive, lasting effects.
Typical parenting approaches do NOT work with children with RAD.
Why? With RAD children, the damage caused to the brain impairs his or her ability to follow through with behavioral plans, in several ways. The first area is lack of trust. Because of their early trauma, there is no reason to expect a positive consequence for good behavior. Why should they believe that you will provide it for them? Unlike typical kids, RAD kids, by definition, are not motivated by their parent's wishes and approval. They view themselves as "not good", so they become agitated and fearful when receiving positive feedback. The fear generated by praise will lead them to do all they can to sabotage any attempt to establish incentives and positive reinforcement. People with RAD seem to get a "high" from breaking rules and flaunting expectations. We know of one 5-year old who gave a response that best illustrates this phenomenon. When confronted by her parents about some missing contact lenses, this child replied that making "bad choices" is fun. Therefore, the (potential) negative consequence IS the reward! There is no reward that you could offer through a behavior plan that can measure up to that high. Conversely, if you try a more rigid, strict disciplinarian approach with RAD kids, the results will be just as ineffective. No matter how severe consequences may seem to you as a compassionate parent, they pale in comparison to the neglect and trauma these children have experienced in the past.
To make things worse, RAD kids have difficulty "switching sets." They struggle due to emotional inflexibility and low frustration tolerance, becoming so upset about having to stop a favorite activity to respond to a request, that they eventually explode. Children with RAD frequently have developmental, emotional, and cognitive deficits or disorders. Ross Greene, the author of The Explosive Child, perhaps said it best with this statement, "Children do well when they can." In other words, if RAD children were capable of receiving praise or discipline, and responding appropriately, they would.
At this point, you (the reader) may be finding yourself in something of a paradox. Namely, if a RAD child cannot be motivated to change behaviors through traditional parenting...
How do you parent RAD children?
You give consequences!
Why? That's a little more complicated.
Safety comes first. This is one rule that can't be ignored or negotiated. Unsafe actions, depending on the their severity, have very significant consequences. In society, if you infringe on the rights of another person, you have to face justice. Unsafe behavior prevents parents from fulfilling their role as protector, as law enforcement and child protective services may become involved. In extreme cases, violent and aggressive behaviors can be so severe that inpatient hospitalization, out-of-home placement and/or juvenile detention may become necessary to ensure the safety of all family members. We have been in contact with a number of parents who have made the choice to place their RAD child out of the home. We have discovered that, despite nagging feelings of guilt and/or inadequacy, the vast majority of these parents expressed relief that all of their children are safer now. They take comfort from knowing that true parenting is admitting when a situation is out of control and taking action, before it becomes too late. We have been amazed by the incredible love and resolve these parents have shown in dealing with incredibly difficult circumstances.
Giving consequences helps the RAD child feel safe. Having RAD means living in a constant state of anxiety, mistrust, and fear. Consistent, reasonable consequences as a response to inappropriate behaviors provides certainty. More certainty means less anxiety and fear. The RAD child still won't trust you or your motives. Consequences still won't be effective at preventing future behaviors. But, a predictable environment is a less threatening one. It creates a safe setting for the RAD child to work through fear and anxiety.
Taking a strictly "hands-off" approach, may result in the RAD child engaging in increasingly chaotic and/or dangerous behaviors. Children with RAD feel powerless in a world that seems to be stacked against them. In response, they strive to either take control or create chaos, through whatever means necessary. RAD children live up to the notion of "give them an inch and they take a mile." Consistent, firm consequences are the key to establishing the limits of acceptable behavior.
RAD children will learn the difference between right and wrong, if you are consistent. Parents have the primary responsibility of teaching their children right and wrong. All children can learn that behaviors have consequences. RAD children will need more time to associate good choices with good consequences than typical children. Knowing right from wrong doesn't mean that they will behave any differently, but the concept will be understood. This lesson will teach them what to expect from real life.
So much time and energy are devoted to dealing with behaviors in families affected by RAD. Having consistent behavioral expectations for all family members and then recognizing and praising those who meet them, can minimize feelings of under appreciation, resentfulness, etc. in typical siblings in the home. Other children in the home will feel better knowing their efforts are noticed. They will see justice carried out when needed.
What Consequences are most effective?
At this point, we need to clarify what we mean by responding consistently. To respond consistently means to give a consequence each time a behavior occurs. The specific consequence that you give does not need to be the same every time. In fact, giving the same consequence every time will make things worse. Predictable consequences will be exploited and manipulated, especially when the thrill of misbehaving outweighs the rewards of being compliant. The solution then? Unpredictable consequences!
Distract and redirect is the first line of defense, well-known to anyone who has spent time around toddlers. In order to defuse a toddler who is on the verge of melting down, you simply distract them with a sound, object, gesture, quick movement, etc. and refocus their attention away from the person/situation that initiated the tantrum. With RAD children, this technique can retain it's efficiency well after the "terrible twos", since most children with RAD also have developmental delays.
Use humor! When my 3-year old persistently asks the same question for several minutes, I reply with a random words like "monkeys" or "bubble gum" each time she asks. Using humor helps because it breaks up the negative communication patterns and cuts through the child's defense mechanisms. It reduces the mounting tension that comes with argumentative verbal exchanges, and it's just plain fun.
Time-in is a behavioral consequence that seems to be tailor-made for RAD children. The parent requires the child to be by her side at all times, everywhere she goes. It may or may not involve the child doing whatever the parent is doing. Remember, RAD children seek the high that comes from getting "into trouble." Time-in takes away the reward and turns the tables on them. They now find themselves in the exact opposite situation that they had expected.
There are two exceptions to this rule:
1. If the behavior is aggressive or violent to the point of threatening the safety of others, the parent will need to remove the RAD child from the situation and isolate them in a safe place, under close supervision. Note that time in can still be the next step, once the child has calmed down and seems ready to return to the family group.
2. You just need a break. If you are in an emotional state that prevents you from managing your responses to misbehavior appropriately, then it is in the child's and your best interest and safety, to both take a brief time out. Time outs must take place in safe locations. It is best that you still remain easily accessible to your RAD child, in case you are needed. Don't hesitate to avail yourself of a quick timeout; those few minutes of separation can make a huge difference in your ability to manage the rest of the day. In extreme circumstances, when you may need a longer time out, be sure to leave your RAD child with a responsible adult who is familiar with behaviors they may encounter.
Restitution is a "real-world" consequence that requires the child to SHOW that they are sorry with actions, instead of just using meaningless words. It's also a tangible consequence, understandable to even young children. In cases where the child is too young or simply not capable of earning money, restitution can take several forms. Preschool children (ages 3-6) can understand that if they've purposely damaged or broken something, it needs to be replaced. This can mean giving the victim a similar toy permanently, to replace the broken one. If the RAD child purposely breaks an item that belongs to a parent or other adult, the child gives restitution by losing a similar item of their own. We know of a 4-year old RAD child that pulled apart her mother's new necklace. The mother threw away one of the child's costume jewelry necklaces as restitution and explained her reasons to the child. For lower (ages 6-9) and upper (ages 9-12) elementary school children, restitution can and should be made in money or monetary equivalence. Denial of participation in an extracurricular activity or special event to compensate for fees and damages sends a very clear message that consequences can stick for a long time. The child who broke two seat belts in the family van is not able to participate in summer dance class, since the repairs and the dance class each cost around $70.
It is important that middle school and high school-aged children take full responsibility for financial restitution through honest and legal means. Parents should avoid taking restitution out of allowances or accepting household chores as "payment in kind." Household chores are an expectation and allowance is coming out of the parents' pocket. Doing odd jobs around the neighborhood for money, holding a yard sale, and/or collecting cans for recycling are all things that most RAD children are capable of doing to earn money, if unable or unwilling to seek employment.
Be aware that requiring a child to pay restitution can be a LONG-term commitment, both for you and for the child. It is effective, but make sure you can dedicate the time to see it through to the end. Do not choose restitution consequences that are going to require supervising time from you, that you don't have.
Physical component- Let me be clear; this is NOT an endorsement for physical punishment. What we mean here is that effective consequences for RAD behaviors include some sort of physical exertion. One of our favorites is what we call "dance it out." When we noticed a 6-year old RAD child acting out or being more defiant than usual, we put on loud music, and she dances until we tell her that time is up (say, 15 minutes.) In our experience, the physical exertion works to calm down the anger, and relieve the tension that is building in the mind and body of the child. She actually feels relief and, most often, completely forgets what she was angry about to begin with.
Pleasant setting/favorite activity This one may seem counter-intuitive, but, like most good things, we discovered it out of desperation. When recent behaviors have escalated or have no apparent pattern, taking a RAD child with you to participate in some sort of enjoyable activity, such as eating lunch at a favorite restaurant, shopping at a favorite store, etc. can be your best move. The pleasant setting reduces the child's defense mechanisms, allowing for more free and honest conversation and improved access to the child's thoughts and feelings. It may be tempting to discredit this technique because it appears to reward "bad" behavior with a "good" consequence. We address this in two ways: One, consequences for any and all inappropriate behaviors that have occurred have already been given. Just because we can see that the child is struggling with something doesn't excuse behaviors that demand consequences. Two, the trip to the buffet is not a reward. It is an opportunity to change the setting and initiate a conversation about whatever thoughts and feelings the parent and child have been unable to discuss in other situations.
Beware and plan ahead for known triggers, anniversaries- Post-Traumatic Stress Disorder (PTSD) results from significant trauma in the past that has not been resolved and leaves a person with irreversible effects on brain functioning. RAD children suffer from PTSD that began with early childhood trauma. Therefore, becoming familiar with the triggers or cues that precipitate intense flashbacks and emotional reactions is crucial for parents of RAD children. A more detailed description of PTSD, triggers and cues, as well as ideas for helping children who struggle with this disorder will be included in another post. For the purposes of this discussion, being aware of your child's PTSD cues and reactions can guide your decision making when considering discipline options for a RAD child.
Anniversaries, such as birthdays, holidays and Mother's Day, present another difficult hurdle in working with RAD children. Developmental grieving involves an almost unconscious longing for birth parents, and intense feelings of loss and abandonment. It takes the form of increased agitation, irritability, fear, anxiety, and impaired social and academic functioning. Again, for the purposes of this post, developmental grief is a major consideration to remember when a RAD child displays more challenging and intense behaviors than usual. Check the calendar, and adjust accordingly when giving consequences.
Antecedents- Of course, behavioral or emotional episodes can be triggered in RAD children with no clear indication of PTSD triggers or developmental grieving. Sometimes, they just happen. The trolls in the movie Frozen perhaps explained this best when they sang, "People make bad choices when they're mad or scared or stressed." RAD kids don't want to be afraid all the time. They just can't help it. Frequently, getting into the underlying causes of a major behavioral or emotional meltdown is just as important as giving consequences when they happen.
A few brief points before we conclude:
Time stands still- A skilled therapist that we know shared this bit of wisdom with us. When a consequence is given to a RAD child, nothing else happens for that child until the consequence is carried out. Other than meals, bathroom needs, sleep, school, etc. the child is dedicated to that consequence until it is satisfied. Please note- this could go on for days, so be prepared to carry it out fully.
Don't give consequences that interfere with your plans- This goes hand-in-hand with the last point. If you have big plans for the night, you might want to hesitate before giving a RAD child a consequence that you know will take several hours to accomplish, sabotaging your plans.
Don't give consequences that interfere with your mood- One of the key themes of this entire post is the significance of choices. Parenting a child with RAD is an emotional roller coaster in the fullest sense. In order to survive and thrive, the parent has to demonstrate emotional self-regulation that is independent of whatever the child is doing. A phrase that is heard frequently around here is "You can choose to be miserable, but I still plan on having fun today." Perhaps the best thing a parent can do for a RAD child is enjoy every day to the fullest.
There is no "one-size fits all" approach to parenting a RAD child. This should be obvious by now, but just as every star is different, so too is every child who has brain damage from early childhood trauma.
Giving consequences for behavior to a child with RAD is extreme parenting When all is said and done, you will know you've done all you could to love a child that can't and won't accept your love in return. You give consequences because you love your RAD child. You cannot expect to change your child's behavior through consequences, but you will be able to prepare that child to function in the world, if possible. You can have the assurance that, when it comes to right and wrong, you taught your child the difference and that he or she will always have a choice.
Resources consulted while preparing this post:
About the Contributing AuthorJason has a master's degree in Marriage and Family Counseling. He has spent the last eight years working as a therapist to adults and children, in a private and group counseling sessions, and in residential facilities. At home, Jason has four plus years experience as a foster parent with his wife Renae, caring for children ages newborn to eighteen years of age with multiple special needs. He is also a parent to four special needs children, two biological, and two adopted, with diagnoses of autism, ADHD, RAD, PTSD, Fetal Alcohol Syndrome of Effect, anxieties, and sleep disorders. Within the last year, Jason was diagnosed with Autism Spectrum Disorder, ADHD and Anxiety Disorder NOS.
Disclaimer: Any advice or suggestions that Jason writes here CANNOT be considered therapy or professional consultation, due to counseling ethics standards. It is not really practical or possible to do counseling with someone he has never met. What we hope to offer IS our personal experience as as parents and foster parents of special needs children, plus things Jason has learned as a professional counselor. Take any advice that fits, leave aside what doesn't fit.