Therapists Struggle to Help Families Reconnect with a Child Unable to Love

20 May 2006

By Leigh Woosley

Charley Edwards balanced himself on the edge of the couch, his leg bobbing up and down with the energy of an 11-year-old.

Charley, who goes by CJ, flipped through a small photo album bulging with pictures of his young life, beginning with images of a caramel-skinned baby in a portrait studio to a boy proud of his police costume on a recent Halloween.

The smiles and holidays are only part of CJ's story.

The darker side is chronicled in manilla folders Donnie Jackson, his biological aunt and adoptive mother, holds on the opposite side of the couch.

This is where records are kept of CJ's myriad admissions into psychiatric hospitals and scores of visits with therapists, all part of a continuing battle to control his explosive behavior.

CJ is diagnosed with reactive attachment disorder, or RAD, a psychiatric illness that ensnares young children who struggle to emotionally attach with anyone, especially the people who love them most.

In general, RAD children have been abused, neglected or forgotten in the past by adults who were supposed to take care of them. They struggle to trust again, fearing the same outcome.

"They have broken attachments that have been riddled with abuse and neglect," said Brenda Smith, a licensed professional counselor at DaySpring Behavioral Health Services who specializes in treating Medicaid-insured children with attachment disorders.

"The children stop trusting. The children decide adults aren't safe to care for their needs."

The damage is mostly done in the first three years of a child's life, a crucial time for brain and emotional development.

The symptoms, which surface before age 5 and often much earlier, are most profound when the child is out of the hurtful environment and finally among people who try to express love and care. Accepting this affection is arduous for children with attachment disorder, as incongruous as it may seem.

Maltreatment. Abandonment. Evils that spark RAD are the very reason the diagnosis is pervasive in the state's child welfare and foster-care systems.

But Oklahoma doesn't have resources to treat the most difficult of these children and each year sends several of them to different states for treatment. This is usually more expensive and cumbersome than treating them here.

A legislature-ordered task force is now learning just how widespread RAD is and how to improve in-state treatment and resources for families fighting it.

Estimates say that 1.5 million U.S. children have severe cases of it. Many more children have milder forms of attachment issues that do not cause the extreme misbehaviors RAD does.

These children are not easy to love, or even like. Those with classic symptoms of attachment disorder don't accept or give affection. They lie, cheat, steal and manipulate. Some have a fascination with fire, blood and gore.

They can be very violent and go so far as to kill animals, even people.

A keystone of RAD behavior is random affection and kindness toward strangers.

"Attachment affects conscience development, and when we are bonded with someone we learn to care," said Nancy Thomas, author of "When Love Is Not Enough: A Guide to Parenting Children with RAD" (Families by Design, $15).

"When children don't have attachment, they have a problem developing a conscience . . . We don't feel good about doing bad things, but these kids don't have that ability. They feel powerful when they kill or when they steal. It gives them a rush of excitement and power rather than guilt or shame."

CJ was most recently hospitalized in January for kicking his therapist and being violent toward Jackson, a single 49-year-old hospital worker who took CJ into her home a decade ago when his father went to prison.

Jackson has awoken to CJ kicking and punching her. When he was 8 years old, he ran from home, planted himself in the middle of the road and refused to move. He threatened to kill the therapist who tried to convince him over the phone to go inside.

Following that incident, CJ spent seven weeks in inpatient treatment at Shadow Mountain, where he was diagnosed with RAD.

Since then, he has thrown a butter knife at his younger brother, who Jackson also adopted, and was suspended from school for 45 days in October for unruly behavior.

"It's 24 hours a day," said Jackson in the living room of her north Tulsa home while Charley and his brother played. "You cannot let him out of your sight. I always have to know what he's doing."

Therapy is helping CJ.

Jackson said the fifth-grader is better managing his anger. After showing little regard for others, he now asks Jackson how she feels.

She has read extensively about RAD and uses techniques at home to treat it.

Jackson said professionals have told her CJ needs to be in a children's home permanently, but she refuses to give up on him.

"He's my son," she says repeatedly.

CJ's therapist is Smith, the local counselor who has dealt with attachment disorder through adoption in her own family.

"These children have a chance at a good, normal life," Smith said. "This (treatment) can be very successful. You just have to give them the right kind of help, and you have to give the parents the right kind of support. We've seen a lot of success."

Smith always does therapy together with the parent and the child because, she said, the "relationship is a family issue, and I build on the family strength."

Treatment for attachment disorder has been controversial because it used to involve, and still does in some treatment programs, touching the child beyond their will and even forcing affection on him or her. This is a type of "hands-on" therapy being abandoned as treatment for attachment disorder.

Smith stressed that those extreme cases do not represent the work of the majority of therapists effectively treating children with attachment disorder. She does not touch children as therapy.

New research has shown that coercive treatment can retraumatize a child, said Lynn Wetterberg, executive director of the Association for Treatment and Training in the Attachment of Children.

The association is against coercive treatment, like forcibly holding a child down or any physically threatening behaviors in treatment.

"It's about therapeutic touch," she said in a phone conversation from Lake Villa, Ill. "Everyone likes to be hugged. There's a big difference between a coercive hold and a nurturing hold."

Thomas believes strongly that parents of children with attachment disorder need to show affection.

"We have parents hold the children, rock them, sing to them, tell them a story or feed them ice cream at home," she said. "It's all snuggle time. It's about love and nurturing . . . There is a lot of hugging and a lot of touch because it affects the brain. It affects brain development, and it affects relationships."

Copyright 2006. Used with permission from Tulsa World.