Parenting Children with RAD and PTSD

by Lynne Lyon, MSW


Q: What do parents need to do to be good parents?

A: Lots of Holding Time, for people who do Holding Time. And for people who don't, they need to! Give lots of kisses - 100,000. And hug as much as the kisses. And don't stop putting in the love. If you stop, the kids will torture you by hitting you and kicking you."

Advice from Aviva, age 6


To say that parenting a child with RAD and/or PTSD is extremely challenging, intense and exhausting, is a vast understatement. But like any undertaking, the rewards are equal to the difficulty of the task.

There are many excellent books on parenting, including some specifically on parenting children with attachment, trauma and adoption issues. Attach-China favorites include:

Attachment Specific Books:
Adopting the Hurt Child by Gregory Keck, PhD and Regina M. Kupecky, LSW; Parenting the Hurt Child by Gregory Keck, PhD and Regina M. Kupecky, LSW; Attachment and Bonding Center of Ohio
Attaching in Adoption by Deborah Gray, MSW; Attachment Center Northwest
Building the Bonds of Attachment
by Daniel Hughes, PhD
When Love is Not Enough: A Guide to Parenting Children with RAD ­ Reactive Attachment Disorder by Nancy L. Thomas; Nancy Thomas Parenting

General Parenting:
How to Talk so Kids Will Listen & Listen So Kids Will Talk by Adele Faber & Elaine Mazlish
Parenting with Love and Logic by Foster Cline, MD and Jim Fay
Raising a Happy, Unspoiled Child by Burton L. White

It would be redundant and presumptuous to re-write on this website what others have said so well in these books. However, since not all attachment experts agree on the details of how to parent children who have experienced trauma and loss, a guide to areas of agreement and importance may be useful. Most attachment therapists agree on the following:
1. Control and Limit Setting
2. Natural Consequences
3. Routines
4. Cuddling
5. Chores
6. Validating feelings
7. Sleep Issues

Control and Limit Setting

One thing that many of these children have in common is their extreme need to be in control of their environment and of the people in it, especially their parents. When they were infants or young children in the orphanage or foster care, they didn't have an opportunity to complete the bonding cycle, which is where trust develops. Or perhaps the move to their new adoptive home interrupted that cycle, and therefore they don't trust adults to take care of them. In addition, when the adults were in charge, the child was abandoned, neglected or possibly hurt. So these very smart children have figured out that to feel safe, they need to be in control.

But it's a Catch-22: The child wants to be in control to feel safe. But a child who is in control is, by definition, not safe, because she doesn't have the cognitive capabilities nor experience to be the leader. This need to control can manifest in non-compliant (oppositional) behavior, such as not obeying parents' requests, talking back, arguing, constantly interrupting, constantly demanding attention and telling parents what to say and where to sit. Even refusal to eat or toilet train can be efforts at maintaining control at all costs.

Children need parents to set limits so that they will feel safe. In Parenting with Love and Logic, Foster Cline, MD and Jim Fay describe what firm limits feel like to a child:

Imagine yourself plopped down on a chair in a strange, totally dark environment. You can't see your hand in front of your face. Your only security is the chair. You don't know if you're on a cliff, in a cave, in a room, or wherever.

Eventually you muster enough nerve to move away from the chair and check your immediate surroundings. You find four solid walls. What a relief! Now you feel a little more secure and safe enough to begin exploring the rest of the room, knowing that you won't fall off the edge.

But what if you tested the walls and they crumbled? You would move quickly back to your chair for security. And there you would stay. Your entire environment is mysterious and threatening. . .

Some parents build walls in the form of firm limits for their children; others leave their kids to feel insecure and afraid by providing few limits, or limits that crumble easily.

In Parenting the Hurt Child, Gregory Keck, PhD and Regina Kupecky, LSW explain that it is even more important for the hurt child to learn to follow their parent leader, rather than to rely on themselves. It is only then that they will be able to learn about "reciprocity, cause-and-effect thinking, being valued, being contained, being safe, or being directed constructively" and about being nurtured. They need to learn that to follow a parent's direction is safe. "They need to know ­ both for their childhood and later on in life ­ that to yield, to cooperate, to surrender, to follow does not signify weakness. Instead, these things may signify wisdom and strength."

Some parents start out by setting firm limits, but the extreme tantrums and opposition of their RAD child may lead them to back off or find a "work around," so that every interaction with their child is not a fight. Sometimes this becomes necessary just to get out of the house and get to work! On the other hand, "There are parents who seem to believe it is so important to encourage a child's independence of mind that they should be very careful about forcing their will on them," writes Burton L. White, PhD in Raising a Happy, Unspoiled Child. "Others seem to be afraid that their two-and-one-half-year-old will throw a tantrum and cause them embarrassment." White has found that those parents who have extremely kind and gentle temperaments have the most difficulty being firm limit setters because they hate to see their child unhappy. And setting a limit for a child is going to make that child unhappy, at least temporarily. He recommends that these parents be mindful of their temperament, and suggests, "When in doubt, you can safely assume you are inclined to be overindulgent, and you should therefore try to draw the line a bit more firmly."

White also suggests taking into account the infant's point of view about limit setting. Parents have no problem setting limits when danger is involved, like a child running into the street. An infant doesn't know the difference between running into the street and kicking while being diapered. All she experiences is a parent preventing her from doing something she wants to do. When a child insists on doing anything at all in spite of your serious opposition, your response should be consistent, regardless of the reasons, whether we're talking about eating crackers on the sofa or playing with a sharp knife.

In addition, the adopted child has experienced what attachment therapist Walt Buenning, PhD refers to as the "Eternal No." Birthmother said "no" by giving the child up for adoption. It's permanent and it's the ultimate "no." So when mom or dad sets a limit and says "No," the adopted child often equates that with "You don't love me" and responds with a tantrum. The adoptive parents get the anger that rightfully belongs to the birthmother.

It is therefore important for parents to lovingly enforce limits. This may require simple holding and comforting if the child tantrums, (which becomes a wonderful opportunity for attaching); Holding Therapy and/or consequences.

Natural Consequences

Natural consequences are recommended by virtually all professionals. Consequences are designed to promote responsibility, correct mistakes, make up for what's been done wrong, and simply to become competent and capable. A consequence can be something as simple as wiping up a glass of spilled milk. Or it may be washing the entire floor of a room after the child has urinated on it.

Consequences should never be dangerous, demeaning or humiliating. Consequences should avoid replicating in any way the abandonment of the child. Sending a child with RAD or PTSD to her room, or even to a time out chair can be a reminder of being "thrown in the trash" by her birthmother. Many children explode into violent rages at this sort of discipline. Rather, having the child sit close by mom for a "time-in," while mom conveys her love with warm touches, smiles and eye contact can help the child calm and get back on track.

"I do non-deprivation, non-punitive, non-violent, non-threatening parenting," says Walt Buenning. "For instance when kids underachieve at school, I never take anything away. I don't take TV away, I don't take girlfriends away, I don't take friends away, I don't take computer away, I don't take the phone away, I don't take fun away, I just say: 'Sally, I want you to have more fun than any other kid. But, you can have your fun after you do your homework. Sit down here. You can sit and study or you can sit and get ready to study. But you can't play, you can't phone, you can't watch TV, you can't be on the computer, you can't talk to girl friends or boy friends until your homework is done. As soon as your homework is done, I hope you have lots of fun.' I'm not into deprivation; I'm into obedience and responsibility. Because what can you take away from a kid who has already lost her birthmother that is going to be worse than that?"

Cuddling

Movement and touch are the most important parts of nurturing a child ­ even more than feeding. Babies who are not touched at all, even if they are fed, will die. Babies who are not touched enough will be traumatized. It is safe to say that most, if not all, post-institutionalized infants have not received enough touching.

Touch and love are synonymous. But touch has been ruined for traumatized children. Touch has become synonymous with love and the threat of love going away. According to Walt Buenning, for attachment disordered children, touching either tickles or hurts, unless they ask for it or are in control of it. If left to their own devices, they would do what feels safe and right and learn to live without touch - and starve their soul in the process.

Therefore, parents need to provide as much touching, cuddling and bottle feeding for their new children as possible. These children should be parented according to their emotional age, not their chronological age. Deborah Gray writes about this extensively in Attaching in Adoption. A child who has just been adopted is one day old, emotionally. A child who is two years old, but was adopted at age one, is one year old emotionally. She may still need to be fed by mom, with several bottles and cuddling throughout the day. Even older children (and adults!) need cuddles.

Cuddling and singing special songs about the family is a morning ritual that can set a loving tone for the rest of the day.

Routines

Traumatized children are very sensitive to changes in routines, transitions and new situations. Long anticipated birthday parties and holidays can become scenes of meltdowns. Vacations can become a nightmare, especially when the child is not sure she will be returning home!

Attachment therapist Daniel Hughes, PhD (Building the Bonds of Attachment) urges mothers to provide structure and set the rhythm of the day that will help the child feel safe: a morning routine which is the same each day for waking, washing, dressing, feeding pets, eating breakfast, and going to school. On weekends, the morning routine can be the same, but instead of school, start chores. Make time each day for free play and special times for cuddling. Have meals at the same time each day, and a comforting bedtime routine. Scheduling something like Chinese food on Friday nights can become a fun ritual.

When the day is going to contain a special event, it is important to prepare the child ahead of time by describing the event and explaining what behavior is expected of the child. When the special or new event is something that may be traumatizing for the child, such as starting school or a field trip where the child will be getting on a bus without mom, Deborah Gray, (Attaching in Adoption) recommends drawing a small book that the child can take with her. It is important that the book include a beginning picture of the child at home with her family, and the child returning home to her family at the end.

Chores

Chores are widely used as a therapeutic activity in many programs, from treating substance abuse at the Betty Ford Clinic to treating children with PTSD and RAD. Having a daily routine which includes chores helps reduce anxiety by teaching competence and instilling self-esteem. Doing chores helps children attach by contributing to the family and learning from their parents.

Chores are also useful as natural consequences. An extra chore might be assigned to pay mom back for taking up too much of her time with bad behavior. Deborah Gray recommends that an offending child do the chore of a sibling she has victimized, as restitution.

Children as young as 18 months of age can begin by helping to put away their toys. Putting away the forks, spoons and butter knives becomes a matching game for toddlers. Many children on the Attach-China list are routinely helping with laundry, making their beds, folding and putting away their own clothes, setting the table, feeding and cleaning up after pets, unloading dishwashers and helping with yard work by the age of 5.

Cuddling should be interspersed with chores and given as a reward for a job well done. Nancy Thomas talks more specifically about chores in her book, "When Love is Not Enough."

Validating Feelings

As parents, one of the greatest gifts we can give our children is to listen to them and understand and accept what they are telling us. When an infant cries, it is up to the parents to interpret her message. Baby cries and Mom responds with empathy; "Oh, sweetie, you're hungry. Let's get your bottle." Or change your diaper, or take off your sweater, you're too hot or you need Mommy, you're sad. Through thousands of these interactions, infants learn how to interpret and name their feelings, including the basic emotions of happy, sad, mad, surprised, etc.

Many Post Institutionalized children have missed out on these crucial steps as infants, and thus can not easily identify their bodily sensations or understand that they are entitled to have their physical and emotional needs met - even after being in their permanent homes for years. They spent too much time as infants having their hunger, pain and physical and emotional discomfort ignored. They may not recognize the beginning feelings of hunger and know that it is OK to ask to be fed. They wait until they are ravenous. They may need to be reminded over and over that they have options in clothing which will keep them comfortable - neither too hot nor too cold.

Parents may need to take extra time teaching their PI children how to identify and express their bodily sensations and emotions. Parents need to take their children back through those early stages so that they can be mastered.

As they get older, many PI children are often unable to talk directly about what is bothering them. They often may not even know what's bothering them, themselves. Instead, they act out or have a meltdown. Many Attach-China parents have found that Holding Time enables the child to come to a place where she is able to identify and communicate what is bothering her. Other parents have found that simply paying attention and listening is enough to get their child to open up. Parents are then able to validate their child's feelings in either case ­ "you must have been so mad" or "I understand why that hurt your feelings." An excellent explanation of this process is in the book, How to Talk so Kids Will Listen & Listen So Kids Will Talk by Adele Faber & Elaine Mazlish.

Because of missing out on having their needs met on demand as infants, PI children may have difficulty learning empathy and how to read social cues. Children with RAD tend to experience themselves as either a victims or the boss, so they often have difficulty presenting themselves in an appealing way to other children. Extra time and attention may need to be given to learning the social skills of making and keeping friends. Older Child Adoption Magazine has some articles to help with these situations.

Sleep Issues

Sleep issues, including night terrors, waking at night and insomnia (fear of or inability to fall asleep), are undoubtedly the most commonly reported challenge of parents of internationally adopted children. The American ideal of sleeping alone in your own room is opposite from that of most other cultures in the world, which favor the family bed. And the family bed is the solution that most Attach-China Families have found for their children's sleep problems.

Children who have spent time in orphanages were undoubtedly left on their own at night, with little or no comforting for hunger, teething, or other discomforts. In addition, things that go bump in the night are much scarier for an infant when she is alone in the dark. Children who are unused to sleeping alone will naturally have a fear of it, along with a greater need for comfort at night.

It is important for adoptive parents to teach their children that nighttime in their new home will be different than in the orphanage. Parents need to understand that their children's fears at nighttime are real, and they need to consistently respond to them in order to develop a trusting relationship. Mary Hopkins, author of Toddler Adoption: The Weaver's Craft writes:

"Always assume that a request for parental contact and comforting represents a need for a toddler [or infant] struggling to develop attachment and meet that need on demand, day or night. Parents need to reframe their thoughts about getting up at night with a new toddler as a wonderful opportunity to build attachment, rather than a dreaded chore. Do NOT leave an adopted toddler [or infant] alone crying at night as often recommended by many parent discipline specialists. The techniques of temporary segregation and isolation are for children who are securely attached, not for toddlers [and infants] learning to trust that their parents will meet their needs in a loving and responsive manner."

Books which advise that infants need to learn to put themselves to sleep were written for biological, secure children. PI children have had many months of putting themselves to sleep.

Many children stop having night terrors once they are sleeping in their parents' bed. Mom is able to easily calm a child by placing a hand on her back or holding her firmly just as a night terror or nightmare is about to begin, thus averting a prolonged episode. Often children who are having nightmares will wake up, see that mom is there in bed, and be comforted enough to go back to sleep instead of fully waking and crying. Mom is able to monitor a sick child more easily as well. All members of the family have their sleep disrupted less often in the family bed.

Parents of anxiously attached children report that their children become less anxious by being able to sleep with their parents. Parents whose children are avoidant report that sleeping with them helps the child to be more attached and more comfortable with a higher degree of closeness.

It is recommended that all newly adopted children, no matter what age, be given a bottle and rocked before bed (parent the emotional age of the child). Establish a bedtime ritual which may include stories or special songs. Stay with the child until she is falling asleep. It may be necessary to provide extra comfort by way of rubbing, patting or just touching her back until she is deeply asleep. It may also be helpful to let the child sleep in Mom's shirt or on a pillowcase that has mom's scent on it. Children with severe anxiety about going to sleep may benefit by a Holding Time at bedtime.

Even children who have been home for years may have trouble falling asleep. Parents can still stay in the room, on or next to the family bed to provide comfort. But they do not need to be drawn into a control battle or be manipulated into giving the child attention. It can be made clear that when it is bedtime for children, it is quiet time for grown-ups, and children need to go to sleep or play quietly in their beds. Mom will sit by the bed until the child falls asleep. Mom will see and talk to the child in the morning, but now Mom is going to read or watch TV with the headphones on and the child is going to sleep!

Most families report that children who have grown up with the family bed naturally move to sleeping in their own bed at about age 7.

Be a Warrior Mom

Once there was a little bunny who wanted to run away. So he said to his mother, "I am running away."

"If you run away," said his mother, "I will run after you. For you are my little bunny."

from The Runaway Bunny by Margaret Wise Brown.

One Attach-China Mom wrote about doing attachment parenting with her daughter:

She is clearly showing me that she likes what I do to stay connected to her, that she needs the assurance that I will not give up, and that she needs to know that I will fight for our relationship. Its almost as if she needs to see me, as her forever mom, fight as hard and as deliberately to keep her as her birth mom was deliberate in letting her go. She needs to repeat this over and over again.

We must constantly fight to win over our children and convince them that we will never break their hearts as their birthmothers did. As much as they push us away, we must pull them back harder. We must show them that we are stronger than they are and we will never give up. We must be Warrior Moms, fighting for their love and trust.

Click here for a Warrior Mom Bracelet.



 

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