Oppositional defiant disorder Reactive attachment disorder
Reactive attachment disorderReactive attachment disorder

Reactive attachment disorder

Letters from Mothers

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John, 13

My son was a mess when I adopted him as a three-year-old. As he grew, he became more scary and violent, and I grew more desperate. I am not exaggerating when I say that the changes I have seen in him after six weeks of treatment with the RAD Consultancy have been more profound and definitive than any I have seen in him cumulatively over the last six years, throughout which time I aggressively pursued remedies for his psychological, emotional, social, and educational difficulties. These included psychotherapeutic solutions of all shapes and sizes-play therapy, perceptual development therapy, traditional psychiatry and psychopharmacology, family therapy, and group therapy. I consulted and contracted with social workers, learning specialists, psychiatrists, and teams of psychologists and psychotherapists. John was variously diagnosed with attention deficit disorder, attention deficit hyperactivity disorder, oppositional defiant disorder, bipolar disorder, depression, generalized anxiety disorder, obsessive-compulsive disorder, and atypical pervasive developmental disorder. When we started working with Aaron Lederer, my son was taking four different prescription medications: a mood stabilizer, an atypical antipsychotic, a Schedule II amphetamine, and a blood pressure medication to shut off the effects of the amphetamine at night so that he could sleep. All of it helped, yet none of it worked. That's the critical distinction.

I approached the RAD Consultancy with the battle-scarred cynicism that might be expected of someone who was thoroughly frustrated-but ever hopeful. I found the initial consultation both refreshing and chimerical. The investment was low-I didn't even have to show up for appointments or involve my other children or husband in the process or, for that matter, even include John-and the promised payoff was high, so I was willing to try it out. I especially liked the assurance that if after four to six weeks I didn't see any positive changes, I should drop the therapy. Another aspect that appealed to me was that it was a terminal program that would, at some point, end. So many of the other therapies we had tried had no end in sight.

Aaron Lederer, with whom I spoke, told me that he couldn't predict exactly how long it would take to help John but that it was likely to be less than a year. He also told me he didn't care about my son's meds-that was between me and the psychiatrist who had prescribed them-but that most of the children he treated successfully got off their medications once the therapy took hold. This was an incredible thought to me.

I agreed to try the therapy, calculating that I'd spent as much on summer camp fees as I would in a year of working with the RAD Consultancy and that I might see better results than the previous therapies. I promised myself to stick with it for thirteen months-my son was thirteen at the time, so I gave myself one month per year. I really liked the convenience of the program, as much as the promise of results.

Aaron gave me my first assignment right then and there. (At the time, he was able to work with me himself, and that was the last time I ever saw him in person. All our work since then has taken place over the phone or via e-mail.) The assignment was to stop talking to my son. I was stunned. It was such a bizarre suggestion. How was I supposed to get him to do things? How could I tell him to stop beating up on his brother and sister, come to dinner, brush his teeth, or clean up his room? Aaron just shrugged and told me not to worry about these things for now. Unless my son spoke directly to me, I was not supposed to talk to him at all. I was not to scold him, greet him, or communicate with him in any way. And if he did talk to me, I was to answer briefly and in a friendly manner without bringing up any ideas of my own.

So in late August of 2004, I stopped talking to my son. In each weekly phone call, Aaron would ask about the week that had just passed and then give me a single instruction, sometimes based on my report or my complaint of the week (he's not bathing; his room is messy; he's stealing money to buy candy) and sometimes independent of them. He would have me write these instructions down and then say to John what he told me to say, word for word. I complied. I was only supposed to say each thing once; I was not to nag or remind or ever repeat something.

The first three weeks of the therapy were challenging. I was a willing student, but I found the initial instructions difficult to execute. Sometimes they brought out the worst in my son. I struggled to reform the way I interacted with him. But even in that short period of time, I saw glimmers of hope. The transition from summertime to the school year, traditionally a time of great disruption and anxiety in our house, was accomplished without mishap, and I was able to successfully discontinue one of John's medications with no discernible effects. Other changes included John's taking full responsibility for his morning routine, which eliminated much conflict in the household, and the startling absence of his violent temper tantrums.

There was a breakthrough moment one Saturday afternoon after four weeks of treatment when John's behaviors literally turned around in a matter of hours, transforming from combative to cooperative. In the weeks that followed, we started to build on the foundation we had established-slowly, step by step. While he still had a long way to go at that point, his behavior definitely changed for the better, and his most difficult moments grew fewer and farther between.

The RAD method of treatment had tremendous practical appeal for me. The support-both in specific instructions and e-mailed hand-holding, of which I often availed myself when I was confused about how to deal with particular situations- was unparalleled. It was also the first therapy we had undertaken in which my husband and I saw eye to eye; it fit with both his observations about John and mine, which before that time had seemed irreconcilable. For example, for many years, he had maintained that John was a child who could not experience love, and I had maintained that he was a child for whom punishment was meaningless.

The next four months were pretty rough. The way Aaron explained things, my son's "nasty" behavior was driven by his need to elicit negative reactions from me. This was partially retaliatory-payback for not getting his way-and partially a conditioned response: as a baby, the only time he got attention was when he was crying or being bad. In those cases, reactions were generally hostile and dismissive. It was my task to deprive him of these negative reactions and to rebuild his internal desire to seek positive responses by pleasing me rather than provoking me. While others (his teachers, my husband) were very good at motivating my son to behave by threatening him, this was a less desirable and less permanent way of getting my son to behave; it was merely a form of external motivation. Our goal was to try to get my son to behave because he wanted to please his mother and not because he was scared he was going to get whacked or was angling for a reward.

When the six-week mark came, I had indeed seen results from the therapy and was willing and eager to continue, but we were still far from "graduating." My son's behavior actually got worse for a while, especially when he saw that the things he usually did failed to provoke reactions from me. I, meanwhile, was working on disengaging when provoked, on the language I used with him, and on several little schemes Aaron gave me to bring him into line. The entire therapy was communication-based, as Aaron often said to me that if you want to change the way a child behaves, you must change the way you communicate with him. I was deeply worried in the beginning that the changes in my son might be superficial and that the evil child still lurked in my son, looking for a way to get out. Aaron insisted that my son's tantrums will continue tapering off and his behavior continue to improve.

Meanwhile, a psychopharmacologist was still seeing my son once a month, and she was increasingly against this new therapy; she didn't understand it and didn't like me to do things she didn't understand. I still brought him in to see her-I was too scared to take him off the meds-but dealing with her was becoming a problem.

At Halloween-always a difficult, tempestuous holiday for us, as John could not control himself around candy and would spend hours hoarding it, counting it, eating it, and getting all jazzed up on it-Aaron told me to tell my son that he had to turn all his candy over to me. I had already been instructed not to give him any money (another weak spot for him), and any money he obtained or found was to be turned over to me. But I was also to hold the candy and dole it out one piece at a time when he'd "give me good feelings." This was a paradigm that Aaron had me set up: I was not to do anything for my son when he didn't do me "the favor of making me feel good, even when he felt bad." This was really interesting to me, since it didn't specify to him what behaviors might give me "good feelings." Since I'd always thought he was an ADHD kid, I had always tried to be as specific as possible with him; this is what the ADHD experts had advised. So I would say, "Please put on your shoes, put on your coat, and meet me at the front door," instead of "Let's get ready to go out," for example. Aaron's instructions were often deliberately vague and ambiguous, so my son was forced to figure things out for himself. Aaron also stopped me from saying "no" to him altogether. Instead, I was told to say "We'll see" or "I'll think about it" or "What a great idea" even to his most absurd requests. But it was part of this whole program of removing opportunities for confrontation.

At Christmas, I was instructed to give John none of the presents I'd bought him. Nada. None. And not to mention it, but to dole these presents, one at a time-as with the candy-whenever he gave me the feeling of wanting to do so. So my son came down Christmas morning to a tiny pile of gifts from my husband and nothing from me. That was difficult for me, but by then Aaron Lederer had earned my trust. John seemed puzzled, but didn't react negatively.

I slipped up a lot and had to spend several months learning how to relate to my son in new ways. The fact that I had two other children made it both more complicated and in some ways easier. I got frustrated sometimes, or I "cheated"; for example, I might tell the other kids to do something that I wanted my oldest son to do, hoping he'd take the hint. But it helped a lot that Aaron was available to me 24/7 on e-mail, and I took advantage of this often.

There were a couple of positive signs in the early spring. For example, we went to Europe, and my son behaved well-certainly far better than he had the year before, when he'd had a major meltdown on the Underground, forcing me to pull him and the other kids off in the middle of a strange neighborhood of London. He was starting to follow a morning routine, which we'd worked hard to establish; there were several mornings when he left the house disheveled and unbathed or didn't leave the house at all, having missed the bus.

By June, ten months after we began, my son's level of cooperation had improved markedly. His psychopharmacologist noted that she was thinking of moving him onto a new drug regimen that included more mundane drugs-Prozac instead of Depakote, the heavy-duty mood stabilizer he was on; Strattera instead of the Adderall stimulant. She also prescribed an antianxiety compound for him, which worked so well that she said she was starting to believe that anxiety was his underlying issue rather than bipolar disorder. It was, to say the least, disconcerting. My goal was to get him off the meds, so I was torn about just moving him to less powerful drugs. I had been systematically reducing his ADHD drugs-he went from thirty milligrams to ten over the course of the school year. However, I couldn't seem to get him off of them altogether, or I would get reports from school that he was having a hard time concentrating. He still took Clonidine to counteract the Adderall so he could sleep at night, so as summer started, he was still taking four drugs (Adderall, Depakote, Clonidine, and the antianxiety Klonapin). The psychopharmacologist wrote me prescriptions for the summer, but it turned out that I had no refills for one of them. When I couldn't get hold of the doctor midsummer to phone in the order, I decided to try to just remove him from the meds, one by one, by taking him down to doses of one-half and then one-third of the remaining dose over three-week periods. By the third week of August, a year after we began the program, he took his last pill, and he hasn't had anything at all since then.

It was clear to me that this course of therapy was working, and Aaron cut our phone consultations down to every other week. Each time we talked, there was less and less to report. I stuck with him past the thirteen-month mark, but we were really pretty much done by the end of the summer. I have now "graduated," and it has been most enjoyable to watch my son catch up with his age group emotionally, socially, and academically. He's not quite there yet, but he's come a long way. There is a certain irony in seeing a child undergo such a remarkable turnaround at the start of his teenage years, a time when most kids cut loose, and not always in pleasant ways. He listens, but he expresses emotion. He still gets mad, but it's a controlled anger, and he gets over it and moves on. He understands what to do to make friends and keep them, and he is much, much happier.

Needless to say, so am I.

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