I was in Hannaford today (of course I was), and a tiny, dark-eyed, smiling girl, who I swear was about 36" tall said to the young man she was walking next to, "Maybe Mama would like some flowers." They made joyful, familiar eye contact, they both grinned, they kept walking, her steps bouncy and fast, their relaxed happiness visible even to an outside observer many feet away.
My own daughter said this at her school today. "I wish I could cut my Mom with a knife. I wish I could cut her face open."
My daughter is a survivor of complicated biology, and of our country's shockingly difficult foster care system. She is living with reactive attachment disorder, with complex developmental trauma, with post traumatic stress disorder. And so, our entire household is living with these, also.
She moved into our house when she was 2.5 years old. She was a walking, talking, terrified, anxious, angry, stressed out toddler. She slammed her own head against the walls and the floor, she scratched us, she bit her two new siblings, she threw marbles at them, she hurt our pets.
We knew something was different within 24 hours. The first time I told her Maine social worker that she had an attachment disorder, that social worker said, "That is a serious diagnosis. That is not terminology you want to be throwing around. It's very rare." And she followed it up with, "I'm surprised you're so overwhelmed by this. I have 22 kids on my caseload, and she is the easiest kid on my caseload."
In my entire life, I will never forget that. I will never forget feeling invalidated during one of the hardest years in my (at that time) 39 years of life. My mouth went dry, my heart rate skyrocketed, my blood pressure, I'm sure, went through the roof. In that moment, I felt betrayed by a system and very, very alone.
Even now, I like almost everyone I have ever met. I really do. I simply and unabashedly enjoy people. But not everyone. As it turns out, I do not like everyone. I will never get over that moment. I could've been listened to in that open moment of desperation, I could've been heard, I could've gotten started early.
But instead I was belittled and ignored.
And I lost months. She lost months.
Eventually she was diagnosed with reactive attachment disorder by a respected psychologist in our area.
Of course she was.
I knew, when she was 3 years old, that was where we were headed.
Reactive Attachment Disorder (RAD) was defined as below by the World Health organization in 2010. (Code F94.1) "Starts in the first five years of life and is characterized by persistent abnormalities in the child's pattern of social relationships that are associated with emotional disturbance and are reactive to changes in environmental circumstances (e.g. fearfulness and hypervigilance, poor social interaction with peers, aggression towards self and others, misery, and growth failure in some cases). The syndrome probably occurs as a direct result of severe parental neglect, abuse, or serious mishandling."
Reactive Attachment Disorder was defined by the DSM-5 (Code 313.89) as follows.
A. A consistent pattern of inhibited, emotionally withdrawn behavior toward adult caregivers, manifested by both of the following: The child rarely or minimally seeks comfort when distressed. The child rarely or minimally responds to comfort when distressed.
B. A persistent social and emotional disturbance characterized by at least two of the following: Minimal social and emotional responsiveness to others. Limited positive affect. Episodes of unexplained irritability, sadness, or fearfulness that are evident even during nonthreatening interaction with adult caregivers.
C. The child has experienced a pattern of extremes of insufficient care as evidenced by at least one of the following: Social neglect or deprivation in the form of persistent lack of having basic emotional needs for comfort, stimulation, and affection met by caregiving adults. Repeated changes of primary caregivers that limit opportunities to form stable attachments (e.g., frequent changes in foster care.) Rearing in unusual settings that severely limit opportunities to form selective attachments (e.g. institutions with child-to-caregiver-ratios.)
D. The care in Criterion C is presumed to be responsible for the disturbed behavior in Criterion A (e.g., the disturbances in Criterion A began following the lack of adequate care in Criterion C.)
E. The criteria are not met for autism spectrum disorder.
F. The disturbance is evident before age 5 years.
G. The child has a developmental age of at least 9 months.
Reactive attachment disorder is rare in the general population. It is not rare in the world in which foster kids have to exist.
The most frequent target of kids with RAD is their mother. It is thought that that is because they harbor the most intense anger toward the person they are closest with, because they learned that being close is a farce and that everyone leaves you eventually, and no relationship is real or permanent.
I took my two older kids to the dentist today for regular six month checkups. While there, I received a message, from my younger daughter's school, "She is having a rough day. She said, "I wish I could cut my Mom with a knife. I wish I could cut her face open.""
[Disclosure: This is not her school being cruel. I need them to tell me what she says even when it's awful because she needs so much help. And if the people who spend time with her don't acknowledge and report on reality, reality cannot be dealt with. So her teachers and her ed technicians are honest with me, even though it's painful, because without that honesty, she cannot get what she needs.]
So I sat in the dentist's room on a blue, padded chair near a bright sunny window while my 13 year old's mouth was open with instruments inside of it, and I participated in a surreal game of back and forth with answering questions out loud about teeth with the hygienist in front of me, and answering questions via typing on my phone about potential emergent ER visits and what constitutes a credible threat with her teachers and with an attachment parenting group.
I did this registering zero emotion.
So, he may need braces to correct an overbite? He should floss better?
Is this a feasible threat? Is she actually dangerous in our home?
Flossing is important. No, he has no new surgical history.
She doesn't really have access to weapons. She is constantly supervised. I don't think she really knows what she is saying. Her brain is not really 7. But this is classic reactive attachment disorder.
Yes, we can do xrays next visit.
No, I'm not scared for my safety. Right now.
Yes, I will call for an orthodontic consult.
No, I won't call crisis this time.
****.
**** ******* ******.
How am I still functioning in this cold blue foamy seat near this jade plant? How did I just get through this appointment while navigating being maybe threatened with a knife? What is the right thing to do at this moment?
Our insurance is the same. Thank you.
Please contact me again if she goes back in the seclusion room. Thank you.
I paid the administrative assistant, I got new appointment dates, the three of us got in my car. "MOM. What are you doing?"
I told both of my older kids what I was doing on my phone, the reason I was distracted. My 13 year old went quiet as he often does. I can't imagine what it's like when someone wants to stab your Mom.
My 16 year old daughter said, looking straight ahead, "I wish we could have gotten her sooner. Like when she was just born. Then maybe she wouldn't be like this."
She could've said, "I wish we hadn't done this."
She didn't say that.
I'm proud of her for that. I'm incredibly proud of her every day for lots of things.
I'm so tired on these days. Like, tired in this heavy way, somehow. As in, a pressure is just always on my chest, and I can't fully inhale, and I spend many minutes staring just ahead toward silence and nothingness.
And then I return to here and I try to remember, this is not her fault. She may not know the gravity of these statements. She didn't do this to herself. She might get better. We might be okay. Please let us be okay.
Look away for just a moment.
Take a breath.
Keep trying.
She is only 7.
Maybe we have enough time.
