QUESTION TO THE INSTITUTE FOR ATTACHMENT AND CHILD DEVELOPMENT:
Dear Institute for Attachment and Child Development,
My 7-year-old AMAZING, adopted, RAD and ADHD-diagnosed nephew has recently been diagnosed with bipolar disorder (by one doctor who tested him once a week for about four weeks). The doctor does not specialize in reactive attachment disorder. Very few doctors seem to specialize in, or know much at all about reactive attachment disorder, so it’s been very difficult for my sister. She is a single-parent of three school-age, “therapeutic,” adopted siblings and has had a difficult time locating an affordable expert in our area.
I was alarmed to find numerous journals and articles stating a bipolar misdiagnosis rate of “up to 70%” for RAD children. I am curious about your personal opinion regarding the rate of misdiagnosis, especially because of your extensive hands-on work with foster/adopted children and their families. I value that authentic experience over the more common “I’ve read about” or “I’ll ask my colleague” level of RAD knowledge my sister has encountered thus far. I think an “up to 70% rate of misdiagnosis” is very frightening… and warrants a second (or third) opinion. I couldn’t locate information on your website that speaks specifically to this, and am hoping you will agree to provide at least your personal opinion, if not your professional one on this.
Thank you so much.
ANSWER FROM THE INSTITUTE FOR ATTACHMENT AND CHILD DEVELOPMENT:
Childhood bipolar disorder is real. It’s especially prevalent in the foster and adopted population due to the genetic mental illnesses inherited from birth parents who neglected or abused them. While not all of the kids in our program have mental illnesses, many do. It’s rare that children come to us on appropriate and effective medication plans.
The reason the misdiagnoses for bipolar disorder are so high in the population of traumatized children is because doctors often mismanage their medications. The dosages they prescribe are often too low to help. This is because traumatized kids have disregulated brains that cause their livers to metabolize medications out of the body without effectively treating their mood problems. Thus, doctors assume that perhaps the child doesn’t have a mood disorder after all. In the end, children and their parents are still left with misdiagnoses and, therefore, insufficient treatments.
We can’t work effectively with children to overcome their trauma until we evaluate and treat their mental illnesses first. Here at the Institute, we rely upon the children’s parents, our therapeutic treatment parents, therapists, and psychiatrist to report symptoms. While the children’s parents are an important part of this step, we provide our reports as well because parents come to us frustrated and worn-out. Therefore, they are less reliable reporters. On the other hand, our therapeutic treatment parents have a keen eye for authentic symptoms in kids with early trauma. Moreover, our therapists and psychiatrist specialize in working with such kiddos. When we determine that children have mental illnesses, we calm their brains through appropriate medication and/or neurofeedback before we can effectively work on their trauma issues.
I hope this information helps your sister and nephew. It’s vital that your sister finds a therapist highly qualified to treat reactive attachment disorder. Your sister also needs to trust that her son’s therapist will refer her to a psychiatrist and/or neurotherapist well-qualified to work with kids with trauma issues.
Best of luck to you and your family. Take good care.
Forrest Lien, LCSW, Executive Director Institute for Attachment & Child Development
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