The topic comes up time and time again when adoptive parents ask whether a child has Reactive Attachment Disorder or autistic spectrum disorders instead. Adoptive parents of traumatized children, especially those coming from institutions where neglect, poor nutrition and lack of stimulation seem to also be a part of the child’s history, often question the diagnoses they receive from professionals. Or the professionals question what other professionals have previously said. And the parents are left wondering who is correct and what the true “answer” is.

I’m here to tell you that many of our children present with such a complexity that there is NO “true” answer. I do know there is a disorder known as RAD that exists and is likely more common in adopted and foster children than many would like to admit. RAD is most likely to occur when a child has been neglected or abused, but can be the result of the basic break between infant and primary caregiver. Some children who have RAD show no developmental delays or signs that would point to any type of an autism-like disorder ever being considered. However, there are others who have symptoms that match those found in RAD, but have other symptoms as well. I also know that a diagnosis of autism looks MUCH different than the symptoms of RAD. And I know there are many of us who have children who fall somewhere in between.

I know that autism in its purest and severest form results in a child unable to communicate with the outside world and whose neurological system is easily overwhelmed by external stimuli. I also know that autism experts now view autism as a spectrum disorder, and that some believe that ADHD exists at the mild end of this spectrum with Aspergers and PDD-NOS along the spectrum as well. I also know that the debate rages on as to what causes autism, whether it is genetics or environmental factors or some combination thereof.

And I know there’s this whole other subset of children, those from institutions or cases of severe abuse and neglect, who exhibit autistic-like behaviors and are called by some to have “institutionalized autism”. Dr. Ron Federici, a neuropsychologist in Virginia was one of the first professionals to start using this term with children adopted from orphanages around the world.

Which leads me back to the question that many adoptive parents of these complex children ask: Is it RAD or autism? The answer is not that easy. Diagnostician purists point to a clause in definition of Reactive Attachment Disorder in the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, Revision IV) that says:

“The disturbance in Criterion A is not accounted for solely by developmental delay (as in Mental Retardation and does not meet criteria for a Pervasive Development Disorder).”

They say this requires the “rule out” of any autistic spectrum disorder before the diagnosis of attachment disorder can be made. Other professionals aren’t so sure that both can’t co-exist. More and more professionals are leaning toward the opinion that attachment disorders are rooted in trauma and that children who have RAD are likely also have post-traumatic stress disorder (PTSD).

But RAD and PTSD often come up short of explaining the repetitive and self-stimulating behaviors that some of these children exhibit. They also do not explain the complex language delays, processing deficits, learning lags or sensory overload. And the autistic spectrum disorders (ASD), while explaining many of those issues, do not explain a child who dissociates or who acts out for parents (especially for mom/primary caregiver) but is able to hold it together in public. So what happens if children exhibit a combination of all these things?

These are the children I affectionately refer to has having the “combo platter”. And sadly they are more common than you think.

More to come…

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