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Doctor Blake
Doctor Blake, Psychologist
Category: Mental Health
Satisfied Customers: 146
Experience:  Ph.D., Ed.S., NCSP Clinical Psychologist; 15+ years of experience; dual licensure
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My child is 4, he is adopted, I have had him since 13 months.

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My child is 4, he is adopted, I have had him since 13 months. I believe he is displaying strong signs of RAD. The after adoption support team are doing nothing to help me get him a diagnosis and help him, also to give me coping strategies. My GP also seems to think it is behavioural. Can I see a psychologist without being referred by a GP and get the theraplay if this is what it is deemed he needs
Submitted: 6 years ago.
Category: Mental Health
Expert:  Doctor Blake replied 6 years ago.

Good morning... thanks for writing to JA.


You should know that Reactive Attachment Disorder (RAD) is somewhat controversial. You should know several things about the field of psychology/psychiatry:

1. The "big book" used for diagnosing mental disorders is the Diagnostic and Statistical Manual of Mental Disorders... and has undergone a number of revisions and changes over the years.

2. You should understand that there are licensed mental health professionals who do not believe in the concept of "attachment" and do not, therefore, believe that attachment can be disordered.

3. Even for those who find sufficient evident for "attachment," a disorder related to attachment seems nearly insurmountable! Besides difficulties with diagnostics, if attachment is an immutable trait of an individual - how can one treat it? If one were to diagnose an individual's entire attachment as "disordered," what could one do to "re-order" it?


The reason you are probably finding difficulty locating an organization that specialized in RAD per se is because of the controversy surrounding the concept of the disorder. Simply put, most licensed mental health professionals would like find other diagnostic categories to describe your son's behavior. Certainly another Axis I disorder would be "more treatable" with a better prognosis than RAD. Axis I disorders also tend to be better researched and have better developed treatment protocols (either drugs or medication).


Research has consistently demonstrated that treatment plus medication is more effective than medication alone or treatment alone for a majority of Axis I disorders. Further research has shown that Cognitive Behavioral Therapy (CBT) is the most effective form of psychological treatment/intervention.


A licensed psychologist/psychotherapist with specific training in CBT modalities would be able to address your concerns. I would encourage you to find a licensed mental health professional with whom to work, employing CBT. Referring to a psychiatrist for medical treatment is appropriate if you are interested in pursuing this approach.


Again, the mantra of years of research says: medication or treatment alone is not as effective as both working in tandem. Some research has also indicated that insight-oriented talk therapy is counter-productive with some forms of Axis I disorders... it actually exacerbates the condition(s). So, seek out a CBT therapist who will provide targeted, efficient, and effective therapy - not someone who signs you as a "lifer." If you're going to a therapist for years, something about the therapy isn't working.


SO: I will return to an adage I learned during my residency... "If you hear hoof beats bearing down upon you, it's far more likely to be a horse than a zebra that's coming..." The same is true with mental health disorders. RAD is highly controversial, very rare (if it exists at all), and some would argue, untreatable. A host of other disorders (that *are* treatable with good prognoses) could explain the very same behaviors used to describe RAD.


Knowing that you care deeply for your son, and want the best for him - I would encourage you to work with licensed mental health professionals who specialize in horses, rather than zebras. You deserve (and he deserves) solutions to his problems... and I believe the first step you might take is getting an objective, scientifically-based evaluation from a licensed mental health professional - preferably someone with a CBT background.


If you insist upon exploring theraplay options (which, I regret to inform you, have minimal (if any) scientific backing), I would encourage you to look for therapists who specialize in therapy, psychodynamics, or object relations. Those are the "buzz words" associated with RAD and play therapy.


Finally, I regret that I cannot advise you about how the UK addresses referrals. Here in the US, some insurance carriers require a GP to refer to a Psychologist... some do not. (You can always check with your GP first as a good safeguard.)


Thanks. I hope you're well and that this was helpful.


* FEEDBACK ENCOURAGED. Please contact me prior to leaving negative feedback so that we can resolve the matter. I am eager to work with all JA clients to provide them with useful/helpful answers. Thanks again.

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