How JustAnswer Works:

  • Ask an Expert
    Experts are full of valuable knowledge and are ready to help with any question. Credentials confirmed by a Fortune 500 verification firm.
  • Get a Professional Answer
    Via email, text message, or notification as you wait on our site.
    Ask follow up questions if you need to.
  • 100% Satisfaction Guarantee
    Rate the answer you receive.

Ask Doctor Blake Your Own Question

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
28863579
Type Your Mental Health Question Here...
Doctor Blake is online now
A new question is answered every 9 seconds

My child is 4, he is adopted, I have had him since 13 months.

Resolved Question:

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: 4 years ago.
Category: Mental Health
Expert:  Doctor Blake replied 4 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.

Doctor Blake, Psychologist
Category: Mental Health
Satisfied Customers: 146
Experience: Ph.D., Ed.S., NCSP Clinical Psychologist; 15+ years of experience; dual licensure
Doctor Blake and 2 other Mental Health Specialists are ready to help you

JustAnswer in the News:

 
 
 
Ask-a-doc Web sites: If you've got a quick question, you can try to get an answer from sites that say they have various specialists on hand to give quick answers... Justanswer.com.
JustAnswer.com...has seen a spike since October in legal questions from readers about layoffs, unemployment and severance.
Web sites like justanswer.com/legal
...leave nothing to chance.
Traffic on JustAnswer rose 14 percent...and had nearly 400,000 page views in 30 days...inquiries related to stress, high blood pressure, drinking and heart pain jumped 33 percent.
Tory Johnson, GMA Workplace Contributor, discusses work-from-home jobs, such as JustAnswer in which verified Experts answer people’s questions.
I will tell you that...the things you have to go through to be an Expert are quite rigorous.
 
 
 

What Customers are Saying:

 
 
 
  • I can go as far as to say it could have resulted in saving my sons life and our entire family now knows what bipolar is and how to assist and understand my most wonderful son, brother and friend to all who loves him dearly. Thank you very much Corrie Moll Pretoria, South Africa
< Last | Next >
  • I can go as far as to say it could have resulted in saving my sons life and our entire family now knows what bipolar is and how to assist and understand my most wonderful son, brother and friend to all who loves him dearly. Thank you very much Corrie Moll Pretoria, South Africa
  • I thank-you so much! It really helped to have this information and confirmation. We will watch her carefully and get her in for the examination and US right away if things do not improve. God bless you as well! Claudia Albuquerque, NM
  • Outstanding response time less than 6 minutes. Answered the question professionally and with a great deal of compassion. Kevin Beaverton, OR
  • Suggested diagnosis was what I hoped and will take this info to my doctor's appointment next week.
    I feel better already! Thank you.
    Elanor Tracy, CA
  • Thank you to the Physician who answered my question today. The answer was far more informative than what I got from the Physicians I saw in person for my problem. Julie Lockesburg, AR
  • You have been more help than you know. I seriously don't know what my sisters situation would be today if you had not gone above and beyond just answering my questions. John and Stefanie Tucson, AZ
  • I have been dealing with an extremely serious health crisis for over three years, and one your physicians asked me more questions, gave me more answers and encouragement than a dozen different doctors who have been treating me!! Janet V Phoenix, AZ
 
 
 

Meet The Experts:

 
 
 
  • Dr. Keane

    Therapist

    Satisfied Customers:

    1262
    Clinical Psychology PhD, Licensed Professional Counselor with experience in marriage/family, teens and child psychology.
< Last | Next >
  • http://ww2.justanswer.com/uploads/DR/Dr.Keane/2013-8-20_204325_drkeane.64x64.jpg Dr. Keane's Avatar

    Dr. Keane

    Therapist

    Satisfied Customers:

    1262
    Clinical Psychology PhD, Licensed Professional Counselor with experience in marriage/family, teens and child psychology.
  • http://ww2.justanswer.com/uploads/RE/resolutions66/2011-1-17_05728_IMG8202smilingeditedforJustAnswer.64x64.jpg Elliott, LPCC, NCC's Avatar

    Elliott, LPCC, NCC

    Psychotherapist

    Satisfied Customers:

    5024
    35 years of experience as a Licensed Professional Clinical Counselor, National Certified Counselor and a college professor.
  • http://ww2.justanswer.com/uploads/formybunch/2010-12-06_191055_img_0975.jpg Kate McCoy, M.Ed, NBCC, LPC's Avatar

    Kate McCoy, M.Ed, NBCC, LPC

    Therapist

    Satisfied Customers:

    3733
    Over 20 years experience specializing in anxiety, depression, drug and alcohol, and relationship issues.
  • http://ww2.justanswer.com/uploads/DR/DrAkiraOlsen/2012-2-20_746_AkiraADpicmain.64x64.jpg Dr. Olsen's Avatar

    Dr. Olsen

    Psychologist

    Satisfied Customers:

    2336
    PsyD Psychologist
  • http://ww2.justanswer.com/uploads/norriem/2009-5-27_134249_nm.jpg Norman M.'s Avatar

    Norman M.

    Psychotherapist

    Satisfied Customers:

    2193
    UK trained in hypnotherapy, counselling and psychotherapy and have been in private practice. ADHP(NC), DEHP(NC), UKCP Registered and ECP.
  • http://ww2.justanswer.com/uploads/PsychologyProf/2010-07-15_171248_logos060400409.jpg Dr. Michael's Avatar

    Dr. Michael

    Psychologist

    Satisfied Customers:

    2177
    Licensed Ph.D. Clinical Health Psychology with 30 years of experience in private practive and as a clinical psychology university professor.
  • http://ww2.justanswer.com/uploads/KURTEMMERLING/2010-07-23_215531_just_ask_picture1.jpg Steven Olsen's Avatar

    Steven Olsen

    Therapist

    Satisfied Customers:

    1727
    More than twenty years of expertise in counseling, psychological diagnosis and education
 
 
 
Chat Now With A Mental Health Professional
Doctor Blake
Doctor Blake
Psychologist
145 Satisfied Customers
Ph.D., Ed.S., NCSP Clinical Psychologist; 15+ years of experience; dual licensure