Without Conscience

Editor's note: The author and her son asked to remain anonymous.In the wake of the tragedy in Littleton, Colo., there has been heightened interest in discovering what leads children to commit such conscienceless, senseless acts, and how we can identify the children at risk. I am the mother of a 10-year-old child with Reactive Attachment Disorder (DSM-IV 313.89). Our son was a severely disturbed child, maybe even capable of committing murder, if left untreated. Just one year ago, our worst fear was that our son would hurt himself -- or someone else. It felt like we were sitting on a time bomb, and no one was listening! Competent, concerned professionals attributed our son's unacceptable behaviors to ADHD, obsessive-compulsive disorder and Tourette's syndrome.When we adopted this robust, energetic toddler seven years ago, we had no idea that he was already sick. We knew that prenatal and postnatal neglect and abuse placed him at risk for problems; we also knew that our unconditional love would override all risks. We were wrong.Outwardly, our son has always appeared physically healthy, sociable and intelligent. But obvious differences emerged early and increased during kindergarten. We began reading, talking with other parents and consulting with a myriad of professionals. Several diagnoses and prescriptions later, our son just continued to get worse.It took a great deal of persistence -- and even contradicting therapeutic professionals and going outside the managed-care system -- in order to identify the appropriate diagnosis and treatment for our son. Finally, almost by chance (and perhaps by divine intervention) we stumbled onto information that matched our son's symptoms and led us, at last, to the right specialists. Last June, our son was evaluated for and diagnosed with Reactive Attachment Disorder.As a result of early neglect and abuse, our son had learned not to trust adults -- especially care-givers. He had internalized justifiable rage. His survival instinct told him he must control everything and everyone in his environment. He developed self-destructive and oppositional behaviors. And he'd had nine years to practice. RAD is progressive: Left untreated, it can truly be life-threatening. Healing a RAD child requires intensive therapy with trained attachment-and-bonding therapists, as well as unrelenting, firm-but-nurturing parenting.For the past seven months, our son has been receiving appropriate help -- both from attachment-and-bonding therapists and from us, his parents. And he is healing.I am writing here to offer hope to hurting children, their families and, yes, even to their unsuspecting communities. There is a large and growing body of knowledge about conscienceless children. Many of them are children who have killed. Attachment-and-bonding therapy is neither experimental nor new. Caring, committed professionals have been successfully working with conscienceless children for nearly 30 years. Below are some of the tangible, significant changes in our son's behavior since beginning therapeutic-parenting interventions (in June 1998) and intensive attachment-and-bonding therapy (in September 1998).But it's important to point out that our son still has much hard work to do. He is not yet well; strong feelings of sadness, anger and fright continue to influence his behaviors. External compliance needs to become internally motivated. He still wants to be in control of things he cannot be, but he routinely complies with our directives. He is showing signs of forming a conscience, and he is demonstrating both empathy and remorse. These are huge changes! They are what separate criminals from productive citizens.Note: "'98" indicates our 9-year-old son's typical, daily behavior as of April 1998. "'99" indicates his typical, daily behavior as of April 1999.'98: Methodically, covertly destroyed property -- poked or cut holes in every shirt he owned as soon as he got it (including his brand-new baseball jersey, the first time he wore it); kicked a hole in the bedroom wall, then picked the hole larger daily when he was mad or frustrated; chipped many holes in every piece of his bedroom furniture; slit his sheets, numerous mattress pads and a new shower curtain; routinely broke doors, toys, tools.'99: Has not destroyed any clothing or other personal belongings since beginning therapy in September! Hand-mended all his clothing and the linens he had damaged -- in excess of 200 holes; works to pay restitution to replace or repair other damaged items, including the bedroom wall; has taken very good care of his furniture and linens since earning his bedroom furniture back (from parental "protective custody").'98: Consistently and adamantly denied all wrongdoing (even obvious, observed incidents) and blamed others for his unacceptable behavior.'99: Openly admits when he makes bad choices that result in damage to property or hurt feelings. Voluntarily reveals past "secrets" about damaging and hiding things; recently declared that he knew he was getting better because he used to urinate throughout our home (a typical attachment-disorder symptom; we were totally unaware that our son had done this, until he revealed it); and he willingly accepts consequences for bad behavior, including working to pay for repair/ replacement of items and paying back "hassle time" with good deeds -- i.e. foot massages, car washing, etc.'98: Argued about everything! From the moment he opened his eyes in the morning, our son would argue with me about anything and everything. He was becoming increasingly argumentative with other adults, too. When he was younger, teachers had seen his eye for detail as a positive sign of his intelligence and inquisitiveness, but increasingly, his interruptions and corrections became annoyances and indications of an abnormal need to be in control of everything. '99: Demonstrates significantly better control of his need to argue with adults. Rarely argues openly and directly, and complies when told to stop arguing or interfering. Frequently, he still "corrects" or "clarifies" or adds detail to what others say or do, but the behavior is much less severe and less frequent. Our son remains very bossy with other children, but our son does not yet have the privilege of playing with other children unsupervised -- even his brother.'98: Poor, almost nonexistent, personal hygiene; neglectful or willful disregard for his own basic personal-care needs. Refused to bathe/shower regularly, even when very dirty. Would willingly lie in a urine-soaked bed several mornings each week. Claimed he did not understand why that would bother me, since it did not bother him. '99: Personal hygiene now probably exceeds that of most children his age. Voluntarily changes his bed linens, "because they don't smell very good." Showers or bathes every day -- sometimes more than once per day, if he has been doing dirty or sweaty work. Brushes his teeth daily, and combs his clean hair routinely. Plans what he wants to wear when going out in public, often over-dressing to make a positive impression. Recently "confessed" that he used to urinate in his bed in the morning, while he was awake, because he did not want to get up and go to the bathroom.'98: Snacked constantly, but refused to eat and/or openly complained about almost everything prepared for him (especially by me); sneaked and hoarded food, primarily candy and raw sugar; used excessive amounts of condiments, spices, etc., and then did not eat the "ruined" food; refused to eat all fruits except bananas, and all vegetables except lettuce.'99: Eats almost everything that is prepared for him; does not sneak foods, no longer hoards candy or hides empty wrappers in his clothing drawers; routinely compliments me and thanks me for meals I prepare for him; now claims to like many fruits and vegetables.'98: Came home from school daily with other people's items in his book bag. Always had a ready explanation about someone having given them to him, which usually turned out not to be the case. He often "conned" others into giving him things or lending him things that he never returned. Drove me nearly crazy by "borrowing" my things constantly, especially items that were prohibited -- i.e. sewing supplies, tape, paper and other office supplies. "Borrowed" Dad's tools and routinely broke or misplaced them.'99: Does not have access to other children's things -- so we cannot accurately assess this yet, but at home, he honors boundaries such as my sewing supplies, office supplies, Dad's tools, etc. (does not borrow them without specific permission to do so).'98: Demonstrated no obvious attachment to us: would go with anyone, anywhere, any time. Often begged to stay with others, though he was never invited. This was painfully demonstrated when, after 10 days at summer camp (June '98), he very subtly hid from me when I came to pick him up! His counselor said my son saw me drive in, then quietly slid behind a large group of people and "hid," while I called and searched. Once found, he coolly said, "Oh, hi, Mom," without allowing hugs or kisses. '99: Our son did not earn the privilege of going on a five-day family trip this March. While staying with a therapeutic foster family (whom our son knows and has often stayed with), he showed true signs of missing us. A first! He cried at night in his room, most noticeably the last night, when he thought we would be back before his bedtime and we were not. Upon our return, he embraced us enthusiastically. In April, after sitting alone for more than an hour in the therapy room while we talked with his therapist, our son began to sob. The therapist went into the room and asked our son what was wrong. He replied tearfully, "I'll bet my mom has left me here. I don't blame her: I've been really bad, but I don't want her to leave." This was a huge breakthrough.'98: Frequently demonstrated rages: apparently out-of-control anger accompanied by a strong need to break things and attack/threaten. We learned early in his life not to touch our son when he was mad, even to direct him to another room or away from the "aggravating" situation. If anyone touched him when he was mad, he responded with extreme physical force. As he grew bigger (and much stronger) the risks associated with his outbursts were also growing. In April 1998, our son "crossed a line" when he responded physically to a woman in authority who tried to move him away from an off-limits area. While the woman was not hurt and did not involve other authorities, she could have been injured. At school, our son has always had a tendency to overreact to physical stimuli, i.e. knocking down students who bumped him in line in kindergarten, advancing to punching another student in the face for running into him while playing kick ball in third grade. In spring 1998, our son threatened to hit his father with an ax saying, "I don't want to, but I will hit you with this if you make me." He did this with seeming lack of emotion, and later, when relaying it to his therapists, he seemed totally unaffected by what might have happened had he killed his father, responding only with, "It would be sad, because then I couldn't go fishing, because Mom doesn't like to fish."'99: Our son has significantly less anger (partially demonstrated by significantly increased compliance, decreased arguing, and the fact that he does not destroy things on a daily basis). Therapy has helped our son identify the source of his rage, and he has been able to vent much of it in therapy. He still has rages, but they are much less frequent, much less intense, much shorter in duration, and he demonstrates regret, remorse and sadness afterward. In March, our son had the first significant aggressive outbursts since starting therapy in September. After escalating "testing" incidents, in which our son threw things at me (first a small hinge, which he obviously aimed poorly so as to miss me, and then, a few weeks later, a glass of cold water in my face). Once, in anger, our son jumped on my back as I was walking away from him. He did not injure me; he did not kick, pinch, bite, hit, spit or kick, as he had done prior to treatment interventions. When I pulled his arms from around me, he immediately fell to the floor and cried. He apologized tearfully and willingly complied with my instructions to go to his room. We called the police, who came and talked with us and "warned" our son. He was terrified and respectful. He cried in my arms when the officer left. When the issue came up in therapy several weeks later, our son cried, begged not to talk about it, and even described his attack as much worse than it actually had been. It was a perfect opportunity to show our son how his behaviors had changed since "the ax" incident. This is conscience development in action! ***Sidebar One: What is attachment disorder?What is "normal" attachment and how does it develop?Attachment is the way humans feel connected to others, beginning with one's mother and gradually extending to the rest of humanity. It begins at conception and continues to develop over time, as the mother consistently meets the infant's needs. Under normal circumstances, and if there are no problems, mother and child will develop a healthy, secure bond, and the child becomes securely attached to his mother and then to other people. What is attachment disorder?Attachment disorder (or Reactive Attachment Disorder) is the inability to form trusting, loving, lasting relationships with others, as a result of a disruption or break in the normal bonding process. Children with attachment disorders have trouble trusting others, and they have deep-seated rage that surrounds and protects an even-deeper sadness. They try to control everyone and everything in their world. Attachment disorder can range from very mild to very severe, and there are different types of attachment disorders. The condition is believed to be quite common: According to one estimate, there are about one million children with RAD in New York City alone. The National Adoption Center reports that 52 percent of adoptable children have attachment-disorder symptoms.Symptoms of attachment disorderChildren (and adults) who are attachment disordered are likely to demonstrate all or most of the following behaviors or characteristics:Superficially charming and engagingPoor eye contact (unless lying)Inability to give and receive affection (not cuddly)Inappropriately demanding and/or clingy Indiscriminately affectionate with strangersExtreme control issues, often manifested in "sneaky" waysDestructive to self, others and material things; accident-prone Cruel to animalsSteals; does not seem to recognize boundariesHoarding or gorging food; abnormal eating patternsPreoccupation with fire, blood, goreLack of impulse control and cause-and-effect thinkingLearning-lags and speech disordersChronic, often obvious, lyingPoor peer relationships Persistent nonsense questions and incessant chatterExpert at pitting adults against each otherLack of conscienceCauses of attachment disorder Since attachment disorder results from a break in the normal bonding process, any of the following factors, especially when they occur during the first three years of life, put a child at risk: Mother's negative attitude toward pregnancyMother's drug and/or alcohol use during pregnancy Premature or traumatic birthAbuse (physical, emotional or sexual)Neglect Sudden separation from primary caregiver (i.e. illness or death of mother, or chronic illness or hospitalization of child) Undiagnosed and/or painful illness (i.e. colic or chronic ear infections) Frequent moves or placements Inconsistent or inadequate day care Chronic maternal depressionUnprepared mothers with poor parenting skillsDrug addiction at birthSidebar Two: Recommended Reading and resourcesBooks:When Love is Not Enough: A Guide to Parenting Children with Reactive Attachment Disorder by Nancy L. Thomas, 1997Children Who Shock and Surprise: A Guide to Attachment Disorders by Elizabeth Randolph, 1997.Therapeutic Parenting: It's a Matter of Attitude (second ed.) by Deborah Hage, 1997Don't Touch My Heart: Healing the Pain of the Unattached Child by Lynda Mansfield & Christopher Waldmann, 1994Parenting With Love and Logic by Foster Cline & Jim Fay, 1990Conscienceless Acts, Societal Mayhem: Uncontrollable, Unreachable Youth and Today's Desensitized World by Foster Cline, 1995Web sites:The Attachment Center at Evergreen, Colo.: www.attachmentcenter.orgAttachment Disorder Support Group: www.syix.com/adsgEvergreen Consultants in Human Behavior: www. attachmenttherapy.comATTACH, professional association and support group: www.attach.orgAttachment Center of Georgia: www.attachment-ga.com

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