4-year old Male

Reactive Attachment Disorder, 4 year old Male

KG 
Age: 4 yrs.  Male
Handedness: possibly ambidextrous

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PRIMARY DIAGNOSIS
 Reactive Attachment Disorder, severe
Expressive Language Disorder

MEDICATION HISTORY
None known

FAMILY HISTORY
Biological Father: learning disabled. Reported  behavior problems in childhood and adolescence. Addiction to alcohol, marijuana, and crack cocaine.

Biological Mother: Speech problems and behavior problems in childhood and adolesence. Epilepsy. both parents were foster children themselves.

 Present situation: The state has custody of KG. History of multiple foster care placements. Moved due to his need for constant supervision and dangerous behaviors. At the time of this report, he is placed (Winter 1998) in foster home with no other children and with intelligent, caring parents who are presently preparing to adopt him. These parents brought KG to me within a week of his arrival for training. They have paid for his training out of pocket.

Relevant Past History:
Pregnancy was marked by exposure to mother’s seizure medication, either Depakote or Dilantin. Mother had grand mal seizure the day before delivery. Labor was precipitous (25 minutes) with birth weight of 5 lbs. 7 ozs.

First six months he was said to have seizures, pneumonia and anemia. During first year functional difficulties noted included unpredictable appetite, poor sleep, headbanging, and hospitalization for failure to thrive. Apparent fall from a 3rd story window at age 3 years. Two serious attempts to kill younger sibling.

 PRESENTING PROBLEMS and RESPONSE TO NEUROFEEDBACK (35 sessions)

1. Nightmares and night terrors throughout most of the night. Very poor sleep, usually less than three hours, needs attention throughout the night. Doesn’t nap. Uses grunts instead of speech. Does not obey.

NIGHT TERRORS ELIMINATED. NIGHTMARES ALMOST ENTIRELY GONE. SLEEPS THROUGH NIGHT, AVERAGING 12 HOURS. PARENTS ABLE TO PUT HIM TO BED AND LEAVE ROOM. NAPS EVERY DAY. These changes occurred within the first week of training.

2. Hyperactivity-unable to sit for more than a few seconds

SITS FOR 30 MINUTE SESSIONS WITH MOM NEXT TO HIM. ABLE TO COMPLETE TASKS. ABLE TO SIT FOR 15 MINUTE PERIODS PLAYING.

3. Aggressive behavior

REDUCED SIGNIFICANTLY.

4. Grinding teeth

GONE

5. High pain threshold

MORE AWARE OF PAIN

6. Manipulative/controlling behaviors

 REDUCED BUT NOT GONE

7. Speech delay

EXPRESSIVE LANGUAGE HAS WORSENED

8. Tantrums

NOW RARE

9. Anxiety

LESSENED TREMENDOUSLY. PREVIOUSLY, VISITS WITH NATURAL PARENTS WOULD LEAVE HIM IN A STATE OF TERROR FOR DAYS.

10. Impatience SPAN>

STILL EVIDENT/ LESS SEVERE

11. Lack of trust

EVIDENCE OF A DEEPENING TRUST WITH FOSTER PARENTS AND OTHERS

12. Abusiveness to animals

NONE OBSERVED. HE HAS NEED TO BE TAUGHT HOW TO BEHAVE WITH CATS IN HOUSE

13. Sexualized behavior

GREATLY REDUCED, NOW RARELY SEEN

14. Refused physical contact

 INSISTENT ON GETTING HUGS

15. Avoids eye contact

WILL LOOK YOU IN THE EYES WHEN ASKED TO. THIS HAS TAKEN A LOT OF WORK WITH FOSTER PARENTS.

16. Defiant

AT TIMES, MUCH LESS THAN BEFORE TRAINING

17. Unable to play with other children

IS ABLE TO PLAY WITH NEIGHBOR’S CHILD IN POSITIVE MANNER

18. Lacks remorse

BEGINNING TO SHOW SIGNS OF GENUINE REMORSE

19. Accident prone

IMPROVED

20. Punishment has no effect on behavior

PARENTS DO NOT USE PHYSICAL PUNISHMENT. HE IS BEGINNING TO UNDERSTAND BEHAVIOR and CONSEQUENCES :CAUSE AND EFFECT

21. Lacks appropriate fear

SOME IMPROVEMENT

TD class=basicBodyText width=”20%”>C4-P4

Sessions (#)
Site(s)
Reward Band
Inhibit Band
Min.
1
C4DIV>
10-13
4-7
18
5
C4-P4
10-13
2-7
18-30
15
C4-P4
9.5-12.5
2-7
30
2
C4-P4
9.5-12.5
2-7
29.30
C3
13-16
2-7
.30
4
C4-P4
9.5-12.5
2-7
29
C3
13-16
2-7
1
7
C4-P4
9.0-12.0
2-7
30
1
9.0-12.0
2-7
29
C4-FP1
9.0-12.0
2-7
1

Unable to test with TOVA

KG has made remarkable progress. He seems to be quite a different child. I am again trying left side training as his expressive speech has deteriorated. He is becoming very frustrated in his attempt to express himself and wants very badly to do so.

Given his response to the first three months of training, it is reasonable to assume that KG’s prognosis is good. We anticipate that he will need in excess of 100 sessions. With the continued support of excellent foster parents and NF, KG has a very good chance to work through a terrifying, neglectful and abusive beginning.

UPDATE:  KG is now adopted, his language is improving significantly ( he speaks on the answering machine), he is a well behaved, and a genuinely affectionate 6 year old child.  He is being home schooled because he still experiences some difficulty in large groups. He is also being trained with neurofeedback ( now over 150 sessions) regularly at home by his parents, who are actively lobbying the State to cover Neurofeedback training for attachment disorder. He is at grade level. He still sleeps twelve hours a night and plays in his room on his own until his parents come for him. His parents report that the changes in him, the ongoing changes, continue to amaze them. ‘He is truly learning to trust and to love.’

Catherine Rule, M.Ed.,CAGS, CRC

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