Psychiatric Diagnosis: Reactive Attachment Disorder (RAD)

RAD is a psychiatric diagnosis involving severe difficulties in forming emotional bonds with caregivers, often seen in children who have experienced neglect or trauma.

EH-M16-6874

Report by psychiatrist
This is a 16-year-old male with a prior history of mild intellectual disability with a full-scale IQ in the 50s but apparent better verbal functioning, bipolar disorder, reactive attachment disorder, autism spectrum disorder and ADHD. Patient was brought in the emergency on 4/27/2026 by law enforcement. He had been making threats at school of stabbing others with a pencil had been attempting to elope. On 4/26/2026 he severely assaulted group home staff causing facial fractures requiring facial surgery. He tells myself “I was mad at the group home made up that stuff I never said I was going to go in there and set the other roommates deck “. Mother states that perhaps he was upset that the other client came out and put the his hand on staff and patient may have been jealous of this. It was a fairly severe sleep assault. Group home and previously given a 60-day notice. However when I talk to group home staff they state that they would have taken him back if he was stabilized. Case manager and mother sent an email on 5/5/2026 terminating their stay with that group home with mother telling me that group home said that they would take the client back but did not want the mothers involved any further. Patient does have some insight in this states he wants to avoid juvenile detention and states he knows what he did was wrong. He also describes knowing it was wrong to assault his mother and apparently another client in their foster home when he previously lived at home and went to juvenile detention. He appears very motivated to avoid juvenile detention.

Overall he has done reasonably well in the emergency room. He is slightly unkempt at times and needs redirection and can be somewhat irritable with this but has not had any physical aggression. In regards to his anger he states “I have bipolar disorder “. He is worried about charges being pressed for his recent actions but does not believe that they have been pressed.

Patient’s mother describes what sounds like perhaps manic episodes which can last for up to 5 days. She notes that the first hallmark is decreased need for sleep with excessive energy he seems to fixate on certain things and may have delusions with her state that he gets out of touch with reality. He has grandiose ideas and is overall very pleasant. He also becomes more hypersexual at these times and may attempt to touch staff. She feels that getting on top of the poor sleep with Zyprexa early on has been helpful.

There is been some concerns about depressive lows at times when he is more irritable and can and will risk of acting out. Patient denies this currently states he enjoys fishing, playing games and cooking. His sleep and appetite are fairly good. He apparently is been making comments to his mother about not wanting to live or being shot by law enforcement. When staff of asked him about this he states “I was just mad and saying that “. He denies current suicidal thoughts of myself. Apparently at age 8 he had placed a cord around his neck.

Patient has a long history of being very impulsive and rapidly fluctuating moods. I did not review symptoms of ADHD in detail with him. There is no current clear psychosis and no clear obsessions or compulsions. There were no clear recent stressors which triggered his change in behavior recently. I do wonder if the group home giving the 60-day termination notice in mid April as part of what triggered some these behaviors.

NFH8EB-F15-6850

Youth struggles to maintain appropriate boundaries with peers, engages in instigating behaviors and has a significantly strained relationship with her caregivers, which has continually contributed to disruptive attachments.

MHF-F19-6833

Came into our ED on 4/27 from group home. Home issued immediate suspension and termination. Looking for waiver crisis or CRS option. Has been denied by all IRTS programs- County CM has made over 200 inquires for placement in the past year. Continues to be denied by many placements. Has been in our ED for almost a month and we have not seen any major behavioral concerns, besides some verbal escalations that have been redirectable.

EH-M16-6799

Adopted adolescent that came from group home prior to presenting to the Emergency Department on 4/27/2026 with Law Enforcement due to increased aggression and agitation at group home. 4/26/26 had aggressive behavior at his group home physically assaulting two staff members. One staff sprained a wrist and the other staff required facial surgery following the incident. Earlier in the day he had made threats to stab teachers and staff at school. He reported he meant to strike is housemates but struck the staff instead. A few years ago patient had a previous episode of physical aggression toward caregivers and was hospitalized at that time.

PH-M13-6717

Recommending PRTF.
13-year-old male who presented to Inpatient from ED after aggression towards adoptive parents and suicidal ideation with intention to act. This is his 2nd psychiatric inpatient hospitalization, and he has been engaged in outpatient care.

Discharge Plan as of 04/22/2026:
Grafton (Declined due to inclusion criteria)
Leo Hoffman Center (Accepted with approx waitlist 2 months)
Nexus East Bethel (Reviewing)
Northwood Children’s (Does not accept pt’s insurance, 2-year waitlist)

In the interim:
Establish PHP: PrairieCare PHP at Mankato (Guardian prefers continuing with ABA Day Program instead)

Continue with established outpatient providers:
CMHCM: Blue Earth County
Psychiatry: Mankato Clinic
IT: Surdey Family Services
Day Program/ABA Therapy: Northway Academy, Children’s Autism Services-Mankato
OT: Mankato Clinic Pediatric Therapy Services

CH8SCH-F13-6644

Patient presented to ER from residential treatment after assaulting staff. This was patient’s second day of residential treatment followed by lengthy back-to-back hospitalizations. Patient recently assaultive to staff and oppositional at times. Has required multiple PRN’s for dysregulation. Residential treatment facility therapeutically discharged her to the hospital.

MHF-F12-6621

Youth came to our ED 3/9/26 after an altercation at home. Mom is not willing to have her return at this time. Mom ultimately wants RTC however County JST has not approved that currently. County team has put intensive in home services in place (CIBS) and report they would like family to try that program completely as the less restrictive option before going to RTC. Youth only seems to have behaviors at home, do not see them at school, at respite, or in the hospital. County reports plan to treat behaviors where they are occurring for best success, but Mom continues to refuse to bring pt home.

PH-F12-6449

Recommending PRTF
12 year old trans male who presents to PrairieCare Inpatient Hospital due to suicide attempt with increased SI, SIB, elopement, and aggression.
He has a history of several inpatient stays, has engaged in PHP, individual therapy, family therapy, and RTC at PrairieCare
Funding is in place for RTC with Hennepin County

Discharge Plan:
PRTF/RTC:
– PrairieCare Residential (administratively discharged due to acuity)
– Bar None Haven (under review)
– Nexus East Bethel ( under review)
– Grafton (referral submitted by PCR, Accepted )

Continue with established outpatient providers:
– Primary Care with Mhealth Fairview
– Psychiatry with Roman Becicka, MD at U of M
– CMHCM with Nakami Tongrit-Green at Hennepin County

CH8SCH-M10-6397

Patient presented to ER the same day he was discharged from 2 month inpatient hospitalization for aggression/safety concerns. Was threatening harm to self and others in the home. Was accepted for admission to Mille Lacs Academy with admission date unknown. Currently stable and no indication to remain in the hospital though family does not feel safe with him in the home. Looking for interim placement while awaiting admission to Mille Lacs.