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     I met Mark on at his foster home placement at the age of 2 1/2. His foster family had been contemplating adopting him but were concerned about his aggressive and uncontrollable behavior. Mark had no tolerance for other children and the family had five children of their own ranging in ages from five to sixteen. If Sandra, the mother, or Tom, the father, paid the slightest attention to any of the other children in front of Mark's presence, he would deliberately do something terrible to cause them to have to focus on himself. For example, he would pull the cat's tail, hit one of the other children, or knock something over and break it.

     Mark was also a biter and would not only bite the other children when provoked, but would also bite them when they least expected it and for no reason. Each of the children showed me scars, some of them still fresh and healing all over their bodies including their faces and the middle of their backs.

     Mark had uncontrollable rages that could not be soothed. The family never knew exactly what caused them but Mark would thrash, hit, scratch, swear, kick, and try to break things for long periods of time. During this time, he had to be restrained to keep from hurting himself or others. He would then try to bite or hurt the persons restraining him and often spit in their faces. These rages lasted anywhere from several minutes to several hours, typically ending when Mark collapsed into sleep in exhaustion. Often, he woke up in an equally sour mood and started the rage right back up where he had left off.

      At the dinner table, he was demanding, often refusing to eat what was provided and screaming and crying for something else. He would fling food at his parents and siblings or sweep his plate and cup from his high care with his arm. He did not sleep well either, often getting up in the middle of the night either in one of his rages or to get into something he knew he was not supposed to get into. One time he emptied out all of the packages of food in the kitchen onto the floor, including cereal, flour, syrup, oil, salt, and everything else he could find. Another time he put the family cat in the refrigerator. The family became the most concerned, however, when they found him with a lighter trying to set things on fire one night and on another night they caught him walking into the 5 year old's room with a knife in his hand.

     Keeping up with Mark on a 24-hour basis was exhausting. They put an alarm on his bedroom door to alert them when Mark got up during the night but the alarm went off so many times during the night, the entire family was losing so much sleep that work and school were becoming impossible to attend. Sandra never got a break as she had to watch Mark every moment of every day. She tried to put him in a nursery school program but they kicked him out after a week. She was afraid to hire a sitter because of what might happen when she was gone. Family members offered to give her respite, but usually they only sat with Mark one time and then made up excuses for not offering to sit with him again.

     Mark was diagnosed with Reactive Attachment Disorder (RAD) based on the fact that he had suffered pathological care as an infant and toddler. Mark's biological mother was mentally retarded and did not know how to take care of him. His father was a drug addict and diagnosed with mental illness. He only visited Mark's mother on occasion. When Mark was found at around his first birthday by a visiting case worker from the Department of Human Services, he was lying in his crib. The case worker described him as looking like 'a living skeleton.' He was starved and dehydrated. His diaper was soiled and sopping wet. The back of his head was flat and had lost its hair from Mark lying on his back so long. Mark did not know how to sit up or crawl. His eyes were dull and lifeless. He showed no expression or interest when she picked him up.

     Mark was placed with Sandra and Tom as quickly as all the arrangements could be made and he quickly put on weight and began catching up to other children his age. Sandra said that when they first took him in, he had an unusual and offensive odor about him that no amount of bathing could get rid of. It took months for that odor to go away. They noticed some behavioral issues right away but decided Mark had never had the chance to learn how to behave correctly so they were patient. They also found it strange that although he would be affectionate to them on his terms, coming up to them with hugs and kisses and telling them he loved them, he could not accept their affection. When they hugged him, he tensed. If they tried to hold him, he wiggled away.

     With each passing month, Mark's behavior worsened until Sandra and Tom no longer knew what to do. It seemed that no amount of love, parenting, or training could erase the earlier years of Mark's life.

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