Monday, July 25, 2011

RAD Behavior Checklist

Have you ever read a RAD check list?


A behavior checklist for RAD symptoms was taken from Liz Randolph's RADQ assessment.
A professional assessment is necessary to determine whether or not a child has an Attachment disorder. This checklist can help you identify areas of potential problem. It is not meant to substitute for a professional assessment and treatment plan. The best person to complete the checklist is the main female care giver of the child, answering the items according to the child’s behaviors seen over the past six months.
Circle the items if they are frequently or often true.
If you find that more than a few items (more than five or so) have been circled, your child may be experiencing difficulties that require professional assistance. If, in addition to several items being marked, any of the last three items is checked, your child may be experiencing attachment related problems.
RAD Behavior Checklist

I did this one for my non-adopted, not traumatized children I gave birth to.
1. My child acts cute or charms others to get others to do what my child wants.
Absolutely, and so does almost every child I have ever meet, with the exception of the kids I know on the autism spectrum.
2. My child often does not make eye contact when adults want to make eye contact with my child.
Yep, especially if they are in trouble or feeling ashamed. Same goes for most kids I have ever met or worked with.
3. My child is overly friendly with strangers.
Yep, my 5 year old loves chatting up anyone who will listen.
4. My child pushes me away or becomes stiff when I try to hug, unless my child wants something from me.
Oh, goodness yes! 13 year old!
5. My child argues for long periods of time, often about ridiculous things.
Ok, what child doesn’t argue with its parents about things that parents THINK are ridiculous? A parents ridiculous, is often a child’s very important. Really, you must have your milk in a princess cup and not the butterfly cup?
6. My child has a tremendous need to have control over everything, becoming very upset if things don't go my child’s way.
Hells yeah! ALL of my kids!
7. My child acts amazingly innocent, or pretends that things aren't that bad when caught doing something wrong.
Um, yeah, hello!
8. My child does very dangerous things, ignoring that my child may be hurt.
Yes, and so do I and every kid I coach!  (If it was easy they would call it football)
9. My child deliberately breaks or ruins things.
Again, just about every little boy I have ever met…I wonder what would happen if…
10. My child doesn't seem to feel age-appropriate guilt when my child does something wrong.
Not always. And unless you are someone with a lot of experience with lots of different children, do you really know what age appropriate guilt looks like anyway?

11. My child teases, hurts, or is cruel to other children.
Now, this can be a serious red flag. My kids are constantly picking with each other as goes on in most families. Many is the day that I feel more like a referee in the WWF than a mother…Again however, if you do not have a lot of experience with children it may be hard to tell what is run of the mill kids pushing boundaries, sibling rivalry, and figuring out how to fit into a group dynamic, self-advocating and real cause for concern which warrants seeking professional help. (In my own childhood I lived with the latter, which was never addressed. So I would never minimize child on child or sibling on sibling violence.)
12. My child seems unable to stop from doing things on impulse.
That describes a good chunk of the kids I work with, most little boys, every kid with ADHD and all kids I know at some point in time.
13. My child steals, or shows up with things that belong to others with unusual or suspicious reasons for how my child got these things.
Like borrowing clothes from friends which I loathe?
14. My child demands things, instead of asking for them.
Abso-freaking -lutely!
15. My child doesn't seem to learn from mistakes and misbehavior (no matter what the consequence, the child continues the behavior).
I have one word…Algebra!  There are other words, to be sure…but that is the one stuck in my craw at the moment.
16. My child tries to get sympathy from others by telling them that I abuse, don't feed, or don't provide the basic life necessities.
Yes, yes, yes! Do you know that we didn’t have ice-cream yesterday, that EVERYONE else’s parents let them go on the class trip to Washington D.C. and we couldn’t afford it, that I MAKE my oldest take care of her sisters, she has to get rides to after school functions when I am at work? I am down right abusive I tell ya!
I could do an entire blog post about the incredibly amusing conversation that my child told me she had with the school counselor! I’d have been mad if it wasn’t so funny…that poor lady!
17. My child "shakes off" pain when hurt, refusing to let anyone provide comfort.
Well…Um my oldest has broken her big toe, once in three places, and practiced on it for two weeks telling me that it ‘wasn’t THAT bad’ before I insisted she needed an X-ray…. I am not a big fan of “shake it off” ….my standard line is, “Are you hurt or scared? ‘Cause if you are just scared there is no need to be carrying on like that!”  because, in all honesty, when you are involved in something where injuries are just a part of what you do you have to know what is what quickly, there is no place for wigging-out over stubbed toes…..broken toes  well, some kids are just tough.
18. My child likes to sneak things without permission, even though my child could have had these things if my child had asked.
Well, she is 3… and she will just blame it on her sister or the cats anyway. 
19. My child lies, often about obvious or ridiculous things, or when it would have been easier to tell the truth.
Oh, man, my three year tells some wild stories, and will tell me she isn’t eating in the living room even as I am standing there watching her do it! And now, “the kittens did it”, is getting a lot of play around here.
20. My child is very bossy with other children and adults.
Oy-vay! 
21. My child hoards or sneaks food, or has other unusual eating habits (eats paper, raw flour, package mixes, baker's chocolate, etc.)
You mean not everyone doesn’t eat paper as a kid? How many people didn’t have that kid in there kindergarten class that eat paste? By the way Pica is can be a medical condition and between 10 and 32% of children ages 1 - 6 have these behaviors.
22. My child can't keep friends for more than a week.
Ha! There are a couple I wish they couldn’t keep for more than a week…does that count?
23. My child throws temper tantrums that last for hours.
Like the energizer bunny! One used to do it, one is coming out the other side, and one has a long way to go…
24. My child chatters non-stop, asks repeated questions about things that make no sense, mutters, or is hard to understand when talking.
Really? Are you kidding?  I have three girls, sometimes I swear my ears are gonna bleed! Muttering?  Like saying she hates me and what ever else under her breath as she sulks off….um yeah. 
25. My child is accident-prone (gets hurt a lot), or complains a lot about every little ache and pain (needs constant band aids).
Yes, yes and yes! I have a gymnast, a daredevil and kid with Apraxia, strangely, around here a paper-cut causes more whining than broken bones.   I should buy stock in, ear-plugs, Johnson and Johnson, ice-packs and Arnica!
26. My child teases, hurts, or is cruel to animals.
Now, this CAN be another real problem…but, since we just brought home two kittens that my children are ‘torturing’ (in my opinion) with excessive hugs, kisses, chasing and bombarding them with cat toys and being generally menacing it is something that may definitely be in the eye of the beholder. A parent’s idea of torture may be a child’s idea of loving-up! Yikes! They are keeping me on my toes!
27. My child doesn't do as well in school as my child could with even a little more effort.
Oh. My. Goodness!
28. My child has set fires, or is preoccupied with fire.
Now, that might upset me.
29. My child prefers to watch violent cartoons and/or TV shows or horror movie (regardless of whether or not you allow your child to do this).
Seriously, my kids (even my 13 year old) aren’t allowed and have never been allowed to watch much TV, movies or even play on the computer in the first place. (We – I mean, they are having a media-free summer. Well, except for the big girl going to see Harry Potter on opening night for her birthday) Because so much media is so violent, and I believe that the more kids are exposed to it the more they crave it. You can’t even walk through the grocery store around here without seeing some little boy sitting in the cart killing stuff on his DS, while mommy picks out her organic fruit. But that is another rant completely.
30. My child was abused/neglected during the first year of life, or had several changes of primary caretaker during the first several years of life.
Not even close!
31. My child was in an orphanage for more than the first year of life.
Nope!
32. My child was adopted after the age of eighteen months.
No.
And wouldn’t you know it, it appears since I have answered yes to more than 5 of the questions on this particular RAD check list, my very own children just may have RAD. And only a professional assessment can determine if the children I gave birth to, have been with from their first moments, have breastfed until they were 2, carried in slings, co-slept with have an attachment disorder. However, with the exception of setting fires, cruelty to animals and cruelty to other children, *most* kids display many of these behaviors to some degree at some point in their childhoods, for some period of time.
I am not in a position to say that RAD doesn’t exist. And I do know what it is like to have a child who I knew had issues, and to have people reassure me I am wrong. What I will say is that I am concerned that foster and adoptive parents look at check lists like this and panic. I have concerns that children with run of the mill attachment issues and PTSD or other more likely illnesses are being over diagnosed with RAD, simply because they are adopted or foster kids and exposed to unnecessary and possibly counterproductive and coercive therapies in the name of RAD.  Some *most* kids are selfish, egocentric, manipulative, demanding, ungrateful, and entitled to some *a large* extent. Because a kid has been “rescued” into foster care or “redeemed” by adoption, doesn’t mean they aren’t a kid by nature…for the good and the bad.

Comments (32)

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a random confession that I think I have Pica and I'm an adult....yikes :)
1 reply · active 714 weeks ago
Dannie, I knew a grown woman who eat clay…as in dirt. She was picky thought it had to be red clay from Alabama. It is also common in pregnant women. I have a friend who has it, she is constantly eating ice and her iron was so low that she had to go to the hospital for transfusions for a while…now she is just on Rx supplements. Maybe next time you see your Gp, you can mention it and have him ck your iron?
I agree that checklists like this can be counter productive. I do believe RAD exists. Though it has never been an official part of Fiona's dx, I do suspect strongly that it should be. But that is based on our 10 yr relationship not on a cklists. Like you my kids variously do most of the things on the list with the exception of the real danger things like fires, torture and cruelty.) They can be mean to each other but are never cruel.
1 reply · active 714 weeks ago
Bring that I was raised by a very wounded and compromised adult adoptee, hat I was tin foster care for 7 years i would at the very least say that child abuse, abandonment and separation can have a lasting and profound effect on its survivors. I believe that my mother’s experiences affected her ability to parent her children and form certain relationships, and that my experiences have left their mark as well. I think some attachment issues happen and are completely understandable. I believe there are some very sick kids out there, I have lived with a couple in my travels…that is for sure, but they are much more than some would have us believe.

Some of what I see*some* people attribute to RAD is just annoying, pain in the ass kind of kid stuff.
What a great post! Thanks, Sunday for exposing these checklists for what they are, general enough to fit almost any kid, and especially when the parent is looking for RAD or some other syndrome as "the answer", and the pne who posted the checklist is selling some kind of therapy to cure it.

I raised three boys, and most of these categories fit any little boy at different ages. By the way they are all happy successful men today. So is the son I relinquished, although he had a harder time of it in a very messed up adoptive family.

There is a whole industry treating "attachment disorder" and some of it involves cruel and dangerous "holding therapy" and other forms of abuse and restraint in order to break the child's will and make them compliant to the parent's wishes. This is very bad stuff.

As to fitting a questionaire, there was a famous experiment by skeptic James Randi where he gave all the people in a class a horoscope after asking their birthday, told them to read it, and then report back how accurate it was. Many people said it was amazing how accurate it was for them. Randi then revealed that everyone had been given the same horoscope, general enough that their own minds saw themselves in it.
1 reply · active 714 weeks ago
And laughing that just about every little boy I have ever met apparently suffers from RAD (and ADHD), at what point will we as a society realize that 1. We have unrealistic expectations about parenting and children and 2. That with the media overload and violence we expose our (collective) children to we have created a generation who are incapable of sitting down and shutting up. That is on us not them.
These checklist items are part of the Randolph Attachment Disorder Questionnaire (RADQ), used by attachment therapists to diagnose RAD-- BUT explicitly stated by its developer, Elizabeth Randolph, not to be about RAD, but instead about a notional problem . AD (plain Attachment Disorder, no Reactive part included). AD is the one whose proponents say the children are fire-setters and so on; the symptoms they are concerned with are in no way associated with the criteria for RAD.

One web site that focuses on this ideology says that the children can be known by "a darkness behind the eyes". Randolph herself states that she can diagnose attachment disorders by seeing whether the children can crawl backward on command.

That's the kind of thinking people are dealing with when they get involved with these checklist things.

By the way, Randolph surrendered her professional license following a disciplinary hearing.
My recent post What About the Fathers? The Anthony Case and Danieal Kelly
yes the checklist can be overwhelming in terms of parents deciding that their kid is a RADish. I have seen a better one where you actually rate the behaviour on a scale and in my experience of assessments for my kids that is what was used. Both of my adopted attachment disordered kids display almost all of those behaviours in some pretty extreme ways and it is always a challenge to filter out the typical little boy stuff from the attachment stuff. There are some quacks out there who are not helping kids but the there are some great people like Daniel Hughes who are - to bad we couldn't just get rid of all the quacks.
1 reply · active 607 weeks ago
First the RAD checklist is not a tool for diagnosis, just the potential for RAD behaviors or criteria. When a child is assessed for RAD there are many psychologist tests to rule in or out the RAD diagnosis. ____Also there is a baseline, the usual behavorial treatment and approaches that work to change behavior, decrease defiant or non-compliant behavior and increase compliant "normal" behaviors are not very effective with kids with the reactive attachment diagnosis. As a therapist I have worked with RAD kids, and the usual structure, consequences, rewards, structure that improves behaviors with kids/adolescents that do not have RAD, doesn't change behavior in RAD kids long term.____Also "normal kids do have some of these behaviors, the difference that these kids have these behaviors over their lifetime, and the frequency, the intensity and the duration of these behaviors is a longer length and a safety concern to themselves and others. They don't grow or mature out of it.____J____
OnceRADmom's avatar

OnceRADmom · 714 weeks ago

I think true reactive attachment disorder is extremely rare, and that many of our kids have reactive behaviors. But I'm pretty sure that many would be very upset to hear me say that. But there. I said it. I think that the reactive behaviors we see are pretty annoying and challenging, but also that it's so much more helpful I think to look at those behaviors through lens of trauma. The parental response is much more focused on what underlies the behaviors in that case. We are all reactive in relationships to a certain degree - I would expect all children who have experienced a removal to be very, very reactive. And I would expect that we can relate to their difficulties as a result. Do I expect their reactivity to be categorically different? I think it's rare and that a lot of kids get misdiagnosed with it. I fear that the misdiagnosis leads to less than optimal parenting (I'm being generous here).
I wish OnceRADmom would say what she means by "reactive". I never heard the word used this way before.
My recent post Behind the Norwegian Terrorist: The Grand Dame of Conspiracy Theory
So, based on my experience running kids' summer camps, the average child will score about 25 out of 31. I'd also say the average adult is about a 10 out of 31. We're all so flawed and imperfect, it's as if we were human beings instead of robots. God forbid!
I agree that this exercise shows the dangers of checklists, not necessarily the non-existence of RAD.

For what it's worth, when we were trying to convince my dad that my grandpa was suffering from dementia, he insisted that all of the symptoms were things "we all do." And it's true. I bump my car into things more frequently than I'd like to admit. I often have a word on the tip of my tongue but can't seem to remember it. I'm often forgetful and need reminders to do various tasks. I lose things all the time.

I think the thing that makes the RAD checklists more dangerous is that at least with dementia you usually have a baseline to compare to. I may drive into things all the time, but my grandpa had always been a very good and cautious driver. I might have trouble thinking of a certain adjective that describes precisely what I have in mind, but I know for sure my grandpa never used to have trouble thinking of the words for eating utensils, televisions, and other common objects. My grandma may have been one to cause a scene at a store if she thought she had been wronged, but my grandpa had always been very mindful of decorum and would have never started shouting over an imagined slight.

And not only did we have a baseline to compare to, but we also had my dad playing devil's advocate. He was completely in denial and didn't want to believe it, even after brain scans and an official diagnosis of Alzheimers and some significant deterioration in my grandpa's abilities. But at least it was the type of thing where, in my family at least, people would rather believe it wasn't true than that it was.

The problem with the RAD checklists is it's a new kid (no baseline), it's much harder to measure, and it's less likely you're going to have someone standing there in denial pointing out every possible plausible explanation for the behavior. And then the kid carries the label. Even with autism, where I'm sure checklists also abound and where it's often not the sort of thing where there is a "baseline" to compare to, for many parents there is at least some incentive to come up with reasons for why their child doesn't have the diagnosis. While all checklists can be dangerous and silly, this distinction is what makes the RAD checklists a bit more troubling.
2 replies · active 502 weeks ago
motherparadox's avatar

motherparadox · 714 weeks ago

Rebecca, this is a brilliant comparison. And I completely agree with you, not knowing the baseline behavior of a kid before being adopted, it is very difficult to determine if RAD is the appropriate diagnosis, which just ends up being the "label."
When a child is adopted the adoptive parents have the complete history to include the most recent psychological evaluations performed while in states custody...so your argument is invalid. RAD has certain criteria that needs to be met to include the symptoms must have been present for at least a 9 month time span BEFORE THE AGE OF 4, not just "all of a sudden."
Christine's avatar

Christine · 714 weeks ago

THANK YOU for pointing this out! What irritates me even more is when parent's aren't willing to put in the hard work they find themselves facing, take it upon themselves to make their own diagnosis of their their children, label them, then throw their hands up and blame EVERYTHING on this diagnosis. Let's face it, it's easier to do that, than what they SHOULD be doing.
2 replies · active 714 weeks ago
Well, and I think that is the crux of the issue. Not that I think RAD flat out doesn’t exist, but that some parents are far too willing to believe that all of their problems are caused by RAD. And let’s face it RAD is an appealing Dx for parents who do not want do the hard work of parenting tough kids; after all of their child’s problems were clearly caused by the evil “birth”-parents, “the system” and were firmly in place before they got duped into trying to “save” their demon-spawn. As a society we expect parents to do everything in their power for their children who have common run of the mill mental and neurological issues, RAD however seems to be looked at *in some cases* as a free pass to a no holds barred type of “therapy”/discipline style and a get out of jail free card when that doesn’t work. In general it would be frowned upon if a parent used unconventional therapy, or abandoned a child suffering from schizophrenia or brain damage from say a car accident or near drowning but that is often not the case with RAD and FAS. I think that is sad and certainly not fair to the kid.
OnceRADmom's avatar

OnceRADmom · 714 weeks ago

Sorry Jean - I am running wild and free with the term "reactive", which I used to basically mean emotionally reactive, or as some might say, emotionally triggered. So I was trying to say that it makes sense that these kids would be triggered by parenting. It should be expected and lovingly accepted. It doesn't necessarily mean that they cannot or will not "attach" or whatever you want to call it. It just seems that it is hard and painful to develop a new relationship with a new caregiver while dealing with the loss of another caregiver. I could be totally wrong, but it doesn't seem disordered, rather it seems normal to be "reactive" to relationships in this sense. And it seems likely that in a sensitive caregiving relationship, it would get easier over time.
1 reply · active 713 weeks ago
" It should be expected and lovingly accepted. It doesn't necessarily mean that they cannot or will not "attach" or whatever you want to call it. It just seems that it is hard and painful to develop a new relationship with a new caregiver while dealing with the loss of another caregiver."
Wow I've never seen anyone twist things around so much to suit their own needs. You really are a wounded individual. I suppose you could take any checklist out there and twist it so the truth is so unrecognizable in order to brainwash your undedicated readers to believe what you want them to believe. But if that's what you need to feel good about yourself, all the power to you. I'm sure you aren't doing it on purpose. Many people with unresolved trauma often need to manipulate in order to have the control they lost as a child.
admittedly, I've read through some of your posts pursuant to the storinguptreasures debacle. I'm not taking sides. Just interested. Regarding this checklist, i agree. It's sketchy at best. However, my daughter's mental health and developmental delay issues are overwhelming to say the least. And I tell people that in addition to her challenges, she has also been diagnosed with reactive attachment disorder inhibited type. My daughter was abused in infancy so her RAD diagnosis is appropriate to explain her behaviors and why those behaviors often skew the results of other psychometric evaluations. I don't just treat her "rad" behaviors, however. We address her whole person when approaching parenting her. She is a very damaged and traumatized young lady and will likely never recover and be functional as an adult in the conventional sense. What I have to say about any psychometric evaluation, including the RADQ, is that with severe cases like my daughter's, evaluations should be done semiannually. ALL of the evaluations. Then over time, there should be a noticable trend in the scores. I also agree with StellarParenting - I use the scaled evaluations provided by my child's psychologist. As a whole, I struggle to use only RAD therapy to treat my daughter's issues because she is a mixed bag and as her psychologist and psychiatrist affirm, she "lights up the score board". And as her therapist declared in a family team meeting just this past week, TRUE RAD diagnoses are few and those that are truly diagnosable are very severe. All that to say, yes, anyone at anytime could be diagnosed as a RAD using that basic questionnaire. It is that continual occurrence off severe and intense behaviors of MANY of those listed on the RADQ for many years, across development milestones with a history of abuse or placements that makes a child diagnosable for the condition. I grieve daily that my daughter is so impaired, that I can not undo her faulty brain wiring from the trauma and abuse. FYI - I was abused by my mother who is also a RAD but I myself am not a RAD and do not have diagnosable mental health issues. (have been seeing a therapist and physician for many years because relationships are hard for me - I am reactionary, as the RAD disorder suggests but I am not a RAD by classification - I do not have brain chemistry or faulty synapses that demonstrate my physical and mental inability to control my responses)
3 replies · active 713 weeks ago
sorry, I meant to write that I struggle to NOT use only RAD therapy to treat my daughter's issues.
I will NEVER judge anyone for grammatical or spelling faux pas.
That has been interesting to say the least. I don’t see sides, it is all shades of grey and everyone has the right to their own perceptions.
It is tough to be parented by a parent from trauma. I have read that holocaust survivor’s children can have the symptoms of PTSD without having suffered the trauma themselves. I find that fascinating. I know I have inadvertently passed some anxiety down to my oldest daughter, but she is learning to deal with her “monkey mind” a little better every day, and so do I.
I truly feel for you and your daughter, parenting is never easy, and having a child with neurological/psychological issues makes it that much harder. You can’t get services without a diagnosis. The problem is, or my fear rather is that kids in need of help, thus a diagnosis will not be getting the proper care when not properly diagnosed. Bad therapy *in some cases* can be much more damaging than none at all.

I hope for your daughter’s future. I personally struggled into my early 20s, nobody would have believed at 11, 16, 18 or 20 that it was possible for me to have the life i have today....please hold on to hope!
It is probably not a good idea for you to be writing about RAD unless you are parenting a child with it. It is not something anyone can fathom or begin to understand untill they have experienced it for themselves.
2 replies · active 704 weeks ago
Not a good idea? In what sense? Is something bad going to happen to me if I do? Is that some kind of veiled threat?
By your comment I assume that you are actively parenting a child with RAD?
And that you know who and what I have parented?
You know what personal experience I have with attachment?
Most parents have had the pleasure of living with one, two, three kids from trauma…I have lived with at least 100, with various issues including many (most) having problems with rage and some form of attachment issues…including myself. I always find it interesting when foster and adoptive parents think that they are the only people who have valid insight into foster and adoptive children. That is a bit narcissistic don’t ya think?
WOW agree with RACHEL, maybe you should spend a year or two caring for a child with RAD before you mock it!!!!
I think you raise some valid points. I also worry about some of the "parenting" I see of these adopted "RAD" kids. I fear it is abusive. But, when I speak up, I get told that I couldn't possibly understand. It's frustrating. I'm an adoptive parent. Our daughter came to us scared to death and damaged. We simply love the daylights out of her, co-sleep, and generally spoil her rotten and she is healing. I know that the way some of my fellow adoptive parents would have parented her would have caused more damage. I'm so thankful this kid is with us.

And, yes, all the RAD questions would have fit at one point. But no way is she ever going to be made to eat differently than we do or forcibly held down. Those two things, in particular, really bother me.
This RAD checklist is not accurate at all. Only five of the questions actually pertain to RAD at all - the rest are common in kids with many different conditions and in some cases normal kids as well.
Although I think you misinterpreted question #3. They're not asking about normal friendly behaviour. A five year old who chats up strangers is not *overly* friendly, just friendly. A five year old who sits on a stranger's lap is overly friendly.
I want to know your medical history? I'm reading this blog seeking help for my child and I truly don't think you really know what your talking about.choosing to sit on a complete strangers lap at 5 yrs old maybe o.k. To you .but trying to say that's enough and keeping a smile on your face to a stranger that has no idea what's going on as your child is refusing to let go in public and screaming her head off is terrifying! You answered all the question with explanations that made since to you and your understand of your children? I need to know why you feel knowable to write this blog? Thank you
I get what you are trying to say....and if I did not have a child that deals with RAD I would champion this article. However the struggle with RAD is very real and painful for all involved. Checklists like thsese should be used if a parent has a concern that something is abnormal...btw if things felt 'normal', a parent probably wouldnt inquire a checklist. My child with RAD has almost all of these behaviors/symptoms, but they are to the extreme and they cause extreme distress is ALL of their relationships. That is the difference here. Symptoms are 1 thing, but when the symptoms cause quality of life to significantly suffer as a result, that is when there is a cause for concern.

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