3 yr old issues with other children

[LovingLocka]

Hello,

I'm new to this site and like many of the posts I've read I am dealing with behavioral issues with my son that have me close to my wits end.

My son is 3 yrs 9 mo and has a 6 mo old baby sister. He has always had a strong willed, independent personality and each year or even 6 months seems to have a different type of battle. His biggest issue is that he is defiant (mostly at school now or with people other than me since I've got a good handle on it), a negotiator, controlling, aggressive and does not share or play well with other children. He is in a Christian Mother's Day Out program 3 days a week from 9-2 and is doing well except for the above areas. He has always been quick to learn, great motor skills, early crawler/walker, early vocabulary, talks in full sentences, seems to understand a lot. He doesn't have a problem with touch, very loving to everyone. Is everyone's best friend and wants so badly to play with us or other kids but wants to be in control of everything. Any toy a child has he wants to play with then and will be physical to get it. He has hit, pushed, kicked, thrown a small car, etc to be in control of what he wants. I dread the daily reports from his teacher because I'm so scared that he has impulsively hurt another child. He also is very noisy and will randomly make silly faces or noises to gain attention in school, like during the pledge the other day. Not tourettes, just attention getting. He also seems somewhat spiteful at times, taking the dogs ball and playing keep away for too long, things like that.

I have my first visit with a child psychologist tomorrow to start a process of behavioral therapy, evaluation, etc. I've read all the signs of ADD, ADHD, ODD and he does show the impulsiveness but doesn't seem to be to the extreme of ODD. I say that because he shows empathy, doesn't want to hurt people but still does impulsive actions. Today his baby sister was on the floor and I was videotaping her because she's started crawling. He was watching a show and just came over and pushed her down from being on her hands and knees. He was immediately put in time out. This is my main form of discipline which has been most effective. I never leave him alone with her. Medicating him scares the hell out of me so I am willing to try ANYTHING else first since he is so young. Aside from the school situation I have a friend in his class come over once a week for play time to try and help on my end. This other little boy is the most patient kid ever and he is about 6 mo older and seems to still enjoy being around Adam. His mom knows what's up and is very supportive in letting her child be a help.

Just curious on anyone else's thoughts, advice, opinions on how normal or severe this is and if there is a chance he will grow out of it with age and maturity. I've seen a lot of improvement but the physical social play thing is so scary to me. Will he end up being a social outcast, ahhhhh!

 

[BusynMember]

I hear you on the medications. I wouldn't give medications to any child who hasn't had a total evaluation and tried everything else first. Which leads me to this total evaluation: If it were my child, I'd have him evaluated before I took him to a behavioral therapist. I've had five kids (youngest 12) and, as you have noted, your son has some atypical behaviors and, since it's vague, I'd want to start the professional evaluations early so he could get help early. I have no idea what is wrong--are there any psychiatric problems on the family tree? Does anyone have Aspergers syndrome (which is neurological, not psychiatric?) There could be a million reasons why he is acting out, but, in the hindsite of raising a child who is wired differently, I would start with an evaluation rather than starting with therapy. To me, I'd rather find out what the problem is rather than correcting something I know nothing about. That in my opinion usually does not work.
I wouldn't be scared though. All of us have walked your path, and there are reasons your child may be acting out that can easily be helped, but again in my opinion it is best to first find out if he has any disorders and a regular psychologist, unless he does intensive testing, is not going to nail that one for you. I recommend seeing a neuropsychologist. He's young and will be hard to diagnose, but if you're asking if he has ADHD--we can't tell you. in my opinion he has more going on than ADHD. The kids who bring us here usually have more than that going on. And I wouldn't try to diagnose my own kid. We tend to see what we want to see and we need a fresh eye--somebody who is trained in the testing and evaluating of kids, but who is NOT emotionally involved. It's not a good idea to get one or two diagnosis. in our heads and run with them. We could be way off. Andt here are some therapists who will not want to test and will just say, "Oh...yeah...he shows traits of _____" just because WE brought it up. I've been there/done that/woudn't do it that way agian. I hope others can learn from my mistakes. Anyway, this is JMO.
Welcome to the board, whatever you decide to do. It's just hard for us to tell you how severe your child's behavior is. Trust your Mommy Gut

 

[Andy]

Welcome - It seems that you have a good handle on what is going on. Much of this may be normal behavior for his age, however, the extreme he takes it to would be concerning. Since you are feeling the "not sure that this is right", you should check it out. Always, always, always follow your instincts - you are the expert on your child and will feel when something is off.

Others will ask more questions and suggest that you read the Explosive Child. That book will give you some more tools to try. Since you talk about him wanting to be controlling, I would suggest that you look at the Manipulative Child. He may be a little young yet to fit into that theory but if his controlling behaviors continue, they could develop into manipulation and you will want a head start on that one.

I agree with MidWest Mom that you should focus on the evaluations at this point. It is difficult to treat what hasn't been recognized.

I am glad he has a patient playmate. My difficult child has a neighbor friend his age. The two of them have such different personalities and are either best of buds or worst of friends. It has been amazing to watch them in action with each other. The neighbor has always been patient/forgiving with difficult child. I have worked hard to make sure difficult child doesn't become a bully as I have seen a little potential of that. I think the very young kids really are more accepting of each other than adults - "Oh, that is just how so an so is, no big deal!"

Keep us informed on how it is going.

 

[LovingLocka]

Hello again,

Since I've written I have taken my son to a psychologist and last Friday to a psychiatrist. To make it short, the psychologist talked with me, next visit evaluated him (play, conversation, observing him play), and then we turned in paperwork/questionnaires from us and his MDO teacher. She concluded that he was still within normal range and to keep being consistent, etc and we could evaluate him again in 6-8 wks. Then he was becoming more aggressive and defiant at school so I took him to our pediatrician and he suggested to go on to a psychiatrist. The pediatrician. felt that what he observed in that particular visit wasn't "normal" behavior. I really didn't like the psychiatrist. He was tactless, made weird comments, and didn't in my opinion observe my child at all. He went with the history of what I told him and the teacher which is not bad, I was just hoping for a little more child friendly and test oriented visit. From that, he prescribed Concerta 18 mg. I was a little worried that my son is not yet 4 and on this but my pediatrician. said it was safe. So he had it yesterday and today and I don't see any change thus far. All I see is that he is not eating hardly at all, more clingy and whiney, today he said his stomach hurt, and he seems like he is more moody. I'm going to go ahead and give it to him again tomorrow for school to see if there is any help in it at all.

I would love to hear opinions on if these type of side effects will get better, if this medication should be working by now. I'm scared to double it and make the loss of appetite, etc worse. Also, what types of ADHD testing has anyone had their kids go through. What should I be looking for in a good psychiatrist or is this normal? Totally overwhelmed and just don't want to harm my child by giving him these type of medications.

Thanks!

 

[SRL]

Hi Lovinglocka. I'm sorry to hear that problems are continuing. This part of the process of feeling like something isn't quite right with your child but not having any answers or any firm direction to go in is incredibly hard. Keep trusting your mommy gut until the pieces fall into places.

If the psychologist doesn't have any answers for you or isn't offering any help after another follow-up appointment, I think I might look around elsewhere. If you haven't read The Explosive Child yet, you might find some help there.

Since you're needing an ASAP answer on Concerta, I've flagged down the moms on the General board. I know what you see on the first few doses of any medication isn't what to expect but someone with experience will be able to tell you a lot more.

Is he doing a lot of very physical activity--ie crashing into things and people or beds, swinging, spinning, etc?

 

[Marguerite]

I don't know how it usually works in the US but here in Australia before they start a kid on the long-acting stimulants, they first test the kid's response to short-acting forms. Concerta is long-acting ritalin.

Our experience - difficult child 1 started taking ritalin at age 6 and the change was dramatic and instant. (well, within half an hour). The medications didn't fix things, they just made it easier for him to concentrate in class a little better. We didn't have long-acting forms of it available back then so we had to keep dosing him through the day, which wasn't always easy and when the dose was dropped off (due to the school not chasing him up for medications) we found we had a problem with rebound.

The easiest way to decribe rebound - it's as if all the symptoms of impulsivity and hyperactivity that the medications have kept at bay all day, suddenly arrive at once and emerge in one big dose. Then after that hyperactivity extreme wears off, the child can become teary, emotional and down. There are varying degrees of this. Not all kids will get rebound, some only get it on the short-acting stimulants, some get it on one stimulant but not the other, some get it on all stimulants, some get it on none.

We switched difficult child 1 to dexamphetamine, from ritalin and found no rebound problems. But because it was only available in short-acting, we had big problems with the school forgetting to medicate difficult child 1. So the doctor found acompoundingpharmacist who makes the medications up into a long-acting form. This compounding is done privately and does cost, but for us it is worth it.

difficult child 3 was started on dex at age 3. The positive benefit was immense, immediate and like magic. We were also very apprehensive about starting him on medications at such a young age, but the change wassopositive that we quickly were won over. We have copped a lot of criticism dfrom some people (who should know better) and I have the confidence to stand my ground and say, "You should have known difficult child 3 before he was medicated - you wouldn't argue against it, if you had."

At about the same time we switched difficult child 1 from ritalin to dexamphetamine. The ritalin rebound had become almost intolerable, but we found no rebound on dex. (A friend of mine had her son rebounding on dex, but not ritalin).

Then we got around the school's failure to medicate difficult child 1 (and easy child 2/difficult child 2, but this stage) by giving them the long-acting form. Again, wonderful improvement.

The thing with stimulants as treatment - if they're going to work, you will know it fast. Within hours. The first day. If they don't work, then the medications wash out of their system by the end of that day.

The long-acting forms, such as Concerta - they may take a few days to fully wash out of the child's system, but I would say no more than three days. You may also notice a bit of build-up over two or three days as the child stabilises on the medications. Rebound is less likely on long-acting medications, but if it is there you will notice it in the evening as medications wear off. Or maybe by next morning, before the medications are given/before they kick in.

Temple Grandin discusses medications and what she calls the "Wow! factor". She says that if you give a kid medications and you notice a really obvious improvement, like "Wow! What a fabulous improvement!" then clearly, the medications are worth pursuing. But if you dose the child and notice little or no difference, then it's time to discuss this with the precribing doctor and ask for some justification for continuing the medications.

Basically - if it works, then go for it. If it doesn't - don't waste your efforts.

Marg

 

[AnnieO]

Warning. This is a bit frightening from the point of view of someone who wasn't in my house. Concerns difficult child 2 who had MAJOR behavioral changes on Concerta and not for the better.

difficult child 2 was on 18mg of Concerta started without husband's knowledge at 8 years old. At first we couldn't figure out why he went from a loving, active child to a mean, violent, whiny brat. He was impossible. Then we found out about the Concerta. We talked to the pediatrician who prescribed it (biomom asked for it specifically) and he said husband had no idea what he was talking about, that it helped difficult child 2 focus and calm down. HE didn't have to live with the medicated monster! After lots of research and questions to several psychiatrists and peds, since he was by then living with us we weaned him off. So biomom yanked him out of school and had the original pediatrician UP THE DOSE to 54mg! difficult child 2 started wetting the bed again, since he was so stimulated that when he came down he crashed and couldn't wake up. Started peeing on the floor in his room, hall, bathroom. Sleepwalking - down stairs, out the door onto the deck (thank the powers that be I wake well). We weaned him off that too and got the extra tabs from the school who was dosing him per biomom. We wouldn't have even known that except difficult child 2 came home one day and said, "the white pills taste funny". WTH?!

in my humble opinion, these drugs have a place. If they are prescribed correctly they will help the child taking them. And they're not meant to treat the problem like an antibiotic, they are meant to help the child focus so that they can learn coping behaviors. Once the behaviors are learned, the medications may or may not be necessary any more.

I would suggest a reevaluation with a lot of documentation about the so-called "changes" in your child on Concerta. Marg is absolutely right you should have seen a dramatic change. It sounds as if this is not the case and perhaps this isn't the best option. There has been so much research and testing and so many options you will probably need to look at a wider base. We are still trying to figure out what is really going on with difficult child 2 and we've been working on it for years.

 

[BusynMember]

At the end of the day, these drugs are speed. They are abused by teenagers and my teen got addicted to them. I know CHADD gets upset with these sorts of posts, but they only work for some kids who really have ADHD. Otherwise, they act like speed and make kids worse. That's also why they are a controlled substance. My grown daughter, who once snorted these pills after crushing them, says Adderrall goes for $10/pill on the street. Concerta is harder to smash so it is less coveted, but it is still speed.

. In hindsight, I would not have put my son on ANY medications until he saw a neuropsychologist. Rather than just testing for ADHD, I would have wanted my son tested for EVERYTHING because ADHD has many mimickers and stims don't help them. Early onset bipolar and autistic spectrum disorder can both look like ADHD and, in fact, can co-exist with ADHD, however the ADHD then becomes the lesser problem and treating the big picture is more effective. I wish I had been slower to try my son on stimulants. He tried all of them and they all made him mean and aggressive and they didn't help him in school either. That is because he was actually on the spectrum and ADHD is part and parcel of the spectrum, but stims are often very bad for spectrum kids. I would do a full scale test before accepting medications. If I could have seen the future, I would have done that for my own son. in my opinion NeuroPsychs are the best, most thorough evaluators even of the very young. Good luck, whatever you decide.

 

[susiestar]

My son started with ritalin (short acting but same medication as concerta) when he was 7. It was a Sat and he had a soccer game. The coach was a good friend of mine. Wiz was AWESOME at the game. He held his position, followed directions, was much better with the other kids, etc. After the game his coach came over and was just totally WOWed with the change. It was hugely dramatic.

If there is not a WOW change, it isn't the right medication for him. No other way to put it. Concerta (and all the stimulants) are fast in, fast out. They don't need weeks to become effective. You should see the change the very first dose. ANY person or psychiatrist (psychiatrist) who tells you differently is very ignorant about the medication. If a psychiatrist tells you to give it a few weeks, RUN and find another psychiatrist. You do not want psychiatric medicine prescribed by a doctor who does not understand them.

Most of the psychiatic medicines require time to see if they work. To my knowledge, stimulants are the ONLY psychiatric medications that are immediately effective. At least the only ones that would be given outside a hospital setting. Stimulants are often used by docs to find out if a child is ADHD. They work with the brain of a child iwth ADHD to sort of synch up the body and the brain. No one is totally sure how, to my knowledge.

While stims ARE speed, and ARE abused by many people, you will NOT make your child into a drug addict by giving him speed. There are reputable studies that show that a child has much LESS chance of becoming a drug addict if ADHD is properly treated with stimulants, even if stims are given at a very early age.

This is because stims work very differently in the brain of a person with ADHD than they do in a neurotypical person. In a NT person the stims act to speed them up, give them energy, the typical things you think about when you think about a person on speed. An ADHD person doesn't get the high. They actually become, more able to focus and interact with their world appropriately. People with ADHD who are NOT treated often go looking for substances to make them more "normal" and that is when they become addicted to things. It is called self-medicating and is not healthy. It is far, far more healthy to deal with ADHD properly with prescription medication.

That being said, it really looks like stims are not going to help with your son's problems. I would not continue treatment with them, and would not continue with a doctor who wanted treatment continued. I also would NOT go into more medications until I had a clue what was going on. MANY disorders can look like ADHD on those questionaires you completed. Often people can look like they have ADHD when really they have some other problem.

I totally agree you need to focus on evaluations. Find a neuropsychologist and get your son in for complete evaluation. It should involve many hours of testing broken up into several sessions. Then the neuropsychologist will take some time and evaluate everything. After that you get a report and recommendations that will really help.

Now on to your instincts. If a doctor of any kind makes you uncomfortable, says weird things, etc... it is immediately time to find a new doctor. Do not stay with them jsut because they are a doctor or you got in quickly. It may take a few months to get in with a new psychiatrist, but it will be worth the wait.ALWAYS FOLLOW YOUR INSTINCTS AND TRUST THEM. I can't stress that enough. You have those instincts for a reason, don't ignore them. The only really BIG mistakes I made with Wiz were times I ignored my instincts.

I hope this is helpful and that you find a neuropsychologist who will help and a psychiatrist you can work wtih better.

Many Hugs!

 

[smallworld]

Welcome! I'm glad you found us.

My son J was diagnosed with ADHD and anxiety and prescribed Concerta (27 mg) at age 10. It improved his attention at school, but we noticed over time that his mood issues intensified. We discontinued Concerta when J was almost 12 because we realized we needed to concentrate on treating his mood issues. We now realize that his attention issues have improved now that his mood has stabilized. Sometimes what looks like ADHD is in reality another disorder altogether. Any stimulant like Concerta can exacerbate pre-exisiting anxiety. That could be happening with your son.

Your son is very young. I think it's almost impossible to know what's going on with him for sure unless he undergoes thorough neuropsychological testing. And even then, it might be the neuropsychologist's best guess. Children are "moving targets" in that they are growing and changing rapidly and their symptoms can mirror normal childhood development (albeit to an extreme). For example, it is not abnormal for a 3-year-old to experience jealousy when a baby sister is receiving attention and figuratively pull the rug out from under her. It is abnormal if the behavior continues for a long time and gets aggressive to the point of threatening her safety.

I also think you need to look at the behavior a little more objectively. Any child who has impulse control challenges does not have the foresight to PLAN to be in control of everything. It sounds more as if he is reacting emotionally -- from anxiety, inflexibility, frustration introlerance, it's anyone's guess. It will be the job of the professionals to figure out what is driving his need to have what he wants when he wants it. And please believe me, it is NOT manipulation at this age. It is more likely a maladaptive coping strategy for dealing with an environment that is challenging to him in some way.

Are there any substance abuse or mental health issues in the family tree?

 

[JLady]

Hello.

My son has ADHD and went through the same side affects that you described when he began medication. It concerned me as well; however, after about 2 weeks the side affects subsided. I'm not impressed with medication either. I was told that if it is ADHD medication will help. If it isn't ADHD, it will make him worse.

I was careful to pick a psychiatrist that specializes in children. That seemed to be really hard to find for us. Good luck.

 

[Marguerite]

It is so difficult sometimes. Medicine is a very inexact science.

Our boys have a diagnosis of ADHD plus autism, but the stimulant medications help with some of the autism symptoms too, in our case. But you have kids with a diagnosis of ADHD and they don't respond well to stimulants.

But as a rule - stimulants will only really help kids with ADHD.

A good diagnosis is needed, a neuropsychologist assessment is really valuable. But at the end of the day, we do what we can to ehlp our kids, using every trick in the book. if medications are showing benefit (at school, at least) thwn great. But if there is no benefit or he seems worse, then first consider that the dose may be wrong, then that the medication is wrong, then that the diagnosis could be wrong.

Always keep an open mind about everything - you never know when a later diagnosis can turn it all on its head.

Marg

 

[LovingLocka]

Thank you all very much for your input and advice. It is a relief to know that I'm not alone in what I'm going through.

Update: Stopped Concerta after a week because it was wreaking havoc on my son in my opinion. He was antisocial, clingy, anxious, and generally sad. Not worth it. We went to a second psychiatrist today that I felt much more comfortable with. I didn't see these responses until this afternoon so I will look into a neuropsychologist. Anyway, this psy. did feel that he was a bit more hyperactive than the average 3 year old but didn't say, "yes I think he is ADHD, etc." Basically he listened, examined the history of what has been observed and to help with some of the impulsivity and hyperactivity he said we could try Strattera 10mg to see if it makes a difference. I'm still very weary of medications but in really watching my child and how he acts from minute to minute, hour to hour, I do feel that I have made the situation as "normal" as I can but am struggling more than I like to admit. Does that make sense? He is bright, funny, loving, but constantly moving, verbal, possessive, needy, loud, rough, etc. I am still going to search for a more clear cut gut answer but for now I think we'll give this medication a try. I gave him his first dose today and I'm trying again not to let the side effects freak me out. Initial observation is that he is tired and when I put him in a time out in his room for taking sisters toys (long story) he got in his bed an fell asleep. He was whiney this afternoon and not easy to please but I'm assuming it's because he is tired. This falling asleep thing rarely happens so I'm assuming it's the medication. Any advice or observations out there about Strattera?

By the way, to answer the family history question. There is no diagnosis of ADD/ADHD but I'm pretty sure my father has it and my brother has been a drug/alcohol addict for a decade now. He was prescribed Ritalin in HS from his pediatrician but he didn't like how it made him feel so he stopped. There has not been anyone in my family however that has been socially struggling like my son so this is new and saddens me because he wants so badly to play with others.

Thank you all again for your time!