Need advice on what to do next with 4 1/2 yo daughter

[vidaloca1011]

Hello! I'm so happy to have found this group. Reading through your posts has made me feel like I'm not alone! Here's what I'm dealing with right now. My daughter is 4 1/2 and has always been difficult. We had her tested by a psychologist at 3 because she was kicked out of her daycare for being to aggressive. The psychologist told us that she scored in the 99.7 percentile for language ability (!) and that she was a gifted child with an adjustment disorder. We have worked with a cognitive behavior therapist on Parent/Child Interaction Therapy, which has had some success, and cranial/sacral therapy with a highly recommended chiropractor (we ended that a few weeks ago when it became obvious that daughter was not making any further improvements). Last summer, we consulted a behavioral pediatrician who diagnosed ODD with possible ADHD (she was clear that no one could diagnose ADHD until daughter was at least 6) and recommended medication. At that point, we were desperate for help and decided to try guanfacine (Tenex), which worked wonders for a week and then turned her into an animal with no impulse control whatsoever. We then tried Abilify, which has helped greatly, but we are very uncomfortable with her on such a powerful medication. We got a second opinion and a third from two psychiatrists, one of whom we are now using, because the behavioral pediatrician wanted us to continue upping her medications anytime she hit a rough patch until she was old enough to diagnose with something. Both second opinions told us to get her off Abilify and that it was inappropriate for someone so young. The psychiatrist we are seeing now advised us to put her on omega - 3 supplements and use valerian at bedtime. We have seen great improvement with the omega-3s and some help with going to sleep with the valerian. She advised us to begin to pull her off the Abilify, which we started almost two weeks ago. She was on 3mgs and we are dropping down 1mg every two weeks. This last week has been a little more difficult and this weekend has been nightmarish. All of her horrible behaviors have returned - throwing tantrums and screaming at the top of her lungs whenever she doesn't get exactly what she wants RIGHT NOW, hitting & kicking us, and generally not responding to any discipline we do. Her lack of impulse control and her unwillingness to consider things like perhaps her foot hurts because she's been kicking the door or us, not because we hurt her, is unbearable. She is nearly angelic in public or at preschool, but as soon as we arrive home, the beast emerges. Suggestions?

 

[BusynMember]

Was there anything difficult about her birth or her very early years? Sounds like you have been trying hard to get help, but I'd suggest you take her to a neuropsychologist. It's not true that a child can't be diagnosed until age six. Are you in the US?

 

[HaoZi]

Has she had a full evaluation from a neuropsychologist? Been checked for food allergies? Also try reading The Explosive Child by Ross Greene as a good starting point. More will be along later to help you out. Hang in there! Sounds like the Abilify was working, though. Are they wanting to try a more gentle AAP for her instead?

 

[InsaneCdn]

Is she by any chance adopted?
Can you give us some idea of her early childhood behaviors and experiences?
Do you have any idea as to what kinds of things trigger her behavior?
If not, you might want to start a journal - it helps to be able to look back and see patterns that you miss when you're just reacting on a day-to-day basis.

 

[BusynMember]

I was thinking adopted too.

 

[vidaloca1011]

Thanks, everyone! She is not, as I sometimes wonder, adopted. She was born via C-section because she was breech. She was head down, ready to go at 36 weeks and then flipped over a few days later - I remember because it was painful when she did it! We tried everything but having me dive into a pool. I'm not a strong swimmer and I didn't feel comfortable doing it. I spent a lot of time inverted, burned moxibustion (sp?) at my pinky toes, went to the chiropractor for the Webster adjustment several times, had an external version where the dr. was able to turn her halfway, but as soon as she let go, daughter zipped right back to where she was and then shoved her feet into my cervix for a couple of hours. Eventually she returned to her L shape, head under my ribs, legs straight out to my side. From the moment she was born she was ****** off and has remained so. She cried for two weeks straight unless she was latched on to my breast. She's tongue tied, which made nursing agony at the beginning, but I didn't know to have her frenulum (sp?) cut when she was an infant, so I just dealt with it for 19 months. It wasn't that bad and I'm glad I did it. I am pretty sure she knew she had it good inside the uterus and had no interest in coming out. I was hopeful that cranial sacral therapy would help. It did a little, but daughter figured out how to manipulate the situation so that she could play with the finger puppets the chiro had in his office.

She is incredibly intelligent. The reason we were asked to remove her from daycare at 2 1/2 is because she didn't like it when new babies would start coming and she figured out that her care provider would have her come and sit in her lap to talk about her feelings after she misbehaved by hitting or biting another kid. Of course, the other kid was tended to first while daughter had to be separated from the group, but she knew if she waited long enough she'd get complete attention. Once she started preschool, she was in heaven and even decided to resume potty training (she trained herself at 19 months and then abruptly quit. We just followed her lead and went back to diapers until she told us she was ready).

As far as triggers, transitions are a sure bet as are any situation where she does not get what she wants. It can be unpredictable - sometimes she will go right along with what she is asked to do without complaint, but then other times something as simple as picking up something will send her into a screaming, hitting fit.

She refuses to nap at home, unless she is really sick. Afternoons are the most difficult time because she still needs a little bit of a nap. She has never been a good napper and as a baby would only nap while she nursed on me, so I gave up and learned to sleep in the rocking chair. She slept through the night at 10 weeks and, except for when she was learning to crawl and then walk or was sick, once she was asleep, she slept all night (10 -12 hours straight). She hit most of her milestones early (the ones I remembered to write down). She talked and then crawled at 7 mo, and then walked at 8 1/2 mo. Both her father and I walked at 9 mo so we were expecting that she might walk early.

We are in Northern California and have pretty good insurance. I don't know if there are any neuropsychs in our area. We're only an hour north of San Francisco, and I imagine they must have some there. The psychiatrist we just switched to specializes in children and noticed immediately how intelligent she is and how perceptive she is. She knows I'm having a bad day before I do sometimes. I think keeping a journal will be very helpful. I just have to get into the habit of doing it.

I work full-time as a teacher and my husband also works full-time. She has been in care since she was 4 mo. Truthfully, I adore her and think she is the most amazing child, but she exhausts me and I worry about the impact her crazy tantrums have on her younger brother (2 yo). She beats on him unless we stay close, but then, five minutes later, she is a super sweet sister, sharing her most beloved toys with him.

 

[Malika]

Medication is a controversial subject. Parents have to take their own decisions, weighing up all the considerations. For me, 4 and a half is too young to be taking a substance that is licenced by the manufacturers for use only on children 6 and above. I would imagine - while knowing little about the subject - that the return of her disturbed behaviour has some link to withdrawal from the medications. Have you tried other natural products - lack of magnesium and iron are also implicated in ADHD/ODD in young children. Some people have reported great success with magnesium and iron supplements. If it is possible, you may wish to get a blood test first to ascertain her iron level. Zinc too is useful, vitamin B. Routine, calm, predictability. Swimming. Animals, especially horse riding. Some left field ideas. Give the withdrawal from Abilify some time to settle. And the book quoted, "The Explosive Child", is very good.

 

[vidaloca1011]

I agree about her medications. The dr. we were working with assured us it was safe, but my gut said otherwise. Both second opinions told us it was a powerful drug that was not recommended for her age group, which is why we want her off ASAP. We're going to wait til she settles a bit before dropping her down any lower. I do have Ross Greene's book and I'm going to re-read it. I really liked many of his suggestions.

 

[InsaneCdn]

Doesn't sound like she has gross motor skills problems... !
But... did you ever consider an Occupational Therapist (OT) evaluation for sensory issues?
Those can drive any kid crazy, and you may not recognize the triggers, or the triggers may be something unrelated, and the child reacts because of "overload".
Occupational Therapist (OT) has interventions, accommodations and therapies that help.
And the Occupational Therapist (OT) report is useful to other evaluators.

 

[vidaloca1011]

We did consider an Occupational Therapist (OT) evaluation when the cognitive behavior therapist suggested it, but of the items on the checklist she gave us, daughter only fit one or two of them. I did talk to the only Occupational Therapist (OT) place in our area and they are not covered by insurance. It was going to cost almost $500 just for an initial evaluation and then if therapy was recommended, we would also have to pay out of pocket for that. We barely make ends meet now as it is, so we decided to forgo it for now, but I will ask our psychiatrist about it and see what she thinks. daughter has no problems with being hugged or touched and never complains about fabric or tags, nor does she use excessive force, unless she's in the middle of an episode. On the bright side, we've had two nights in a row of peaceful bedtime!

 

[InsaneCdn]

At 4 and a half... she's too young to test for this, but you might want to keep an eye out for it... auditory processing disorders include subtle issues like auditory figure ground - where the person has trouble tuning out the background noise or focusing on the "important" sounds...

APDs can burn up a LOT of mental energy - which then leads to melt-downs and other issues later, but not necessarily consistently, because it depends on how the day has gone.

Does she hear/respond better, when the environment around her is quiet? (no TV, radio, dishwasher running, etc)

 

[BusynMember]

Check your school district. My son saw an Occupational Therapist (OT) from school at no cost. Also, intelligent or not, her behavior suggests she probably has special needs and the school districts do have early education for children who are wired differently. Doesn't cost anything and helps the kids with the things they have trouble doing, be it educational or behavioral. Being a teacher, I am probably telling you what you already know. If so, I apologize I always get overly zealous in trying to help our "different" children become happier and better understood.

 

[buddy]

We did consider an Occupational Therapist (OT) evaluation when the cognitive behavior therapist suggested it, but of the items on the checklist she gave us, daughter only fit one or two of them. I did talk to the only Occupational Therapist (OT) place in our area and they are not covered by insurance. It was going to cost almost $500 just for an initial evaluation and then if therapy was recommended, we would also have to pay out of pocket for that. We barely make ends meet now as it is, so we decided to forgo it for now, but I will ask our psychiatrist about it and see what she thinks. daughter has no problems with being hugged or touched and never complains about fabric or tags, nor does she use excessive force, unless she's in the middle of an episode. On the bright side, we've had two nights in a row of peaceful bedtime!

This of course depends on how good your school system but nationally it is law that every child with needs be evaluated from birth. Good districts (I have worked in wonderful ones that provided far more therapy than medically could be given, but if you can get both ....get both, that's what I personally did for my son)....

Anyway, good districts will have all of those professionals, PT, Occupational Therapist (OT), Speech Language Pathologist (SLP), and Special Education teachers who can help sort through some of this. They can provide individual and or group therapies if she qualifies. In early childhood it is very different to qualify a child than once they are in elementary school. Unfortunately, some districts dont have much funding and hire some not as experienced therapists so things get missed.....Still, you wont know until you try. Early Childhood folks as a group (always exceptions) tend to be pretty nice folks.

If interested, call your district and ask for early childhood special education. Say you need an evaluation for a child who has developmental concerns. Do not get specific. This is not the time to brag about accomplishments, smile. Just how hard things are and what help you need.

(later if you get services then you can enjoy the bragging about her higher skills, smile)

 

[vidaloca1011]

Thank you all so much! You have given me lots of great ideas. One of my friends is a speech pathologist specializing in children and I'll be asking her more about auditory processing problems. I'm also going to talk to our district as well for an evaluation. You are all a wonderful resource!!!

 

[vidaloca1011]

Just wanted to let you know that we continued working with the psychiatrist and just discovered that our daughter (almost 5 now!) probably has bipolar disorder. We were able to wean her off the Abilify and put her on guanfacine, which made her CRAZY. The psychiatrist is having us wean her off the guanfacine ASAP and we will begin lamictal as soon as we can get it from the pharmacy. Thank you all so very much for the ideas and advice. I feel so alone most of the time and it's good to know that there are other parents out there struggling to support their kids.