Please help me figure out my 4 year old

[fun fam]

Hi. I"m so confused by my 4.5 year old and his behaviour. I am researching all kinds of disorders and he has some traits of sensory processing disorder (SPD), Aspergers, ODD, and ADHD. The one that fits best would be mild ODD, however, from reading on this forum, most people don't seem to think that is a real diagnosis. I have taken him to a very good developmental pediatrician, who evaluated him for 1.5 hrs (played lots of games, both with us there and in another room with a nurse--also asked lots of questions about him) The dev pediatrician said its not aspergers and he is not on the spectrum, and probably not ADHD. His best guess was "anxiety." I just don't know what is going on with him. Our family history is that we have a few people with aspergers or Pervasive Developmental Disorder (PDD)-not otherwise specified and a few with anxiety disorder (but adult onset.) Some comments about my son:

--very dominating, in your face, personality. Needs to be engaged or have someone to play with at all times. Poor self-entertaining skills. Loves/needs constant interaction with another person. Bosses his way older siblings around non-stop. (or at least he tries to)

--talks constantly, dominates conversations, interrups constantly, whines a ton

--complains a ton. His food is too hot, we ran out of his favorite snack, he doesn't want to go to the store, he doesn't want to eat lunch, etc. It feels like he complains about everything.

--very oppositional. Fights pretty much everything. If you give him two choices for lunch, he wants a third choice. If you give him a piece of candy, he wants more or he wants a different kind. If I tell him we are going to the park, he fights getting ready to go, and then fights leaving the park when we are done. Things are never "good enough" for him. This aspect of him WEARS ME OUT.

--poor self-help skills. Doesn't want to dress himself, feed himself, etc. Hates learning anything that makes him independent. Likes to have me to stuff for him all the time.

--very bright kid, and is ahead academically and is a very very fast learner. (knew numbers, letters, at age 2, and he figures games/puzzles out quickly, is doing 1st grade math, etc) Preschool teacher commented to me he is supposedly the brightest 3 year old (this was last year) she has ever seen. His older brothers are in gifted programs and he appears (so far) to be the brightest of the bunch.

--is extremely social. LOVES to have friends over, and begs for them constantly. Usually has 4-5 playdates a week. He has three best friends and they all seem to love him. (they call him to come over too) He gets along very well with other kids (won't hit them and takes turns, is a good friend etc). Has amazing social skills and knows how to play in groups. Behaves well in group settings like preschool, gym class, etc. Respects other adults but not those close to him like parents, grandparents, etc.

--has anywhere from 2-10 full on screaming, hitting, flailing tantrums a day. I have to lock him in a room when he does this. Almost anything can set him off.

--loves to annoy people, on purpose. (not his friends, but adults and older siblings) Constantly pokes, pushes, tries to close doors on people, takes off his shoes and then screams to have them back on, throws food, etc. If you are on the toilet and he wants to use it, he will barge in and try to push you off. He loves to annoy his older brothers in any way he can. He is VERY aware of what he is doing and it is on purpose.

--amazing imagination. Loves to play pretend. Plays 'house,' 'restaurant,' "star wars' etc. He loves to pretend to be "daddy" and when he is pretending to be daddy, he acts and talks JUST LIKE husband.

--very self-aware. He will say, "when I scream, I have to go to my room. And if I hit you on the way to my room, you will add 5 min to my time-out." or "If I throw a tantrum when I'm supposed to stop playing wii, then you will take it away for the day. But mom, did you know that I never throw wii tantrums when I have a friend over?"

I am taking him to a mental health professional next week but wanted to know if you have any thoughts. Thanks!

 

[BusynMember]

Your son is tough to figure out. Frankly, I'd skip the mental health professional and take him for a full scale evaluation by a neuropsychologist. A counselor isn't going to be able to guess any better than us. He doesn't have the training of a neuropsychologist. The closest he sounds like is Aspergers, but if he can really interact with kids that well, it doesn't fit. Does he play WITH them and TALK to them or does he sort of just play beside them? Does he make good eye contact? Does he have any obsessive interests? Trouble transitioning? Any odd quirks? Is he OVERLY fascinated by numbers, letters, memorizing things by rote? My Autism Spectrum Disorders (ASD) son was fascinated by those things. Does your son ever recite things verbatim that he hears on TV or that other people say? Does he have a vocabulary that makes him sound a bit like a little professor?

Just because your son does things on purpose, doesn't mean he has no reason for it or that it is only to annoy them. You really don't know why he does it, and this needs exploration.

The amount of tantrums he has is alarming and needs to be explored. I 'm one who thinks ODD is for the birds so I'd never accept that as a diagnosis. More is going on than ODD. I think this is a good time to explore it, understanding that at his age, he can get a WORKING diagnosis that will probably change as he gets older and other stuff shows up. I really think this is also more than anxiety. Anxiety also rarely stands alone, just like ODD. The earlier you can sort of get a handle on things and find a treatment plan, the better the long term prognosis. I do NOT recommend a behavioral therapist. Most of our k ids do not respond to their reward charts and other methods that more typical kids do respond to.

Not saying he is, but the developmental pediatrician could be wrong. 1.5 hours without specific testing is way too short a period of time and not intensisve enough. My son was tested for ten hours and for everything under the sun. It went way beyond just talking to him, although that also happened.

Welcome to the board ....but I'm sorry you had to come here. Amazing people are here with lots of good advice.

 

[fun fam]

Thanks for your reply, Midwest mom! I will look and see if I can find a neuropsychologist in my area. I hadn't thought of that.

I have thought about aspergers a lot, just because it runs in husband's family (an uncle, and two nephews have some form of Autism Spectrum Disorders (ASD)) but my son does not fit the social aspects of Autism Spectrum Disorders (ASD) at all. To answer your questions.

Does he play WITH them and TALK to them or does he sort of just play beside them? yes, he talks with them, interacts with them, imagines with them, creates games with them. He is a popular kid and I can't explain it other than he is socially very normal from what I can tell. He does not act at all like his cousins with aspegers socially.

Does he make good eye contact? Yes

Does he have any obsessive interests? He is somewhat obsessed with visual mediums like wii, and the ipad.

Trouble transitioning? He does have trouble transitioning. If he is doing something he likes, the doesn't want to stop, even though I give him 10, 5, and 2 minute warnings. He also has trouble getting ready to go places. He often tantrums when I am trying to get him out the door, even though I give him plenty of time to get ready and we usually stick to routines.

Is he OVERLY fascinated by numbers, letters, memorizing things by rote? No, he does learn quickly but is not obsessed with letters or numbers or things like that.

Does your son ever recite things verbatim that he hears on TV or that other people say? Does he have a vocabulary that makes him sound a bit like a little professor? He has no echolalia, and he doesn't sound like a professor.

As for him being purposely annoying, he usually does it when he is mad about something. For example: His is building a tower and it gets too high and falls down. Its no one's fault, but he screams and is angry about it. He runs over and starts poking his brother to annoy him, even though his brother had nothing to do with his tower falling.

 

[InsaneCdn]

For the record - MWM and I are actually on similar pages, we just come at things from a different direction, because our experiences have been quite opposite... which just means, you get two different perspectives... <grin>

I totally agree there is more going on. Also totally agree that it probably isn't something "obvious".

Before I'd go tracking down another comprehensive-type evaluation so soon, I'd try adding some other evaluations to the mix, based on specific comments in your post.

poor self-help skills. Doesn't want to dress himself, feed himself, etc. Hates learning anything that makes him independent. Likes to have me to stuff for him all the time.​

Having had a kid like this... I'd strongly recommend getting an Occupational Therapist (OT) evaluation for motor skills and sensory issues. Self-help skills are often a red flag for both gross and fine motor skills. Sensory issues are not always obvious. Either kind of issues can drive a kid around the bend really fast... and many of "our" kids have both kinds of problems.

The Occupational Therapist (OT) can do a very thorough evaluation. They have therapies and interventions that help. AND, the Occupational Therapist (OT) report will be of use to the next person/team who does a comprehensive evaluation.

--talks constantly, dominates conversations, interrups constantly, whines a ton
​

Has his hearing ever been evaluated? If that is normal, perhaps an Speech Language Pathologist (SLP) evaluation is in order. Some of the auditory processing disorders are difficult to pin down before about age 7 or 8... but if they are there, the impact is huge. Hearing or auditory processing problems often show up in people who either talk too much, or talk too little, or who tend to bring the conversation back to their topic - not necessarily because they are on a single track as an Autism Spectrum Disorders (ASD)/Aspie kid might be, but because they don't really pick up on the change of topic.

His best guess was "anxiety."

Just my opinion, but... as far as I'm concerned, "anxiety" is nothing to play around with. We got told that. Turned out... there was LOTS more going on... in a kid who is NOT on the spectrum, is ADD not ADHD... and was going insane trying to deal with life. Occupational Therapist (OT) and Speech Language Pathologist (SLP) evaluations were critical - but not the only - components in getting answers.

I really doubt you'll be dealing with a generic "anxiety" problem... it won't be something mental health professionals can solve, and they might make it worse by trying to "fix" your parenting (our experience). Not that mental health professionals can't be a good resource. But... sometimes, you need to get your own ducks in a row before you bring them on board. We never found a good therapist, but have a great psychiatrist... something that is absolutely necessary if you end up needing medications. But... the psychiatrist and the tdocs never ever had a clue about the cause of the anxiety and depression.

At age 4.5, I knew difficult child was in trouble. so trust your Mommy gut that something is going on for your child. For us, it took 7 more years to get anyone to even admit that what I was seeing, was real. And another several after that to get dxes and interventions/accommodations/medications that were even close. However, there are more options available now, than when we started, and available at a much younger age.

While you're at it... you might want to start a parent report. Wish I'd known about that when difficult child as 4.5! Fastest way to find that is to look for a recent post by Susiestar... the link to that is on her signature.

 

[buddy]

Hi there. I'm on my phone so hope you don't mind this may be choppy. First, welcome! Second, I agree with Mwm and IC. I personally would do the order of getting the Occupational Therapist (OT) and Speech Language Pathologist (SLP) pieces to bring to the neuropsychologist because it gives them much more info to consider. I too think your mommy gut is right. Given the family history of aspergers, there could be some level of spectrum -like stuff going on that doesn't quite meet criteria. Afterall our kids don't read the diagnostic criteria! LOL. This is where the soon to be non existent Pervasive Developmental Disorder (PDD)-not otherwise specified diagnosis can be helpful for some. (The dsm revision doesnt seem to have anything like this but we'll see ). It may not be that at all, but in any event given the genetics, he could have parts of things like sensory and some pragmatic language issues (just examples ) and not others. Just mho from your post but even though not the more typical social challenges his cousins present with, the loud voice, in your face, bossy, etc. types of things can be considered pragmatic/social communication problems. These things are often seen in Autism Spectrum Disorders (ASD) and again he may not meet criteria for that but I'd approach it neurologically in my mind and work on skill building.
It is sometimes much harder to get comprehensive treatment for kids who fall just under an umbrella diagnosis but again just mho ....I'd be very protective about anyone diagnosing odd and starting traditional behavioral treatment to stop inappropriate things and maybe setting the stage for how he is viewed in school (shouldn't be this way because ODD kids have just as much right to compassionate, skill building interventions but often are seen as just choosing to be difficult and huge self-esteem issues can arise )....
Hope that makes sense ....for some more challenging kids to diagnosis., (A diagnosis afterall does streamline getting therapies esp thru insurance BUT you want the right therapies), it really is helpful to find underlying issues and work on habilitation and skill building. At his age you are blessed to push to help him.
While you're at it ...even though my son easily and obviously qualified for traditional therapies like speech, early intervention and Special Education. , Occupational Therapist (OT), pt, on and on, the most beneficial "therapies " by far have been horse back riding therapy, adaptive sports, art therapy, recently we added a therapy dog agility /social program, he has done Neurofeedback for anxiety and calming since age 4 on and off ...and I hate to admit (as an Speech Language Pathologist (SLP) I am betraying my people, LOL ) but these types of things, especially the horses, have done more for my son than any of the others. The combination really is important but just wanted to share because looking back I wish I'd have started many of those earlier.

 

[Malika]

lI'd be very protective about anyone diagnosing odd and starting traditional behavioral treatment to stop inappropriate things and maybe setting the stage for how he is viewed in school (shouldn't be this way because ODD kids have just as much right to compassionate, skill building interventions but often are seen as just choosing to be difficult and huge self-esteem issues can arise )....QUOTE]

Oh, that is really true. It is incredibly difficult to see oppositional behaviour as a malady rather than a choice but it must be, of course - in the sense that it creates so much rejection, suffering and isolation for the child, who would really choose it if they were able to choose differently?

Your son does sound intriguing, I must say. Some of the characteristics you mention sound just like my son but others - the social skills and obvious giftedness - do not. I have no experience of Asperger's to go on so take my words with a bucket of salt but your boy really doesn't sound Aspergers or autistic to me. But clearly there are real challenges and skills deficits. So I'd go with Buddy in encouraging you to explore ways to work on skill building.

Welcome.

 

[Ktllc]

Welcome,
If you find confort in it: we are too struggling to find a good usefull diagnosis for V. I'm still exploring Autism Spectrum Disorders (ASD). V has sensory processing disorder (SPD) for sure and that is something you can learn to manage.
But keep in mind: a diagnosis is extremely useful in the US but is noway the end of the road! It is just a road map. And even if you don't get a clear diagnosis, you can still identify his difficulties and learn to deal with them, teach him new skills.

 

[TeDo]

fun fam, my difficult child 2 is VERY social and has pretty good social skills, EXCEPT he takes things to the extreme which is socially awkward. He gets obsessed with certain people, has to talk to them or be wherever they are or ...... If anyone were to evaluate him for only 1.5 hours there is NO WAY he would have been found to be on the spectrum. For us, it's a good thing he was seeing a therapist that was a PhD level psychologist for some time and she really got to know him and gave him the spectrum diagnosis.

If you're pretty convinced he's on the spectrum, you could deal with it as if it is because most of the changes/approaches for dealing a kid on the spectrum work for most kids also.

 

[fun fam]

Thanks for all your replies!

His hearing has been tested and is fine. I have read about auditory processing disorder and it doesn't seem to fit, but I am not totally sure. He actually is in speech therapy, for articulation problems. His language pragmatics and vocab, etc are all normal, but his pronounciation has always been poor. He has been seeing a Speech Language Pathologist (SLP) for a year now and has made huge progress. He will go for another year at least.

I do keep coming back to aspergers because of the family history, but socially it doesn't seem to fit. Yes, he is bossy, dominating, controlling and in-your-face, but that is with adults he knows well (mostly me and husband) ONLY. He is NOT bossy, rude, dominating, aggressive, obsessive, rude, etc with his friends. He is kind, compromises, easy to get along with, etc when it comes to peers and he does great in groups. Totally different kid in his attitude when it comes to dealing with us (parents) and dealing with friends. He really does have very good social skills for his age.

I bet my son would just LOVE horse therapy (he adores animals) but I have no idea how we'd afford it.

 

[nvts]

Wow! Welcome to the crowd - you've gotten a lot of great input - I'm also on the sensory page...have you considered a weighted blanket or vest? It might help when you see him start to spiral toward a meltdown, head him over to the couch and let him just rest with it...

Occupational Therapist (OT) might be just the trick!

As far as horse therapy, I wonder if a prescription was written by a psychiatrist your insurance might help? Just a "thing to think of!"

Beth

 

[aliyawilson]

Your son is tough to figure out. Frankly, I'd skip the mental health professional and take him for a full scale evaluation by a neuropsychologist.

But I think mental health professional is also a good option for him.

 

[BusynMember]

A neuropsychologist is a very experienced mental health professional who also can test for deficits and problems that other professionals tend to miss. If you're talking about therapy though, I agree that trying therapy is always a good idea! But not without the evaluation.