new strategies for challenging 5 year old?

Discussion in 'General Parenting' started by steelgogator, Sep 28, 2012.

  1. steelgogator

    steelgogator New Member

    I am new to the forum and found reading the early childhood threads really helpful. I would be grateful for any ideas about my challenging 5 year old son.

    A quick history: He has trouble forming peer relationships. He has a low frustration tolerance. He gets disorganized in transitions, e.g., acts out when I get home from work (making messes, running out of the house, grabbing something from his brother); acts out at school when transitioning from one activity to the next; regressed majorly (had accidents, exhibited rigid behavior, had epic meltdowns over tiny things) in the transition from school to summer and to a new summer camp.

    We have had him observed in school and evaluated several times: by an Occupational Therapist (OT)/therapist, by a developmental pediatrician, by the early intervention group in our school district. In his evaluations, Aspergers has been discussed but not diagnosed: On the one hand, he exhibits the rigidity, lack of empathy, and challenges with peer relationships associated with Aspergers. On the other hand, he does not have obsessive interests or encyclopedic knowledge about any particular thing; his interests are broad; he makes good eye contact; he engages quickly and warmly with most adults, mainly has trouble with peers. Early on (age 3-4) he had some motor skills and motor planning deficits that were addressed by Occupational Therapist (OT), and he's doing pretty well in these areas now. I think there may be some remaining sensory processing pieces: e.g, he seeks sensory input/some stomp and crash behavior, he is a messy eater and doesn't really notice his messy face, he doesn't get dizzy, lacks body awareness/is clumsy, will sometimes get into impulsive "grab everything" mode, seems to be calmed by heavy labor such as raking or carrying groceries.

    The newest challenges are the ones that I'm struggling with the most. He has started to exhibit impulsive, and oppositional defiant behavior, which have me completely at a loss. My A-game doesn't work anymore, and I'm just feeling desperate.

    Last night was a good example. He got upset about something small (a control issue - he had wanted to surprise me, but I saw what he was doing and he got upset). I said, "I'll bet you can think of another way to surprise me" and I took his 3 year old brother up to bath. Then, my older son came up and threw toys into the bath and laughed maniacally. I tried not the rise to the bait and said "You found a way to surprise me after all." Then, he proceeded to throw dirty washcloths, underwear, toilet paper into the bath. He was acting fast. I tried to calmly stop him and say, please don't. I got in his way and asked him calmly what he was planning to do. He said he was planning to get into the bath. Then he went back to throwing more things into the bath. Things continued this way. He turned on a shower and a tap, banged on a computer, climbed on top of a tall dresser, etc.

    I have learned that when I get upset and yell that he just escalates his bad behavior, so I try my best to stay totally calm. But there are times that he just will not give up until I have lost my temper. It's like that's his whole objective. I don't get it, and I'm really unsure what strategy I should be using at these times.

    In his new kindergarten, he is sometimes cooperative but not always. When he decides not to listen, there is very little the teachers can do to get him to cooperate. The other day he climbed over a fence at the edge of school property and was defiant when asked to return.

    We have plans to work with psychologist individually with floortime therapy and to have him observed in school again. I'm really scared about his behavior getting worse and him getting in a deep hole. We are spending insane amounts of money trying to help him and figure him out, and I'm just not sure that what we're doing is making any difference. The last couple of evaluations didn't tell us anything we didn't already know, and a social communication group he participated in seemed pretty useless.

    Some of his recent behavior seems classic oppositional/defiant and he is definitely a child who wants to be in control. But the defiance comes and goes. He also loves to be helpful and has many days when he's really cooperative. His family situation is stable, but he is much more attached to me than to his father. He is pretty mean and rejecting to his father. His father tries but is not able to be as patient as I am. Over time, it's created some imbalance (something we're hoping the floortime therapy will help). He started a new school for kindergarten. It's a great school. Only 14 kids and 2 full-time experienced teachers. Still, I know that the transition to a new school is a challenge for him.

    Any suggestions about dealing with the intermittent oppositional defiant and impulsive behavior? The loss of self regulation? Up until recently, I felt like I could always manage my son one-on-one but now I feel like even under optimum conditions things can be touch and go. I am out of ideas and a little panicked.

    Any thoughts would be much appreciated!!!!
  2. InsaneCdn

    InsaneCdn Well-Known Member

    Hi, and welcome.

    First, my personal bias: I do not buy into ODD as a useful diagnosis, other than as a placeholder for when professionals can't find the "real" problem yet. It is a diagnosis with no interventions, accommodations or medications that help... and at least in my experience, and observation of others, usually there is "something else" going on.

    And no, it is NOT your parenting! (you'll have heard that, I'm sure...!)

    Do you keep a journal? Everything from bed-time/wake-time/quality of sleep, what is eaten and when, what kind of activities are going on that day (and when), and the behaviours that are happening. When you write it all down for a few weeks, patterns often emerge that you don't see on a day-to-day basis.

    Example: My difficult child was... worse in the afternoon than in the morning, and much worse on Friday than on Monday. Something was causing accumulated issues to build up. It took us a lot of years to get to the bottom of it, but... it ended up being several different things, which taken together were a serious deficit. And then, compound that with many years of being treated the wrong way by school and medical systems (it's attitude, he's lazy, let him fail and that will teach him... )... and we have major issues to deal with.

    The definitions of Asperger's and Autism Spectrum Disorders (ASD) are just "lines in the sand" on a whole range of challenges. Some kids have many Autism Spectrum Disorders (ASD)-ish challenges (things that tend to go with Autism Spectrum Disorders (ASD) but not always), and are not on the spectrum... other kids are definitely on the spectrum but don't have so many of the other challenges. These include: sensory, motor skills, social challenges, LDs, and APDs (there are probably others).

    You're dealing with sensory and motor skills.
    Social stuff with peers can be the result of the sensory and motor skills issues plus developmental immaturity (was for our difficult child)... they get left out of the playground activities etc. because they can't keep up... and it can be very subtle.
    The biggest single issue we finally found? Auditory figure ground deficits (a form of Auditory Processing Disorders (APD)). But... even the professionals who know how to find these, often can't test for them until age 7 or so, due to the complexity of the tests.

    All of these can result in "burn-out" and "melt-downs". The current 'trigger' may just be the 'last straw' rather than the "real" trigger.

    You're doing well. You've gotten him some good evaluations and some good help. But... it really can be a long day when we're in the middle of it all!
  3. SomewhereOutThere

    SomewhereOutThere Well-Known Member

    What kind of professionals have evaluated him? Has he ever seen a neuropsychologist?
  4. steelgogator

    steelgogator New Member

    Thanks for the quick replies!

    Keeping a journal is a really helpful idea. Thank you. I also appreciate the reminder of the "last straw" dynamic. Last night, I think I identified the trigger and put too much emphasis on managing that today. But I think it was a last straw rather than a core stressor. It is really hard to process all the information in real time, so I think recording notes in a journal makes tons of sense.

    To answer the question, he has not been evaluated by a neuropsychologist. Do you think this would be helpful? He has been observed/evaluated by:

    - May 2011 a really excellent Occupational Therapist (OT) and therapist who has generally given very helpful recommendations (observed in school, did further assessment one on one, will soon observe him again)
    - October 2011 early intervention for our city (1.5 hour evaluation in office)
    - December 2011 a not-helpful Occupational Therapist (OT) (observed him in school)
    - Spring 2012 participated for several weeks in a social communication group with an Occupational Therapist (OT) (not helpful)
    - August 2012 a developmental pediatrician (1.5 hour evaluation in office)

    Because his main challenges are evident in groups of peers, when he is tired or stressed, and when he is just with his parents, it's hard for the evaluations to get a good picture of his challenges. I feel like the evaluations more or less just echo back the challenges that we articulate! With the exception of the one excellent Occupational Therapist (OT) who was the first to observe him in school and saw things that we didn't.

    I'd be interested to hear opinions about whether a neuropsychologist evaluation seems like a good next step. For some reason, no one has recommended it before.

    Thanks again for the replies. I really appreciate it.
  5. Malika

    Malika Well-Known Member

    Hello and welcome to the forum. I too have a challenging 5 year old... who is also, like yours, intermittently oppositional, defiant and other undesirable things and intermittently helpful, eager to please and very sweet.
    One thing I have seen is that he really has little or no volitional control over his outbursts and unpleasant behaviour such as screaming and shouting when I say no to something or when he wants something he cannot have immediately. Probably if we could somehow have an inside view of what is happening inside the brain at that moment and a real understanding of what is causing this behaviour, we would be less clueless and more compassionate in the moment. Well, I speak for myself anyway...
    Staying calm is very good, as you have discovered. Acting with unconditional positive regard is also very good. And very difficult. Your son is probably just like mine - he loves praise and encouragement and can be motivated to do things by positive rather than negative means. Rewards work very well, all the time, particularly immediate ones of course. Humour works very well with my son - he can always be relied on to agree to be tickled out of a tantrum, for example (or squashed, or made funny faces at). I'm thinking five year old here :)
    There's an underlying anxiety there, doubtless in your son too. Routine, stability, repetition are helpful.
    Please don't panic. Your son's new school sounds fantastic and is bound to help, after the initial transition difficulty. Good luck and I hope others will post more advice and insights.
  6. Tracy0197

    Tracy0197 New Member

    I am new to the forum too (just sought it out today) and feel like you just described by 5 year old! We are just starting the process of full evaluations, developing an IEP, etc. None of this was going on before he started Kindergarten either - it was like a light switch got flipped from low level defiance (doesn't always want to do what the adults say) to full blown opposition, anger, aggression, and severe attention seeking behavior. My husband and I are so lost.

    Our Kindergarten class is small too - 16 or 17 kids and at least 2 teachers, but they claim that is too busy and that they have too much to focus on with the other kids (just a cop-out, in my opinion), and we are having trouble getting them on board to try anything (other than paddling, which we forbid them to do.

    My husband struggles to interact with our son now, as well - loses his temper and can't give our son the positive interaction that he so desperately needs.

    I am interested to see what comes back on the neuro-psychiatric. We've heard that once or twice, but there are none in the area, so we are trying to work through the steps to get referred to one, even long distance.
  7. SomewhereOutThere

    SomewhereOutThere Well-Known Member

    1.5 hours isn't long enough for intensive testing. My son was tested for ten hours.

    Yes, I strongly recommend a neuropsychologist!!! Good luck :)
  8. InsaneCdn

    InsaneCdn Well-Known Member

    Tracy - welcome. You'll get more response, though, if you start a new thread. You can copy what you posted here, if you want...