Question about getting DS evaluated

[ljames103]

First off, thanks to everyone who responded to my other post about my son. Silly as it may seem, it helped a lot just to know that someone cares and knows what I'm going through.

Now, several people have suggested that I get him evaluated to find out what's going on with him. My question is, do I need to suspect a certain "disorder" to do that? Because I've done some research and nothing really pops out at me. Will I look silly if I just call up and say "I have no idea if anything's even wrong"?
Also, I'm not even sure who I should contact for that. Any ideas? I apologize for my ignorance on the subject. I feel a little dumb. You all seem to be so knowledgeable about this.

Anyway, any input greatly appreciated. I have no idea what to do next.

 

[SRL]

I just went back and read over your description and I am suspecting you would have a hard time getting a referral with just this. I don't want to jump the gun on suggesting evaluation but I don't want to miss since you are seeing enough to come looking for help.

Some further questions:
1) What does the family mental health picture look like--any bipolar, anxiety, obsessive compulsive disorder, depression, etc.
2) We're so used to defiance and explosiveness here that it would be good for you to clarify. When you say defiant are you saying that he doesn't obey quickly and easily or that he has tantrums that bring the household to a complete standstill for a few hours? (I just thought to ask that remembering that when my best friend described her daughter as defiant it was to her but she was a cakewalk compared to the kids we often see through here)
3) Are you noticing any quirky or unusual interests or behaviors, especially play behaviors?
4) Are you seeing any hypersensitivities to sensory stimuli like light, sound, easily irritated by fabrics, foods, etc?
5) The potty clogging issue is the sort of issue we frequently see in children with anxiety. Do you see that in him--fears of new places, things, severe separation anxiety, etc.?
6) Any speech delays or differences (such as adult sounding speech)?

 

[ljames103]

I realized that I didn't really give enough detail about Riley's situation. It's sometimes so hard to put into words. To answer your questions-



1) What does the family mental health picture look like--any bipolar, anxiety, obsessive compulsive disorder, depression, etc.

I have a history of depression and anxiety. I also have an uncle who's schizophrenic.

2) We're so used to defiance and explosiveness here that it would be good for you to clarify. When you say defiant are you saying that he doesn't obey quickly and easily or that he has tantrums that bring the household to a complete standstill for a few hours? (I just thought to ask that remembering that when my best friend described her daughter as defiant it was to her but she was a cakewalk compared to the kids we often see through here)

I guess defiance and explosiveness can vary a lot. I didn't think of it that way. Riley is defiant to the point where it seems like he enjoys getting in trouble (laughing if he gets yelled at, etc.) He also seems like he is frantically looking for something bad to do. He sometimes talks back for no apparent reason "stupid mommy" "I hate you", things like that. As far as explosiveness, it's usually when he loses at a game, or his blocks fall down, or his sister gets into his stuff. All pretty trivial things as far as I can see. He will scream, cry, hit, kick, throw himself on the floor.

3) Are you noticing any quirky or unusual interests or behaviors, especially play behaviors?

I haven't really noticed anything like that, at least at this point.

4) Are you seeing any hypersensitivities to sensory stimuli like light, sound, easily irritated by fabrics, foods, etc?

He is very picky about tags in his clothes, but I can't think of much else.

5) The potty clogging issue is the sort of issue we frequently see in children with anxiety. Do you see that in him--fears of new places, things, severe separation anxiety, etc.?

Riley has always had noticable anxieties, which isn't too surprising, because I have a history of that. He is very shy around strangers, and is nervous when we go somewhere new, even if it's something fun like storytime at the library. He cried when I dropped him off at preschool all last year (luckily he's doing better this year). It's also funny because when I remember back to him as a baby, I could never take him in a public restroom because he would freak out over the sound of the flushing toilets.

6) Any speech delays or differences (such as adult sounding speech)?

His speech has always been very advanced, almost to the point where it seems odd. I'm not sure that I would call it adult-sounding per se, but he definitely uses big words that I don't hear other 4 year olds saying.

 

[SRL]

I am thinking an evaluation might be premature for him at this point since the behaviors aren't causing serious functioning problems. Usually they won't evaluate unless there is at least one issue causing functioning problems for the child and I'm just not seeing that in your descriptions.

With the family history I would be very cautious, however, and if you see any recurring problems don't let it go very long wihtout digging for answers. Both anxiety and depression tend to run very strongly in families so if one or both would be present in a child it would be a great advantage to recognize that early.


Things to watch for:
-An increase in "irrational" fears such as the toilet clogging. This can go sky high very quickly and become very debilitating.
-Difficulty with transitions or changes in routines, such as when he goes off to school
-Language usage and comments getting in the way of social interactions. Sometimes kids who seem shy or to be standing off from other kids are actually doing so because they aren't naturally picking up on how to use social language.
-Any increase in defiance, tantrums, meltdowns that is causing functioning issues for him and/or for the family.
-Also watch for triggers (ie did he just watch a movie where toilets were involved or did he have a huge bowel movement) because sometimes you'll see patterns.

As for the toilet thing, since you have a firsthand knowledge of anxiety, I would recommend that when issues like these come up that you treat him like you want to be treated in situations that make you anxious--with understanding. Through the years my son has had some anxiety with things that I see as legitimate (fire) but also things that seemed silly (cabbage white butterflies) and those that seem inappropriate for his age/developmental stage (going to school all day). Over and over again I found that when I pushed him or demanded that he rise to the situation he not only wasn't able to, but that I usually added to his stress. When I backed down, took a different route, put something on hold, changed strategies, and gave him time, that's when he was able to make the most lasting progress. Also very helpful is finding ways to empower him to head off and/or fix any fearful areas. My son suddenly became hysterical over the level of water in the tub but a simple solution turned out to be to take a permanent marker and write instructions and arrows so he could turn off the knobs at any time. Maybe you could bring up a plunger and show that clogged toilets are going to be fixed.

Hope this helps.

 

[jal]

Your Riley sounds exactly like my child in a lot of ways. My difficult child is 4.5. He does not like the noise of public toilet's flushing either. He talks advanced for his age (always has) but not like an adult. He hates us one minute, loves us the next. We are stupid one minute, smart the next. My difficult child too, loved to laugh at us when he was being punished or yelled at. Consequences mean nothing. He says sorry so non-chalantly sometimes you want to scream. He started behaviors like this though around 2 years and they have just continued. He though actually started the acting out in daycare and then eventually brought it into the home. He was so bad at daycare they could not handle him and the rages. He was kicked out of his first daycare, wore his welcome out at his second and kicked out of his first preschool. Currently, his 2 preschool teachers opened their own school (they were from the school he got kicked out of) and have worked so patiently with us.

Currently, with medication he has been able to cope much better during the school day. If he did not get his way or was told know he would lash out physically, kick at the teachers, scream, tell them he hates them. He would never stay in time out, it just angered him more. We still have issues at home, but things with both home and school have mellowed.

Good luck!

 

[BusynMember]

I never think it's too early for an evaluation. AT his age, you probably can't get the right diagnosis, but you can certainly get referrals for interventions that can help your boy. My son was "not diagnosable" at his age either. It turned out he has Pervasive Developmental Disorder (PDD)-not otherwise specified and, if not for his early interventions, he would not be doing so well now that he is 13. I would go for a multidisciplary evalution either at a children's or university hospital. They will point out trouble areas and, although the diagnosis is very likely to change as he ages, give you a working diagnosis so you can get him into your school's early intervention program. SOMETHING is going on and I think you know it. His regression in speech is a red flag. Your family history is also a red flag for many possible disorders. At his age, in my opinion, getting the right interventions to help him is more important than the diagnosis. If he is violent, however, he may need medications so he can calm down and learn. I advise against stims. That's my personal bias with violent kids. I personally, not being a doctor, have not seen good things happen long term to kids who are violent and take stimulants. I'm thinking he shows some signs of autism (high functioning, like Aspergers), some of bipolar, some of other stuff. Here's a Pervasive Developmental Disorder (PDD) test you can take online to maybe give you direction, and a site about early onset BiPolar (BP), but I'd NOT diagnose your own kid. It's too hard. And I'd skip the therapists for diagnosis. They dont have the education to do it. School districts aren't good at diagnosing either, however they can offer excellent help. Here ya go:
http://www.childbrain.com/pddassess.html

 

[smallworld]

Hi Laura, welcome! I'm glad you found us.

Has anyone recommended reading The Explosive Child by Ross Greene? The techniques outlined in the book really might help you with the meltdowns.

I have two kids who were very anxious as toddlers/preschoolers. Both my son (difficult child 1) and daughter (easy child) had separation anxiety when going to preschool and trouble transitioning. We had frequent meltdowns that didn't always make a lot of sense and often seemed out of proportion to the event. They also had sensory issues with clothing (sock seams!) and some food textures.

When easy child was 4, she was diagnosed with selective mutism, a form of social anxiety. She would only speak with us and peers, no adults that included her preschool teachers or even grandparents. We sought help from a psychologist who worked with easy child on coping skills to overcome her anxiety. It was very helpful. Since then, her anxiety has shifted and taken a lot of different forms. She now sees a child psychiatrist for medication management and weekly psychotherapy.

I don't usually recommend this, but if you're struggling at home with Riley's anxiety, you might want to get involved with some therapy that will help Riley cope with his anxiety and help you cope with Riley. The trick is finding the right person. Some therapists focus on modifying the behavior rather than trying to understand it and work with it. You don't want the former. You do want a therapist who will work on coping skills and techniques similar to the ones outlined in Ross Greene's book.

Anyway, just my two cents. Certainly, if the behaviors worsen or become more worrisome, you definitely would want to seek out a multidisciplinary evaluation.