Does this sound like a child with special needs?

[4Marmalade]

We have been struggling for a while now and I have three recent examples that I need to get out there and discover if it's in the realm of "normal" or there's more going on.  Background - ds1 is 8 years old and always been a "handful".  We recently had some evaluating done but it was only an hour long video conference with a child psychologist as well as a local behavioural therapist.  It resulted in them telling us he might have some issues with anxiety and some sensory things going on.  But it was very vague adn I did not have a great feeling coming out of the appointment.  The therapist wants to work on some of his anxiety which we will do.  But it seems like so much more than that.  I also have friends (who don't actually see ds in meltdown mode) tell me that their 8 year olds get upset over some of the same things and can meltdown.  I go back and forth between thinking ds is typical and maybe we're not doing a great job parenting him and thinking something else is going on. These are three examples of the last couple of days:

Example #1 - dh and ds1 were planning on a snowshoe hike.  Ds was given 20 minutes to get his outdoor gear on and get outside.  We've been struggling with him getting ready on time for things so dh told him he needed to be ready by 9am if they were going to have enough time to go (we had to be somewhere else later).  Ds did not get ready in time so dh calmly told him they no longer had time to go.  Ds has a complete meltdown in which he tore open a large box of toilet paper and threw the rolls all over the basement.  Screaming and crying the entire time.  After calming down (15 minutes later) he was told that he needed to clean up the mess before going outside to play.  He eventually did this.

Example #2 - ds saw me having some frozen mango and yogurt and decided he wanted some too.  He found out that we had finished the mango and proceeded to yell and scream at me and slam things around.  Screaming at me that we had a rule to ask before we finished something (normally we ask this to be followed at the dinner table when someone wants the last of something).  I did not think about it in this instance because ds hasn't wanted yogurt in a year.

Example #3 - this morning he asked dh to make him some toast.  Dh had just sat down to eat his own breakfast so he told ds that he would make it as soon as he was done.  Ds had already eaten some cereal so we ask him to wait.  This is not new and every time ds has a hard time with us doing this.  This morning he freaked out and cried and ended up throwing the jam (luckily the glass jar did not break) and tub of margarine on the floor.  The margarine spilled everywhere and when I told ds he would need to clean it up he proceeded to try to smear it everywhere.  He was crying and screaming the whole time and acting like he would kick or hit us.  I ended up removing him.  Later in his room we talked and I told him he needed to fix the problem and I expected three things: an apology, mop the kitchen floor and money from his allowance to replace the margarine.  He was not happy but complied once he calmed down.

Is it at all "normal" for an 8 year old to become so frustrated and disappointed that he acts out this way?  It is a full body meltdown and he is out of control during it.  I know his anxiety is a bit of an issue because it is not new to us and I am glad we are getting some help with that but with the above examples it is hard to see the anxiety issue.  It just seems so much like a purely defiant child.  He so desperately wants to control everything which causes major friction in a family of 6.  He very rarely does anything we ask easily.  He also seems to have poor impulse control, almost like he can't stop himself from doing things.

We are not perfect parents but we are there for our children.  I am a SAHM, we spend time with them, talk with them, listen to them.  We try to practice gentle discipline and have expectations/responsibilities for our children.  We have basic rules.  I read a lot.  Dh and I come up with different strategies to try and it feels like things are always falling apart.

He is fine at school although that is where we more of the anxiety issue.  He likes routine and is very much a perfectionist and is not as social as some other children.

I'm sorry this is so long.  I am in tears because I am so overwhelmed with his behaviour.  It is not OK, it is causing stress in our family.  He is on a waiting list for a pediatrician.  We can also get a neuro-psych evaluation done but that will cost about $1500 out of pocket.  Not ruling it out but......  For the record, ds is a great kid.  He can be loving to us, kind to his siblings (rarer now that they are older and he wants to control them) and sweet.  He is smart, has a insatiable desire to talk and be part of the adult world and is very active and energetic.  

How can we be doing such a horrible job with this? 

[Emmeline II]

1. No, this is not normal.
2. No, it is not your parenting. There may be other ways to more effectively parent him, but you did not cause this. Having a second child who is the complete opposite of ds was helpful in keeping us from thinking that we "caused" ds.

If you can, I would try a different therapist. I've found so far that I get a sense of whether or not someone is going to be helpful with ds. I would also have a video camera ready and try to record one of your son's tantrums--people really do not understand what these are like until they see one. We finally have an appointment with a developmental ped next week for an evaluation and will get the results next month.

A lot of what you describe is similar to my ds (nearly 7), though in K he had severe behavioral issues; now he is on his second medication (Concerta, then Vyvanse) for ADHD and is doing very well in school since the medication change, though the first med was still a huge improvement over K. The second med greatly increased his impulse control; he argues much less in school and has stopped raiding others lunch boxes (this had become a huge problem by December).

Quoting myself in another thread:

We tried a family therapist for awhile and pretty much just figured out that our discipline style did not really impact his behavior; though too lenient or strict made it worse, the middle ground did not make it better, just not worse. Ds appears to have little intrinsic motivation to "do the right thing" and lacks in empathy; though these seem to have improved with medication.

Kindergarten was hell; I'll pm you the bullet list I took to the family doctor for a referral to a developmental pediatrician. Though ds' behavior at home improved immensely after a couple months of school.

So, we went to the family therapist from February to May. In June I took my bullet list to the family doctor who diagnosed ADHD/ODD on the referral form; I sent the referral form to the local children's hospital that has a clinic with a developmental pediatrician--once an appointment is had it is a full day of interdisciplinary consults and evaluations.

While waiting on the DP we had an evaluation with an occupational therapist in July; this report was very useful in communicating what ds is like, to his teacher, therapist, and psychiatrist. The OT noted his sensory issues but also said she say signs of Asperger's but she is not qualified to diagnose that.

In August ds freaked us by playing with matches in a closed bathroom and we finally took him to a child psychiatrist. The psychiatrist diagnosed ADHD/Adjustment Disorder w/Mixed Disturbance of Emotions and Conduct. but is not ready to diagnose Asperger's yet; she also recommended "psychotherapy"; I found that the therapist she recommended does CBT and we're hoping that ds will benefit more from her than the last therapist, though she did mention how "unique" ds is in his issues. Ds is now taking Concerta.

Ds school experience this year is MUCH MUCH MUCH better than last year. Though he is still exhibiting the same "quirks," he is now redirectable. His new (charter) school is much smaller, he has a more understanding/flexable teacher and a special ed person who actually sees ds issues as something to be addressed with actions other than behavior charts. Ds is also gifted which complicated things with his last school (which is primarily concerned with working on grade level, anything beyond that they didn't care).

Sensory Processing Disorder Checklist

[LynnS6]

Quote:

Originally Posted by 4Marmalade 

Is it at all "normal" for an 8 year old to become so frustrated and disappointed that he acts out this way?  It is a full body meltdown and he is out of control during it.  I know his anxiety is a bit of an issue because it is not new to us and I am glad we are getting some help with that but with the above examples it is hard to see the anxiety issue.  It just seems so much like a purely defiant child.  He so desperately wants to control everything which causes major friction in a family of 6.  He very rarely does anything we ask easily.  He also seems to have poor impulse control, almost like he can't stop himself from doing things.

The things that I bolded struck me as definitely not being typical for an 8 year old. One of my 'criteria' for looking at the possibility of special needs is when parenting techniques that work with most children simply do not work with your child. If you're doing most things right as a parent and it's not working/getting better, it's time for outside help.

The question I have about the anxiety is whether the anxiety is the cause of the need for control, or whether it's the result of his feeling out of control. Anxiety can cause a need for control because it's one way to reduce the anxiety. If you know exactly what's going to happen, then your anxiety is manageable. I come from a long line of anxious/controlling people ( me too!) and the more out of control we feel, the more we want to micromanage the world. It's not a great personality trait, and I've learned to recognize the symptoms and try to reduce those tendencies. However what your son is doing seems to me to be more than that. If his body/mind is out of control, I could see that causing control issues in other areas of his life.

The lack of ability to regulate himself (time or emotions), the poor impulse control and the full body meltdowns make me wonder about ADHD. But there are a myriad of other possibilities that you can't know without having them checked out.

A good book that I really like is: The Challenging Child by Stanley Greenspan -- he's got a chapter on the defiant child that might be helpful.

 

[4Marmalade]

Emmeline II - thank you so much for your response.  It was the same for us in terms of having that second child to see just how different ds1 was.  I tried to record ds once and he became even more distraught and basically attacked me so I had to turn it off.  I think we have a difficult time with this because ds1 does so well in school.  Any time I've mentioned any concerns to his teachers they are surprised to hear about any issues.  The only thing his current teacher has mentioned is that she really needs to encourage him in his work because he is very afraid of making mistakes so she wants him to become more confident with his work.  He is very smart, a rule-follower and quiet in class.  I would be very surprised to hear about him being aggressive or destructive in any way.  I know he can be anxious at school when the routine is changed or there's a test coming up, etc...  but for the most part he enjoys school right now.  It was a struggle to get there as he had major separation anxiety for kindergarten but aside from the first few days of school he adjusts fairly easily now.  I definitely think there are some sensory issues going on.  

LynnS6 - thank you.  I've read about the anxiety issues and I agree with you that it's difficult to know where the anxiety is the root cause of the outbursts and inflexibility or if the anxiety is a symptom of something else.  I suppose ADHD is a possibility as he could probably be termed hyperactive and he does have some impulse issues but the inattention is not there (in ADHD terms anyway).  But like I said above it's so difficult when home is the only place we are experiencing these behaviours.  It really makes us doubt ourselves.   

[Emmeline II]

Are either of you tech savy? Perhaps you can use a laptop camera or nannycam type thing to record him so he won't see http://nannycam.com/. They are not cheap but it may be the only way to show what is really happening. Another option may be to see if you can find a similar tantrum online--such as on youtube.

I would do some research into ODD also. I found this website of a psychiatrist in Nova Scotia; not the easiest read but you may find useful info there. http://jamesdauntchandler.tripod.com/table_of_contents,Oppositional Defiant Disorder (ODD) and Conduct Disorder (CD) in ...

The American Academy of Child and Adolescent Psychiatry offers excellent resources on ODD at

www.aacap.org/cs/ODD.ResourceCenter.

I agree that you really need a more in depth evaluation. The hospital clinic that Ds' evaluation is at next week, has asked for reams of forms to be filled out by me, his therapist, psychiatrist, teacher, and special ed coordinator.

That psychiatrist I mention above has some advice on finding a pediatric psychiatrist http://jamesdauntchandler.tripod.com/

http://www.mayoclinic.com/health/oppositional-defiant-disorder/DS00630/DSECTION=preparing-for-your-appointment

[homemademomma]

Sorry to bump an old thread, but I am just coming to terms with the fact that my 7yo ds most likely has a behavioral disorder. My googlepsych degree makes me think it is ODD.  I could have written your OP verbatim, Karen.  He has had behavior problems his whole life (mainly out of control tantrums), but it would come and go, so by the time we decided we needed to seek intervention, his behavior would stabilize and we would think he had grown out of it.  I think he might have some anxiety as well, as his current behavior seems tied to the fact that we are moving again.

He does well at school, for the most part. His work is often messy and he can  be inattentive, but we get good feedback from the staff and his teacher. He does appear to have some mild sensory issues- socks and pockets and whatnot; very similar to what I experienced as a child (I have mostly outgrown it)

Last night he had an epic meltdown that prompted us to call a therapist and set up an appt. It was awful. I had to sit on him and hold his arms down so he would stop punching us and throwing things. It finally ended when we gave in to what he had wanted in the first place- watching tv. He had lost his tv privilege for the evening because of consistent rude and mean behavior, despite multiple warnings. 

It makes me so sad. When he is happy, he is SO GOOD. Everyone comments about what a polite and pleasant kid he is. Sometimes it seems that there is no trigger, and other times it is obvious what sets him off, but he generally only acts like this for me and dh. I know that we are not the best parents, but we do try. My 4yo has SN so that probably plays a part. My dh and I also fight way too much. I love my son and I just want him to be happy. It kills me when he acts like this. I am so scared of what will happen when he is a teenager. 

[Emmeline II]

I may be repeating myself (I did not reread above).

It may actually be ADHD w/ conduct disorder (it technically would not be called ODD at his age--also, he need not be hyperactive for the diagnosis)--ds' diagnosis from the psych was "ADHD with disturbance of emotion and conduct." I would contact a place like this Developmental and Behavioral Pediatrics - Connecticut Children's ...  If the DP appointment is far out I would contact a psychiatrist experienced with ADHD and conduct disorders in children for an evaluation.  For ds, medication helped a lot; he did not show progress in his cognitive behavioral therapy until we hit the right med, but ds' "wild we're trying to murder him" tantrums ended when he started medication. With conduct disorder, clear expectations, consistent enforcement, and not giving in are important. With ds, more media (TV/computers) made him harder to handle in general so we did cut it out completely for a time.

[homemademomma]

Originally Posted by Emmeline II 

I may be repeating myself (I did not reread above).

It may actually be ADHD w/ conduct disorder (it technically would not be called ODD at his age--also, he need not be hyperactive for the diagnosis)--ds' diagnosis from the psych was "ADHD with disturbance of emotion and conduct." I would contact a place like this Developmental and Behavioral Pediatrics - Connecticut Children's ...  If the DP appointment is far out I would contact a psychiatrist experienced with ADHD and conduct disorders in children for an evaluation.  For ds, medication helped a lot; he did not show progress in his cognitive behavioral therapy until we hit the right med, but ds' "wild we're trying to murder him" tantrums ended when he started medication. With conduct disorder, clear expectations, consistent enforcement, and not giving in are important. With ds, more media (TV/computers) made him harder to handle in general so we did cut it out completely for a time.

I thought conduct disorder was typically not a diagnosis given to a young child? My understanding is that ODD can lead to CD if not treated.

Anyway, the screen is definitely a trigger for ds. We have completely cut out tv and video games for long stretches and it definitely helps. We had another complete meltdown tonight, and I haven't the slightest idea what triggered it.  
 

[mom2mygirls]

if you feel something is not right have him re evaluated mothers always knows best. good luck!

[joensally]

4Marmalade and homemademomma, hugs to you. 

I'm underwhelmed by the diagnostic criteria for ODD in the DSM-IV.  It is more descriptive than determinative. Kids with ODD aren't usually able to maintain at school, and it involves a lot more than rigid thinking and lack of emotional regulation.   Here's the DSM criteria:

http://www.behavenet.com/capsules/disorders/odd.htm    Conduct disorder is usually reserved for an older age when a youth is engaged in highly antisocial, destructive behaviour.

I would highly recommend you both seek in-person help from someone with a broad range of experience, at the psychologist or pediatrician level.  From your descriptions, it could be unfettered anxiety, ADHD/ADD, sensory issues, autism spectrum, executive function deficits, something else, or a differential diagnosis (more than one thing).  Anxiety is a funny thing - is it the chicken or the egg?  Is the behaviour a manifestation of anxiety, or is the anxiety a manifestation of something else (ie kids with sensory issues often have anxiety due to their discomfort in their world)?

Reading about the prefrontal cortex may be very helpful:  Kids reach a "point of no return" where they can't regain their equilibrium.  The prefrontal cortex does not completely develop until the mid-twenties and is the CEO of decision making.  When kids amp up, the prefrontal cortex can shut down and you're not dealing with a reasonable person.  There's an apex to this, the amped up brain chemicals recede and the child returns to a more reasonable point (this may involve apologies, crying, self-soothing, pretending nothing happened).  IME, expect less when they're out of control, help them to regain equilibrium and only then deal with the issue - do not get into conflict with them when they're out of control as this isn't the time for parental discipline as they won't hear it, they'll just negatively react.  They're really just oversized two year olds who need adult help to regain equilibrium.  Outside of these episodes they need structure and lots of coaching to help them build their emotional regulation skills so that they get better over time.

I have some recommendations for books:

Smart but Scattered

http://books.google.com/books?id=J5MA8e5YHmQC&printsec=frontcover&dq=smart+but+scattered&hl=en&ei=TDPETcbcBYGisAP9n6m8AQ&sa=X&oi=book_result&ct=result&resnum=1&ved=0CDAQ6AEwAA#v=onepage&q&f=false

This is a great book on executive function, and whatever your sons are experiencing it's very likely to include executive function challenges.  The book includes descriptions of where a child should be functioning by age, making it easy to determine where a child is ahead, on target or struggling.

The Mislabeled Child

When the Labels Don't Fit

http://books.google.com/books?id=kPtmPoUAfXMC&printsec=frontcover&dq=when+the+labels+don't+fit&hl=en&ei=pzbETZiNMZOesQOH3ojBAQ&sa=X&oi=book_result&ct=result&resnum=1&ved=0CEgQ6AEwAA#v=onepage&q&f=false 

I really like this book and the author is extremely gentle, reassuring and comforting to the intended reader - a parent with a child with challenges who is trying to figure out their child and navigate the system.

This is targetted for older kids, but has great ideas about parent attitude/thinking that I found helped:

Getting to Calm

http://books.google.com/books?id=aYGDd3DjR0wC&pg=PR15&dq=calm+parent&hl=en&ei=1jfETeerCY-gsQOC6bDrAQ&sa=X&oi=book_result&ct=result&resnum=8&ved=0CEsQ6AEwBw#v=onepage&q=calm%20parent&f=false

This is good for dealing with ADHD/low impulse control issues:

Transforming the Difficult Child: The Nurtured Heart Approach

http://books.google.com/books?id=aYGDd3DjR0wC&pg=PR15&dq=calm+parent&hl=en&ei=1jfETeerCY-gsQOC6bDrAQ&sa=X&oi=book_result&ct=result&resnum=8&ved=0CEsQ6AEwBw#v=onepage&q=calm%20parent&f=false

Good luck to you both.

[Emmeline II]

Originally Posted by homemademomma 
I thought conduct disorder was typically not a diagnosis given to a young child? My understanding is that ODD can lead to CD if not treated.

I think you are right and I had it backwards.
 

[mistymama]

My son has Aspergers and AHDH - example #1 he would totally do. It's normal for him. We are working hard to get to where he is more self sufficient but as of right now (8 years old, 2nd grade) he still needs multiple reminders in the AM to get ready for school.  "Alex get your shoes on ... Alex what are you supposed to be doing?!"  etc, etc .. he takes the same thing at school and has an IEP dedicated to helping him be more self reliant in this area. 

The throwing stuff and temper tantrum like stuff I can't really relate to - although he does have some very intense emotions. I think he's just learned how to deal with them in a more constructive way.

Have you taken him to a child Psychologist?  We did that after Kindy and got the Aspergers/ ADHD diagnosis. My son is medicated for school and as much as I was 100% against it ... it has helped him focus SO MUCH.  I don't see the results at home since we don't medicate on weekends or holidays and it's worn off before he gets home .. but as far as school goes it makes a huge difference.

Anyway, your post screams ADHD and impulse control issues to me, and I would certainly look deeper into them.

[beenmum]

The fact that he can calm down and follow through on consequences seems to me that he has a temper and doesnt like it when he percieves that he has been wronged.

Its not horribly abnormal. HE may have some mild anxiety issues, possibly in regards to controlling his environment.

But honestly the fact that he could calm down and then actually do and understand his consequences is a good sign.