Some more ??s: UPDATE

So DS will be 5 in December. He is in Pre-K right now and he just had his CPSE meeting. They are going to leave OT in 2x a week because he's making progress. I haven't heard of there being any issues in school at all. He seems to love it and can write his name and the basic letters.

We do continue to see a lot of issues with him in terms of his attention. When he starts to get tired as well, it can be a nightmare.

He becomes very physically aggressive and it can get scary, because he's not little anymore. I'm talking about kicking, pulling hair, throwing things, even biting.

Do you ladies have any suggestions? I feel in my gut he needs to be on some very small dose of something because he rarely naps anymore and this behavior can start in the early afternoon and carry on until 8 or 9 at night when he physically crashes.

He also is having major meltdowns now with the cold weather and having to wear warmer layers. Trying to get him to keep a winter coat on is a nightmare.

Since he's good in school though I don't think that's the route to go in terms of adding more services. I feel that it's more than that.

He is like this around me, DH, my ILs, my family and his aunts/uncles and some of our friends who are teachers have noticed.

Message edited 12/3/2013 6:46:50 PM.

Some more ??s

I would talk to your pediatrician about the behaviors he's exhibiting. It's great that he is good at school, but if this behavior is occurring at home, it could start happening at school. Your pediatrician would be to evaluate him and point you in the right direction.

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Anyone else? Not to sound dismissive, but the pediatrician's office kind of has always had a wait and see attitude........and deferred it back to me if I wanted to get him evaluated somewhere.

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I have had concerns about DS' behavior and his short attention span and behaviors. When I first brought it up to Dev. Ped. in the summer he told me I should consider meds but we would discuss after school started. We went back in October and after speaking to his teacher, she said he absolutely does NOT need medication for school. The psychologist suggested that he understands what is expected of him and is able to "hold it together" while in a school environment but then "unwinds" when he's home. We have been implimenting different behavior management strategies at home and while the sensory issues are still there (which we are trying to address seperately) it has been helping. All this said, he is only in school half day and will re-evaluate what happens next year when he is in school for a whole day (he may not be able to hold it together for that long).

As far as playing the wait and see game, let your gut be the guide. Peds only see our kids for a very short period of time. If I had waited around for my ped to refer me to EI it would have been months after I decided to cal the county myself.

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Thanks ladies :).

I don't need a referral from the ped so I think I will try the neuro as a next step.

I work for the NS/LIJ health system and have been impressed with their care even before I started work here. Does anyone have a rec of a neuro affiliated with the health system who sees kids?

I'm on the SS/Western Suffolk but don't mind taking him closer to Queens for a good one.

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Some more ??s

Have you had him tested for sensory processing disorder? Your description sounds very much like my son's behavior when he was in pre-K, I'm happy to go in to more detail via FM but long story short we had him diagnosed with ODD to get him services at school, but what really, truly helped him more than anything was OT for SPD. He processes activity different than others, and could not verbalize when things were bothering him. If your son is having meltdowns over wearing additional layers he could be tactile sensitive. We also found that if he has ANY red dye in his foods we are dealing with days of endless meltdowns. I was not against medications but wanted it to be a last resort (he won't even take tylenol for me).

Trust your gut and do not wait and see if you don't think it's right. I did wait at my ped's recommendation, and regretted it - K and 1st grade were rougher because of it.

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You can also ask for parent training. This is suppose to help you with issues that you are seeing at home and not at school. Depending on district they are hard to get though. I would go see a dev ped to get their take on it and they might be able to assist with some techniques to use at home.

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A think seeing a school psychologist privately through insurance may be beneficial. They can help you work on behavior modification and point you in the right direction in regards to adhd. You can try a behavior chart or token system at home.

My ds had aggressive behavior that went away as he matured. Sometimes he can be a little aggressive but I think it's more impulsivity. I can't tell you how much being in full day school has helped him mature.

Personally I don't love an odd dx. I'm not sure it would benefit you anything more than adhd would. Plus I would treat the adhd before I considered it.

Hope that helps. If you are really considering meds my ds is on a very low dose of vyvanse and he does well with it.

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We went to Sensational Development for the SPD evaluation and I would highly recommend them.

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Thanks, that's not too far from me.

I also took DS to a private psychologist before going the CPSE route and he told us to bring him back if we felt the need.

It's a lot of money out of pocket though.........I would rather not do that if they are going to be like, well, we need to wait until he's 7 to do anything.

This whole process is so frustrating.

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I totally get why you would consider odd if it helps you get services. I'm just saying in my situation where I thought adhd was the issue, I think oppositional behavior can a result of that sometimes.

We also tried a psychologist a few times. At the time we didn't have much of a goal since it was after the adhd dx. I think it could help with some behavior issues though. But like you said, it wasn't fully covered by our insurance, and it was a time commitment.

I know it's super frustrating to go through. Maybe you can ask the ot about the sensory issues.. Like with the clothes. They may be able to write up a sensory diet for you. I think that's what it's called.

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OK thanks ladies.

It's interesting because I have yet to have received a phone call from the OT.

I will follow up on these suggestions.

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When I was considering meds for DS, I was referred to Dr. Trepel at Winthrop. I heard he is very knowledgeable specifically with ADD/ADHD meds. I have an upcoming appt that I will not be keeping. Let me know if you want it

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I also wanted to note that my Dev. Pediatrician "scoffed" at not diagnosising ADD/ADHD before 7 and said that is the "old" way of thinking...

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Awww thanks. Let me get all of my ducks in a row a little. I am thinking of starting a daily diary to track all of the behaviors so they don't think I'm exaggerating.

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You seemed to have pinpointed the cause of the behaviors "being tired".

Proprioceptive input/vestibular movement helps keep the body alert. When your ds is in that "in between' stage of the day, where he is tired but it's not time for sleep, having activities to regulate him" can help prevent meltdowns. They should be natural and may truly help soothe him. For instance, when he gets home from school maybe a thick drink he has to suck through a straw, and some crunchy snacks or a bagel which requires a lot of oral motor work,.

"Dancing' to music, or something with movement, mini trampoline. Even something that makes his 'eyes' move (ocular motor) is considered vestibular movement. Watching bubbles can be a way of getting that input.

If he can play outside (if he doesn't already) after the school.

Joint compressions can help. Maybe even a compression vest protocol, 30 minutes on, 30 minutes off.

A bath right earlier than usual (water gives proprioceptive input)

What it sounds like is, he is trying to keep alert during a time of day he is fatigued. He is doing things that are negative but if you redirect him to some things that give the same input the negative may go away.

Try to get him with a great OT in a sensory gym.

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Thanks ladies, these are great.

I don't know if I mentioned that when he gets with my IL's, he's also there with his 3 younger cousins.

Now that it's cold out and they are cooped up in the house more and more, I am sure that is adding to the behaviors.

I will suggest to MIL that she just let him go outside and run around bundled up. He generally doesn't have a problem wearing his coat if play is involved.

Re: Some more ??s: UPDATE

So I contacted Cohen's today with intent of going through one of their neurologists.

They emailed me a packet of stuff for a developmental pediatrician and their ADHD program.

Over the past few weeks his behavior is actually getting worse in my opinion, especially with the clothing thing.

He now often doesn't want to wear clothes at all after his shower and in the AM when he wakes up and it's a HUGE battle.

I also think the meltdowns/temper tantrums are very developmentally inappropriate.

I didn't get to actually speak with someone because I was busy at work and then out of the office at a seminar this afternoon but I will report back what happens next.

Re: Some more ??s: UPDATE