Saturday, May 5, 2012

This week

After losing his mind last Sunday at Target, Monday was actually a good day at school.  It went downhill from there.  He was sent home Tuesday and Wednesday, and wasn't sent home but was sent to the office on Thursday and Friday.

He struggled at soccer this week, too.  It's hard to believe but he has NEVER had a problem with sports.  He's never given a coach or teammate or opposing team attitude, and he's played against some aggressive kids.  This week at soccer he was irritable from the first moment during practice, and he got angry during the game when he wasn't in.  Daddio reports that he listened well to his coaches at tee ball today.

Sunday, April 29, 2012


Sorry for abandoning you, blog.  While I think that documentation could be super-helpful and this is a format I'm familiar with, I'm barely keeping my head above water so this has fallen by the wayside.

So to randomly jump to today, a small amount of background: the psychiatrist suggested that if we don't see improvements by our next appointment, that we seriously consider a medication called Tenex.  The same drug is in another ADHD medication called Intuniv.  I don't know the difference.  I said that I'd rather make sure I tried all non-medication options first, which would include an elimination diet.  Some people with children with ADHD or Autism-like behavior have found that their children are intolerant of certain food or food additives.

I'm not quite ready to dive into that but wanted to document this instance - Today Daddio got the kids doughnuts at around 11:00 a.m.  They're yeast doughnuts with chocolate icing and maroon and orange sprinkles.  Sprout ate a whole doughnut and Little Man ate half.

I took the boys for haircuts at noon and they both did fine.  After that I took them to Target to get things for Little Man's "sensory bag," which is something we decided to put together with the daycare.  Hoping that some tactile toys will help him calm a bit when he's not ready to make the choice to come back to a 1 or a 2 on the 5-point-scale.  I want him to take ownership of the bag so he decided to call it the "choices bag" and come with me to get things for it.

He asked if he could pick out unrelated toys, and I kept saying no.  He would neither stay with me nor stay in the cart so I left the cart, picked up Sprout, and carried him out.  Little Man followed and by the time we got to the door he was hitting me with his hat.  In the parking lot he bit my arm.  I forcibly strapped him in his carseat while he hit me repeatedly.  When I went to put Sprout in his seat, Little Man unbuckled himself and got out of the car.  I told him he'd get hit by a car if he ran away from me in the parking lot, and I again forcibly put him in his seat.  He screamed and cried and kicked my seat all the way home.

This all started about 2 hours after he ate the doughnut.  Previously in the day he'd eaten high-fiber cereal and half a banana.

ETA:  Of course yesterday he had a blue Hawaiian Punch drink which I'm sure was full of artificial colors, preservatives, and HFCS, and the day was fine.

Wednesday, March 7, 2012

Sent Home Today

I wish I'd kept better records of when he was sent home. We just got the call that he hit a kid today. I think he's averaging about once every other week (0.5/ week) or twice every three weeks right now (0.67 times per week). He tried to hit a teacher and missed on Monday which saved us from an early pickup, and one day last week I think he hurt someone right at the end of the day because he was in the office when Tim picked him up. But they didn't bother to call because it was after 5.

Public school psychologist and behavioral specialist said that if he is in control of his actions in those moments and simply didn't understand that that behavior was unacceptable at school, this "consequence" will work and we won't see him coming home as often. We have seen a decrease. Week one he was sent home 3 times. There have been incidents where he's clearly testing the school to see if they'll really send him home. He said, "You can't send me home if I hit you" then hit an administrator.

So the success of this plan is iffy. Except it's not really a plan to adjust his behavior. It's a coping mechanism on behalf of our daycare. So we don't have any say in the plan other than to switch daycares and frankly we're just trying to get through the next [less than] 6 months until we can get to public school.

Friday, February 3, 2012

Sent Home

Little Man was sent home today for punching an administrator. So for my own records, since the policy started on 1/9, he was sent home:

1/18 (he wasn't sent home but I knew he couldn't succeed at school after he hurt me after an appointment so I brought him home)

He did seem repentant today when I picked him up; he apologized to me and told me he apologized to the person he hurt. He also didn't want them to call me and send him home, so that's a good sign. I was told that he has caught himself before hurting someone recently, so that's good.

On Monday the behavioralist from our local public schools is scheduled to observe him. I'm hoping for something useful out of that.

Also on Monday, we have an appointment with a local organization that I'll call Community Services. I'd always thought it was income-based and only took Medicaid. But it turns out they're open to the public. They have a variety of counseling options as well as psychiatrists, and we're on the urgent list so hopefully that will be what we need.

Monday, January 30, 2012

Early Intervention - It's Great in Theory

Since we last spoke, our pediatrician referred us to a psychiatrist here in town.  The psychiatrist told someone in the pediatrician's office that he needs us to go to a counselor first and get referred from there, and even told us which counseling office to go to.  So we did.  This counseling appointment was a frustrating experience because once again, Little Man had to just sit there and play while we talked about him with him in the room.  And after all that the counselor suggested a book called 1-2-3 Magic.  Which I'm sure is a lovely book on discipline, but we've been working for over 2 years to ensure that Little Man understands the expectations for his behavior and that we have immediate, logical consequences for him.  I'm willing to read and try the techniques in this book, but his violence & outbursts aren't going to be solved by counting to 3.  I did schedule a follow-up for us with this counselor.  She's quite young and the book thing frustrates me, but I do feel that she's sincerely trying to figure out what will work for Little Man.

She, like the pediatrician, suggested high-functioning Aspergers.  It's funny that people who have interacted with him (psychologist briefly, and a family member who is a child psychiatrist, plus Daddio and me) don't see Aspergers, but people who have spent little time with him and are making assessments primarily on what has been written about him (pediatrician, counselor) say Aspergers.  We're willing to get assessed for it and I've contacted the VT Autism Clinic, but I was told immediately that the waiting list is up to a year long.  At that point we might as well take him to a city that has more resources to get him assessed.  But since Daddio and I are both still skeptical of this path, I'm not sure how many hoops we're willing to jump through.  The Autism Clinic gave me the name of a psychiatrist/ physician duo in Roanoke who may be able to help.

The counselor also said it seemed funny to her that a psychiatrist is requiring us to see a counselor when we've already been referred to psychiatry by our pediatrician.  So I went ahead and called the counseling group that this psychiatrist is with.  And they don't see kids under 10.  You have got to be kidding me!  So I called the pediatrician's office back.  They seemed a bit confused.  One message they gave me was that they knew that this office doesn't see under 10.  But then they kept referring back to a note that said that this psychiatrist will manage medication for kids of any age.  I updated the person working on the referrals on what we've done so far and where we're at in regards to his assessment/ treatment, and she's trying to find something that will work for us.

In the meantime, we sent everything we have to a family member who is in child psychiatry.  He said that any psychiatrist we see will suspect bipolar disorder due to family history and Little Man's unpredictability.  But it's just too early to tell on that.  Plus, mood stabilizing drugs are difficult to manage, especially in little people.  He felt that ADHD is a decent theory to explain Little Man's "poor frustration tolerance" and violent outbursts.  We are just about convinced to try an old-school stimulant-based med.  These work quickly and metabolize out quickly.  So if there are negative side effects, they'll be gone by the end of the day.  There was one that he specifically recommended against due to the possibility of a developing mood disorder in Little Man.  However, as I mentioned in my prior post, our pediatrician isn't willing to medicate.  Which is part of the reason we need a psychiatrist.  Alternately, we could switch his primary care physician to someone willing to medicate.  I don't think we're there yet, though.

And hence, the name of this post.  Early Intervention - It's Great in Theory.  We are really trying to intervene on behalf of our son to get him ready for Kindergarten.  And ultimately, our goal is to find techniques that we and his teachers can use to cope now, but also that he can use to cope throughout his life.  And we've all heard that early intervention is key.  But it's darn hard to get early intervention.

Up Next: I experienced a violent outburst personally and lived to tell about it.

Friday, January 20, 2012


Sorry to abandon you so soon in our relationship, blog.  Actually dealing with Little Man has left me with little emotional energy with which to document it.  Here's an edited version of a summary I sent someone late last week:

Little Man's violence has gotten worse.  He punches a classmate or teacher 2-3 times per week now.  The daycare instituted a policy this week that if he hurts someone, we have to pick him up immediately.  This is the third day this week I've picked him up early.

Here are the results of the things we've investigated:

Non-Verbal Learning Disorder: Psychologist gave him the WPPSI.  His verbal IQ is 34 points higher than his performance IQ, which qualifies him for Non-Verbal Learning Disorder.  She feels that if his attention span were better the performance IQ would come up, but that it would still be far enough away from the verbal IQ to qualify him for this disorder.  We have an appointment on Monday with a speech pathologist to do her own evaluation.

Sensory Processing Disorder: The Occupational Therapist said she noticed a few things but nothing to qualify him for OT.  She did think she saw anxiety in the frequency that he checked in with me during the appointment.  For example, he interrupted to ask me when we were going to gymnastics again.  We haven't done gymnastics in almost 2 years.

ADHD: After spending 45 minutes with Little Man giving him the WPPSI, the psychologist concluded that he has ADHD and is approximately in the mid-range of kids who have it.  Our pediatrician, however, feels that the violence (which at this point is all Daddio and I care about, not whether he can sit still during circle time) is not a symptom of ADHD and that to medicate a 4-year-old for something that's not his primary problem would be unwise.

Anxiety: Little Man has been observed by the elementary school psychologist in our county and the special ed and preschool coordinators of the school we're zoned for.  The psychologist feels strongly that Little Man is more anxious than other kids.  He said that in one hour Little Man ground his teeth 6 times and set his jaw (the visual is an adult preparing to run a race or do some other daunting task) 12 times.  He was not able to see one of Little Man's outbursts.  The private psychologist, however, told us that kids who suffer from anxiety are obsessed with death or harm.  Little Man is not.

Bipolar Disorder: We informed the private psychologist that bipolar disorder runs in the family (I had some family history here).  She said that she does not see bipolar disorder in Little Man at this time.  I also understand that bipolar disorder usually becomes apparent later in life.

Future Steps:
Our pediatrician has referred us to a psychiatrist.  However, all psychiatrists who treat children in our area or even in the closest city have a 6 month waiting list, and even at that point they require you to see their psychologist first.  We're going through the steps of that process now, but it will be a long time before we'll see any results.  Our pediatrician is thinking that Little Man's problem is Oppositional Defiant Disorder (which I pretty much self-diagnosed in him a year ago) and perhaps Autism Spectrum Disorder.  We're skeptical about Aspergers but willing to do anything that could help.
The behavioralist for our county school system has an appointment to observe Little Man at school on February 7.

We have been working closely with our daycare as well as the special ed department in the county.  We are confident at this point that consequences for his behavior are consistent.  There has been no improvements.

Little Man does have outbursts at home, which result in us putting him in his room with the understanding that we'll talk to him when he's done.  He can rage on for quite a while, the longest being 90 minutes.  He has never hurt Sprout.  He doesn't hurt animals.  He hasn't ever hurt friends in a private setting such as our home, someone else's home, or sports.  In fall soccer one team we played against was aggressive and he was pushed to the ground more than once.  He didn't seem tempted to retaliate, and instead told an adult that he was pushed.

He sleeps well and eats well.  Dentist and doctor have cleared his health.  Intellectually he knows how to behave.  We talk about how feeling angry feels in his body; we talk about things you can do when you're angry that aren't hurting others.  He'll say, "I want to make good choices, but my body won't let me."  I don't now if that's genuine or if he's playing me, but I am mostly convinced that in those moments when he hits someone, he is completely out of control.  Which is why consequences don't work.

I work from home, so when he's sent home to be with me I send him to his room to spend the day alone without toys so that I can do work and to ensure that he's not having a fun at-home day.  We also tried having him clean the house after he gets sent home but that was an untenable amount of work for me, and he actually enjoyed it.

Wednesday, January 11, 2012

And Again

The call for pickup came at 10:30 today.  He punched a child in the face because, as I understand it, he didn't believe his turn in the soccer game was coming quickly enough.

I'm at a loss.